Time to Revise the Medical Model (PTSD)

The Medical Model and Diagnosis

By now I think it should be clear that I have serious reservations about the medical model and that includes diagnoses. As I’ve said, granted ,taking people out of the realm of possession by demons was a distinct move forward. But now it is time to reevaluate a great deal about what we call mental illness.. Once we have a diagnosis then we are supposed to have a clear course forward. As a psychologist I must say I do not agree with that viewpoint. I’ve seen psychiatrists recommending long term intensive psychotherapy for heroin addicts. I prefer to think of long term guidance and support to gain a viable life course. The difference is notable. Such can be said in many other places.

A Lifetime Issue

Now we have what is called PTSD or post traumatic stress disorder.  It seems to have arisen as a recognized disorder during the Vietnam War. Actually it was discussed at least as far back as World War II and possibly World War I as such things as shell shock. Probably though we have always recognized forms of battle fatigue etc. The problem now is that the disorder often gets in the way of people getting help. The military is struggling with simply adopting post traumatic stress and dropping the word disorder. And we need a clear view that reacting to living months in an environment where you are trying to kill people or be killed may overwhelm people. In fact many don’t seem overwhelmed but some simply shut down and close themselves off. I’ve met such cold and distant people.

What’s The Point?

The point is that we have yet to come to terms with the reality of human existence. It is not an indication of mental illness if a person is reacting to a high stress environment or sudden trauma. It is much more reassuring to tell someone they are having a normal and understandable reaction. Granted reactions can vary from person to person but that is to be expected.

We still seem to not have clarity about these facts. There have been several times when I discussed such a reaction with a veteran in a social occasion and they were then in tears. Often they would express relief that they weren’t pathological and that a burden had been lifted.

Just Recently

And just recently we seem to have jumped a barrier. Particularly after the mass murder in a school in Florida the students began to speak about PTSD. Yes! Of course! You go to school on a quiet day and suddenly someone is running through the halls killing your fellow students and friends. What would be wrong is if the other students didn’t have a reaction. They need to accept feelings and work to deal with them either personally or with others. But a reaction is to be expected and may be variable but above all it should be accepted as reality. Life delivers blows to us and we have to respond and cope.

Can we now take a different approach to trauma. Diagnosis really doesn’t show us the way forward. Each person may well have a different reaction or way of handling it. They may need to discuss tactics but need to accept that a reaction is understandable and is not pathological.

A Personal Story

I  can share a personal story. In 1984 I had a catastrophic auto accident when someone drove in my driver’s door at high speed. I went through years of surgery and recovery. Then ten years later I was waiting at a traffic light when a man turned a corner at high speed, spilled his coffee on himself and totaled my car. I got off with a light blow to my head. But within twenty-four hours I recognized that I had been hurled back to the other accident. I called a colleague and we spent three sessions discussing it and my reaction. I was then able to put away my experience with PTS.

The Bottom Line

Life can be difficult, dangerous and terrifying. We need not deal with such events and our reaction with a diagnosis and a declaration of mental illness. And we need to deal with insurance companies and their practices. If it is not pathology then they won’t pay for someone getting help with management of a reaction. But help is often essential. The bottom line here is that there is such a thing as life management which is crucial. And life management often requires help with understanding, restructuring and engagement of coping tactics. Its time to reframe mental illness and life management.

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The Tragedy of Post Traumatic Stress Disorder

Not the Tragedy You Might Think

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Have you ever had a reaction to a painful or terrifying event?

Not all things in our inner life and parts of reality are what we would want. We have an image or images of how things are supposed to be. If we are fortunate these images are not seriously violated. But sometimes they are.

Sometimes life is devastating and devastation can come suddenly in many forms or slowly and insidiously. A terrible storm, a horrifying accident may visit long term consequences on us.

Up front I need to say that this post is not simply about trauma and stress. The term usually noted with the short form of PTSD most often makes us think of returning veterans. But, of course, it isn’t confined to veterans. It is my perception as a psychologist that we need a wholesale revision of the meaning and even the use of the term.

Diagnostic Labels

Long ago we removed many difficult personal issues from the care of the church and said particular kinds of suffering people were not being tortured or possessed by demons. Instead we took them to doctors and defined them as suffering from mental illness and give them a diagnosis. Well and good up to a point. A compassionate response and management was better than exorcism.

But now we use the medical model for ever so many things and it is time to redefine our intervention and perception of cause. In this blog the focus is on battlefield trauma. But trauma is not confined to the battlefield and there can be many contributing factors.

Origins of PTSD

In wartime we send our people into zones where people are trying to kill them on a daily basis and they are supposed to kill on a daily basis.Then we send them home and tell them to have a nice day. We are asking a huge adjustment overnight. And recently I heard an officer speak about the nature of the experience and that it includes close personal support from fellow military people. Suddenly, when they leave service they have to give up this essential daily support even while they are to leave the killing fields. We are asking a lot and we tell them they have a disorder—a mental illness. There is typically stigma attached to mental illness and it places a barrier to getting help for what is fundamentally an adjustment.

A Personal Experience

Decades ago I was in a terrible auto accident which sent me into years of pain and recovery. And then more recently I was sitting at a stoplight when a man came around the corner too fast, spilled his coffee on himself and he ran full speed into my car which was totaled. I escaped with only a bruise. But within 48 hours I was anxious, having terrible dreams and a variety of other reactions. As a psychologist I knew I was thrown into PTS because it called up my prior accident. I called a psychologist friends and in four sessions we detailed the reaction and separated it from my current life. The bottom line here is that I had a reaction, not a mental illness and I went to someone to help me through my reaction.

The Real Tragedy of PTSD

Too often the outcome of trauma continues but it can typically be attenuated if the person seeks support and understanding which can be on a personal basis or a group setting. But it is important that they don’t feel stigmatized by being called “mentally ill”. The military is working to use PTS rather than PTSD which is important. It can be dealt with but not if we don’t respond correctly.

Mental Illness in General

We have work to do. Our lives are filled with stress and simple change. Over time we have multiple adjustments sequentially or at once. Guidance and clarification often is crucial and disturbing definitions and often unnecessary psychotropic medications may not be helpful.

Wisdom is needed to handle our world as it is and wisdom should lead us to a complete rethinking of the mental health field. It is complex. Yes, we have anxiety and some people constitutionally have more anxiety than others. It is manageable. Yes, we have depression and in my case my bouts with it were a function of an inherited vitamin D deficiency. I won’t even attempt to detail all the ins and outs of what has been thrown on the heap of “mental illness”. Basically it is clearly time for a complete restudy and reevaluaiton.

What is your catalogue of stress factors and adjustments needed in your life?

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