When It’s Not PTSD

by Jessie Roberts

Lynne Jones questions the spread of the diagnosis, which entered the DSM-III in 1980. She recalls that, while working as a psychatrist in Sarejevo during the Bosnian War, “what immediately struck all of us living under siege at that time was the irrelevance of describing anything as ‘post-traumatic’”:

One researcher found that almost 94 per cent of displaced Bosnian children living in collective centres met the criteria for PTSD. But he wondered if some of those symptoms might be adaptive in the midst of continuing conflict. The children had been repeatedly shelled during the two-month research period. The hyper-vigilance that made a child startle at a sudden sound might actually keep them alert enough to take cover.

Jones went on to run a mental health clinic in Gorazde, Bosnia in 1996. She remembers that “most of the problems people brought to the clinic simply did not fit [the PTSD] pattern of symptoms”:

The most common problem among the ex-soldiers was chest pain. Bojan arrived at the clinic short of breath and trembling with anxiety. A short chubby man, slightly balding, he sat down and talked without stopping. The problem had begun during the war. After the funeral of a close friend, who had died in fighting, Bojan had collapsed with chest pain. Everyone thought he was having a heart attack. He had been sent to Sarajevo and put in intensive care with chest monitors and blood tests. After a few days, they told him it was his ‘nerves’ and sent him back to his unit in Gorazde. He was angry at doctors who had mishandled his problem and terrified of dying of a heart attack like his father. But he did not have nightmares or tend to relive painful memories from the war. He enjoyed his six-year-old child, his wife, his work; and whatever he had, it was not PTSD.

Some of my colleagues at home argued that the PTSD construct should be adjusted to include all post-conflict reactions, in both adults and children. But the point of a diagnosis is to distinguish problems that require different approaches. What is gained by extending the frame to include different symptom patterns, when all they have in common is exposure to the same supposed triggering event? A patient who has a persistent cough and is diagnosed with pulmonary tuberculosis requires a quite different treatment from a chronic smoker with a cough. If no distinction is made, one may end up giving the psychological equivalent of cough mixture: the ubiquitous, undefined ‘counselling’.