During the past few months, a number of leaders in the psychiatric profession have discussed coining an alternative name for post-traumatic stress disorder in an effort to reduce the stigma for military service members and veterans. But there is still no agreement among mental health luminaries and those with wartime experience about what the alternative should be -- or even if there should be an alternative.
Talks are continuing behind the scenes, and one of the original forces behind the proposed terminology change -- Army Gen. Peter Chiarelli -- will be participating in a discussion on the matter at the American Psychiatric Association's annual meeting in Philadelphia on Monday.
Chiarelli, who retired as the Army's vice chief of staff in January, first called for a name change in October. The general said referring to the condition as a "disorder" perpetuates a bias against the mental health illness and "has the connotation of being something that is a pre-existing condition that an individual has" before joining the Army and "makes the person seem weak."
Calling it an injury instead "would have a huge impact" and would encourage service members suffering from the condition to seek help, the four-star general said.
Last month, two psychiatrists with extensive experience treating patients with trauma joined Chiarelli's call. In a letter to the president of the American Psychiatric Association, Dr. Frank Ochberg, a clinical professor of psychiatry at Michigan State University, and Dr. Jonathan Shay, an author of two books on trauma in soldiers, wrote that "it was time for a change."
They wrote that dubbing the condition an injury instead of a disorder meant "we physicians believe that brain physiology has been injured by exposure to some external force, not that we are just anxious or depressed by tragic and traumatic reality."
"The person is not 'disordered' but a brain function is injured," the two psychiatrists wrote. "It no longer works the way it used to."
The two doctors agree with Chiarelli that the negative connotations commonly associated with the word "disorder" have discouraged people from getting treatment, and they said that the stigma could be reduced if it were instead referred to as post-traumatic stress injury.
The 167-year-old American Psychiatric Association is in the process of updating the Diagnostic and Statistical Manual for Mental Disorders, its dictionary of mental health illnesses. The doctors want the revision to be made there.
PTSD is estimated to affect 10 percent to 30 percent of service members -- depending on the level of exposure to combat and other traumatic experiences -- who fought in Afghanistan and Iraq during the past decade.
The president of the American Psychiatric Association, Dr. John Oldham, has moved to foster dialogue aimed at resolving the matter in a way that might help encourage sufferers of the condition to seek help.
Although there was no interest among the doctors revising the dictionary of mental illness, Oldham said he still was interested in exploring whether there should be a subcategory of the overall condition that could be called an "injury" and applied to those traumatized in the military.
Last week, leaders of the association's committee updating the criteria for PTSD for the revised dictionary of mental illness held a conference call with Ochberg and Shay. Oldham said the purpose of the call was not to reach a consensus -- "I wouldn't say that there was one" -- but to get the doctors' input.
Not everyone agrees that the word "injury" works, Oldham said. "I think there is a range of opinion about whether the science does support the injury model.
"We all have inherent risk factors that run in our families for all kinds of things. So that includes diabetes, that includes hypertension, that includes heart disease, that includes cancer, that includes depression.
"And that includes potentially for PTSD as well. So taking a categorical position that this is always an externally caused [condition] and not at all related to susceptibility overstates the case. There are some in the military who are going to be more likely to be traumatized than others," he said.
Oldham also said there was doubt among committee members updating the PTSD criteria that changing the name would have any impact. "We don't have any evidence," he said. "It's a discussion where we don't have data. We don't know if it would make a difference."
Ochberg said he felt "a feeling of partnership" with the leaders of the psychiatric association but he "would have liked to have found one person" who agreed with the change to "injury."
But he said he believes there is a lot of support among fellow mental health experts, veterans and other concerned citizens for changing the name of PTSD to PTSI. And he's set up a website where he hopes people will register those views.
The problem with creating a subcategory that changes disorder to injury, Ochberg and Shay said, is that it would be limited to those with military experience. "Veterans are not alone in feeling" stigmatized by the label "disorder," they wrote in their letter to the psychiatric association. "Survivors of rape and battering have reason to resent a stigmatizing label, when their posttraumatic reactions are consistent with an injury model."
But Oldham said it's unlikely the next edition of the dictionary of mental illness -- slated for publication in May 2013 -- will contain the change because it's "very close to the home stretch right now." But the next version will be more of a "living document" that could be revised more often than the previous one, he added.