Talk:Post-traumatic stress disorder/Archive 4

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To achieve A-Class status for article: proposed edits/amendments - 2010.03.26 edition

I am revising this completely; I begin the process today. My goal is a prioritized list of tasks to be completed to bring this article's quality up to A-Class candidacy. As I have said from the beginning, I enthusiastically invite additions to this list which may help achieve this goal. Given the endemic under-diagnosis of this very serious disorder, with a consequence across-the-board failure to treat many if not most people who have it, getting quality, correct, accessible information into this prominent article is a legitimate priority for us.

My method to produce this list is this:

• to review and take into consideration -
  • the structure of major reviews of this disorder in current books and journals articles by respected experts, and...
  • the structure of similar articles published online.
• to respond to "red-flag" subjective responses I have to the article derived from my clinical experience with PTSD.

In the interest of making good use of our Talk page archives, I'll be moving from this list to a similar list in the archive all list items which are completed.

Completed edits

Proposal	Status	Date
"SIGNS AND SYMPTOMS" (initial section) PROBLEM: This material was taken without significant alteration from an external public domain source, which itself has no authors or citations (but does have references). It is merely a gloss of the DSM-IV diagnostic criteria, already addressed in the PTSD article, and thus contributes nothing new. Most importantly, the notion of "signs and symptoms" (a distinction I really like) simply is not used in professional mental health (with a few odd-ball exceptions, such as the reference from which the section was lifted!). I cannot recall EVER seeing it in a major (or minor) reference. This means that it will be unexpected and foreign to virtually all article readers. Such novelty is perilously close to an "original contribution", and in any case seems unwarranted. SOLUTION: Merge this material into the Diagnosis section, as the probable new first section of the article.	DONE 2010.03.22	2010.01.01
EXTERNAL RESOURCE LINKS: PROBLEM: Addition of quality resource links would not be a difficult improvement to this article. The problem, of course, is that the listing will have to be actively watched to weed out junk additions made by the less-than-well-informed. Merely offering a link to another listing is avoiding the issue. Merely opening the section to drive-by input is not a solution either, as it likely will quickly become populated with low-quality-or-worse links. SOLUTION: Propose and develop simple criteria for selection of links for the "External resource links" section. After a reasonable period of time, publish the criteria on the TALK page, and act on them.	DONE 2010.01.27	2009.08.24, rev. 2009.10.31, 2010.01.04
"CULTURAL REFERENCES" - The value of this entire section, as written, is extremely dubious. It seems rather off-topic - which in this article is NOT culture history or cultural awareness. Worse, it appears to be essentially unsourced and to a significant degree is constructed of original material - a Wikipedia no-no. The history of cultural awareness and conceptualization of mental illness is a fine topic, but not as treated here. For many reasons, this very likely doesn't belong in an article we're trying to move up to A-Class status.	DONE 2009.12.25	2009.08.29

Reactions? Please reference proposed changes by its capitalized short title in table above...

More is coming. TomCloyd (talk) 11:59, 24 August 2009 (UTC)

Comments

Hyphenating 'posttraumatic'"

I've removed this from my list, as there is now a fine paragraph on this at the end of the "History > Earliest reports" section; it's of recent origin, but I don't know who wrote it. I just put it into its own little section, largely to call attention to its content. The sourcing for this section may not be as good as it could be, however, and I may fix that.--TomCloyd (talk) 22:05, 29 September 2009 (UTC)

Scrapping "Cultural references"

I completely agree with scrapping the 'CULTURAL REFERENCES' section. It's a nice idea, but in reality is largely speculative fluff which needs regular pruning (pardon my mixed metaphor).

Finally, while I'd love to put a stop to the debate over hyphenating "posttraumatic," I don't know if this justifies a whole section on 'PTSD TERMINOLOGY.' Maybe a sentence in the intro.

