Why Drop the Disorder From Post-Traumatic Stress Disorder?

In my book What Doesn’t Kill Us, I described what I saw as the problems with the trauma industry. By trauma industry, I meant all the counselors, psychotherapists, psychologists, psychiatrists, and social workers who offer therapy and research based on the concept of post-traumatic stress disorder (PTSD) and whose efforts, although meant well, may also have had unintended and unhelpful consequences.

First, although PTSD has been beneficial in providing recognition of the suffering experienced by many people, the language of medicine it uses puts therapists in a doctor-­like position, which takes the responsibility for recovery away from the patient. Indeed, the very word patient is problematic because it portrays the person as someone who is damaged, impaired, deficient, maladjusted, disordered. In short, it subtly shifts responsibility for their recovery into the hands of the therapist. However, trauma is not an illness to be cured by a doctor. Certainly, therapists can offer people guidance and be expert companions along the way, but, ultimately, people must be able to take responsibility for their own recovery and for the meaning that they give to their experiences.

Second, it has also created a culture of expectation in which there is a mistaken assumption that PTSD is both inevitable and inescapable. When trauma strikes, often the message that follows is that people will be affected, that they will develop PTSD, and that they will need professional help for the foreseeable future. This may well be true of some people. But research over the past decade has shown us that trauma survivors are not necessarily destined for a life of unremitting despair and that the damaging effects of trauma have been overestimated. If people are told that they are vulnerable and need help, these conditions may become a self-fulfilling prophecy. Indeed, what the research actually shows us is that the majority of those who face potentially traumatic events are relatively resilient, able either to resist stressors or recover quickly and then to maintain relatively high levels of functioning. This is the message that needs to be conveyed: that the majority of people are resilient to the tragedies, misfortunes, and disasters that will befall them.

Third, our criterion for successful treatment has become confined to the alleviation of PTSD, which leads us to disregard the body of research showing not only that most people are resilient, but also that many people find benefits in adversity that can provide a springboard to higher levels of functioning than before. Post-traumatic reactions are multifaceted, encompassing both distress and growth. People are capable of finding pathways to reverse the destructiveness of trauma and turn it to their advantage. Such observations have in the past been treated as exceptions to the rule—as little more than interesting anecdotes—rather than being seen as part of the very nature of trauma. But therapists who fail to recognize this possibility of growth in their clients do them a disservice.

In short, while the adoption of PTSD as a diagnostic category has been beneficial in terms of increasing access to psychological therapies, it has been detrimental in these three ways: in taking responsibility away from people, in creating a culture of expectation, and in ignoring the personal growth that often arises following trauma.

The aim of my book was to correct the imbalance—to show that the negative and the positive of trauma go hand in hand. This is not to deny for one second the distress that trauma causes but to offer a new perspective: namely, that reactions to trauma are a natural and normal process of adaption to adversity that often marks the beginning of a transformative journey. In this way, it makes sense to drop the word 'disorder,' and refer to these reactions simply as post-traumatic stress.

Viewed in this light, post-traumatic stress can be understood as indicative of a search for meaning in which the drive to revisit, remember, and think about the trauma is a normal urge to make sense of a shocking experience, to grasp new realities, and incorporate them into one’s own life story.

At the heart of my book was the idea that post-traumatic stress is the engine of transformation—of the process known as post-traumatic growth. For me, post-traumatic growth is a way to think about reactions to trauma as a natural and normal way of responding to adversity, which may help clients to feel empowered, to understand that change is possible, and to be able to find some hope for the future.