Key Psychiatric Doctor Rejects Name Change for PTSD

BY Daniel Sagalyn  May 10, 2012 at 4:15 PM EST

PHILADELPHIA | A key leader in the psychiatric community has rejected the idea of altering the name of a traumatic condition affecting an estimated tens of thousands of U.S. combat veterans — a move that effectively blocks growing efforts by a small group of psychiatrists and military brass concerned about reducing patient stigma.

Dr. Matthew Friedman, who is chairing the committee that is updating the trauma section of the dictionary of mental illness, said changing the name of the condition could have “unintended negative consequences” because “it would confuse the issue and set up diagnostic distinctions for which there is no scientific evidence.” The dictionary, known as the Diagnostic and Statistical Manual of Mental Disorders, is considered the bible by the psychiatric association.

Last year, then-Army Vice Chief of Staff Peter Chiarelli asked the American Psychiatric Association to modify the name of Post-Traumatic Stress Disorder. The four star general says calling the condition a “disorder” perpetuates a bias against the mental health illness and is a barrier to veterans getting the care they need.

More recently, two leading trauma psychiatrists similarly asked the Association, which is updating its dictionary of mental health illness, to change the word “disorder” to “injury,” calling the condition PTSI instead.

But at Monday’s psychiatric association annual conference, Friedman said the net effect of such a modification would be to tinker with a psychiatric diagnosis rather than help patients. “To change to PTSI without anything else would accomplish nothing positive,” Friedman said.

But Chiarelli, who is now retired and spoke on the same panel as Friedman at the conference, assailed the leading psychiatric professional organization’s refusal to make a one-word change in nomenclature. “I believe language means something — and it means something if your desire is to help and to treat everyone,” he said. “To allow a word like disorder — which may be no barrier to you whatsoever — to get in the way of the help they need, I find this just absolutely unconscionable.”

Friedman argued that the focus should not be on altering condition names but instead should be placed on how the U.S. military handles traumatized troops. He said it was “unfortunate” the Pentagon refuses to entitle soldiers with PTSD for the Purple Heart.

“I realize it’s a complicated and contentious issue,” he said. “But I think it would have gone much further in reducing stigma than changing the name of PTSD to PTSI.”

Friedman suggested that a better approach would be for the U.S. military to follow the Canadian military’s route to helping soldiers with wartime psychological trauma.

“The Canadians have demonstrated some exciting and successful approaches to helping military personnel acknowledge their PTSD, to reducing stigma for seeking help,” he said.

The Canadian military has sponsored peer counseling centers for veterans and embarked on an education campaign to raise awareness about mental health wounds, Friedman stressed. The military also has coined the term “Operational Stress Injury,” which refers to “persistent psychological difficulty resulting from military service … such as anxiety, depression and post-traumatic stress disorder.”

The Canadian military also makes soldiers with Operational Stress Injuries eligible for the Sacrifice Medal — the equivalent of the U.S. Purple Heart.

Speaking at the APA event, retired Canadian Lt. Gen. Romeo Dallaire said “it would be a great mistake” if the medical establishment were to alter its lingo just to suit the military.

Now a Canadian senator, Dallaire commanded United Nations forces in Rwanda in 1994. There, he bore witness to genocide and was later diagnosed with PTSD.

Medically discharged in 2000, Dallaire said the Canadian military’s decision around that time to call a mental health “disorder” an “injury” helped soldiers accept their condition. However, he said, it was unnecessary for psychiatrists to make a comparable change.

Following the APA panel discussion, Dallaire told the NewsHour that it was important that the military use its own jargon and “not fiddle with somebody else’s in order to achieve the aim we are looking for.”

But Chiarelli told the NewsHour that Canada’s approach of creating its own language to be used solely among troops was “a wrong half-measure” that “doesn’t go far enough.”

If Army doctors adopted the Canadian term, OSI, Chiarelli maintained, it would be confusing for the troops once they separate from the military. “If we bring all our [Army] doctors on board and tell them to call it an Operational Stress Injury,” then what happens when a soldier goes into civilian life where the health professionals will call it something else? “What are you going to do with this dual naming of a disease? Well, wait a second, I left the Army and it was Operational Stress Injury, but now I’m a veteran and it’s Post-Traumatic Stress Disorder?”

By contrast, Friedman said, the Canadian approach is “brilliant” and is “proof that stigma can be addressed successfully without changing the name of the diagnostic label. So we can have it both ways. Keep the PTSD diagnostic term and have it regarded as an injury.”

Chiarelli said, though, that one reason why the Canadian military invented its own term “is because the APA won’t change the name.” Canada’s mental health community, he said, has accepted the medical language that the American Psychiatric Association dictates.

Dr. John Oldham, the APA president, has moved recently to bridge the two communities. However, his proposal to maintain the PTSD moniker for civilian cases — such as following a rape or other trauma — but create a subcategory for combat-related “injuries” appeared this week to have fallen by the wayside.

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Top photo by Luis Robayo/AFP/GettyImages. Conference photos by Dan Sagalyn/PBS NewsHour.