By and large, this is a great proposal, and will bring the article closer to A-Class! Zefryl (talk) 04:32, 26 September 2009 (UTC)

I'm now thinking we should probably make a strategic decision to keep this section, and simply work to make it respectable relative to sourcing, and rhetorically coherent. I'm thinking that for many people it is an entry point from which they will think more about the whole question of seeing psychological trauma in daily life, and that this is a good thing. Also, it seems to be a popular section - it sees rather frequent edits. We'll just have to stay on top of things and keep it from becoming a rubbish bin - if we decide to keep it. What think you? --TomCloyd (talk) 22:05, 29 September 2009 (UTC)

I disagree with the blanking of the cultural section. We should try to preserve and improve on sourced content WP:Preserve. If we're unhappy with a whole section, which we nonetheless accept as a valid one, it's our duty to improve it - deleting a valid section of an article, because its content isn't up to scratch, is a lazy short-cut. It is desirable to keep the section, and hope that in the future other editors will come along and work on it. Avaya1 (talk) 15:04, 14 March 2010 (UTC)

I don't need to recapitulate here a discussion of my reasons for deletion, which are carefully detailed elsewhere on this Talk page. You would do well to read them, and respond to them specifically. We do NOT accept the deleted section as valid, as that discussion makes clear. AND...I give reasons for my position, referencing standard Wikipedia policies as to adequacy of sourcing. I have no time to teach you those policies. You are expected to be familiar with them. You need to do what I did: go study up a bit. I provided links to some relevant sections. Go read what's there.

Multiple requests were posted in the deleted section, for months, pointing out the need for adequate sourcing. There was no response. My position now is that until such sourcing is found (and not by me), the section stays deleted. I'm trying to move this article to A-Class status. Having this sub-standard (and, I argue elsewhere on this page, inappropriate, section here is no help at all. Tom Cloyd (talk) 15:41, 17 March 2010 (UTC)

Gulf war syndrome - topic needs inclusion

As Gulf war syndrome and PTSD two overlap significantly, a section under classification contrasting the two may be needed.Doc James (talk · contribs · email) 08:09, 1 January 2010 (UTC)

They overlap in some meaningful way? Really? Is there a new study out? Frankly, I'm not aware of any serious evidence which suggests that GWS is some form of PTSD. So...why the need for a compare and contrast here? At one time, this question was alive, but for what reason would we feed old rumors now? (Just asking for clarification.)

TomCloyd (talk) 05:27, 2 January 2010 (UTC)

Oh I guess I am a little behind than. This is the rumor I remember from medical school :-) I guess I am getting old. We do however say it was railway spine, stress syndrome, shell shock, battle fatigue, traumatic war neurosis.

Many consider it related to GWS and if this is not the case than a line saying so would be good IMO.Doc James (talk · contribs · email) 05:53, 2 January 2010 (UTC)

I think you have a point! Well drawn, relevant distinctions, even if of only historical interest, seem likely always to be useful. So, we need a tiny lit. review (for a quality citation or two re: current status) and we have it. At the moment, I'm seeing this as belonging in the history section. As for the railway spine, etc., business, I've long thought that doesn't belong in the article summary. Too much detail. We need the idea, not the data, there, I think. Finally, you're getting old? Sorry, but latest research on aging and the brain suggests that rigorous intellectual activity, such as we engage in here, keeps the brain lively, supple, alive, and dare I say, sexy... Doesn't help the body, though. That's a different issue, alas. So, your problem likely lies elsewhere. Could it be failure-to-know-everything syndrome? (Takes one to know one.)

TomCloyd (talk) 07:14, 2 January 2010 (UTC)

Thanks Tom for the words of advice. I often find this information (the distinction between one syndrome and another that it may be confused with) fits well under the classification section. Buts that is just me.. ::::I do agree that this would be difficult and yes there is only a few dozen of us who actively edit medical articles so it is probably not currently feasible on any scale. Is this justification however to never attempt it?

Re: last question - certainly not! However, I don't think PTSD has at any time recently been considered a syndrome. The concept has been more rigorous than that from the point it was introduced into the DSM - DSM-III, after all, was the big conversion of diagnostic description formats, in which it was decided to offer formal protocols for making a diagnostic.

