Think Piece: Drop the ‘D’

Source: Director of Veterans SA, Rob Manton, published Thursday 9 March, 2017

DSCF0017.JPG copyIt has been termed an invisible wound, is as old as war itself, and has undergone a metamorphosis since it was first defined as ‘shell shock’ in World War One, and ‘Battle Fatigue’ or ‘Combat Stress Reaction’ in World War II. Post-Traumatic Stress (Disorder) – you’ll understand the brackets around disorder if you read on – is the most common and familiar term for mental illness faced by service men and women, past and present.

The dictionary defines ‘disorder’ as “…a derangement of physical or mental health or functions…” It further defines ‘derange’ as, amongst other definitions, to “make insane”. It implies permanency.

Not long after I assumed my role as Director, Veterans SA, I was invited to address an Adelaide Legacy lunch to outline my priorities and vision for the Agency and to touch on issues of concern to me for the South Australian veteran community. One of the issues I highlighted related to the perceived stigma associated with Post-Traumatic Stress (Disorder) (PTS(D)) and my desire to start a bit of a campaign to remove the ‘D’ from the acronym. In so doing, I had hoped to make some small in-roads to remove the stigma, encourage those suffering to seek assistance and possibly treatment, and to start a conversation about this condition to remove any perceived or actual bias towards those so diagnosed.

My rationale was, and remains, quite simple: the stigma stems from the ‘Disorder’ component of the term, not the ‘Post-Traumatic Stress’ part. A member of the audience that day suggested that the ‘D’ was a requirement for compensatory purposes. My view is that PTS is a condition not a disorder. I believe our number one priority should be treatment not compensation. If it requires legislative change, then we should make that happen such that the removal of the word ‘disorder’ does not impact compensation. But, our first order of business must be to promote recovery at every turn.

Former US President George W Bush began a similar campaign to ‘drop the D’ in 2014 when he said:

“We’re getting rid of the D. PTS is an injury; it’s not a disorder. The problem is when you call it a disorder, [veterans] don’t think they can be treated. An employer says, ‘I don’t want to hire somebody with a disorder.’ And so our mission tomorrow is to begin to change the dialogue in the United States. And we’ve got a lot of good support.”

His Royal Highness, Prince Harry, has a similar view. “I’ve spoken to everybody who has severe PTSD to minor depression, anxiety — whatever it might be. Everybody says the same thing: If you can deal with it soon enough, if you can deal with it quick enough and have the ability and the platform to speak about it openly, then you can fix these problems. And if you can’t fix it, you can at least find coping mechanisms. There’s no reason people should be hiding in shame after they’ve served their country.”

You don’t need to be a medical professional to understand how the use of the word disorder could have a negative impact on anyone diagnosed with PTS(D). There could potentially be resignation that being so diagnosed renders an individual deranged and unable to be treated. The likelihood of a ‘cure’ could be seen as remote. That’s the individual side of the equation.

From an employer perspective, and let’s speak plainly, they will hire someone with a disability but they won’t hire someone with a disorder, as former President Bush suggested. Unfortunately many in the broader community have the perspective that everyone who has served has PTS(D). As we try to reintegrate young, working age veterans into society and assist their transition from the military into civilian employment we need to be doing everything we can to destroy the myth that all service personnel have PTS(D).

About 18 months ago I caught up with a classmate of mine. We graduated from the Officer Cadet School, Portsea in 1981 and served together in Iraq in 2006. I think he won every award in our graduating class except the Sword of Honour. He was what we termed in those days ‘a jet’. He was then, and remains, a great bloke. When we caught up during his visit to Adelaide I was concerned to see the impact his three tours of the Middle East had had on him. While I haven’t spoken directly to him about it, it was clear to me that he was, and I am sure still is, focussed on recovery and managing his PTS. It was also clear that, while he was engaged in a constant struggle, he did not fit any of the definitions offered earlier.

On Sunday evening Australia lost another ex-serviceman to suicide. A former soldier from 5/7 RAR who had deployed to Afghanistan before transitioning from the military and joining the South Australian Police Force, took his own life in Cowell, north east of Port Lincoln. It is not yet clear why he took his life or whether signs were missed that, if noticed, may have averted this tragedy. Once again a valued servant of the community is no longer with us.

It’s time we changed the narrative on this issue. Society has changed – for the better. We now embrace our mentally ill. We no longer lock them away in asylums. We have accepted, particularly for serving and ex-serving personnel, that we owe the same debt to those with mental health challenges as we do to those with obvious physical injuries.

We may not be able to change the medical terminology but we should try and change the perception in society and amongst employers. Employers would not hesitate to hire an employee being treated for a medical condition like diabetes or high blood pressure, and they should not hesitate to hire veterans with post-traumatic stress. As former President Bush has said “Post-traumatic stress…is an injury that can result from the experience of war. And like other injuries, PTS is treatable.”

Our service personnel are the 0.24% of the population that keeps the other 99.76% safe.

If for no other reason than this, let’s drop the D.


Rob Manton is a former Army Officer with 30 years of command and leadership experience. His military career involved command appointments at every rank level from Lieutenant to Colonel including as Commanding Officer 8th/12th Medium Regiment, Royal Australian Artillery, and culminating in a formation level appointment as Commandant of the Army’s Combat Arms Training Centre in 2005. Rob has served in exchange positions with the Defence Forces of both the United States and the United Kingdom. His operational experience includes service with the United Nations in the Middle East in 1990, and with the Multi-National Force – Iraq in 2006 as the Deputy Chief of Staff with responsibility for strategic campaign planning. Rob’s final appointment in uniform was as the Military Adviser to Australia’s Ambassador to the United Nations during Australia’s successful candidacy for a non-permanent seat on the Security Council. Rob was appointed Director, Veterans SA in October 2014.