Traumas hit official wallets

Philip Fine, in Montreal, reports on a common psychiatric diagnosis that could cost governments millions.

An ever-widening group is being diagnosed with post-traumatic stress disorder (PTSD) and their demands for compensation could cause undue economic stress to government and business, says a medical anthropologist who has written extensively on the syndrome.

McGill University professor Allan Young has helped raise questions in the psychiatric community about the possible overdiagnosis of PTSD, a condition originally named for American soldiers, many of whom felt ill effects from the Vietnam war years after their return.

While he has long advocated compensating Vietnam veterans diagnosed with PTSD, the author of The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton University Press, 1997) has lately seen a growing number of other people falling under the same diagnosis.

Most recently, British ambulance drivers have been trying to win compensation for the psychological strain they blame on their work environment. With many others scarred by international atrocities, the global number of active cases could run into tens of millions, says Dr Young. PTSD compensation ranks as one of the most costly items in the budget of the United States Veterans Administration Medical System.

Professor Young explains the possible reasons for PTSD's popularity by saying that many doctors prefer to bring biology to the diagnostic table and patients have latched on to a term that does not carry the burden of other psychiatric illnesses.

"It's the only non-stigmatising disorder," says Professor Young of the syndrome that began to gain currency in the 1970s and was listed in the DSM III, the diagnostic bible of the western medical practitioner, by 1980.

In 1994, the DSM IV redefined a traumatic event as an experience that is "subjectively distressful". That move could open the compensation floodgates.

"The new hypothesis challenges a notion taken for granted since 1980: PTSD is a normal response to an abnormal situation. PTSD is (now seen as) an abnormal response to widely occurring situations with which normal people are able to cope," said Professor Young in a paper, The Brain and its Sciences in the 20th Century, he presented at a conference held at Berlin's Max Planck Institute.

He says PTSD is not as new as people would like to believe and would still be called traumatic neurosis if Freud was not such an embarrassment to many in the psychiatric field. When PTSD was written into the DSM III, neurosis, as an illness, was written out.

"It was banished in the front door and returned through the back door," said Dr Young. "One could say the popularity of PTSD is the triumph of the neurosis concept."