An ethichal perspective on PTSD: an innate disease or social construtction

During the last twenty years there have been an ongoing debate in circles within the field of the history on psychiatry. This debate revolves around a common psychological state known as post-traumatic stress disorder (PTSD). Proponents of the diagnosis puts forward that ptsd has been described by various historical actors, put that the diagnosis itself did not exist. Therefore, PTSD is seen as the best currently diagnosis on the corpus of knowledge avaible to us. Other scholars remain critical of the diagnosis and put forward that the diagnosis were created at special time and place, and thus is a political rather psychological state. In this regard scholars have showed that PTSD was established as a diagnosis in the years following the Vietnam-war, when there was a lack of support for veterans in the us due to the many war atrocities. The veteran movement therefore needed to reframe the issue and put forward that the soldiers themselves were victims, since their war-experience led to trauma. After protests from the American federation of psychatrist the diagnosis were eventually put into the DSM in 1980. Since then it is not only war experience that have been seen as part of PTSD diagnosis, but traumatization have been transferred into a wide range of society, were even dangerous workplaces are seen as enabling the diagnosis.

Picture from Wikipedia depicting a PTSD flashback. 


This discussion have been rather low-key but in recent years more and more knowledge have been generated on the subject. One of the key points of this research is that PTSD functions in two ways. For the state, it both enables intervention and the possibility to solve issues within various fields. For private persons the diagnosis both creates social rights and provide ways to manage their identity. Research have for instance highlighted that men that are otherwise unwillingly to seek psychological counseling can do this after being diagnosed, since the innate nature of PTSD provides a way to keep their masculinity intact.

The debate amongst scholars invoke several important questions, none the least ethical once. Already in the 1990's Ong published a paper were medicine could be seen as a way to discipline and normalize groups that did not fit into society. Therefore, labelling indivudals or groups with diagnosises such as PTSD contributes to social control over groups instead of discussing other parts of the groups living conditions. From this point of view it would be ethical to study how such diagnosises where made since questioning them would provide for another way of thinking about the groups possibilities and room for action. 

On the other hand, it is also dangerous to question such diagnosises from mainly two perspectives. The first is the risk of reducing the patients traumas, since they were much interfere both with the well-being of the individual and their daily lives. The second critique that can be brought forward is that diagnosises of PTSD in western society often comes with social benefits. For refugees they mean ability for the treatment of trauma and for veterans it also put forward the possibility of being viewed as having been harmed in the line of duty, thus enabling them to gain social benefits they would not have. 

For me as a post-foucaldian the potentials gains of putting this diagnosis under critical scrutiny however outweights the possible negative impact. As a social-construvistic I think that is essential that society knows about the deep-laying cultural assumptions behind a policy, since such imaginations often have real consequences for real people. I also think that a cultural critique of psychiatry in the end can help society forrward, since it enables for clinicians to create new treatments that are more effective. However, such research must be undertaken with great respect for the possible consequences for it's results, which might not always be what the researcher want. 

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