My understanding of "syndrome" is that it a more loosely constructed concept, often carrying the connotation that when it's better understood we'll call it something else. (It IS sometimes used as synonymous with "diagnosis", however, is it not?). Gulf War Syndrome certainly fits that notion, but from DSM-III on (before which there WAS no "PTSD" term), PTSD has been fairly rigorously defined - a diagnosis. So, we're not really needing to delineate two syndromes. That said, there WAS afloat the notion that Gulf War Syndrome was perhaps somehow strongly related to PTSD. What happened to that idea might be usefully summarized here. I could do it in about 15 minutes or less, likely. Not my top priority here, but it's now on the list I keep here, as you may have noticed.TomCloyd (talk) 09:15, 2 January 2010 (UTC)

If someone however has the tenacity to put together a section like this why not? It would give place to remove excess names from the lead without deleting them.Doc James (talk · contribs · email) 08:26, 2 January 2010 (UTC)

I think a "section" (or more likely sub-section) would be reasonable if we had more than one distinction to make. What else might go there in addition to Gulf War Syndrome? I don't see that as being historically equivalent to "railroad spine" or "battle fatique", which can accurately described as precursors to "PTSD". The issue was always about what exactly was going on with Gulf War Syndrome, with PTSD being advanced as one way to account for some (but not all) of the symptoms. (And at this point I REALLY need to review the literature on this - it's been a while!).TomCloyd (talk) 09:20, 2 January 2010 (UTC)

Medical/psychological perspective on PTSD not enough: The Catch 22 Perspective...

To quote the author(and the screenplay)[1][2][@1:53/6:32]

From the novel: ".....There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind.....[he]... was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. [he] would be crazy to fly more missions and sane if he didn't, but if he was sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to......"That's some catch, that Catch-22,".............."It's the best there is,"......"[3]

To paraphrase the author (and the screenplay): Is coping with an insane situation evidence of sanity?

There is an phenomena in news gathering that when news happens too fast to cover it's history.

Athletes, such as goal keepers, often have trained reflexes that are so fast that they are unable to remember their best "saves". In the Military and Martial Arts training and fast reflexes are essential for survival.

Yet much happens in a crisis, and there is little time for physical reaction, much less the comprehension and larger relevance (social, moral, religious, etc.) of the circumstances, often new to the victim. However if the brain records the events accurately the mind will try to process these events over and over, at a much slower speed. If this is true, the trauma will occur over and over, albiet it eventually diminished, until the victim has resolved all aspects of the event.

The "catch 22" or irony of the dilemma is that the very training, aptitudes(genetic or learned) and preparation that preserve the victim may well contribute to the prolonging of the trauma.

More than the Medical or Psychological perspectives the article ought to have a section on Pragmatic Human Coping with an historical (traditional methods)subsection.[4]

Pete318 (talk) 18:35, 20 January 2010 (UTC)

And how does one talk about human coping without getting psychological? Historically, as B. Russell predicted, much philosophical discourse about human behavior and nature (including ethics) gave way to psychological discourse, as psychology became competent to address the subject. Such is the power of observation-driven inductive thought, as opposed to the philosophical idealism that was all we could manage until the methods of inductive science were established.

There is little doubt that the training methods of the US Army in the mid-20th century, which employed quick-response firing rather than the careful marksmanship of former times, led to the massive increase in posttraumatic shock that was clearly seen in the US military in Viet Nam. Now we know what happens when one shots first and thinks second. That military success, in turn, led the psychological disease epidemic which necessitated the formalization of PTSD in the psychiatric nosology. The great irony of this is that the majority of PTSD victims have probably always been, and still are, women, not combat soldiers.

The problem isn't "coping with an insane situation" so much as coping with the intense feelings which usually are produced by "insane" situations. But even that description isn't quite right. Situations aren't insane. WE are when responses to them - our brain's affective responses to our perceptions - make us unable to think or make good decisions - not-sane = "insane". Without recourse to psychology we cannot really see what's happening.

