About a Letter: My Rant -

About a Letter: My Rant
"I" before "D"

Dear friends and supporters,

Words matter. I knew that. You knew that.

But I’ve learned letters matter, too.

I learned this in talking with Matthew Farwell about his first-person report for Playboy on his experiences with “The God Shot,” the stellate ganglion block treatment done by Dr. Eugene Lipov, a Ukrainian-born Chicago-based anesthesiologist. For more than half a dozen years, stellate ganglion block treatment has been used so frequently it has acquired a shorthand SGB.

If you haven’t heard the program, you should (open on the panel next to this)

The reason Matt went to Dr. Lipov was to seek relief from extreme symptoms of something else that has its own coded name, PTSD, and it’s that last letter that I am writing about.

PTSD is code for Post-Traumatic Stress Disorder, and it’s a code that Matt and many other affected veterans dislike. Their preference is PTSI, Post-Traumatic Stress Injury.

Their reasoning is simple, and to me, compelling.

“Disorder” is a medico-psychiatric term for some internal dysfunction. It doesn’t exactly demean the patient, but it does assert the source of distress is susceptible to psychological re-ordering.

“Injury” refers to a wound with an external cause. PTSI, advocates say, is like a TBI (Traumatic Brain Injury) or a bullet, knife or shrapnel wound, even if the experience of terrible events leave no physical scars.

More and more peer-reviewed research suggests that SGB treatment, an injection of any of several well-known, apparently safe anesthetics into a cluster of nerves in the neck, is much more effective in treating the symptoms of post-traumatic stress than the two main therapies used in the Veterans Administration medical system.

The 2 sides of the coin of conventional psychiatric treatment are: anti-depressant or anti-anxiety drugs or psycho- (or “talk”-) therapy. And it would seem a combination of coin and professional parochialism has led the American psychiatric industry to disparage SGB, and to cling to the assertion that PTSD is a mental condition, a “disorder” only their members can treat effectively.

Case evidence suggests otherwise, and as the www.posttraumaticstressinjury.org website puts it the “disorder” label needs changing: “The name, PTSD, has helped all of us who care about trauma and its consequences. But the name has also been a source of stigma. The “D” in PTSD, the word, “disorder,” discourages some from seeking care, from revealing their condition and from feeling a sense of honor, when their PTSD is just as honorable as any physical injury. When an injury is earned in battle, awards are given. There is no Purple Heart for PTSD.”

This is not to say that either medication or psychotherapy cannot help people with PTSI. We know there are many cases in which either or both do produce very beneficial effects. But peer-reviewed studies show the VA claim that they have a 50% “success rate” may be an exaggeration, while stellate ganglion block treatment does better.

So, to the VA – wake up! And to the “disorder” advocates in the psychiatric community – give it up! SGB should be an approved treatment for PTSI.

Now, an apology.

Confronted by the reductive universe that is Twitter, I was forced to a choice of how to promote our HERE & THERE with Matt Farwell. Should I use PTSD or PTSI? I picked the former because it’s the code most people know, and therefore the reference more likely to draw listeners to H&T.

I don’t intend to make that choice again. I both agree with the logic of, and want to signal my allegiance to the community of American military veterans who have been affected.

And I thank Matthew Farwell, and other vets who have communicated to say how grateful they are for their SGB treatments, for impressing upon me how much a single letter can mean.




Subscribe to insider notes from Dave Marash along with previews and cartoons of upcoming podcasts. You’ll be richer, taller, and if you don’t eat, thinner.


Here & There is kept afloat by wonderful sponsors and curious listeners like you. Your support is appreciated!