INTERNATIONAL CONCERNS ABOUT PTSD

In recent years, Western concepts of psychological trauma have come under increasing challenge, particularly from a transcultural perspective (see Silove, 1999a). The evolving critique is based on several loosely interrelated assertions (Summerfield, 1999): that the psychiatric category posttraumatic stress disorder (PTSD) has its roots in the historical and social imperatives of the 1970s when there was a need to vindicate and advocate for Vietnam combat veterans returning to a hostile public reception in the USA; that, in turn, the medicalization of PTSD spawned a self-sustaining and self-serving trauma counseling industry; and that the consequences, intentional or otherwise, have been to encourage a culture of victimization, compensation seeking, and unrealistic expectations. Concerns have been raised, in particular, about the proliferation of psychological debriefing after disasters, in spite of mounting evidence that indiscriminate interventions of that type may be ineffective, and in some cases injurious, to natural recovery (Raphael & Wilson, 2000). The added concern is that the professional appropriation of psychological trauma may undermine communal support mechanisms that traditionally provided comfort to survivors.

Such concerns are particularly relevant to conflict-affected countries that lack the resources and skills to apply best practice treatments for PTSD. Issues of feasibility and affordability make it impossible to offer best practice interventions (whether pharmacological or cognitive behavioral) on a mass scale to the large portion of trauma-affected populations meeting criteria for PTSD soon after major humanitarian disasters.