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39 States and both Houses of Congress drop the “D” to diminish stigma

A WOUND NOT A WEAKNESS     

     In 2012, the APA held an open hearing to debate the name change of post-traumatic stress disorder (PTSD) to, or include, post-traumatic stress injury (PTSI). Regrettably, the APA’s decision was to not change or add to the name for DSM 5. Shortly thereafter Honor for ALL launched a grassroots campaign to publicly rebrand the term as PTSI by petitioning federal, state and local officials to declare June 27 as Post-traumatic Stress Injury Awareness Day. Our ultimate objective was, and still remains, to gather enough support among governing bodies, the press, and the electorate, to motivate the APA’s Scientific Review Committee to revise the DSM to include PTSI as an alternative name for PTSD.

     The diagnostic term PTSD was first crafted in 1980 by the American Psychiatric Association to commonly describe severe traumatic combat stress in Vietnam veterans. As a result of intensive research and recent developments in electro-magnetic imaging, it has been shown that severe post-traumatic stress can cause physical, and reversible, changes within the brain which more accurately describe an injury than a disorder – a treatable wound calling for timely care.

     Beyond the harmful affect it has on cure, the dispassionate use of the word “disorder” assails the sense of honor due the brave men and women who have received these wounds in action against an enemy of the United States and similarly fails to acknowledge the gallantry exhibited by first-responders while putting themselves at risk on a regular basis. At the community level, its use can inadvertently disparage the character of victims of crime and abuse, as well as survivors of life-threatening accidents and natural disaster. Plainly, there is room for advancement here. The elimination of stigma and an elevation of recognition here can translate into increased care and decreased hardship.

     HFA Medical Advisor, Dr. Frank Ochberg, former Associate Director of the National Institute of Mental Health (NIMH) and member and chair of APA councils, committees and task forces in the late 1970s and early 1980s materially responsible for advancing the creation and modification of the original diagnosis known as PTSD agrees, “As far as I am concerned, the name PTSD, was never important.  The concept was important.  We knew before 1980 that research would help us adjust the diagnostic criteria through time.  We knew that later versions would reflect evolving scientific knowledge.  And now, evolving knowledge leads us to a modification in the name as well as modifications in criteria.  The basic concept remains. Some details have changed.  The fact that profound trauma creates injuries to brain function, brain physiology and brain anatomy is well established.  The fact that calling this phenomenon an injury, not a disorder, confers honor rather than stigma is now established.

     Our first state resolution for PTSI Awareness Day came from Michigan in 2014. In 2015 we gained the support of the National Guard Association of the United States (NGAUS) and the Adjutant Generals Association of the United States (AGAUS) enabling us to better network with state legislatures nationally; that year we counted participation from 7 states. In 2016 we were joined by 27 states; in 2017, 34. In 2018 we had 39 states, as well as the US House of Representatives, officially proclaim support by designating Post-traumatic Stress Injury Awareness Day through bill, resolution and/or proclamation. The US Senate went so far as to adopt a resolution for PTS Awareness Day.

     Although any movement away from the word “disorder” can be considered intellectual growth, we do not support merely dropping it from the title, leaving that as post-traumatic stress or PTS. We do not wish to create any unnecessary confusion concerning the APA’s existing distinction between common post-traumatic stress and the more debilitating, unrelenting embodiment of that condition. As specified in DSM 3 through 5, under paragraph A of the PTSD criteria, it is normal to have post-traumatic stress (PTS) after directly or indirectly experiencing a traumatic event or stressor – only when symptoms persist and conform additionally with criteria B through H, is disability confirmed.  A traumatized, yet only slightly injured, brain stays in appropriate alarm mode as needed, returning to normal within a month. A critically injured brain, remaining in alarm mode for more than a month, has been physically altered and requires timely medical attention.

     Initially a veterans focused organization, our concern has grown to include all who suffer from the psychological and moral injuries now grouped together under the term post-traumatic stress disorder (PTSD). Removing the “D” takes away from the stigma and that is good. Adding the “I” for injury introduces honor and that is better. 

