Immediately following traumatic events, most (95%) exposed survivors experience
some mental distress (Norris et al, 2003). Therefore, in the early stages, some
psychological distress is “normal”. ICD-10 has described “a mixed and usually
changing picture” including “daze, depression, anxiety, anger, despair, over-activity,
and withdrawal may be seen, but no one type of symptom predominates for long”.
Some scholars who take a broad sociological/cultural view doubt the validity of the
diagnosis of PTSD, or at least the claimed high prevalence of this disorder
(Summerfield, 1999, 2001; Bracken, 2002; Pupavac, 2001, 2004). As with Major
depressive disorder, caution has been expressed against the uncritical use of
diagnostic checklists which can inflate prevalence (Summerfield, 1999).
A recent study of 245 adults exposed to war found 99% of these survivors suffered
PTSD (De Jong et al, 2000). A possible conclusion from such findings is that PTSD is
a normal response, and treatment is therefore not indicated. A more likely explanation
is that normal responses have been medicalized and incorrectly labelled as PTSD.
There is no terminological equivalent for PTSD in many language groups (Pilgrim &
Bentall, 1999), which indicates that this is not a universal disorder and that cultural
factors are important. Modern Western society emphasises the vulnerability of the
individual and the prudence of risk avoidance (Pupavac, 2001), which creates the
expectation that trauma will result in pathology. Summerfield (2001) observes that
Western society has become “an individualistic, rights conscious culture”, and that
PTSD “is the diagnosis of an age of disenchantment”. Pupavac (2004) observes that
current Western society lack a clear moral or ideological framework, that individuals
are thereby less robust, and that social policy involves the “psychologizing of social