Devaluation of PTSD

The item from the Editor’s desk on the devaluation of post-traumatic stress disorder (PTSD) (Tyrer, 2005) is to be welcomed, and in my view this issue is indeed ‘highly significant’. Post-traumatic stress disorder is surely not a true medical diagnosis, rather it is best seen as a medicolegal, benefit-linked criterion. It is a bureaucratic hurdle for a claimant to surmount, not a medical diagnosis with implications for treatment and cure. Hence its ‘interference in care’ for the clinician who unwittingly misuses it. The vague and emotive idea of ‘postVietnam syndrome’ was explicitly introduced in the USA to ensure that returning Vietnam veterans, with various and often non-specific mental reaction symptoms which may or may not have followed experience of ordeal, were able to have a quasi-diagnostic ‘label’ attached to them, and thus receive care under the Veterans’ Administration Medical Service, rather than being bereft of help. A core of largely anti-war psychiatrists and veterans worked for years to create the PTSD concept, and put it in DSM–III in 1980 (Scott, 1993). The PTSD category may include probably virtually anyone suffering an unpleasant experience of which they have disagreeable memories. It simply lacks precision in distinguishing between claimed subjective distress and objective disorder. The core question is often whether the claimed sufferer is impaired in their capacity to function. If they are, conventional symptoms of mental reaction following trauma, such as anxiety, depression, phobia and addiction, in their various manifestations are overwhelmingly more likely to be the cause rather than any putative PTSD derivative. Post-traumatic stress disorder is in my view virtually useless as a medical diagnosis. Its use does more harm than good, it carries no useful treatment implications, it is liable to lead to needless chronicity and worry, and it is irredeemably contaminated by litigation. Those whose clinical practice leads them to such conclusions should recognise that ICD is a ‘menu’, with some items best avoided, and that a psychiatric diagnosis is not necessarily a disease (Summerfield, 2001). Our patients’ needs and interests are invariably most fully met through such an approach, and with us being alert to a compensation agenda.