In my last post I wrote a bit about how PTSD became a diagnosis. This week, I’m going to talk about how the diagnosis shapes trauma treatment, and why there can be a gap between the way a clinician approaches trauma treatment–what they think is most likely to bring people relief–and what the survivor might hope for, in terms of reckoning with what happened.
The naming of PTSD as a disorder, rather than a syndrome, meant that the Diagnostic and Statistical Manual III, published in 1980, had to include a list of symptoms that clinicians could use to determine if a survivor of a traumatic event had PTSD. By drawing the clinician’s focus to symptoms—their severity, persistence, increase, or decrease—the diagnosis implied that the work of treating PTSD, like any other medical condition, was to reduce or eliminate altogether the patient’s symptoms. (I’m using the word “patient” here because evidence-based trauma treatments are often provided in clinical settings that are rooted in a medical model.)
Though mainstream, evidence-based treatments like Cognitive Processing Therapy and Exposure Therapy are quite different in their approach to trauma, for example, what they have in common is a focus on symptom reduction.
There’s an intrinsic tension between the clinician’s focus on symptom management and the survivor’s focus on meaning. The question trauma evokes in the survivor isn’t “how do I stop the symptoms?” It’s “why did this happen in the first place? How could a person do that? What if I hadn’t gone out that night? What if I hadn’t agreed to be part of that group? What if I hadn’t married that person? Why did I participate? Who am I, now that I know what I and others are capable of doing?”