As for use of "an historical (traditional methods) subsection", as I have pointed out "traditional methods" have simply not shown an ability to cope (!) with the human phenomenon of posttraumatic stress by giving it an adequate description, from which we can consequently develop adequate treatments. We now have those treatments, thanks to models developed from psychological observations, and validated using psychological research methodology. Believe me, if there were a better way, it would be used. As it is, what we have is up to the task. I regularly treat and cure PTSD. Better now that we act to reduce the exposure to situations which produce such problems.

TomCloyd (talk) 17:36, 21 January 2010 (UTC)

Very well put, Tom. I am curious about one thing. Why is it that, as you say, the vast preponderance of PTSD sufferers are women? Thanks. MarmadukePercy (talk) 23:39, 21 January 2010 (UTC)

Traditional methods existed long before the concept of dissecting the human psyche were imagined. Think "natural selection", at least. Those creatures excessively traumatized by predation, for example, would have trouble hunting for or gathering food. If that were the case, only the large predators, who were not prey would cope and dominate the gene pool.

Clinical terminology has encroached upon the traditional concepts such as morale, heart, soul, spirit and so on. A defeated army suffering from "low morale", with a "broken spirit" would not necessarily be suffering from mass clinical depression. Good leadership and material, with a rally might lead to a counter attack and subsequent victory. Most troops would be cured instantly and the effects of Post Battle trauma minimized, although by no means eliminated.

Well put:"....Better now that we act to reduce the exposure to situations which produce such problems. .....".

Good idea, but not new "....20:8 And the officers shall speak further unto the people, and they shall say, What man is there that is fearful and fainthearted? let him go and return unto his house, lest his brethren's heart faint as well as his heart......" Duet 20:8, KJV.

Gone(for now) are the days of the press gangs, salvaging any and all to feed the trenches. Intelligent recruitment, assignment and training are invaluable in more than military applications. However, the flaw in this reasoning is that the best, the bravest and most skilled are the first to fight. As usually is the case, the war takes a new twist, tactics fail, equipment becomes obsolete the enemy digs in. The Generals are left to plead to the Parliaments to conscipt.

The best of the wine is spilled early in the engagement. The only game left is survival.

As far as the observation about "women" ?? The gender context in much more complex than that. They say the only thing more fearsome than crossing a Grizzly is crossing a Grizzly cub. "Sitting (broody) Ducks" make easy targets since they often fend for their young (sometimes unhatched)to the death. But, then again, do statistics lie?

Pete318 (talk) 19:20, 22 January 2010 (UTC)

As I have in the past, I will largely decline to discuss here material not directly related to article improvement, per the admonition at the top of this page: This is the talk page for discussing improvements to the Posttraumatic stress disorder article. However - 3 comments:

[1] It is difficult to derive from your posts here anything specific we might do to improve the article. There certainly is room for a discursive treatment of human (or animal) nature as revealed by response to situational and experiential extremity, but probably not in an article clearly about a formal mental illness diagnosis developed by a coordinated effort carried out by an diverse group of international mental health professionals over a number of years - UNLESS well-done formal research can be found which addresses this question.

[2] That Clinical terminology has encroached upon the traditional concepts such as morale, heart, soul, spirit and so on... is no accident of history, nor at all unfortunate, I think. Before development of the formal diagnosis, there was essentially no well-focused, fact-based discussion of human trauma response. Clinical terminology in general has a simple purpose, the need for which was well understood by philosophers by the 12th century in Europe - to "cut nature at its joints", which is to say to accurately name the critical elements and relations of the problem at hand. This "clinical terminology" has been hard won, believe me. Because of the consequences of getting it wrong, it is appropriate that we should have struggled over it (and still do, when appropriate).

[3] Re: gender and PTSD - MarmadukePercy has asked about that, above. I am concerned simply about what we actually know, at this point, and will very soon be addressing this - in the article and here.

TomCloyd (talk) 04:52, 23 January 2010 (UTC)

Taking the time to respond in this Discussion Section has been appreciated. It appears that the intent of the authors is to keep the main article as academic and/ or professionally clinical as possible. Clearly, this is not an area of my training nor special interest, per se, except that this area (Post Stress Trauma et. al.) it is becoming a more recognized phenomena in the general population. It is wise to study the literature if only in the interest of prevention.

