In November, Lady Gaga was visiting a center for homeless LGBT teens in Harlem when she disclosed that she has PTSD (Post-Traumatic Stress Disorder), a physiological set of symptoms that arises after a traumatic incident. In her case, she revealed, she was raped at age 19 and didn’t speak about it for seven years. (Gaga also created the moving song and video “Til It Happens to You”, featured in the film, “The Hunting Ground,” and exploring the experience of sexual assault.)
It is exceptionally brave of her to speak up now about this, and especially in the context of urging young people to be brave and kind, and to be a role model for healing and for #stigmafree in talking about her mental health issues. (You can view a clip of her visit to the Center here.)
Gaga’s experience was a trauma, and she has self-identified as someone with PTSD – she has been and is receiving treatment. But the emergence of this term also means a lot of people are beginning to misuse the label, perhaps using it more casually or frivolously.
And as you probably know, I have a PhD in neuroscience and I studied for a combined 12 years specializing in psychoneuroendocrinology, focusing on Obsessive Compulsive Disorder in individuals with a rare genetic disorder called Prader-Willi Syndrome. I studied PTSD as part of my thesis research.
One of the blessings and curses of being a neuroscientist is that I have very low tolerance for the misuse of medical terms. I wrote a post about the misuse of “OCD” since so many people like to say, “I need to shower every day, I’m super OCD about it.” OCD is an actual clinical diagnosis that has very specific internalizing and externalizing features, and simply being fastidious does not designate you as having that disorder. In addition, not to be a wet blanket, but the misuse of clinical terms surrounding psychiatric diagnoses in particular creates a sense of misunderstanding about people who actually live with these conditions and have real and significant challenges to life because of them. So I wanted to explain a bit about PTSD and how and why the term can be used or misused.
Although there are many upsetting things people may experience in their lives which may have long-lasting repercussions, clinically, PTSD is very specific:
If a person has been exposed to a traumatic event, they will experience repeated and intrusive memories of the event both in real life and in dreams. They will have the feeling as if the traumatic event were actually happening again and they may have illusions, hallucinations, and flashback episodes. They also will experience intense psychological distress surrounding the trauma. They will also experience physiological distress from anything relating the trauma, such as heart palpitations, panic attacks, increased heart rate and blood pressure, and sweating.
People with PTSD also tend to avoid anything related to the trauma such as thinking about it, talking about it, or dealing with feelings, places or people, that remind them of it. Diminished interest or participation in significant activities, feeling detached from others, and having other symptoms that can look like clinical depression are also typically seen, as are problems with sleep, anger, and concentration.
A hallmark of PTSD is an exaggerated startle response, where a small sound or even visual stimulus can produce all of the psychological and physiological symptoms as well. All of these symptoms need to be present for more than a month to meet PTSD criteria and they must also cause significant distress or impairment in social, work, or social life.
I’ve heard people say that they went through a bad break-up that “left me with PTSD.” Or that they got into a verbal disagreement with someone and now they have PTSD. While there are upsetting things about break-ups and arguments, you don’t “get” PTSD from that kind of situation unless there is trauma involved. Traumatic events have the strength to make a deep impact on the way your brain operates and functions. Tramuatic events include things like sexual abuse or assault, rape, physical abuse (especially if it is repeated), a particularly violent or upsetting accident, a mugging or robbery, or a natural disaster. These are very specific and very neurochemically-potent experiences that should not be confused with things that are difficult, emotionally complicated or even very upsetting.
So why do people care about the language you use to describe reactions like these? Why does it matter? It matters for two reasons. First, the misuse of a term with as much significance as PTSD detracts from the experiences of those who are living with such disturbing and disruptive symptoms. In a culture that seems to thrive on drama, it can be tempting to speak in hyperbole, but it actually takes away legitimacy from those who are really struggling with it.
Second, this over-identifying with a diagnosis that is not yours for reasons that are less significant clinically creates a certain environment that one can and should “get over it.” Meaning, the recovery from a break-up, while difficult and long-term in some cases, should not be confused with the recovery from the experience of a clinically significant traumatic event. We have enough misunderstanding about mental illness in our country and in the world; if we start using the term PTSD to describe getting over a break-up – a recovery time which, for the most part, will be far shorter than recovery from a trauma that results in PTSD – we lose touch with the reality of the PTSD profile and we may start to accuse the person with PTSD of “dragging it out” or “generalizing” when in actuality, the fact that those with PTSD generalize is a neurological feature of the disorder that is very difficult to “get over.”
I totally get that speaking in hyperbole is sometimes done for dramatic or comedic effect. But when it comes to using clinical diagnoses as exaggerated proclamations, I implore you to think a bit more or find other ways to express it if at all possible.
Lady Gaga’s use of the term is an opportunity for us all to learn a bit more about PTSD, what it is and what it isn’t. And it’s also a chance to support those who suffer from this condition, and from other mental illnesses, toward a future in which we’ll all be brave and kind enough to live stigma-free.