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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Is PTSD a normal event?

Q: Dear Frank, Many people say PTSD is a normal reaction. Is it really? Not everyone gets this condition after a traumatic event.

A: Dear Joyce, We need to stay away from saying to our patients and teaching future therapists that PTSD is a normal reaction. It isn't. It is a medical condition that affects some and not all who are injured by traumatic stress. I know many like to say that having PTSD is normal. "Normalization" is one of my principles of treatment. Just as I would explain to a person who was recovering from being shot in the chest that "you are going to live...you are progressing normally...healing is good...you are normal..this pain is normal..this discharge is normal," I normalize the course of posttraumatic stress disorder and reassure when all is on track. But in creating a diagnosis, we have to use "normal" in a different way. It is medically abnormal to have a condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM). We have to call this condition posttraumatic stress disorder or posttraumatic stress injury.

It can't just be a normal response to traumatic stress and qualify for a diagnostic label. The word normal has several different meanings. In medicine it means healthy as distinct from diseased or injured. In statistics it means evenly distributed or average as opposed to skewed or extreme. When an unusual and extreme event occurs, our reactions are expected to be proportionally intense. In fact, during and immediately after a trauma that qualifies as meeting the DSM definition of a traumatic stressor, it is both healthy and normative to have many of the symptoms of PTSD. In a state of sudden shock and danger we are numb to other extraneous stimuli, we are in a heightened condition of arousal and we are consumed with the impact of the event. But when this reaction persists over a month, reducing our ability to engage with friends, family, work or school, the situation merits a medical label.

Many of us are ready for a more honorable, accurate label. We prefer PTSI - for Injury, rather than Disorder. The condition is the same. The diagnosis is essentially the same. But a name that refers to a wound caused by an external force is less stigmatizing and more evocative of the true nature of this condition. In sum, PTSD affects normal people in a pattern that is now well recognized. It helps to think of this as a wound that hurts and that may hurt for a long time. But the wound usually heals and the pain can be borne with tolerance and dignity.

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Page created on 7 June 2012
Last updated by on 18 May 2017