Duke University, Durham, North Carolina, USA.
J Med Philos. 2020 Nov 30;45(6):644-662. doi: 10.1093/jmp/jhaa023.
Although post-traumatic stress disorder (PTSD) is now constituted by a set of characteristic symptoms, its roots lie in Post-Vietnam Syndrome, a label generated by a Vietnam-era advocacy movement that focused not on symptoms but on war's traumatic context. When Post-Vietnam Syndrome was subsumed into the abstract, individualistic, symptom-centered language of DSM-III and rendered as PTSD, it not only lost this focus on context but also neglected the experiences of veterans who suffer from things done or witnessed, not primarily from what was done to them, in war. This agent-related trauma has been rediscovered in contemporary work on moral injury, but moral injury too is increasingly subjected to the hegemony of the symptom. Focusing on symptoms, however, unhelpfully pathologizes and individualizes trauma, neglects traumatic context, and legitimates problematic therapeutic approaches. Trauma researchers and clinicians should decenter the language of symptoms and focus instead on context and on alternative accounts of trauma.
尽管创伤后应激障碍（PTSD）现在由一系列特征性症状构成，但它的根源在于战后越南综合征，这是一个由越南战争时期倡导运动产生的标签，该运动关注的不是症状，而是战争的创伤背景。当战后越南综合征被纳入 DSM-III 的抽象、个人主义、以症状为中心的语言中，并被表述为 PTSD 时，它不仅失去了对背景的关注，而且忽视了那些因在战争中做过或目睹过某些事情而受苦的退伍军人的经历，而不是主要因为战争中对他们做过的事情而受苦。这种与代理有关的创伤在当代关于道德伤害的研究中得到了重新发现，但道德伤害也越来越受到症状的霸权的影响。然而，关注症状无益于将创伤病态化和个体化，忽视了创伤背景，并使有问题的治疗方法合法化。创伤研究人员和临床医生应该将症状语言去中心化，转而关注背景和创伤的替代解释。