     For individual Bills, Resolutions and Proclamations in 2018 go to *Supporters*.  

   PTSI RESOLUTION TEMPLATE 

WHEREAS, all citizens of the United States possess the basic human right to the preservation of personal dignity;   

WHEREAS, all citizens of the United States deserve the investment of every possible resource to ensure their lasting physical, mental, and emotional well-being;

WHEREAS, the diagnosis known as Post-Traumatic Stress Disorder (PTSD) was initially formulated in 1980 by the American Psychiatric Association to more accurately assess and assist veterans who had endured severe combat stress in Vietnam;

WHEREAS, combat stress is an invisible wound which has historically been unjustly portrayed as a mental illness caused by a preexisting flaw of character or ability, and that the word “disorder” carries a stigma which perpetuates this misconception;

WHEREAS, it has been shown though electro-magnetic imaging that these invisible wounds can cause physical changes to the brain which more accurately describe an injury than a disorder;

WHEREAS, referring to invisible wounds as a disorder can discourage the injured from seeking proper and timely medical treatment;

WHEREAS, referring to invisible wounds as post-traumatic stress injury (PTSI) is less stigmatizing and viewed as more honorable, and this designation can favorably influence those affected and encourage them to seek treatment without fear of retribution or shame;

WHEREAS, post-traumatic stress injury can occur following exposure to extremely traumatic events other than combat such as, but not exclusive to: interpersonal violence, life-threatening accidents and natural disasters;

WHEREAS, post-traumatic stress injury satisfying criteria A through H of the diagnosis for post-traumatic stress disorder in the Diagnostic Statistical Manual deserves disability compensation equal to that allowed for PTSD under the law;

WHEREAS, all citizens suffering post-traumatic stress injuries deserve our compassion and consideration, those brave men and women of the United States Armed Forces who have received these wounds in operational action against an enemy of the United States further deserve our clear and obvious recognition; and

WHEREAS, timely and appropriate treatment of post-traumatic stress injury can diminish complications and avert suicides:

NOW, THEREFORE, be it RESOLVED that the (Senate/House/Assembly):

designates June 27th of each year is designated as (state) Post-Traumatic Stress Injury Awareness Day;

designates June as (state) Post-Traumatic Stress Injury Awareness Month;

respectfully urges our Departments of Public Health, Military and Veterans Affairs to continue working to educate victims of interpersonal violence, combat, life-threatening accidents or natural disasters and their families, as well as the general public, about the causes, symptoms, and treatment of post-traumatic stress injury and

respectfully directs that this resolution be transmitted to the Governor for appropriate proclamation and execution and to the Secretary of State for appropriate publication and preservation.

 

Tom Mahany started a hunger strike on Veterans Day 2009 lasting 29 days to draw attention to the issue of combat stress and related suicide. He fasted again in August of 2012, this time for 17 days, when he learned that the number of suicides among active duty service members had doubled from June to July.

Now Mahany heads up the veterans’ advocacy group Honor for ALL, which organizes an annual event, Visible Honor for Invisible Wounds, to raise awareness of posttraumatic stress injury.

This year’s event recognized the passing of legislation introduced by U.S. Senator Heidi Heitkamp designating June 2014 as National Posttraumatic Stress Disorder Awareness Month. JB Moore, NAMI Manager for Military and Veterans Policy and Support, represented NAMI at the event.

Though usually held in Washington, D.C., Visible Honor for Invisible Wounds took place in New York City on Saturday, June 28, 2014 and was co-hosted by the Mental Health Association of New York City. The scope of the program was expanded to include first responders and victims of abuse.

The keynote speaker Staff Sergeant Ty Carter, who has struggled with PTSD, was the 2013 recipient of the Congressional Medal of Honor. When awarding the Medal of Honor, President Obama described SSgt. Carter this way, “He’s as tough as they come. And if he can find the courage and the strength to not only seek help, but also to speak out about it, to take care of himself and to stay strong, then so can you.”

