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Friday, June 22, 2007

Comments

Hello Dr.X,

Very informative roundup. Schizophrenia has plagued our systems for many years. Today, mental health experts are finding more cases of schizophrenia than they counted in the past. Schizophrenia is nothing to play with, and anyone ignoring this diagnose is only throwing fuel to the fire.

I find it interesting that you call PTSD a fraud (which it most likely is) but then endorse psychoanalysis which is most assuredly a fraud. I don't know of any creditable psychologist who thinks psychoanalysis is legit.

Hi Steve,

I didn't call PTSD a fraud. This post is a recap of what a few others in the psych blogs have posted recently; it was not a commentary on my part. I suspect that you inferred from the words "in my opinion" that you were reading Dr. X's opinion. Actually, that was a quote from Dr. Bliss with a link to her entire post on PTSD. She didn't call it a fraud, but she expressed concern about the diagnosis being used as a "legal scam" along with a bumper crop of other "new" diagnoses. Certainly, you've heard of malingering and you know that some patients with ulterior motives will shop for a diagnosis? PTSD is ripe for such abuse because legal blame can be assigned to an outside party.

But, while I share some concern with Dr. Bliss about the abuse of the diagnosis, I don't share Dr. Bliss's suspicion that the diagnosis itself lacks merit. The presence of predisposing factors (see link to Dr. Bliss) in some cases does not make the condition any less real than a fracture that occurs in a person with osteoporosis. Moreover, I also believe that the nature and/or duration of trauma can be such that PTSD can occur in persons with no discernable preexisting vulnerability other than being human.

Dr. Bliss also emphasizes the use of the word "stress" in the name of the diagnosis and notes that stress is a normal part of life. Emphasizing the word stress to the exclusion of "traumatic" would make it all sound very normal. It is the trauma and the psychological sequelae that are, together, not normal. Less important to me than whether they are normal, however, is whether the symptoms cause unalleviated suffering and impairment that don't clear up without intervention.

Update:

I see that Dr. Bliss explains a bit more here.

That post has as much to do with PTSD as Maggie's Farm has to do with Bob Dylan.

What does Dr. Bliss have to say about PTSD? Simple, we must dismantle the welfare state.

PTSD is what happens to people who's perpetrators fail to kill them.

Those who want to reduce the incidence of PTSD (which has specific diagnostic criteria), can work to prevent war, child abuse and rape.

It's not PTSD Joy Bliss wants to limit, but the accountability for having caused it. I refer to her happy post in favor of corporal punishment. And doesn't her plastic surgeon husband turn a tidy profit cutting up women? What's that about?

Dusty Miller has done some interesting research on affluent mental patients who go under the knife over and over in rituals of self-mutilation, ostensibly to improve their looks, but given their history can be seen as re-enactment of unresolved trauma.

If I were Dr. Bliss I'd denounce the legitimacy of PTSD too.

{Less important to me than whether they are normal, however, is whether the symptoms cause unalleviated suffering and impairment that don't clear up without intervention.}

So... this statement reads as if intervention can/will 'clear up unalleviated suffering and impairment' in those afflicted with PTSD. In your opinion, does the same hold true for those with Complex PTSD? It's beefier. ;)

Curious.

Would it be true then that intervention would fundamentally alter the personality of those who do suffer Complex PTSD? Would aspects of the original personality be altered? Such as empathic abilities?

I'm speaking specifically of PTS reaction to a single event or interwoven set of events of relatively short duration that aren't necessarily of a highly interpersonal nature. The pervavise defensive and coping adaptations (and, in children, the profound deveolpmental derailments and alterations) associated with what is being called complex-PTSD are different phenomenologically, in clinical manifestation, at the underlying dynamic level and, I suspect, at the neurological level. With C-PTSD I am far less optimistic about what treatment can do, especially when we're talking about what was done to the developing mind/brain of a child over a prolonged period of time. Got to run, but this is an interesting subject and I'll try to get back to it later today with a few additional thoughts.

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