MAD: missing arm disorder… ?
Could it be that the language we use to describe debilitating stress caused by a traumatic event is actually causing some folks not to seek treatment? Jonathan Shay, M.D., Ph.D., a psychiatrist for the veteran’s affairs clinic in Boston, had some thought provoking things to say about PTSD (post traumatic stress disorder) during a recent American Psychoanalytic Association meeting. According to Dr. Shay, the word “disorder” may cause some returning soldiers to shun treatment. The word has stigma attached to it; if you have a disorder then there must be something innately wrong with you [some may assume]. Dr. Shay prefers the designation psychological injury instead, acknowledging that there are a variety of other word combinations that could replace the word “disorder.” “I want to get everyone thinking like a trauma surgeon rather than an internist,” said Dr. Shay. For instance, if a soldier lost his arm during battle “he would not be diagnosed with ‘MAD’ or missing arm disorder…” Dr. Shay said. Commenting, Prudence Gourguechon, M.D., president of the American Psychoanalytic Association, said, “It is a psychological injury of war… it’s not that there is something wrong with you.” The following is an excerpt of an article from Medpage Today that discusses Dr. Shay’s thoughts on the implications attached to the word disorder further:
…psychoanalysts have long been making contributions to the effects of combat on the human psyche, and the discipline’s theories may foster better understanding of how to treat the problem.
One of those tenets is a long-term approach to treatment. PTSD may continue to manifest for some time after a soldier returns from war, so ensuring that VA clinics can provide access to long-term care is a necessity, she said.
Also, the idea of “transference,” or unconsciously projecting inner experiences onto others around you, enables healthcare providers to assess the collateral effects of PTSD — how the disease affects soldiers’ families and children.
Dr. Shay, who does not practice psychoanalysis, said there is definite value to the “relationship between a skilled clinician and single person in pain or trouble.” But he advocates the importance of community in rebuilding veterans’ lost social trust.