In addition to SSgt. Carter, officials included commissioners from the New York City police and fire departments, representatives from the Chiefs of Staff of the Army and Navy; the Wounded Warrior Project; Iraq Afghanistan Veterans of America (IAVA); Service Women’s Action Network.

“It is reprehensible that an estimated 22 veterans take their lives each day”, declared JB in her remarks.  “Posttraumatic stress is treatable. Let’s eradicate stigma!”

According to Mahany, “There was an unmistakable message from the event. Posttraumatic stress is an injury that needs to be accepted and honored as such. If we don’t attend to it, it will be allowed to progress into a disorder.”

Earlier this year, the Senate Armed Services Committee passed the Jacob Sexton Military Suicide Prevention Act of 2014 – introduced by U.S. Senator Joe Donnelly (D-Ind.), as part of this year’s National Defense Authorization (NDAA) bill.  If passed, this legislation will: (1) Require annual mental health assessments for all service members-Active, Reserve, and Guard; (2) Establish a working group between the Department of Defense and Department of Health and Human Services; and (3) Require an interagency report to evaluate existing military mental health practices and provide recommendations for improvement.

According to Mary Giliberti, NAMI’s Executive Director, “The National Alliance on Mental Illness strongly supports the Jacob Sexton Military Suicide Prevention Act of 2014 and applauds Senator Donnelly for his recognition that suicide rates among active duty service members, National Guardsmen and Reservists are unacceptably high and in dire need of attention.  This important piece of legislation advances NAMI’s goals of parity, accountability, collaboration and action.”

Honor for ALL is already at work organizing next year’s National Posttraumatic Stress Awareness activities. Events will be held in New York, Michigan, San Diego, and Indianapolis, all on Saturday June 27, 2015.

Tom Mahany believes the sure sign of true awareness about posttraumatic stress will be when Major League Baseball plays with purple bats for the month of June

Honor for ALL is responsible for initiating the first governmental resolution of its kind designating Post-traumatic Stress Injury Awareness Day

Adopted concurrently by the House and Senate of the State of Michigan, June 23, 2014:

June 27, 2014, is designated ‘‘Michigan Post-traumatic Stress Injury Awareness Day’’

Whereas the brave men and women of the United States Armed Forces, who proudly serve the United States, risk their lives to protect the freedom of the United States and deserve the investment of every possible resource to ensure their lasting physical, mental, and emotional well-being;

Whereas more than 2,000,000 United States service members have deployed as part of overseas contingency operations since the events of September 11, 2001;

Whereas the military has sustained an operational tempo for a period of time unprecedented in the history of the United States, with many service members deploying multiple times to combat zones, placing them at high risk of post-traumatic stress injury (referred to in this preamble as “PTSI”);

Whereas it is expected that ten thousand veterans will return to the State of Michigan every year for the next three to five years after spending a significant amount of time in combat environments, exposing thousands of soldiers to traumatic life threatening events;

Whereas the Department of Veterans Affairs reports that in fiscal year 2012, more than 500,000 veterans from all wars sought care at a Department of Veterans Affairs medical center received treatment for PTSI;

Whereas PTSI significantly increases the risk of depression, suicide, and drug and alcohol related disorders and deaths;

Whereas the Department of Defense and the United States Department of Veterans Affairs have made significant advances in the prevention, diagnosis, and treatment of PTSI and the symptoms of PTSI, many challenges remain; and

Whereas the establishment of a Michigan Post-Traumatic Stress Injury Awareness Day will raise public awareness about issues related to PTSI:

Now, therefore, be it Resolved, that the (Senate/House) —

(1) designates June 27, 2014, as ‘‘Michigan Post-Traumatic Stress Injury Awareness Day’’;

2) urges the Michigan Veterans Affairs Agency and The Adjutant General to continue working to educate servicemembers, veterans, the families of servicemembers and veterans, and the public about the causes, symptoms, and treatment of post-traumatic stress injury; and

(3) respectfully requests that the –(Sec of the Senate/Clerk of the House)– transmit a copy of this resolution to the governor of the State of Michigan.

Tom Mahany and others talk about suicides among Vietnam Veterans