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How PTSD Became the Malady of Millions

by Stewart Justman

Trauma For Everyone

Trauma For Everyone

Following the attacks on the World Trade Center on September 11, 2001, trauma experts feared that as much as a quarter of the population of New York City needed psychological treatment.1 In the spirit of emergency aid, counselors offered Critical Incident Stress Debriefing (CISD), a one-session procedure in which those in shock are encouraged to air their emotions and advised of symptoms of Posttraumatic Stress Disorder (PTSD) likely to appear in the future. Evidence from controlled trials, however, suggests that CISD does not promote recovery and sometimes hinders it, presumably by cueing the symptoms of PTSD in the process of warning about them.2 For some people, the CISD ritual seems only to raise expectations of PTSD which then come to life. Evidently the notion that PTSD lies in wait for those exposed to trauma is now familiar enough that not only therapists but people at large commonly find it intuitive. But how did the entity known as PTSD become so familiar? How did “PTSD” become a household word?

PTSD and Social Injuries

By the early 1970s the American public had lost belief in the Vietnam War. The term “credibility gap” had entered the national lexicon, and with the Watergate affair that gap would soon swallow up the Nixon presidency. Against this backdrop of a severe credibility crisis, the American Psychiatric Association (APA) found itself in the untenable position of lacking both credible definitions of mental disorders and diagnostic criteria that could bring different observers to reliably similar conclusions about particular cases. In an effort to fix the problem, reformers led by Robert Spitzer of the New York State Psychiatric Institute worked out a new taxonomy that abandoned speculation about the origins of disorders—Freudian speculation in particular—and focused instead on the symptoms presented by the patient. (For example, if you had a certain cluster of symptoms including low mood, fatigue, and disturbed sleep, you qualified as depressed regardless of why or how you became depressed.) A man whose strengths matched the challenge of the times, Spitzer is accounted one of the most influential psychiatrists of the twentieth century—some say the most influential of all—on the basis of this revolutionary accomplishment. The new system of classification made its appearance in the third edition (1980) of the APA’s Diagnostic and Statistical Manual, the now-famous DSM-III.

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