Elliott Luther, Bennett Alexander S, Szott Kelly, Golub Andrew
National Development and Research Institutes, 71 W. 23rd St. 4th Fl, New York, NY, USA.
Department of Anthropology and Sociology, Earlham College, 331 Landrum Bolling Center, Richmond, IN, 47374, USA.
Cult Med Psychiatry. 2018 Dec;42(4):778-799. doi: 10.1007/s11013-018-9586-7.
Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This examination of PTSD narratives-as voiced in qualitative interviews and focus groups with 50 veterans of the recent Iraq and Afghanistan wars living in New York City-attends to the processes through which veterans conceive and navigate PTSD symptoms and diagnoses. In so doing we highlight the social constructivist positions undertaken by veterans themselves as they varyingly challenge and internalize symptomology in dialogue with psychiatric definitions and the stigma associated with PTSD. Findings demonstrate the rejection of classic psychopathological etiology-in brain disease, for example-by many veterans as well as the complex balancing of benefit and stigma that veterans undertake when making decisions about presenting to psychiatric clinicians. Drawing on veterans' accounts, we argue for greater cultural specificity in characterizing the diagnosis-seeking behavior of trauma survivors and a greater appreciation for the contradictions and compromise related to both acceptance and rejection of a mental health diagnosis.
创伤后应激障碍（PTSD）是一种跨越道德和精神科领域的精神病理学形式。PTSD基于离散的创伤事件，在一个日益关注精神疾病遗传学的时代，它代表了一种病因学上的异类，也是对精神疾病进行社会建构主义分析的主要对象。本次对PTSD叙事的研究——通过对居住在纽约市的50名近期伊拉克和阿富汗战争退伍军人进行定性访谈和焦点小组讨论得出——关注退伍军人构想和应对PTSD症状及诊断的过程。在此过程中，我们强调了退伍军人自身所采取的社会建构主义立场，他们在与精神科定义以及与PTSD相关的污名进行对话时，以不同方式挑战并内化症状学。研究结果表明，许多退伍军人拒绝经典的精神病理学病因，比如脑部疾病，同时也表明退伍军人在决定是否就诊于精神科临床医生时，会在益处和污名之间进行复杂的权衡。基于退伍军人的叙述，我们主张在描述创伤幸存者寻求诊断的行为时要有更高的文化特异性，并且要更加理解与接受和拒绝心理健康诊断相关的矛盾与妥协。