I have no objection to having the entire section deleted, if it clutters the discussion.

However the authors of this article might consider searching this topic which is covered more and more in Canadian News.[5], et. al.. There is also some new terms arising which may or may not have clinical relevence such as "operational stress injury" and "Third location decompression " [6]

As far as the gender context is concerned the pending(?) article should be interesting.

Pete318 (talk) 17:46, 25 January 2010 (UTC)

I hope you understand that the time was taken out of respect for the seriousness of your initial and subsequent posts here.

As to the focus of the article: My own understanding is that this is a populist encyclopedia, with the term "populist" referring to the contributors, not the style or quality of information found here, to the extent that this can be controlled.

Relative to psychology in general and psychotherapy and PTSD in particular, it is true that there are strong academic traditions, in both subject areas, which have generated considerable serious discussion, research, and data. But more important, I ask you to consider that for a very long time the most thoughtful people in society have grouped together to talk among themselves, and that this inwardly focused social interaction tends to lead to the highest quality discussion and literature, in all times and places. Plato had his Academy, and in many cultures and society centers of learning have been developed and maintained by various religious traditions, with few other alternatives until approximately the time of the Renaissance (in Europe - I won't address the history of other areas here).

A major feature of the Renaissance in Europe was that knowledge production became secularized - accomplished by non-clerics such as Galileo, individuals who nevertheless often were educated in institutions heavily influenced by religious institutions. That was the beginning of "popular science", and led to the founding of topic-focused "Societies" (a kind of profession club, if you will), in which people presented their idea to each other. Newton did this, as did Darwin, and many many others. This, the best thought of the time, by common consensus, confirmed repeatedly subsequently, was specialist and professional discussion, not popular discussion. What makes Wikipedia populist is that one is admitted here not because of credentials per se but because of product. To the extent that you can think and write well, working from the best sources, you're "in". This wouldn't work too well if there weren't a fairly high level of education in the general population, outside of "the academy".

If the discussion of PTSD here is "academic" it's because academics have done the most serious, elaborated work on the subject. "PTSD" itself was a concept formalized by a group of mental health professionals, BUT many of them were academics (i.e., teachers in various graduate schools). When you are competing for recognition, position, and in recent times research funding, against the most acute minds of your time, you tend to be extremely concerned about possessing and using the very best conceptual and analytic tools available. From this comes the best results, all else being held equal. Where else, then, would we look for good information about PTSD - in popular magazines, newspapers, and such? That makes no sense, at least not to me.

An example: I received a call very recently from a client of mine, an individual who was traumatized while working for his government, and subsequently "treated" by professionals paid for by the government. The treatment was out of date and did not work. He's had a tough existence for years, as a result of this incompetence - professional incompetence. He's referred to me by someone who knows of my work, approach, and seriousness. It's clear to me that this individual is treatable, if valid methods are used. But what does that mean? It means methods which careful objective observation (i.e., research) have shown usually work. I'm trained in such methods and have had success with them. Why would I use any other methods? Why would I write HERE, in this article, about any other sort of methods, expect under the heading of "Inadequately validated PTSD treatments", or "Discredited PTSD treatments" (both of which I plan to do)?

The single most important point I would make about professionals and academics is that from their seriousness and huge investment of effort and time have come our best METHODS for producing knowledge when it really counts. You see, this isn't just about ideas. It's people's lives, what happens to them, and what we can do about it. Get it wrong and people suffer - very seriously.

I think it's interesting, up to a point, if new "popular" ideas about PTSD are developing, as it indicates that the general population is coming to understand that PTSD exists, that it isn't just malingering or weak character, or any of the other now-discredited pre-scientific ideas of why traumatized people act the way they do. It's a reliably distinguishable mental illness, and there are validated treatments for it. A social history of the concept of psychological trauma disorders would be wonderful to have, but it won't be written here (that would be original work, and we don't do that in Wikipedia).

In any case, the single highest priority we have in this article, I propose, is to get the BEST information we can find into the article in coherent, easily accessible language. People come here for INFORMATION, first of all. Until we clearly accomplish that (and we're well on our way), I know I'll personally be committed to this above all else.

