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Lawren Bradberry ENG 501-Online #11389 November 15, 2012 By any other name… We should all be as wise as Shakespeare. In Romeo and Juliet, he wrote, “What's in a name? / that which we call a rose / By any other name would smell as sweet;” (2.2.43-44). Debates continue regarding the proposed changes to the name of Post-Traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual (DSM) to Post Traumatic Stress Injury (PTSI). Some argue the stigmatizing power behind the word disorder creates a barrier to service members and veterans seeking care for mental health needs. Supporters assert changing the name will “will reduce the stigma that stops troops from seeking treatment” (Jaffe, 2012). Retired Army General Peter Chiarelli, a major supporter of the change, argues: Calling the condition a "disorder" perpetuates a bias against the mental health illness and "has the connotation of being something that is a pre-existing problem that an individual has" before they came into the Army and "makes the person seem weak," (as cited in Sagalyn, 2012, p. 1; emphasis added) As of May 2012, 247,243 veterans were seen for potential PTSD at Veterans Health Administration facilities following their return from Iraq or Afghanistan (Veterans Administration [VA], 2012). If the “D” is replaced with and “I”, will this significantly diminish the stigma reported by General Chiarelli? I argue that the stigma is not in the name; the stigma is within and perpetuated by military culture and attitudes towards those who seek treatment for PTSD. As a service member and military mental health army sergeant, I am moved by the conviction of military leaders to take the lead in reducing the stigma of mental health care for those they command. Upon entry into the military, we are programmed to place our confidence, trust, and lives

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in the hands of our leadership. This unwavering loyalty and faith is necessary for battle. Junior soldiers must, without question, execute the orders of their superiors. I recall, as a young soldier, my First Sergeant, Edwin Perez, caught me smoking in a non-smoking area. We often shared cigarettes and dialogued about life during smoke breaks. Instead of reprimanding me, he looked at me, shook his head, and said, “Soldier you let me down. I’m very disappointed in you, Bradberry. Get out of my… face.” I cried for weeks. It was as if it had come from my very own father. In many ways, he was a father figure. The power and influence of military leadership is as powerful as the will to live or die serving. Top military leadership to voicing their support is a move in the right direction. While I do not believe the stigma of mental health in the military community is always intentional, it exists within the military culture. “Suck it up, soldier!” is a phrase that echoes through the ranks. It is the response to any sign of weakness. General Chiarelli illustrates this point by his comment:

"disorder" perpetuates a bias … "has the connotation of being something that is a preexisting problem … before they came into the Army and "makes the person seem weak," (as cited in Sagalyn, 2012, p. 1; emphasis added). According to a 2004 research study conducted by the Department of the Army, 65% of respondents who met the screening criteria for a mental disorder reported being perceived as weak as a barrier to seeking care (Hoge, 2004, p. 21). Approximately 50% of respondents identified the following barriers to seeking care: 1. Difficulty getting time off work for appointments 2. Embarrassment 3. Harm to their career 4. Members of unit losing confidence in them 5. Leaders blaming them for the problem

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6. Too embarrassing (Hoge, 2004, p. 21). I argue these are the issues that create the stigma, not the name. Item 5 is significant in relation to the memory of my interaction with my First Sergeant. Unfortunately, there are military leaders who “frown” upon seeking mental health care. Mission comes first. If one is deemed unfit for combat that leaves one less soldier for the mission. It creates stress on the unit from the lowest level to the highest level. It costs upwards of $100,000 to service members for basic, advanced, and unit level training, all of which happens during the first year or two of enlistment. Leaders are pressured to maintain the manpower and integrity of the unit as a whole. This may, at times, lead to encourage soldiers to “suck it up”, if possible. It is unlikely that a name change will affect these issues. Service members are not inanimate objects; they are not action figures or drones. Combatting stigma involves approaching the issue at the core; the nearly impossible expectation imposed on some to operate in inhumane arenas without feeling human pain and emotion. Absent of war, such a reaction to the atrocities witnessed by those who serve in combat would earn them the label of sociopath. My argument does not, however, end with the proper assignment of stigma.

A Key argument for those in favor of the new label is that what service members experience is an injury, not a disorder. I argue it is an injury that progresses to the stage of a disorder. In 1998, I broke my left ankle skiing in Black Forest Germany. When I was informed I would not be able to deploy with my unit if I had not fully recovered, elected to transition to have my cast removed to deploy; in an effort to maintain the fighting force and serve with my comrades. My ankle healed improperly. It is not broken, but it is not as it was prior to my injury. In an x-ray, it does not appear to be broken, however, there are significant indications that a break healed improperly. Now, I can’t wear stiletto heels without experiencing pain. After an

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active night, I simply take off my shoes and walk barefoot to avoid the pain. My injury healed, although improperly, can no longer be deemed an injury today. This is an example of how PTSI is valid. An injury, improperly cared for, can lead to a disorder. I will never have the agile mobility I enjoyed prior to my injury. In 2006, I was deployed in support of Operation Iraqi Freedom. I left this country one person, but came home another. I have reconciled that who I was is no longer. The impact of what I experienced will remain with me forever. It has inspired me to learn about the invisible wounds of service members and the hidden secrets of the military as a culture. With 16 years of empirical knowledge as a mental health specialist in the US Army, I stand by the American Psychiatric Associations label. In my experience, there is nothing orderly about PTSD. It is no secret that combat veterans witness atrocities than most can only imagine. Actively engaging in what may result in the loss of the lives of many men, women, and children, all in the line of duty and obeying orders, is not easy to digest. The images, sounds, and smells tend to haunt those who experience them for the rest of their lives; this attack of memory is the core of PTSD. All sides agree that stigma is the barrier; education, honesty, and compassion is the only approach.

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Works Cited About. Com. “United States Military Basic Training Attrition Rates”. (2012). Retrieved from http://usmilitary.about.com/od/joiningthemilitary/l/blbasicattrit.htm Charles W. Hoge, M.D., Carl A. Castro, Ph.D., Stephen C. Messer, Ph.D., Dennis McGurk, Ph.D. (2004, July). “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care” The New England Journal of Medicine, 351, 13-22 Dave I. Cotting, Ph.D., and Robert L. Koffman, M.D., M.P.H. Jaffe, G. (2012, May). “New name for PTSD could mean less stigma”. The Washington Post. Retrieved from http://www.washingtonpost.com/world/national-security/new-name-forptsd-could-mean-less-stigma/2012/05/05/gIQAlV8M4T_print.html Moore, J. (2012). “A Rose by Any Other Name Would Smell As Sweet—Or Would It?” National Alliance on Mental Illness. Retrieved from: http://www.nami.org/Template.cfm?Section=Top_Story&template=/ContentManagement /ContentDisplay.cfm&ContentID=139848 Ochberg, F. M.D. (2012, September). “An Injury, Not a Disorder”. Dart Center for Journalism & Trauma Web. Retrieved from http://dartcenter.org/content/injury-not-disorder0#.UKQ_F4fXap0. Sagalyn, D. (2012, May). “Psychiatric Community Still Divided Over Idea of Changing PTSD's Name. PBS NewsHour. Retrieved from http://www.pbs.org/newshour/updates/military/jan-june12/ptsd_05-04.html Shakespeare, W., & Durband, A. (1985). “Romeo and Juliet”. Woodbury, N.Y: Barron's. U.S. Department of Veteran Affairs. (2012, September). Report on VA Facility Specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New

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Dawn (OND) Veterans Coded with Potential PTSD. (Publication No. GAO-03-631). Retrieved from VA Public Health: http://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2012-qtr3.pdf