EXPERT WHO SAYS MOST PTSD CASES ARE BOGUS
He accepts battlefield soldiers suffer it. But as diagnoses of Post Traumatic Stress Disorder become ever more common, a top psychiatrist has a VERY provocative view...
THE patient, a woman in her early 40s, is t earful. She can’t sleep and feels constantly anxious. It’s been this way ever since she was involved in a minor car accident a few months back, she tells her therapist. She is irritable, can’t concentrate and keeps having flashbacks of the smash.
The counsellor, understandably, is keen to give a diagnosis. He tells her that she is suffering from posttraumatic stress disorder (PTSD) – a condition four per cent of the adult population is now said to have – and recommends she attends a few sessions of cognitive behavioural therapy. Case closed? I fear not. For, as a psychiatrist with 37 years of experience, the label of PTSD is one that is often made far too readily, both in my opinion and that of many colleagues.
I don’t blame patients. Indeed, their problems are very real and they need help. Yet I have never met a patient who really has PTSD, and I believe the majority of these diagnoses are bogus.
Today, anyone who has been through any kind of traumatic experience seems to be told they have PTSD, which is simply wrong.
These is little doubt that the condition exists in a small handful of war veterans. Ministry of Defence statistics show that as of April 2017, there were 78,407 full- time and fully trained troops.
Just 307 UK Armed Forces personnel had an initial assessment for PTSD that year. This represents 0.19 per cent of all personnel.
But I believe the diagnosis is being hijacked and bandied about far too flimsily, doing a major disservice to the few who do seriously suffer from it. So what’s going on?
PTSD first came to prominence when US veterans returned home from the Vietnam War in the 1970s. It was the modern version of ‘shell shock’, a term first coined during the First World War.
Witnessing bombs explode and watching colleagues and innocents of war blown t o smithereens, and then having to remain on the front line because that is what you are trained and expected to do, is severely traumatic.
Troops suffered flashbacks of what they had seen and experienced, and became anxious and depressed as a result, and turned to alcohol to cope. And this is my big problem with PTSD being adopted within everyday society today: it trivialises the unimaginable horror of what many war veterans have really been through.
Celebrity after celebrity has spoken out about their experiences of PTSD: glamour model Katie Price was recently told she had the disorder at a private clinic, for reasons not divulged, and is now in rehab.
Hollywood actress Glenn Close revealed last month that she experienced ‘ a kind of PTSD’ after growing up in a Right-wing religious cult. TV presenter Amanda Holden was diagnosed following traumatic childbirth, and last week Pirates Of The Caribbean star Keira Knightley said she had been diagnosed with PTSD as she strug- gled with her rapid rise to fame. I don’t doubt their experiences were highly stressful. But it concerns me that high-profile coverage is giving the wrong impression about what PTSD really is. We saw a similar story with celebrity cases of obsessive compulsive disorder, or OCD, a few years ago. I remember reports of footballer David Beckham saying he had it because he liked to keep his refrigerator well organised.
The term became vernacular for being fastidiously tidy, yet OCD is a wide ranging and debilitating illness that has very little to do with how neat your sock drawer is.
People like labels. They confirm there is something wrong and t hat s omething can be done. Perhaps, in an attempt to meet this demand, therapists are giving t hese di agnoses without r eal clinical justification.
For instance, in the immediate aftermath of the 2004 Boxing Day tsunamis that killed more than 200,000 people in 14 countries in the Indian Ocean, I read that up to 45 per cent of survivors had been diagnosed with PTSD. Diagnostic guidelines state that symptoms of post traumatic stress should be present for at least six months before the label is considered.
If you’ve lost your family, your home and your livelihood, of course you’re going to feel devastated. But does this mean you have PTSD? No, it does not. The fact is, there are serious consequences in medicalising normal human reactions and emotions in this way as it may send the clinician in the wrong direction. Diagnosing people with PTSD means they may get totally inappropriate treatment, potentially making the condition worse.
Patients with depression and anxiety get medication and psychotherapy specifically targeted at those illnesses. But the first-line treatment for PTSD involves therapy sessions that involve talking about the traumatic event, with the aim of reducing the negative feelings associated with it.
If the patient’s actual problems are depression, anxiety or some- thing else, then it is unlikely this approach will address or alleviate their symptoms.
What’s also important to remember is that bad things do happen in life. It is how we respond to those situations that makes a difference. During the Brixton riots in the early 1990s, I was stabbed multiple times on my doorstep, something many would consider a traumatic experience. While it is something I think about from time to time, I don’t ponder on it and neither do I have flashbacks.
My advice to anyone is to seek help from their GP if how they are feeling is interfering with how they function and their relationships in daily life. GPs can determine and identify the right next steps. But beware if you are quickly handed a diagnosis of PTSD, even by a mental health professional.
As a society we need to stop throwing the term around, not to belittle the traumatic experiences people have had, but to ensure they aren’t given an unhelpful label they almost certainly don’t need.
The diagnosis has been hijacked, bandied about far too flimsily Celebrity after celebrity has spoken out about their ‘experience’ of PTSD and given the wrong impression of what it really is