Periodically we come across something great that a PTSD sufferer has written about what it's like to live that experience, not just read about it. The following post is uniquely compelling and articulate, and it's written by Joan Esnayra, Ph.D., founder of the Psychiatric Service Dog Society. Read more about Joan's organization here. But for her wonderful letter, reprinted with permission, keep on reading below:
Dear Veterans,
Here is what I wrote in response to one of [name redacted's] posts the other day about whether or not PTSD is a mental illness. It comes from the heart and it is offered with respect, (if not a little tough love, too).
Dear [Name Redacted],
I know that a lot of veterans are not happy hearing PTSD referred to as a mental illness. Perhaps this is because of some latent fears about what mental illness really is. Mental illness is quite simply abnormal brain function in the domains of speech, cognition, behavior, and/or sensory capacities. Not all abnormal brain function is a mental illness, but all mental illnesses are characterized by abnormal brain function. Does this make sense?
PTSD is described extensively in the DSM-IV. This is the 'Diagnostic and Statistical Manual of Mental Disorders.' It is the bible of Psychiatry. You don't go to a podiatrist or an audiologist for PTSD treatment. You go to a mental health professional. This is because it is a mental illness. There is no value judgment, here. It's just a fact.
I've been diagnosed for so many years that sometimes I forget how scary it was for me when I received my first mental health diagnosis at the age of 25 (Major Depression & PTSD). Having grown up with a mother who attempted suicide with some regularity throughout my childhood years, the last thing I wanted to receive was a mental health diagnosis. Voila! There it was staring me in the face. And, despite the fact that I should have been hospitalized (indeed hospitalization was offered to me), I declined the invitation, swearing to myself that I would not become my mother! he idea of psychiatric hospitalization was absolutely frightening to me at the time.
Since then, I have "been there, and done that". I've seen what psychiatry and neuroscience have to offer people like me (and people like you). Did you know that Bipolar Disorder is believed by some researchers to be a dysregulation of the circadian rhythm circuitry of the brain? Where is the mental illness in that? How can a genetic malfunction of the brain's day/night & sleep/wake cycle cause people to suicide to the tune of 25%? To say that something is a mental illness, is not personal. There is no value judgment in the statement. It is just the category of pathology that each of these mental disorders falls under. It is logical and nothing else.
One of the things that veterans with PTSD have to reckon with is that they do have a mental illness. For some of you, this is a no-brainer, no big deal, like "Duh, that's pretty obvious, Joan." For others, especially the newly diagnosed, this prospect is exceedingly frightening. Allow me to proffer that the fear is not in the classification, rather, it is in our own assumptions about mental illness. When I give public presentations on PSD, sometimes people assume that I am a non-mentally ill psychologist, because I come across professionally, and because I know my subject matter, and I'm articulate. I couldn't possibly be a knife-wielding psycho, right? I mean, isn't that what mentally ill people are really like?
Of course not! Mentally ill people are as diverse as any other group of people. You have the high functioning, the low functioning, the assertive self-starter entrepreneurial types, and the passive, quiet, stay at home types. The whole gamut of humanity is represented on the spectrum of mental illness. There is no "type" among those who live with mental illnesses. As a result, there is no judgment, either.
The mental health consumer community has been pioneering PSD for 13 years. We have an intervention that the veterans community wants and needs. Thus, we need to be building bridges to communication so that we can benefit one another over the long term. Disparaging the characteristics of persons living with mental illness is not going to get us there. So, I'm asking you to re-think your assumptions about mental illnesses and the people who live with them.
Someone in this group recently disparaged others' talk of suicidal ideation and self-injury. This is incredibly disrespectful to our community members. Unless you have walked a mile in someone else's moccasins, it is inappropriate to disparage a legitimate feature of their disability. To do so is tantamount to making fun of someone who wears a colostomy bag. "Hey Poopy Boy, You Stink!" That would be terribly rude. Don't you think?
One of the assumptions that people who are not comfortable with the concept of mental illness make is that people with mental illnesses are victims. This strikes our community as a completely bizarre attribution. What is a victim? Ostensibly, it is someone who, through no fault of their own, is harmed, used, or taken advantage by some force that is more powerful than they are. Using this definition, one might conclude that persons living with mental illnesses are indeed victims to the same extent that anyone is a victim,...of their own genetics!
But, there is another way of using the term 'victim' that disparages the sufferer. In this instance, there is implicit judgment that the person is weak, cowardly, ineffectual, and quite frankly, worthless in the eyes of society.This is the version of 'victim' that I was responding to when I read the term in your previous post. It offended me. I am not weak or cowardly or ineffectual, or worthless, and I AM mentally ill. I have no shame about saying to the world, "I live with mental illness". If I did have a problem with this, then, it would be more so a problem of self-acceptance. The fact is, I am mentally ill. Underestimate my abilities and I will prove you wrong. Call me mentally ill, and I will agree with you. Do you see the challenge, here, to familiar assumptions?
The veterans community needs the PSD community, and the PSD community needs the veterans community. We are like newly reunited cousins. My side of the tracks has never gained societal acceptance because we could never hide the fact that we live with mental illnesses. (We've been symptomatic our entire lives). Your side of the tracks has experienced societal acceptance in your role as non-mentally ill soldiers. Importantly, your side of the tracks (your peer group) has accepted you on the condition that you are not mentally ill.
Well, guess what? Living with PTSD means that you ARE mentally ill. So, do you go into the proverbial closet (a lot of people do), or, do you establish a separatist agenda ("we are not like those people"), or are you going to challenge society's fundamental assumptions about mental illnesses? It is my sincere hope that you will choose the more enlightened path and look for ways to challenge societal assumptions about persons living with mental illnesses with an eye towards growing a more equitable society for all of us.
Joan
