PTSD, Stigma, and Treatment; the Clinical Perspective.

Nicholas Eaton, Ph.D. is an assistant professor of psychology at Stony Brook University. As someone who has experience with both the clinical side of psychology as well as research, Professor Eaton has valuable insight into the workings and treatment of various mental health conditions, as well as the numerous factors that influence treatment and willingness to seek professional assistance. Professor Eaton…

Can you give me a little summary about your educational background and experience with mental health?
Nicholas Eaton received his PhD clinical psychology from University of Minnesota (2012) “Then I moved to NY started research on psychopathology, which has mostly been focused on classification. In recent years my focus has been applying this to different groups and trying to understand how oppressive influence may influence mental health.”

Do you have experience with PTSD clients?
“Yes, both research and clinically.”

What did your PTSD research focus on?
My research looks at how PTSD relates to mental disorders and to what extent it’s a unique thing vs. a mixture of things like depression and anxiety. The treatment for PTSD largely looks like anxiety treatment, so cognitive vs. exposure based treatment as well both work.

Can you tell me about any unique experiences with your clients who had PTSD?

Well PTSD can occur in many different ways and manifestations.
One client in particular I remember had a traumatic work accident. So he came in thinking he had panic disorder. After we talked it, actually turned out he had PTSD. After explaining to him why I thought this was the case, and showed him that his presentation of symptoms, he himself agreed that this seemed to explain why he tried many different things to get over his symptoms, as he thought it was the result of a panic disorder rather than trauma, and therefore why his personality was changing. In that we kind of saw this misconception that PTSD is a disease for Veterans, but after showing them the diagnostic chart it clicked, his personality changed based on an accident, and he kept reliving the incident.

Treatments in PTSD/other groups:

With Veterans, you gradually get them thinking about service and things that remind them that provoke anxiety of service, and retrain their brain such that they can have a more balanced view of their service. So it’s not like every time they see a uniform or flag they’ll have strong negative reactions, they can tolerate the anxiety and over time it has less pull, and their reactions are less strong, so it becomes livable.

Working with different groups (ethnic minorities, non-gender binary, etc.):
In terms of treatment it doesn’t impact the treatment so long as you take unique factors into consideration. If it is PTSD resulting from someone being assaulted in transphobic attack it behooves the therapist to have knowledge of trans issues as to not miss important complexities. Particularly when we see people traumatized more vicariously through hate crimes, which are layered in social, cultural, and political impact. For others outside that attack, when we see our own communities being impacted it makes up worries. However, regardless of individual circumstance it becomes exposure based treatment.

How does stigma affect the treatment of patients?

“So within certain communities, there certainly are stigmas about mental disorder. So for example, in some communities people may feel as though someone with a mental disorder doesn’t have enough willpower, or within other communities, they say within some military context people might view PTSD (historically at least) with some sort of weakness that someone who’s strong enough would be able to overcome or not be affected by. Whereas in other communities there’s actually a reduced stigma. I remember one client I met, a kid who was Hmong and the kid had psychosis; so hallucinations, and normally we would treat the kid with antipsychotic medication but in this case the family really viewed [his illness] as a benefit. That the kid had this kind of extrasensory perception and would be able to serve an important role in the community because of this, so kind of an anti-stigma as well, like quite accepting of these experiences.”

So this impacted their willingness to get treatment?

“Yeah, and they didn’t want treatment.”

How was that perceived by professionals?

“Certainly within the clinic, there was a diversity of opinions. With some people feeling like it was an important cultural difference that must be respected and other people feeling like it was just really almost child abuse.”

If it’s something that’s seen as potentially harmful to the patient, at what point does a professional step in?

“Well professionals are required legally to step in when there’s imminent threat of harm to the patient or to someone else by the patient or when you know someone is being harmed, who’s vulnerable like a kid or an older adult who can’t take care of themself. But so in general outside of those requirements, the clinician has no authority to do anything unless the person wants treatment.”

Even in the case of children?

“In the case of children who are being abused, as in actual abuse defined by law, than no. In similar cases (Hmong) the courts will side with the parents, due to First Amendment issues.”

How have you found that families typically react to members of their family seeking treatment in terms of misunderstandings, or stigmas? Especially in the case of it being “the first” family member to seek treatment?

“It varies quite widely. By the time someone seeks treatment, often the family has really wanted them to make some sort of change because they see that they’re in pain; so they’re excited because the person has chosen to seek treatment. But sometimes the family does stigmatize, typically in more traditional settings. But in my experience people are, if they are not leery of psychotherapy or medication, they’re usually pretty happy that someone they care about is pursuing something that may help them.”

Have you found that patients coming in have preconceived notions of illness? Especially if they came seeking treatment believing they had one illness and they got diagnosed with something different?

“Most people, in my experience, don’t really know enough about these things to have much of a preconception unless they’ve tried researching on their own or have some sort of specialized education. Some people though will definitely disagree with the diagnosis and you really need to clarify for them why you think the diagnosis is appropriate and how that diagnosis fits better than the other diagnosis but in a lot of situations you don’t even talk about the diagnosis. I often don’t. I don’t think it’s necessary for most clients.

Diagnosis to me doesn’t really do very much. It puts a label on something, which for some people is very important, but for some people is very stigmatizing. So for me, I don’t usually find it profitable to do a lot of diagnosis unless a person really needs one, or really wants a name for things. Ultimately I feel like making that careful differential diagnosis is usually not a very good use of time and because most of the similar things wind up being treated similarly anyway, I’m really going to target it to their presentation and their symptoms rather than to a particular diagnosis “