Published on April 26, 2011 here.
© Copyright 2011 Paula J. Caplan All rights reserved
"Scientific brilliance is an important tool but is not the magic inherent in healing."
--Dr. Patch Adams 
This essay comes in response to two comments written about my previous essay here. One of the comments came from theologian and counselor Dr. Roger Ray and appears at the end of my essay called "What Is a Healthy Response to War?" and the other was sent to me privately by a friend. In combination, they raise these important questions:
(1) Since some people feel better once their anguish has been labeled, what's wrong with calling it a mental illness?
(2) However we label emotional trauma from war, how can we help those who continue to suffer from it?
Before I respond to the first, excellent question, let me explain what my friend wrote to me privately in this regard. Since her mother's death many years ago, she had suffered in many ways both emotional and physical. Recently, when someone told her that she had Post-traumatic Stress Disorder (which is listed in the psychiatric diagnostic "Bible," the Diagnostic and Statistical Manual of Mental Disorders ) because she had not done much grieving about her mother's death, she felt mightily relieved, and as she allowed the grief to come forth, she began to feel better.
I am delighted that she obtained some relief. Suppressed grief is excruciating and is common in our society, where there is much pressure to "get over it" rapidly, and one is treated as weird or sick for failing to do so. Recall that in my previous essay, I mentioned that in the DSM, someone who is grieving just two months after losing a loved one is considered mentally ill (in fact, to have Major Depressive Disorder). For both my friend and the war veterans who were the subject of the previous essay, grief has loomed large, and grief ignored carries emotional dangers. So it was important for my friend to have her feelings named and acknowledged.
What I would ask, however, are two questions:
(A) What would my friend - and war veterans - have lost if instead of being told they have PTSD, they were told that they were suffering as many or most people suffer deeply when they lose people they love - or, in the case of veterans, lose their innocence or, for some, their faith in certain people, principles, or institutions that had mattered to them? That feelings are common and powerful does not mean they are signs of mental disorders. And naming a person's feelings without saying they are signs of mental disorders can be extremely helpful.
(B) What would both my friend and war veterans gain by being told what I just suggested rather than that they have a mental illness? The gains are enormous. First, they avoid feeling that they are weak or sick for continuing to feel grief, anger, numbness, and other powerful, negative feelings (or lack of feelings). It's hard enough to deal with loss and other kinds of trauma, without shouldering the additional burden of believing that one has to stop having those feelings immediately. Second, they avoid the considerable risks that simply receiving any psychiatric diagnosis can carry, including (but not limited to) loss of health insurance or huge increases in premiums, as well as loss of custody of a child, a job, or the right to make decisions about one's medical and legal affairs. Third, they avoid the blinders imposed on many therapists and many laypeople, who, once they know a person has a psychiatric label, believe that that person must take psychiatric drugs and attend psychotherapy sessions and that either or both will help.
What's wrong with those beliefs? To begin with, psychiatric diagnoses are hardly ever based on any good scientific evidence, although the DSM is surrounded by an undeserved aura of scientific precision. In fact, the authors of the DSM have acknowledged that they have not even found a good way to define the overarching category of "mental illness," not to mention each subcategory. Furthermore, the widespread belief that knowing a person's psychiatric label(s) will help the therapist know how to help them and improve their prognosis is largely a myth. Finally, although for some people at some times, psychotherapy and/or medication can certainly be helpful, many more are not helped at all or are seriously harmed by either or both.
A look at the statistics about veterans from every single war reveals that hundreds of thousands are still suffering emotionally, are homeless, jobless, suicidal, and/or violent toward others, despite having been in therapy and taken psychiatric drugs, usually having been tried on an astonishingly long list of such drugs. One of the many reasons for the harm that comes to some people from drugs and yes, even psychotherapy, is that this traditional, two-pronged approach is often less helpful than other approaches that are not implemented because of the overreliance on the traditional. For instance, one of the best-supported findings in research about human behavior is the importance of social support. In some cultures, the community expects to welcome those traumatized in any way to come back into the community, find a place to belong, be productive, feel accepted, and begin to heal; but too often in this country and others, we hand over to the mental health system all of these responsibilities.
Professionals in the mental health system can help some people, but others will not enter the system for fear of being pathologized or otherwise misunderstood, because they fear that having such treatment on their record will interfere with career advancement or carry other risks, or because they know from their experience and those of others who were similarly traumatized that help was not forthcoming. And stories are legion of already-traumatized people being harmed because therapists do not assist them in reconnecting with the wider community; with finding safe places to open up about their traumatic experiences to those by whom they wish to be understood (and who are not being paid to listen to them); with finding a decent job and place to live; with making the massive changes required by the move from the military's rules, structures, and aims to the very different ones of civilian life; and with changing from a focus on death and destruction to life and creation or production. Yet all of these are ways to help. So that is a partial answer to Dr. Ray's question of how to alleviate some of vets' suffering, no matter what we call it.
Within the traditional mental health system, war trauma is more likely to be called Post-Traumatic Stress Disorder or Major Depressive Disorder than perhaps anything else, although Bipolar Disorder is increasingly used as well. Those labels mask the cause of war trauma, leaving out any words that are clearly related to war, in contrast to the transparent terms like the Civil War term soldier's heart and the World War I and II terms shell shock and combat fatigue.
There is something unseemly about using a euphemism to apply to an experience of intense horror or sorrow, such as war or the loss of a beloved parent or rape. To use these psychiatric euphemisms distances therapists and the loved ones of those who are traumatized from the traumatized person's experience. It isolates the latter as we move that much farther away from sharing their experience with them and from having the chance to show that we respect the fact that they have been through hell.
So when the Reverend Doctor Roger Ray describes his father's suffering as it went on decades after the war in which he fought, and he says poignantly that hospitalization and different kinds of drugs failed to help him, that makes his father frighteningly typical of many veterans of all wars. And although Dr. Ray refers to the tens of thousands of vets who still suffer, the number is actually well into the hundreds of thousands.
To respond further to Dr. Ray's question about how to help, at this point we cannot be sure of finding ways to help every veteran, and that in itself should move us to seek for more and better answers. I know from the research I did for my book about vets that some of what I described above is helpful. And in my next essay here, I will describe a specific proposal for assisting more vets. But I certainly cannot pretend to have all the answers, and the more I talk to war veterans, and the longer I follow their struggles, the more compelling I see is the need to acknowledge when what we do is not helping but to keep trying to find what brings comfort.
Patch Adams. Gesundheit. Healing Arts Press, Rochester, VT. 1998, p. 35.
 Paula J. Caplan. When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. Cambridge: MIT Press, 2011.
 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV. Washington, D.C.: American Psychiatric Association. 1994.
 See psychdiagnosis.net for 53 stories of different ways people’s lives have been seriously harmed because they received a psychiatric label, as well as for solutions aimed at avoiding such harm.
 See psychdiagnosis.net and Paula J. Caplan, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal. Reading, MA: Addison-Wesley, 1995.
 Robert L. Whitaker. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown. 2010.
 Caplan, 2011.
 Many more reasons for such harm are described by Caplan, 2011.