What's in a name? Everything, according to Gen. Peter Chiarelli, a recently retired military officer.
Prior to leaving his post this past February, Chiarelli's chief responsibility was to direct the Army's efforts to cut its escalating suicide rate. He led an aggressive drive to change the image of mental illness in the military ranks, having personally served two tours of duty in Iraq; his efforts, though, have not yet resulted in measurable change.
Now, Chiarelli and a team of psychiatrists are leading a campaign to change the term Post-Traumatic Stress Disorder (PTSD) to post-traumatic stress injury. Speaking to the Washington Post, Chiarelli suggested that the term 'disorder' implies permanent and irrevocable damage that “no 19-year-old kid wants to be told" he has.
Injuries Can Be Fixed
Instead, he and his followers propose the word 'injury' because it implies a potential for healing. And such a change, they say, can make the difference between a solider seeking help versus avoiding it. The new moniker, they explain, reduces the stigma associated with having a disorder, because the existing term evokes feelings of permanent mental illness, shame and weakness. Labeling a mental trauma as an injury, on the other hand, makes it similar to labels given for physical battle traumas that are not only treatable and temporary, but also symbolize honorable sacrifice.
Chiarelli originally sought to drop the term disorder from the diagnosis without replacing it, calling the condition simply PTS. While Defense Secretary Leon E. Panetta and other top officials at the Pentagon accepted that change, those in the medical field were reluctant to use it, concerned that insurance companies would not cover a condition that was not clearly labeled as a disease or disorder.
Hence, the new label—with the term injury—arose, though it has triggered a heated debate among healthcare professionals and politicians.
Supporters of the Name Change
Psychiatrists backing Chiarelli's efforts to change the label argue that PTSD is triggered by a trauma caused by an outside element. It originates from a specific event, as do injuries from being shot in battle, being raped, or suffering from broken bones in an accident. In these cases, the victim is mentally healthy prior to the event, unlike in other mental illnesses, and his brain is suddenly and sharply altered specifically because of the trauma.
Also, labeling the condition as an injury rather than a disorder opens the possibility of future recognition with the Purple Heart, an honorable distinction which currently excludes mental illnesses from combat duty in its criteria.
Experts opposing the change suggest that emotional wounds take time to heal, and sometimes may not heal at all. Furthermore, the emergence of PTSD and its symptoms may take years to surface.
They also argue that many who are exposed to a trauma do not develop the condition. However, a bullet wounds anyone it hits. Thus, the term disorder is more appropriate since it expresses this distinction.
Some also warn that changing the label might prevent veterans from receiving permanent disability checks from the government. With an injury, a treatment course containing a final resolution is expected. Millions of dollars may be at stake, with mentally-affected service members likely to suffer financial consequences.
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Date of original publication: April 02, 2013
Updated: January 16, 2017