I am somewhat aware of some of the discussion of PTSD in the Canadian press, and elsewhere, as I receive filtered news feeds on PTSD from a wide variety of sources. Very, very rarely is there anything there new or even novel, and when it occurs, it usually is about changes in government policy relative to various traumatized populations (such as female veterans, domestic abuse victims, etc.) This is important for several reasons, one of which being that it has to do with improved (usually) access to treatment. But this is about policy, not basic concepts of the disease and its treatment. Indeed, a fair amount of what makes it into the press is simply the sort of things reporters think their editors will print, because they have to answer to publishers, who have to sell advertising, which requires readers. Readers like to read about car wrecks of various sorts. That DOESN'T mean that "car wrecks" are important - just that they sell ads.

The next edition of the | Diagnostic and Statistical Manual of the American Psychiatric Association has been under intensive development by a large team of the best professional, clinical, and academic minds for a number of years, and likely will be out in the first half of 2013. This date was recently reset - forward 2 years from 2011, because of the intensity of the revision effort. The general population has little awareness of this very substantive document, and essentially NO awareness of how much work has gone into it over the years. That's unfortunate. "PTSD" is not and never will be a folkloric idea. It's a professional concept, and it's home is the DSM and the | ICD-10. Informed people know this. All else is to one degree or another derivative - although the research part of this derivative literature does feed back into new versions of the concept, with obvious benefit.

TomCloyd (talk) 12:04, 26 January 2010 (UTC)

I have heard that the best teachers learn as much from their students as the students from them, and who knows, perhaps the greatest compositions of classical music were made by contributions and criticisms from some the members of the orchestra?

Wikipaedia is both dynamic and interactic. Ocassionally when I was bored for something to read, I would browse a (Printed) encyclopeadia volume, the way some would a magazine. The concise text was not as entertaining as a novel, for example, but the perspective was so much broader. How often did I wish that I could query or challenge the article or it's author, much less contribute. Even scientific and professional societies occasionally fall victim to internal social structures, pecking orders and bias. However this Wikipaedia phenomena appears to complement rather than necessarily rival other information sources, and is a study in itself.

I cherish the opportunity to contribute, and read others contributions, whether that contribution is academic, profesional, empirical or just some very good observations or questions. Those intellectuals ignoring this window of opportunity, in my opinion, do themselves a disservice.

Pete318 (talk) 20:24, 26 January 2010 (UTC)

I agree with your main points. My greatest sources of learning have often been my clients. That is not the same as saying that they have been my greatest teachers. That wasn't their intention or function. As with your analogy to classical music, those who implement, who experience, have important things to say to those who think and create. Professionals in both psychotherapy and classical music would readily agree with you, I'm sure.

Wikipedia fascinates me also, as a kind of social experiment which appears to be significantly, but not universally, working. Some articles are very fine. Some are worthless. This means that intelligent, educated readers will benefit most from the articles, as they will best be able to evaluate what they're reading.

It also means those who write here do well to remember that many readers are NOT well equipped to make good assessments of what they read, so we'd better work hard to provide them with the best material we can. It's akin a good parent's working to put good food on the table for children, who cannot really decide for themselves what "good" food is. Irresponsible writing in Wikipedia is a bad thing.

I ask you to remember that Wikipedia is not a forum, or a blog. It is not an arena for speculation. There are other places for those activities. Here, instead, we report the best of what we know, and when we don't know, we report that, always citing sources that appear to be trustworthy. THAT decision - what is and is not a trustworthy source, is the subject of considerable instruction in universities and colleges, and there is some good material about it here in Wikipedia (for example: Wikipedia:Verifiability.

I urge you to study this material a bit. You will learn, for example, that newspapers and magazines are primary sources for historians, but not for psychologists. If you dig into the psychological epistemology, you'll also learn that there are serious limits to what can be learned even in a clinician's office (I'm referring to the distinction that is insisted upon between "anecdotal" or "case historical" data and sample data drawn from populations of interest.) These distinctions came into being because people made bad mistakes in the beginning of our discipline, and had to figure out why after the fact. Much of what we have learned, as in the other sciences, has been hard won. It takes literally years to master what we now know about these things. You cannot just walk onto the scene and expect to make much of a contribution, any more than you can expect to just pick up a violin and join an orchestra.

