It is at a later point, when the threat is relived and when no further action can be taken, that the adrenaline and related neurobiological changes create havoc and illness (both physical and mental). As Robert Sapolsky (2004) has noted, human beings are quite adept at imagining lions and reacting to these imagined lion as if they actually exist. In the case of PTSD, the lion might have been real at one point in time or at many points in time (there really was a threatening enemy); however, the lions (threatening enemy) is now being remembered (rather than being imagined or encountered in reality). Whether real, imagined or remembered, the lions produce reactions that are not helpful under the second or third condition.
DSM seems to fit beautifully in the domain of PTSD. It is through the DSM diagnostic process that we can classify the symptoms being observed and point to the established procedures for treating this “disorder.” Furthermore, the domain of PTSD is growing. We now assign this label to the disorders that arise from many other traumatic events or enduring life in a traumatizing environment (family, organization, society). While PTSD and DSM diagnoses of PTSD is clearly a “growth industry” in the field of mental health, there is a major roadblock to be confronted or (as is often the case) ignored. It seems that PTSD is not a personal malady (though some people are more prone to this “disorder” than other people); rather, it is an environmental malady.
The symptoms of PTSD probably would not have afflicted this person if there was no war, no dysfunctional family, no sexually abusive uncle, physically and emotionally abusive mother, or cruel and vindictive boss. This means that individual diagnoses of PTSD, using DSM, is inadequate—especially as a source of guidance for the treatment of this “disorder.” Immediately, there might be critical to remove the PTSD patient from the abusive setting. Over the longer term, we must seek to remove the abusive boss, provide counselling (or incarceration) to the abusive family member—or work toward the elimination (or at least reduction) of war.
All these actions require that we better understand the nature of the system in which the trauma took (and may be still taking) place. This requires assessment as well as diagnosis. This requires that we look beyond the individual and seek a fully appreciation of the whole, rather than just the dissected part (the PTSD patient). The traumatized ex-soldier, like the smashed frog’s leg, is only one part of the puzzle that must be solved. The traumatized daughter is only a part of the traumatized and traumatizing dysfunctional family.
