Rethinking PTSD, a Condition Whose Name Also Wounds

Man poses for photo in front of U.S. flag

General Peter Chiarelli (Ret.), former Vice Chief of Staff of the U.S. Army and now CEO of One Mind for Research, and UC-affiliated researchers will discuss brain injuries and why they must be cured at the National Underground Freedom Center Aug. 30.

We all know that a rose by any other name would smell as sweet. That sticks and stones break bones, but names are harmless.

Or maybe not. Retired General Peter Chiarelli, the former Vice Chief of Staff of the U.S. Army who now heads up One Mind for Research and will be visiting Cincinnati Aug 30-31, has expressed the view that we should consider changing a name that we have long known and accepted. The name in question is PTSD, or Post-Traumatic Stress Disorder, defined by the National Institutes of Health as a type of anxiety disorder that can occur after an individual “has seen or experienced a traumatic event that involved the threat of injury or death.”

Such threats can follow a flood, fire or tornado; they can follow violent events that include assault, domestic abuse or rape; and, as our Iraq and Afghanistan soldiers and veterans know only too well, they can happen during war.  Symptoms of PTSD, which can cause crippling dysfunction, include nightmares, mood swings and flashbacks. The condition affects 7 percent of the population over the course of a lifetime, but up to 10 to 30 percent of soldiers in combat.

As Vice Chief of Staff for the Army, General Chiarelli worked to reduce suicide rates in the Army and to eliminate the stigma associated with the invisible scars left by traumatic brain injury (TBI) and PTSD. He has proposed changing the word “disorder” in PTSD to “injury” to further reduce stigma, which prevents many service members and veterans from seeking the treatments they need. The Web site identifies the condition simply as post traumatic stress, or PTS.

“No 19-year-old kid wants to be told he’s got a disorder,” General Chiarelli told the Washington Post this spring.

“It is an injury,” he told the PBS NewsHour in 2011. Calling the condition a disorder, he added, perpetuates a bias against the mental health illness and “has the connotation of being something that is a pre-existing problem that an individual has” before he or she came into the Army and “makes the person seem weak.”

Changing PTSD to PTSI isn’t something that could happen overnight. PTSD is not only embedded in the medical lexicon, it is also part of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association to serve as “the standard classification of mental disorders used by mental health professionals in the United States.” The DSM is currently being updated, however, and General Chiarelli’s recommendation that PTSD be changed to PTSI has been discussed, though not adopted at this time.

Paul Keck, MD, President and CEO of the Lindner Center of HOPE, an affiliate of UC Health and the UC Gardner Neuroscience Institute, echoes General Chiarelli’s point of view.

“Despite how common mental health issues like Post Traumatic Stress Disorder are — one in four people are affected by mental illness — stigma and access continue to discourage the treatment-seeking efforts of those suffering,” Dr. Keck says. “As President and CEO of Lindner Center of HOPE, a treatment center near Cincinnati, Ohio, I believe that initiatives that reduce stigma and create access are ones worth championing.

“Terms like ‘injury’ or ‘stress’ convey that an individual is a victim of the diagnosis. This distinction could go a long way in helping sufferers feel more comfortable with treatment, as they would with getting treatment for a wound. The fact is, these disorders are just like a wound or medical diagnosis — though increasingly more common — and they are just as treatable.”

“Soldiers have traditionally viewed stress and psychological disturbance as weakness, a violation of the warrior ethos of toughness and resiliency,” adds Jed Hartings, PhD, Assistant Professor in the Department of Neurosurgery and former U.S. Army Major at the Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research.

“Now we suspect that these stress disorders may be partly organic – related to concussive injuries that soldiers may have experienced months, or even years ago.  We still have a lot to learn about TBI and PTSD, but it’s clear that when soldiers are experiencing symptoms, we need to remove barriers to treatment, and that includes stigma.”

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In 2008 the U.S. Department of Defense (DOD) designated Cincinnati a PTSD/TBI Clinical Consortium Study Site and awarded UC’s Department of Neurosurgery and Department of Psychiatry and Behavioral Neuroscience more than $2.3 million over five years to study TBI and PTSD. Neuroscience researchers who are studying treatments for PTSD as well as its molecular underpinnings will attend meetings with General Chiarelli while he is in Cincinnati.

Thomas Geracioti, MD, Professor and Director of the Psychoneuroendocrinology Program at UC, and his colleagues have studied neuropeptide Y (NPY), a peptide neurotransmitter that regulates stress and anxiety and have found that men with combat-related PTSD have low concentrations of NPY in their cerebrospinal fluid. Neuropeptide Y is a major neurochemical linked to an individual’s response to severe emotional trauma, and scientists increasingly suspect that it is a “stress-resilience” factor in humans.

Kathleen Chard, PhD, Director of the PTSD and Anxiety Disorders Division at the Cincinnati VA Medical Center and Associate Professor of Clinical Psychiatry at UC, has conducted several studies about the causes of PTSD and its treatment. She is currently exploring whether cognitive processing therapy (CPT) is an effective treatment for veterans with post-traumatic stress who also have suffered a traumatic brain injury.

–Cindy Starr

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