July 13, 2010 will be an important day in the history of posttraumatic stress disorder. Consistent with President Obama’s address this weekend and the US’s increasing awareness of the post-deployment problems of veterans of Iraq and Afghanistan, the Veteran’s Administration has made the procedure for obtaining disability benefits due to PTSD easier by changing what qualifies as a benefit-worthy potentially traumatic event. This has been all over the US news today (you can Google the news yourself), but here’s the VA’s own press release on the new policy.
Under the old requirements, a vet seeking the $2700 per month disability benefits for PTSD would have to show that he or she had been in a “firefight” (the key word) by getting some sort of corroborating documentation — complete with dates and names — that the event had occurred (of course, he/she would also have to show evidence of suffering from symptoms of PTSD as well). This proof might be possible if the vet had actually fought in a large battle, but most potentially traumatic events don’t come with receipts. Therefore, under the old rules, most potentially traumatic stressors during wartime — roadside bombings, handling dead bodies, rockets overhead — were outside the realm of potentially traumatic events. Under the new rules, vets will only have to show that they served in a “war zone” (in any capacity) and have a PTSD diagnosis from a VA psychiatrist (the latter, by the way, is a point of controversy among some veterans’ groups).
Why is this important to mental health? PTSD is one of a very few psychiatric diagnoses that requires a precipitating stressor. Criterion A of the DSM-IV diagnosis is the occurrence of a trauma, which is further defined as a potentially traumatic event — “Criterion A1” — that causes “fear, helplessness, or horror” (A2). What counts as a legitimate “Criterion A1 event” that might cause fear, helplessness, or horror has bedeviled diagnosticians and psychological taxonomists for over a century now in one form or another, and today’s decision can be seen as a government stamp of approval of the trend towards inclusiveness.
Whether the “conceptual bracket creep” (as Bruce McNally at Harvard calls it) of this particular potentially traumatic event will influence psychiatry’s conceptions of non-war zone PTSD has yet to be seen. Given that the VA and Department of Defense are by far the biggest funders of research into PTSD, it seems likely.