Intended for healthcare professionals


Post-traumatic stress disorder

BMJ 2001; 322 doi: (Published 26 May 2001) Cite this as: BMJ 2001;322:1301

Disorder takes away human dignity and character

  1. Arieh Y Shalev, professor of psychiatry
  1. Department of Psychiatry, Hadassah University Hospital, Jerusalem, 9120 Israel
  2. Donnington Health Centre, 1 Henley Avenue, Oxford OX4 4DH
  3. North Staffordshire Royal Infirmary, Keele University, Stoke-on-Trent, Staffordshire ST4 7LN
  4. Department of Primary Care, Whelan Building, University Of Liverpool, Liverpool L69 3GB
  5. Department of Criminology, University of Melbourne, Parkville, Victoria 3010, Australia.
  6. University of Birmingham, Birmingham B15 2TT
  7. Regina, Saskatchewan, Canada S4P 2E3
  8. InterHealth, 157 Waterloo Road, London SE1 8US
  9. St George's Hospital Medical School, London SW17 0RE

    EDITOR—Encouraged by Summerfield's revelation about post-traumatic stress disorder,1 I imagined myself going to my clinic the next day and, at last, telling my patients who have post-traumatic stress disorder that their disorder is but social invention. I also thought that I would apologise, admitting that I was wrong in choosing to diagnose their problem and thereby medicalise their condition instead of seeing it as normal human suffering. Given that suffering is normal, as Summerfield says, I was also prepared to encourage my patients to be happy with having survived adversity and never again mention the word victim. It is a matter of dignity. Better be normal and suffer than have a mental disorder treated.

    My daydreaming continued, and I saw myself meeting an anorectic patient, for whom I care very much, and telling her that given the social roots of her disease in ideals of feminine thinness, she should simply start eating. To my very sick schizophrenic patient, overwhelmed by demonic exacerbation, I was to show that schizophrenia is but a scientific delusion.2 So far for social constructivism.

    If anything, the birth of post-traumatic stress disorder exemplifies how good it is that despite orthodoxy and haughtiness the medical profession is sometimes forced to listen to people's pain. Not that post-traumatic stress disorder is built in stone. But neither are depression, psychosis, or delirium. Meanings change with time, and I hope that this will continue. What is, however, fascinating in post-traumatic stress disorder is that, despite its tentative beginnings, this diagnosis has generated more replicable biological findings than many traditional disorders.3 Moreover, the development of post-traumatic stress disorder in traumatised people offers a major opportunity to study the ways in which mental events transform the central nervous system.4 The marriage between post-traumatic stress disorder and the neurosciences …

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