When PTSD Misses The P

Andrew Sullivan —  Aug 4 2012 @ 7:35am

In the developing world, it's sometimes difficult to distinguish mental health problems from the stresses of poverty and conflict:

Debates as to what could be regarded as a mental illness erupted frequently throughout the [Advanced Study Institute] discussion, particularly in regards to suicide. Summerfield asked: "Does an Indian farmer commit suicide because of a mental illness, or because farming broke down and left him with no income?" Fred Hickling also spoke to the issue of suicide stating that Jamaica has the lowest suicide rates worldwide, but that its homicide rates are amongst the highest. If suicide is considered a mental illness, is homicide a mental illness category as well?

Vaughn Bell digs deeper:

PTSD makes sense in the West because it has the implicit assumption that the person is now safe (after all, it’s post-traumatic stress disorder) and that the experiences and reactions described in the diagnosis are, therefore, inappropriate.

However, if you live in a war zone, intrusive thoughts, feeling on edge and avoiding reminders of danger could be considered quite a reasonable reaction to the constant experience of death and violence. When you meet people who do live in war zones, who would clearly meet the criteria for PTSD, they rarely complain about their mental state. They’re usually more concerned about the actual dangers…the threat of rape, not rape-related anxiety. So, the hard question becomes: are we really helping by sending professionals and training locals to recognise and treat people with, for example, PTSD?