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Ask the Mental Health Expert Archives 2001-2004

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Education About PTSD

Q. I am a Registered Nurse, a manager of a busy ER and ICU, and have been diagnosed with chronic post-traumatic stress disorder (PTSD) since age 18. I took the events of this horrible time and suppressed them, thinking I could just deal with this. I had been taken by some men for three days and nights, where I was violently raped, beaten, tied down, etc. It was a very traumatic time and I believed I would not live.

I was injured badly, and I was threatened never to tell anyone or my parents, brother, and sister would be killed. I didn't tell, and used a story of being in an altering vehicle accident to explain my physical bruises, cuts, and other injuries.

I truly believed I could handle this so I stuffed it and went on. I'm married now and have grandchildren. I had been functioning well, becoming a nurse, and aspired to management. Then, I had a flashback (31 years later). After several months of nightmares, flashbacks, and depression, I sought out mental health assistance. I have been faithfully going weekly for the past 18 months.

I have had one time at work where I had a crisis and felt overwhelmed and was crying. This was never in public, only in my office. I had people who supported me at work which included my boss and the DNS. I went to a hospital for help with my PTSD, and have done well since. This was two months ago.

How can I teach upper management in a Health Organization that having a diagnosis of PTSD does not disqualify me from being able to function, work in a well organized fashion, and give them information without seeming to push this on them? I believe, even in this time of 2002, even Health Care discriminates or perceives PTSD or mental health as different from physical illnesses. I have no idea what to do to assure them PTSD is no different than someone that has diabetes or other physical disorders. They don't appear nor seem to want to know about the disorder, but rather hide from it. Do you have any suggestions in how I can deal with this in a positive fashion?

A. This is clearly a difficult and delicate situation for you. First, let me say that you have done well by getting involved in therapy, which sounds as if it has been helpful for you. But as you have observed, there is still a good deal of stigma associated with psychiatric diagnoses such as PTSD.

Helping people understand the nature of such conditions requires tact, empathy, and patience. There is often a fine line between gently steering people toward a better understanding, and sounding like you're lecturing down to people from a soap-box, or else just looking for sympathy. It may be that trying to assure people that PTSD is "no different than...diabetes" would be going faster and further than most people are ready to go. (I'm not sure I entirely agree, by the way, that PTSD is no different than such medical disorders. Clearly, there is a cognitive and emotional component to PTSD that differentiates it from, say, pancreatitis or a lung infection. But of course, even diabetes may be influenced by psychological factors. I take your message to be, "People who have conditions like PTSD can be fully-functioning, highly-capable, and terrifically productive workers, and should be treated as such!" That, I think, is an easier message to convey).

How to get your message across? I would suggest setting up a few educational seminars in your hospital and/or emergency department, in which the general nature of PTSD is described and normalized. For example, you might point out that as many as 15% of women in the U.S. may develop PTSD at one time or another (some studies give even higher figures).

You might discuss the impact of PTSD on emergency rooms, whose staff often have to deal with the acute effects of trauma. Rather than making yourself the center of such a presentation, you might want to contact your local mental health clinic or hospital department of psychiatry, to see if you can find a particularly good speaker with expertise in PTSD. Or, you might want to set up a panel, perhaps including yourself, so that you don't appear to be grandstanding. I would also suggest checking out a few websites that provide links to relevant support groups and organizations; e.g., www.ncptsd.org and http://incestabuse.about.com.

Of course, I'm assuming that you are not facing any actual discriminatory practices in your work place--just misinformed attitudes. If you are facing actual discrimination (e.g., being turned down for a promotion because of your condition), then you may need to seek legal avenues of remedy. But for now, it sounds like you have a good opportunity to do some positive education. Good luck!

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August 2002

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