June is Post-Traumatic Stress Disorder Awareness Month. As the articles in this e-newsletter attest, we have made considerable progress in raising awareness about PTSD among patients, providers, and the public. One might be tempted to say that we have perhaps done too good a job. While traumatic stress is indeed a real disorder and one that needs credible, effective treatments, some might say that excessive attention to PTSD runs the risk of trivializing a very real problem. We have without doubt made advances in our understanding of effective treatments for PTSD. We are moving away from “one-size fits all” by-the-book treatment approaches to more sophisticated interventions. Our diagnostic schemes for PTSD are more complex than before, and we recognize that the disorder is not a unitary one. All of these advances will benefit patients and providers. But there remains much work to be done. There is still a tendency to view PTSD as a lifelong, debilitating disorder, rather than a recoverable one. In part, a system of perverse incentives reinforces this notion. The classification of PTSD as a disability by the Veteran’s Administration has allowed many patients to get the services they need. On the other hand, the prospect of losing a disability rating may rob some patients of an incentive to engage in effective treatment. Also, too often the diagnosis of PTSD is reduced to tallying items on a checklist. While this might help identify individual symptom clusters, approaching PTSD in this manner does not provide an understanding of the context of the disorder—a vital factor in effective intervention. My experience as a military psychologist treating stress disorders in combatants both in Iraq and in military hospitals in the US taught me not to over-pathologize responses to traumatic stress and grief. It also taught me to help patients contextualize the symptoms of PTSD—an exaggerated startle response may be a lifesaving reaction in Iraq, it is likely to be a dysfunctional response in the domestic environment.
Treated early and well, PTSD and related disorders are completely recoverable problems. But to treat these disorders effectively, it is essential to not only manage symptoms but to recognize the phenomenology of the disorder. Exposure to severe trauma not only produces transient and long-term symptomatic responses, it almost always changes the world view of the traumatized patient. Patients may rightfully assess that their lives will never be the same after such an event. To assist a patient in understanding that life following a severe trauma is not tragically ruined, but is irrevocably reshaped in ways that can be both meaningful and enriching, is truly the mark of an expert. I hope the accompanying articles assist you in developing your expertise in working with these challenging patients.