What’s in a name? From “solders heart” to PTSD and the way forward.
October 20, 2015
Following the Civil War (1861–1865), Dr. Mendez DaCosta described veterans in his 1876 research paper as having “irritable heart or soldiers’ heart.” His descriptions in 1876 sounded much like the descriptions we hear today -- startle responses, hyper-vigilance, and heart arrhythmias. During the 20th Century, two world wars, other conflicts, and the ongoing war on terrorism introduced many more descriptions of symptoms like Post-Traumatic Stress Disorder (PTSD).
In World War I (1914-1918), the terms combat fatigue and shell shock were introduced; in World War II (1939-1945) the term battle fatigue was coined. In 1952, the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published, codifying the wide variety of known mental health conditions. This first edition used the term stress reaction to describe PTSD. Following the Vietnam conflict (1961-1975), the term Vietnam Syndrome emerged. In the 1980s, the term PTSD was finally introduced in the DSM-III.
Names Matter: The Future of the Term PTSD
The term PTSD is simply the latest in a long line of terms describing the same condition. However, there is a movement growing today to rename PTSD. The reclassification is long overdue because ‘disorder’ implies a psychological condition, thus not a real disease, and it doesn't correctly characterize what is happening in the brain of someone suffering with Post-Traumatic Stress.
Dropping the word "disorder" would lift the stigma associated with the condition, making active duty military personnel and veterans less hesitant to seek treatment. Jonathan Shay, M.D., Ph.D., a psychiatrist who most recently worked at the VA clinic in Boston, echoed these sentiments in remarks at the American Psychoanalytic Association meeting.
Robert Filner, former chairman of the VA Subcommittee, proposed the term “PTS” instead. Removing the word “disorder” might reduce the negative connotations, making it easier for service members to talk about their symptoms and improving access to care. As Dr. Shay pointed out, if a soldier loses an arm in a roadside bombing incident, "he wouldn't be diagnosed with 'MAD,' or Missing Arm Disorder.”
We believe changing the name to PTS doesn’t go quite far enough. A new term is needed to convey the neurobiologic cause of this condition. Dr. Frank Ochberg proposed the term Post Traumatic Stress Injury (PTSI). PTSI is a biological injury that develops after a person has experienced or witnessed a terrifying event.
PTSI can be recognized as biological trauma on medical scans. As such, it often responds to an approach that reverses or treats the biological alteration of the nervous system. The division of the nervous system, which likely plays a dominant role in the development and continuation of PTSI, is the sympathetic system.
If the argument on the biological causes of PTSI is accepted, the utilization of a blockade of the sympathetic system supplying the brain could be applicable. A cervical sympathetic ganglion injection called Stellate Ganglion Block (SGB) has been tested on more than 2000 patients suffering from PTSI and has shown to be effective in treating the patient’s symptoms more than 75% of the time.
The time has come to acknowledge PTSI for what it really is – an injury not a disorder. Physicians need to look at PTSD as they would any other physical injury, and identify the problem as early as possible. Delaying treatment only causes the injury to get worse. As Dr. Shay stated, “I want to get everyone thinking like a trauma surgeon rather than an internist.”