How a PTSD Diagnosis Can Help, and Harm
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This June, CT drew attention to veterans’ experience in the cover story “Formed by War.” To continue the discourse sparked by that story, alongside the Centurions Guild, CT is hosting an online series called Ponder Christian Soldiers. (Read the Introduction to the series here.) The following essay is from Warren Kinghorn, associate professor of psychiatry and pastoral and moral theology at Duke Divinity School.

Ray sat in my examination room, tense and uncomfortable. A Vietnam combat veteran with a wiry build and a gray, frizzled beard, he was sitting in a Department of Veterans Affairs (VA) hospital for the first time in 38 years. He had visited once in the 1970s and had left angrily, vowing never to return. But his wife had recently told him that she was leaving for good if he didn't get help. So he was back, sitting in my office.

After hearing Ray’s story, I asked him a set of standard clinical questions:

Do you have trouble sleeping?

Yes—four or fewer hours per night, since Vietnam.

Frequent nightmares?

Yes—at least twice weekly, usually of experiences in Vietnam that he doesn’t want to talk about now.

Do you avoid situations that remind you of combat? Check.

Are you "triggered" by certain smells and sounds? Check.

Is being in crowds difficult? Do you startle easily at loud noises? Check. Check.

I asked if he had ever heard of post-traumatic stress disorder (PTSD). He hadn’t. I told him that PTSD names the experience of some veterans who witness hard things in war and then have difficulty moving past those memories. The memories return at unexpected times and places, sometimes as nightmares. People go to great lengths to avoid them, but still they come. People may feel tense all the time and have trouble sleeping. “Does any of that describe you?”

Ray looked at me as if I had read his soul. So we kept talking—about how he was not alone, how other veterans would want to support him, and how there were treatments that could help. He brightened, even smiled a little, and left with a plan.

3 Ways a Diagnosis Can Harm

Christians and non-Christians alike worry about ways that psychiatry uses diagnostic language to label people. They worry that diagnostic labels can stigmatize and disempower a person—or, rather, that other people use labels to stigmatize and disempower those who have them. More subtly, diagnostic language can teach that big parts of a person’s human experience—anxiety, reactions to memories, difficulty in relationships—are medical problems that medicine alone can address.

But Ray’s story shows how a psychiatric diagnosis can help. For a veteran struggling with confusing, uncontrollable thoughts and nagging shame, a PTSD diagnosis can be good news. A diagnosis says: You are not alone. Others have experienced this also. You have a community of support. There is help.

PTSD is without question a real set of experiences for hundreds of thousands of veterans. But that does not mean that the label “PTSD,” even when it fits, is always helpful. Rather, it must be made helpful.

There are at least three ways that a psychiatric diagnosis can be harmful. The first way is to treat a person as if their diagnosis is their identity—to speak of someone as a “raving schizophrenic,” a “hopeless alcoholic,” or, in the case of PTSD, a “crazy vet.” This brings shame to the person diagnosed, and aversion from everyone else.

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How a PTSD Diagnosis Can Help, and Harm