The stories of a diagnosis that helped millions, and of one that still hasn’t happened.
June is designated as National PTSD Awareness Month, with a specific spotlight on June 27 as National PTSD Awareness Day. That date was chosen in 2010 by Senator Kent Conrad of North Dakota, as a tribute to Army Staff Sergeant Joe Biel of the North Dakota National Guard. Biel had come home from two tours in Iraq carrying severe PTSD, and died by suicide in April 2007. June 27 was his birthday.
PTSD — Post-Traumatic Stress Disorder — is the mind’s response to an overwhelming terror. The DSM-5, the manual American clinicians diagnose from, defines its trigger as “exposure to actual or threatened death, serious injury, or sexual violence.” The symptoms run in four directions: intrusion — flashbacks, nightmares, the event replaying uncontollably; avoidance of anything that brings it back; negative shifts in mood and thought — fear, guilt, shame, a future that feels foreshortened; and a body stuck on high alert, with hypervigilance, broken sleep, and a startle reflex that never fully resets. PTSD describes a reality in which the threat ended, but the inner experience of it persists.
Today, PTSD is a universally recognized condition. It’s among the most common disability claims the VA handles — more than a million veterans receive compensation for it. It’s worth remembering that this recognition, and the care that follows from it, were not a gift from medicine. They were hard won.
In the 1970s, when Vietnam veterans first came home with a condition the medical manuals had no name for, they had to mobilize to get it recognized. Antiwar psychiatrists — Robert Jay Lifton, Chaim Shatan — sat with veterans in “rap groups,” testified before Congress, and pressed the American Psychiatric Association to recognize what they first called “post-Vietnam syndrome.” In 1980, after a decade of lobbying and pressure, Robert Spitzer’s DSM-III task force accepted the diagnosis — broadened to cover Holocaust survivors and others — under a new name: Post-Traumatic Stress Disorder.
What made the PTSD diagnosis stick was as much the politics as it was the science. PTSD was attached to a beloved constituency — one the nation owed a patriotic debt, and one with strong political backing.
Complex PTSD (CPTSD) is a far lesser-known condition. Psychiatrist Judith Herman first named it in her book Trauma and Recovery (1992), defining it as “the syndrome that follows upon prolonged, repeated trauma” at the hands of someone you cannot escape. In plain terms, it’s the mind’s response to being trapped: by a parent, a partner, a boss, an actual captor. Complex PTSD is the clinical term that describes the effects of living inside a Toxic Abusive Relationship.
In 1998, the physician Vincent Felitti and the CDC epidemiologist Robert Anda published the Adverse Childhood Experiences study — more than 17,000 ordinary, insured adults asked about the abuse, neglect, and household chaos they had survived as children. They found that childhood adversity was common, and its damage stacked. The higher a person’s ACE score, the higher their risk of depression, addiction, chronic disease, and suicide — rising in a clean dose-response line, the way harm tracks the dose of a toxin. The ACE study was an empirical demonstration, at population scale, of Herman’s clinical term. But it was built to prove a public-health correlation, not to certify a diagnosis — and that distinction is exactly where Complex PTSD fell through the floor. ACEs counted what happened to people and what became of them; it did not define a discrete disorder, with reliable criteria, that a clinician could name and treat.
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is the primary authoritative guide used by mental health and medical professionals in the U.S. to diagnose and classify mental illnesses. In 2009, when researchers formally proposed Complex PTSD for the DSM-5, the American Psychiatric Association turned it down. Their reason: the idea that adverse childhood experiences “cause substantial alterations in development,” the committee held, was “more a clinical intuition than a fact based on research.”
In truth, what prevented Complex PTSD from sticking is just as much the politics as the science. Rather than to war heroes, Complex PTSD is attached to an inconvenient constituency: survivors of childhood and relational abuse — largely women and children, often the wives and children of the same war heroes PTSD recognizes. There is no patriotic debt to settle here, no medal, no flag; no lobby, no department, no senator who will rise to name a day. The injury points back not to a patriotic cause but to the hallowed institutions of marriage and family. It’s a wound our society is slow to canonize, because to name it is to look in the mirror.
In 2019, the World Health Organization added Complex PTSD to the ICD-11, the diagnostic system most of the world uses. The American manual still leaves it out. For a TAR survivor — almost by definition a Complex PTSD case — that vacuum is a dangerous ordeal. Survivors are either diagnosed with PTSD “with a side note,” or relabeled and medicated for bipolar or borderline personality disorder. Having no name for the diagnosis means no name for the relationship that caused it, and none for the person carrying it — only confusion, misdiagnosis, and a system that mistreats while believing it helps. It’s the oldest story in our movement, told in clinical code: a person is harmed by someone with power over them, then told the problem was theirs all along. Whoever controls the recognition controls the story of what was done to you.
This June 27, if you are marking PTSD Awareness Day, thank you. The veterans who fought for that day were right: awareness is only the beginning, and recognition is worth fighting for. Meanwhile, to bridge the void, STAR Network built TAR survivors a fellowship. TAR Anon does not need the DSM’s permission to name what happened to you: It offers the recognition, understanding, and healing that the system is still witholding. Join a TAR Anon® meeting here.
