All posts by Kelly Berg

Trauma and Violence

Post-traumatic stress is something that can take on many forms and arise from many different circumstances. It is also known at post-traumatic stress disorder (PTSD) but sometimes the word disorder is removed to decrease the stigma surrounding it. In an article in Vanity Fair called How PTSD Became a Problem Far Beyond the Battlefield, the author, Sebastian Junger, explains that “Because PTSD is so adaptive, many have begun leaving the word “disorder” out of the term to avoid stigmatizing a basically healthy reaction.” PTSD was originally associated with combat soldiers, but has since been recognized as something that can affect anyone who faces any trauma. As Junger explains in his article, sometimes those who experience the most severe forms of PTSD are victims of rape, and those who witnessed but were not directly involved in combat, such as himself, as journalist who travelled to Afghanistan. Sharon Abramowitz explains, in her article, Searching for Normal In the Wake of the Liberian War, people are forced into a condition they are not accustomed to, where the suffering detaches them even before they have made a trial run. Abramowitz states, almost fifty percent of the population living in Liberia at the time of the Liberian war reported severe symptoms of PTSD.

Unfortunately, there is very little treatment for this and any other form of mental disorder due to many different barriers to care. Based on research for a paper I wrote discussing PTSD in American soldiers returning from war, the two biggest barriers were stigma and lack of access to care. In Farmer et al.’s book, Reimagining Global Health, one way to decrease the lack of access to care is to combine mental health care with primary health care. Many countries have found this to be more efficient and reach more people, either by having psychiatrists located in the same location as primary care physicians or having primary care providers trained in psychological health maintenance and care.

As I found in my research, the VA (Veteran’s Association) had tried to implement something similar based on survey results from soldiers saying this would be helpful. Unfortunately what this does not help is the stigma associated with any mental health diagnosis, as Farmer et al. describes as something that can greatly affect someone’s life, causing them to not be able to gain employment, and affecting the way family and friend’s view them.

Abramowitz explains that the entire mental and physical demeanor changes in people affected by PTSD, to the point that their own friends and family do not even recognize them. Because of this, often the friends and family try to get the person help before they themselves will reach out. Both in Liberia and the United States alike, many people who wish to seek treatment cannot afford the treatment they need. Farmer explains that neuropsychiatric morbidity is underdiagnosed and antidepressants are underutilized in rich and poor countries alike. In Reimagining Global Health, the DSM-V manual of mental disorders is discussed as something that can be a barrier to care because of the different forms across different cultures. The DSM-V describes PTSD and the symptoms associated with it, and is something for health care providers to use as a baseline to help diagnose different mental disorders and illnesses. Farmer et al. explains that the DSM-V is written based on American and European cultures, which may limit its use across culturally diverse populations.IMG_2374

 

Discussion Questions:

  • Do you agree that stigma is one of the biggest barriers to mental health care, especially the treatment of PTSD? What do you think might be other effective ways of dealing with stigma as a barrier to care? If you can think of any other major barriers to receiving mental health care, what are they and what might be some possible solutions?
  • Based on Farmer et al., the DSM-V can limit utility across cultures, which might reduce the diagnosing and care of mental health disorders around the world. What might be some of the cultural barriers caused by the DSM-V and what are some possible ways to address these problems? What might be some ideas for a more universal approach to mental health diagnosis and treatment?

Additional Sources:

Junger, Sebastian. “How PTSD Became a Problem Far Beyond the Battlefield.” Vanity Fair June 2015: n. pag. Web. <http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebastian-junger>.

Doolin, D. T. (2009). Healing Hidden Wounds: The Mental Health Crisis of America’s Veterans. DTIC Document.

McNally, R. J. (2012). Are We Winning the War Against Posttraumatic Stress Disorder? Science, 336 (6083), 872–874. http://doi.org/10.1126/science.1222069