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.

Shame, "Self-Esteem", and Buddhism

Been thinking a lot about how most of us, when we were kids, didn’t have a lot of compunction about playing with other kids, meeting new people we liked and such. Maybe when we were very little we might have been “shy”, but in this case I think we’re talking about caution, fearfulness, as opposed to lack of a sense of self esteem.

When I was a kid, it was easy for me to go down the street and ask about a kid there I thought was my age that I could play with, to try new things… I think because we’re actually born with a sense of self esteem or self worth, and that sense of worth gets taken away. That sense of our value, how we are connected to others, self esteem or self worth, gets replaced by shame- feeling “less than”, insufficient, unlovable, broken and defective as human beings.

This sense of self esteem is diminished or removed a lot of ways. Verbal abuse- actually being shamed by others, made fun of, called names, diminished for mistakes or lack of knowledge of a thing, literally being told one is somehow bad, not going to amount to anything, being compared against others, being yelled at or threatened.

Physical abuse. The predominant message a person gets when struck by another person out of anger, an effort to discipline, etc. is that they are somehow flawed. Being treated gently shows someone their worth. It takes effort… attention, patience, softness- the opposite of which takes little effort. Of course, this is often coupled with verbal abuse, sometimes sexual abuse.

Sexual abuse. When this happens to someone, they often get the message that this is their only value, their only utility as a person. It’s also extremely common, in order for the abuser to be able to continue the act, that they diminish the victim as a person. Taking away their power, their human-ness, their self worth, makes it easier to continue violating them. The act itself literally causes shame- it instills something in the person that they have to hide, something that makes them feel less human, separates them from others.

The media. There’s a lot of images in our society, a lot of messages that we get about our worth. Television, magazines, movies, other people, all bombard us with a message about what we “need” to do, have, look like. We are given the sense that unless we’re attached to some product, some lifestyle, some particular achievement, we are somehow not successful. This is not simply a message about how far we’ve gone in life, it’s a message about our being-ness, our human-ness.

We do a lot of work to “get” self esteem- take care of ourselves physically, our appearance, do esteemable acts, visualization, affirmations and etc. Those of us that have done these things often haven’t been able to maintain our self worth despite such efforts. These ideas help us feel better in the moment, but long term, we often still experience a deep sense of shame.

Some have said that a central idea in Buddhism is that at the center of each human being is the fear we don’t exist. This lends itself to the idea that we are constantly reaching outside of ourselves for things, naming and labeling them, attaching ourselves to them, trying to obtain them. In doing so, being attached to a thing (person, etc), we can fear less that we don’t exist. So we go about our lives in a way that diminishes our personhood, our being-ness, our selves being “enough” simply as we are.

The answer to this is not simply adding things to our lives, behaviors, personhood. Shame, low self worth and etc is something we have to give away. We have had experiences that diminished our self esteem- abuse, abandonment, exposure or humiliation, being diminished or demeaned verbally- those are the things that make us feel less of ourselves. Until we find a way to “let go” of those feelings, to give them away, to make space for our self esteem, we will be unable to experience it no matter how many “creative visualizations”, affirmations and etc. that we do.

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