Post-Traumatic Stress…Disorder?

Eric Maisel proposed a few years ago that post-traumatic stress disorder (PTSD) isn’t actually a disorder nor should it be labeled as such.  It should just be termed post-traumatic stress response or something similar.  Others are starting to agree with him.


Well, if we step back for a moment and take a look at why PTSD develops in people in the first place, then you might see that Maisel et al make an excellent point.  Let’s use the example of a war veteran.

After experiencing the inexplicable and nightmarish realities of war and its inherent violence and atrocities, how does one imagine a healthy individual to respond afterwards? One could anticipate flashbacks, avoidance, isolation, nightmares, and hyperarousal reactions including anger outbursts, tension and hypervigilance.  One would expect somatic symptoms as well like migraines, tension headaches, and other physical symptoms.  This isn’t unusual.  In fact, it was asserted that a healthy person would return from war with some kind of post-traumatic response in place, and this very response reflects their prior mental health.

What does that mean? Everyone has a different level of tolerance for trauma.  What one person can tolerate may vary wildly from what another person can tolerate.  Someone may be able to return from war and integrate into society and family life with greater ease than another person, and this is almost certainly to do with the resiliency factor.  Everyone has their own resiliency spectrum.  For those with a lower tolerance for trauma then,  it is completely normal and to be expected even that they would return from a war setting experiencing a post-traumatic response.

Labeling a completely normal human response to trauma a “disorder” stigmatizes trauma survivors.  Anyone who has been through trauma and admitted it to the wrong person knows all about this.  It also keeps people away from the very environments that would allow for healing.  Many trauma survivors already struggle with that uniquely depersonalized feeling that causes them to feel like they are on the outside of their lives looking in.  Adding stigma to the emotional experience amplifies that ontological isolation–the Outsider Experience–and perpetuates the anxiety that a good future is for other people.

PTSD is a brain-based experience.  Studies have shown that the size of the hippocampus is a factor in the development of PTSD.  This is why two people can go through the same trauma while only one develops PTSD.  Those with a smaller hippocampus may be genetically vulnerable to the development of PTSD after trauma.  The emotional experience of PTSD is an expression of an experience originating in the brain, and your brain believes that it is doing its job.  Even the post-traumatic response lies on a spectrum.  Some people experience it acutely while others endure a chronic experience.

Much of what has been labeled as “disorder”, in my opinion, isn’t that disordered at all.  It’s an expected response.  In fact, it’s the brain adapting to fit an extreme environment–even if that extreme environment is very short-lived.  The problem that exists is retraining the brain.  Telling the brain to stand down.  Adapt again.  The environment has changed yet again.  I think, hence, that PTSD is an adaptation, not a disorder.

The good news is that there is help for that.  We adapted to a situation in order to survive it.  We can adapt again in our lives in order to do more than survive.  In order to really live and regain a sense of control.  Discover our options.  Create happiness.

EMDR and doing therapeutic work with a qualified therapist will get you there, but, in case you can’t pursue that yet, this book will get you started:

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5 Comments on “Post-Traumatic Stress…Disorder?

  1. The major difference is the stress response that is normal is processed and does not end up interfering with life.
    PTSD- the trauma doesn’t process the same. “We are not stuck in the past. The past is stuck in us.”
    Resiliency is part of why some process, some don’t. But there are other risk and protective factors. Some risk factors: prior trauma, lack of support when the trauma occurs, repeated trauma at the time (like war), no time to actually integrate the trauma when it happens.
    Protective factors: social and family support, ability to talk about the traumatic event safely, coping skills (these can be overwhelmed).

    Here’s an example: many survivors of sexual assault don’t report it until years after. If they do report it, the process of investigation is often traumatic. They face blame for the assault, an invasive medical exams, often the police don’t take it seriously, stigma and other issues. There’s an extremely low conviction rate and often unreasonable sentences of the rapists are convicted. Like Brock Turner and others.

    PTSD is not black and white.

    • Thank you for your insightful comment. You are correct. It’s not black and white nor did I imply that. I’ve been writing this blog since 2009, and I have written many posts about PTSD. I have PTSD. I have lived with it for decades. The idea that PTSD isn’t necessarily a disorder is worth considering. The pathologizing of human experience and applying the Cartesian-based medical model to it can prevent a better recovery and more integrative healing. It’s simply an idea worth considering as neuroscience,epigenetics,and psychoendoneuroimmunology (PENI) are pursued and come together in the context of what is currently understood about the brain, trauma, and recovery.

      • The post was great and does give some things to consider. When I read things like this, I always get concerned that it will reinforce someone is “weak” if they have PTSD or “you can just get over it any time.”

        I also have PTSD along with brain injury. They take a lot of strength to function with.

        Sorry if it sounded like I was jumping down your throat.

        • It didn’t sound like you were jumping down my throat.

          Mental illness of almost all kinds are heavily stigmatized. Mental illness associated with trauma, however, carries a special sort of stigma due to victim blaming, cultural gnosticism and fear. But, if you go back and read the premise in the post, in no way was it suggested that a person is weak or that PTSD was something to “get over”. Suggesting that a post-traumatic response–even chronic rather than acute–is an adaptation rather than a disorder, however, explains why it can be so hard to change or reverse. In nature, adaptations are part of the evolutionary cycle of change. We don’t easily change adaptations. And adapting is a strength. Not a weakness. In the current climate of psychology which follows a more medical model, we medicate disorders for the most part and attempt to aim coping skills at disorders. A disorder is part of a disease process. PTSD is a brain-based experience not a disease process. So, in terms of “reading things like this”, I’m not entirely sure how that assertion says that people are weak. How does someone “just get over” a brain-based experience that interferes with normal activities of daily living? Certainly not a weak person. No weak person could live with PTSD (but you know that).

          Because neurogenesis occurs until the day we die, we can retrain the brain no matter what adaptations it has picked up along the way to survive, but it can be a grueling journey particularly when trauma is on the table. The brain has ways of holding onto its protective patterns (migraines, for example. I get migraines during therapy if a topic comes up that is too close to certain traumas, and I actually emotionally feel fine to talk about it. But…something in me isn’t, I guess). Recovering from PTSD is extraordinarily difficult, but, for me, stepping back and removing the applied pathology actually helps me. It makes the process easier when I see that all my current symptoms reflect an adaptation to a traumatic environment rather than a “disorder”. Complex PTSD is also very similar. We were healthy before we were traumatized and our response to the trauma is actually normal.

  2. I agree, how are we to expect people to react after withstanding heinous events? Of course there is a NATURAL reaction of hypervigilance, re-experiencing and so on. A title such as Posttraumatic Stress Experience or something along those lines is far more appropriate and accurate.

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