of PTSD, however, the dangerous event must involve an actual threat to
life or physical integrity—blows to the ego, no matter how painful, do not
count. And that threatening event is persistently reexperienced in dreams,
fantasies, and physical responses. This does not mean just thinking about
the situation and getting upset. Persistent reexperiencing means forgetting
where you are and believing you’re back there in the literal rather than
metaphoric sense. There is no as if about it.
I am not usually doctrinaire about diagnostic criteria, but in the case
of PTSD, I am an absolute purist. In 30 years as a therapist, I have seen
the initial identification of this disorder in Vietnam war veterans, and its
expansion to include people with a history of sexual abuse—remembered
or not—the verbally battered, the sexually harassed, and anybody else who
has been discriminated against on the basis of anything at any time in their
lives. Delayed PTSD can occur years after the dangerous event. It’s not
that these injured people don’t have problems, it’s just that diagnosing
these problems as PTSD may do them more harm than good.
I believe in helping people with mental disorders to get better. I also
believe in helping the downtrodden to gain social, political, and economic
power. I do not believe that mental health treatment can accomplish the
second goal without sacrificing the first. The overdiagnosing of PTSD is
a well-meaning attempt to do the impossible: to help patients both to get
well and get back at the people who caused them to be sick.
PTSD is the only mental disorder, other than those resulting from
blows to the head, that is by definitioncaused by somebody else. It is com-
pensable in a court of law, and can be considered a handicap to be
accommodated under the Americans with Disabilities Act.
PTSD is also a fear disorder that accommodation makes worse. To
recover, people need to see their symptoms as hang-ups to be overcome,
rather than handicaps to be accommodated or, worse yet, scores to be settled.
The issue is even more complicated because a necessary step in
the treatment of PTSD, especially the delayed type, is recognizing that the
symptoms are the result of trauma rather than personal choice. To make
matters more confusing, recent research suggests that repeated, unac-
knowledged abuse actually does damage the brain. In these studies, abuse
is narrowly defined as incest, beatings, and physical torture. Outside the
laboratory, the definition of abuse has been widened to include pretty
much anything that outrages someone in an on-line support group.
72 ❧Explosions into Fear