What drives all this is simple: When dealing with important questions, one does not want to use trivial tools, because the consequences of error are too great. It's that simple. Do you want your clever 15 year old cousin operating on your brain tumor, or a Board-certified neurosurgeon? There is a time where only true expertise will do. I propose that this article, in this encyclopedia, is such a place, and that now is such a time. There are people waiting, today, for us to get our facts straight. For reasons of simple human compassion, we'd better do just that.

Anyone who wants to become a significant contributor has a number of skills to get under control. There is a fair amount written IN Wikipedia about how to contribute meaningfully here. But a fair amount of the skill needed must be learned other places. We all have simply to start and then just keep going. Skilled reading, critical thinking, competent written expression, intelligent use of existing sources - these are skills that may be acquired by those who are willing to make the effort. Speaking personally, I have worked on my skills literally for decades, and continue this work daily. My writing THIS is part of that continuation, and I'm well aware of this. If you love doing this sort of thing, you'll just do it, and the love will pull you deeper into it. Ultimately, it's a way of life, but only for those who find value in the activity. It sounds like you might be such a person. If so, join the community and find something to work on that has value. That's what we all do, I think.

TomCloyd (talk) 23:12, 26 January 2010 (UTC)

This exchange has revived my interest in formal psychology, at least. I have three University Level Courses completed, but it was not my major and it was some time ago. The major revival in my interest was while I studied aptitude/skills evaluation when choosing a second or third career.

The Stress, trauma, and post trauma interest arose more in the context of workplace hazard where the employee/worker is exposed to a severe crisis in an otherwise mundane occupation. For example a technician caught in an industrial fire as opposed to combat soldiers, police officers or trained fire fighters.

I have lots of revision and homework to do before seriously participating in this page, but have found the visit to this article beneficial.

Best of luck,

Pete318 (talk) 18:18, 27 January 2010 (UTC)

Pete, I'm excited to read this. You have embraced a topic of great value - work-related traumatic stress and its prevention, management, and treatment. and your real interest in the topic can serve to fuel your efforts to achieve adequate mastery of key parts of the relevant literature.

There is, as yet, nothing directly related to that in the article beyond the material relating to the work of members of various military organizations. If you can locate and become familiar with some good review articles on occupation-related traumatic stress, bringing the conclusions in those articles to THIS one would be a genuinely valuable contribution. If you are uncertain how to summarize or present the material here, I'm quite sure you could get supportive assistance here on this talk page.

For example, you might propose here a paragraph or section, with references, and ask for feedback, then work on it using the feedback you get until you're ready to move it to the article. That would be a superb use both of the opportunity Wikipedia offers you AND this Talk page. You would also likely learn some valuable skills in this exercise (I find that I learn every time I write, to be frank), AND make a significant contribution to the article, and thus to Wikipedia. An enticing prospect, to my eyes, and I hope to yours as well.

Nothing like a good challenge, eh? TomCloyd (talk) 01:04, 28 January 2010 (UTC)

An update, as a courtesy. I am assembling my research strategy and methodology on this topic. Since I am technically still an undergraduate with respect to Psychology, I plan to stick to undergrad textbooks, supplemented by published papers.

My first step was to review ("relearn") some topics from my old College Text. The first chapter I chose was that on Basic learning and remembering. Good review, but in this context I wondered how the role of mild Post Trauma Stress played in learning or (negative) reinforcement?[That would be so ironic if traumatic discipline actually helped prepare the trainee for stressful situations(??). ]

So I am continuing to search text material on this matter. Strangely, so far, material on Corporal Punishment in Schools (including my religious grade school) generally considers it to be negative, including causing PTSD but not necessarily a legitamite negative reinforcement.I was looking at this reference, but I have to study it more.[7]

I though about dropping in on the discussion page for this[8] , but why clutter their page until I have something more concrete.

