PTSD, Euphemisms, and George Carlin

The famous American standup philosopher George Carlin has a fantastic piece about euphemisms.  Paraphrasing and simplifying, he offers that he’s against euphemistic language.  Part of what I’m with him on is that euphemisms tend to conceal the truth.

May 5th, there was this article in the Washington Post indicating that there are a group of psychiatrists hoping to change the term “Post Traumatic Stress Disorder” (AKA “PTSD”) in the upcoming DSM-V (the “Diagnostic and Statistical Manual, 5th Edition”, the industry standard for all things psychiatric diagnosis… quick primer on my website here) to “Post Traumatic Stress Injury“.  The change, they hope, will make it easier for people, particularly military personnel, to more readily seek help.  They are citing that the term PTSD has a stigma attached to it.

While it arguably does, “Post Traumatic Stress Injury” might also be an equally unhelpful euphemism.  Non-military personnel frequently get the symptoms of PTSD as well.  Victims of crimes, violence, sexual abuse and more often have sufficient symptoms to justify being diagnosed with the disorder (Wiki here, for a quick look).

My concern about this is not simply haggling the diagnosis.  In all candor, the tome (the DSM) is a convention (with some real science too, but arguably still a convention)- a means of shorthand for mental health professionals to communicate.  My interest in the book is mostly about how it helps us guide treatment, and obtain treatment from the relevant funding sources.

Back to Carlin, he specifically addresses PTSD.  He takes us through the historical context- that the problem began with our recognition of the symptoms post war.  A condition we used to refer to as “shellshock” gave way to “battle fatigue”, then “operational exhaustion” (probably the grossest evasion of the depth of the severity of the symptoms of the problem), eventually leading to the current “PTSD”- arguably in light of the awareness that lots of things besides war can cause the aforementioned symptoms above.

We need a shorthand.  This will be the 6th shorthand (if we count “combat stress”) we’ve endeavored to come up with.  What we need more though, is an honest representation (and advocacy of awareness) of the consequences of these horrific events.  I’m less worried as a professional about whether or not someone suffering needs help than I am about whether we can actually get them access to it- and our evasion of these truths, often through our language, prevents us from getting legislation, funding, and other resources necessary that we can serve all victims of trauma in the ways that they need and deserve most.  Sadly, my experience of the last 28 years (at this point) has led me to feel that how we communicate about these problems has led largely to desensitization, in part, due to a euphemistic way of communicating such problems.

On a related note, often, a lot of the language in my discipline serves the individuals and the discipline itself, rather than the sufferer.  Pharmaceutical companies are served, occasionally a “new” theorist is served in terms of marketing their ideas, insurance companies are served, but rarely is it people that are suffering who are served.  It’s a source of consternation for me, both personally and professionally.

Some might say I need to come up with a more accurate term.  Maybe I should, but it’s not really the part of this that I’m invested in.  It takes longer to talk about someone suffering flashbacks, avoiding situations and experiences, fears, hypervigilance, poor regulation of their feelings, struggling with being overwhelmed by sadness or shame, having their ability to function in their responsibilities and relationships diminished (and much more), and explain what these things are to people, specifically.  But seeing how these folk are so suffering, it’s clear that doing so is worth it.  Taking the time to live with these words and feelings means much not just in terms of understanding the suffering, but honoring it.  If we’re truly going to care for people who are suffering, it will take at least that.

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