Those of you who follow my work know that I often stand on a soapbox regarding post-traumatic stress. You may have heard me make the case for not calling it a disorder, or you might have read about, what I call, post-traumatic GLOW. Today, I want to talk about reducing the stigma. There are four levels of stigma from my perspective: First, there is a systemic stigma within the psychiatric community regarding PTSD, as evidenced by its inclusion in the DSM-5 and the label it carries of a “disorder.” Insurance companies also have a role to play in this systemic stigma because they require diagnoses to provide payment or reimbursement for services connected to post-traumatic stress. The second level of stigma comes from individual counselors and therapists who treat PTSD as if the traumatic event had the power to inextricably alter a person for the remainder of their lives. Thirdly, the stigma from the general public mostly follows in the footsteps of the systemic stigma. However, the worst stigma of all is the stigma sufferers assign to themselves. Let’s break this all down.
Let’s begin with a definition of post-traumatic stress without the capital letters or the word disorder affixed to the end of the phrase. Post-traumatic stress means that incidents of trauma (traumatic) often lead victims into a stress response (stress) after the event is over (post). Simply stated, following a traumatic event, the victims who experienced the trauma will undergo certain levels of stress. Why should there be stigma around this? This is an absolutely normal response to an extraordinary situation. Experience a rape and try not to have nightmares about the attack—impossible. Fight in combat and see people next to you shot or blown up and try not to flashback to the most horrific event you’ve ever witnessed—you won’t be able to do it.
The telltale signs of post-traumatic stress are the mind’s way of protecting itself. If you are experiencing the symptoms, you may feel like you are losing your mind, but the exact opposite is happening. Whatever you experienced was so horrific that your mind is struggling to make sense of something that makes no sense. It’s a fool’s errand. Your brain cannot process the trauma you’ve experienced, but this is not something for you to be ashamed about. If your body contracts an infection and your white blood cell count elevates to handle that infection, you wouldn’t blame yourself for the elevated white blood cell count, would you? Then why blame yourself for the nightmares and flashbacks? Perhaps you think if you were braver, these things wouldn’t be happening. Wrong! Your bravery is what got you through this trauma in the first place. You lived through it. You survived. Perhaps you wish you hadn’t, but you did. Now you need to learn to live on the other side, and the good news is, there are many paths that can get you there.
If you do decide to go for counseling, watch out for the therapists who want you to use medication to handle a problem that isn’t medical. Also, look out for counselors who treat you as if what happened to you has somehow broken you forever. You need a counselor who understands the normalcy of post-traumatic stress and has been trained to help you manage or eliminate your symptoms while operating with a wealth of optimism that you have what you need to get better. The question shouldn’t be what’s wrong with you; it should be what’s happened to you.
Stigma from the general public will subside once we manage to get rid of systemic stigma and the stigma you heap on yourself. Community stigma is more a symptom of systemic stigma, and you shouldn’t have to confront it directly. The exception would be if there is someone close to you who sees you with anything less than compassion for what you have endured. You could give them this article to read or have a straightforward conversation about how you are no longer stigmatizing yourself, and you would like it if they would also stop. Let them know that what is happening with you is normal and that you are taking steps to handle your stress from the trauma you experienced.
Systemic stress is a bigger machine. I feel miniscule in comparison. While I want to take insurance companies and psychiatry on myself, I know I am no David. This Goliath will be toppled when enough of us—including you, reader, and myself—get in the trenches and ban together with the common cause of promoting true mental health and resilience, instead of supporting a system that makes money from keeping people mentally ill.