Posttraumatic stress disorder (PTSD): The malleable diagnosis?

The paper seeks to raise questions about the rigour of psychiatric diagnosis with specific reference to the diagnostic category of posttraumatic stress disorder (PTSD). It is argued that because of the inclusion of the stressor criterion (verifiable exposure to an external event) PTSD is very much located in consensual reality. In addition, because of its application to victims in extremity, the diagnosis cannot help but engage with people who are at the receiving end of abuses of power. Such characteristics shape PTSD as a somewhat uniquely socially-located diagnostic category and bring specific challenges to bear in the employment of the diagnosis. Not only is PTSD problematic in its location within a Western, medically-based system of classification, but it has also been drawn upon to serve explicitly political rather than purely clinical agendas. The political role of PTSD has tended to be most evident in the psycho-forensic domain where it has been cited in favour of both complainants and defendants, both perpetrators and victims. Examples of such evidence are discussed with particular emphasis on the role played by PTSD diagnosticians in the South African context. It is argued that the malleability of PTSD offers both problems and opportunities and that ultimately the integrity of the diagnosis may rest on moral as much as clinical principles. In this respect the paper seeks to illustrate that definitions of normality and abnormality in the psychiatric domain remain flawed and open to contestation and abuse. The importance of organizational and collegial support in grappling with these issues is also emphasized.