PCPE Special Ethics Workshop: Ghislaine Boulanger, Ph.D. "When Diagnoses Obscure The Real: Ethical Considerations Surrounding Posttraumatic Stress Disorder"

Invited Speaker -- Ghislaine Boulanger, Ph.D.

Ghislaine Boulanger, Ph.D., is a member of the supervisory and teaching faculty in the Clinical Psychology Program at Teachers College, Columbia University, and is a clinical psychologist/psychoanalyst in private practice in New York City.  Her interest in adult onset trauma began in the mid-1970s when she joined a congressionally mandated research team to do an epidemiological study of Vietnam veterans.  Her findings about the long-term consequences of surviving violence led to a career of research, writing, and teaching about the psychodynamic causes and consequences of adult onset trauma.  In 1986 She was a member of the Subcommittee defining PostTraumatic Stress Disorder for DSMIII-R.  Her most recent book, Wounded by Reality: Understanding and Treating Adult Onset Trauma, was included in the Psychoanalysis in a New Key Series and published by The Analytic Press in 2007.

 

 

It is frequently argued that psychiatric diagnoses give rise to expectations that shape the clinician’s observations and interactions with her patient.  This is never more true than in the case of posttraumatic stress disorder where political and social interest in the immediate cause of the disorder exerts further pressure on individual clinicians and negatively impacts the patients to which the diagnosis is applied.  In her great pacifist essay The Iliad or the poem of force, Simone Weil (1940) writes that violence turns anyone subjected to it into a thing.  Regrettably, the diagnosis that was created to acknowledge reactions to violence can compound the objectifying forces of violence.

 

The diagnosis of Post Traumatic Stress Disorder is the legacy of political action taken in the nineteen seventies by Vietnam veterans, by women’s groups, and by Holocaust survivors who believed that their particular plight was not represented in the diagnostic choices that were then available.  It is a bitter irony that in its mandate to represent these disenfranchised groups, the diagnosis has become a caricature of what those who originally lobbied for its inclusion in DSM III had intended.

 

I shall review the ways in which the media, epidemiologists, insurance companies, politicians, the military, and even trauma counselors use the diagnosis to shape public expectations about the consequences of violence.   Too often the diagnosis marks the end of an inquiry rather than the beginning of treatment.  With overuse, misuse, and even correct use, the very words 'post traumatic stress disorder' have become a cliché.  When details of the trauma itself and of its consequences have been categorized and fixed in place, the response to terror is reduced to a formula.  Rather than encouraging understanding of the experience, it is forced into recognizable and socially prescribed categories which discourage further investigation.

 

 

 

1.  Determine when is the diagnosis of Posttraumatic Stress Disorder appropriate.

2.  Understand why the diagnosis of Posttraumatic Stress Disorder subject to so much disinformation.

3.  Determine when psychodynamic treatment for Posttraumatic Stress Disorder is appropriate given the many treatments available.