Later,

Pete318 (talk) 20:06, 11 February 2010 (UTC)

About External Links - a plea for thoughtfulness

Link lists are a magnet for "drive-by editing", if not outright vandalism. The easiest thing to do to an article is to casually add an external link. That really isn't helpful with a complex subject such as PTSD (and quite possibly not with any other, either).

Mere links can be had by the hundreds through any of the well-known Internet search engines. We need here, surely, only links of the highest quality, offering information of central importance to the core information of the article. Going beyond that risks merely cluttering the article. We surely do NOT need links to various blogs, little known and unresearched treatments, or any of various sites devoted to victim forums, etc. None of these meet the proposed criterion of "highest quality information". That is a mere concept, of course, and there's no handy device for sorting the quality few from the ordinary many. I chose sites which had professional authors, or who were managed by organizations of unquestionable authority.

So, before adding a link to the list (which you certainly should feel free to do), I simply request that you pause and think about that "highest quality" criterion, vague though it surely is. (And thank you for reading this!)

TomCloyd (talk) 14:05, 27 January 2010 (UTC)

Couldn't agree more with your thoughts on this. In fact, I was going to add a couple of links, but see you've already included them. :-) MarmadukePercy (talk) 17:09, 27 January 2010 (UTC)

Excellent. And, from what you say, it appears that my secret plan for link-list mission-creep management is working. :) It's a nasty job, taking out the garbage - best that there be no garbage to take out, to the extent that can be managed. (I know...blatant naive idealism. I'll stop now.) TomCloyd (talk) 00:52, 28 January 2010 (UTC)

I've replaced your "BEFORE adding an external link to this section, it is requested that you read "a plea for thoughtfulness" on the Talk page." comment with the simple No More Links template, which is only visible to people who are actually editing the section. We shouldn't be giving "before adding a link" warnings in plain article text, as they're obviously meaningless to anyone who doesn't intend to edit the article, or is reading a print version of Wikipedia. --McGeddon (talk) 11:30, 16 March 2010 (UTC)

I recognize that your action is taken in good faith. Thanks for your concern for the quality of this article. Please consider:

1. You make an interesting point: "We shouldn't be giving "before adding a link" warnings in plain article text, as they're obviously meaningless to anyone who doesn't intend to edit the article, or is reading a print version of Wikipedia." The problem with this assertion is that page has LOTS of links which would be "meaningless" to the same degree, to those who only come to read. So, my addition of one is hardly anomalous. Further, the addition has a specific intent: to reduce insertion of garbage links which [a] add nothing of real substance, [b] detract from the article quality, and [c] require an explicit maintenance response from those who regularly tend the article. Previously, as I have said, there was a real problem with the appearance of such garbage links. I'm not aware of any Wikipedia which is being disrespected by my little notice.

2. Your template is new to me. There are three problems with it, such that it won't likely work as intended here:

• It is ONLY seen if one clicks the edit link for the main External Links section. Few people are likely to do that. Clicking a subsection link, one sees nothing.
• The template title "No more links" sends the wrong message. I don't think we're trying to "close" the section, but to filter the insertions that are likely to come, over time.
• It is internally inconsistent. The title contradicts the content, which appears to welcome quality link additions (that's the RIGHT message, I think). Confusing. I like clear messages. They work better.

The template seems useful, even if contradictory, so I'm leaving it alone, although I don't think many people will see it.

I am restoring my message+link to its position right below the main section heading, as this location will likely lead to people's actually READING the request, which itself is reasonable, and seems justified in light of the history of abuse of this section.

Tom Cloyd (talk) 22:28, 17 March 2010 (UTC)

Just the {{DMOZ}} should be used really. Most of the links were repetitive across countries, generic source search-engine style sites, professional associations, and the like. This edit is inappropriate since it is a form of self-reference that doesn't add much beyond the {{nomorelinks}} text that heads the section. By using the DMOZ you avoid having a linkfarm, you avoid link creep by having multiple countries or geographic areas that duplicate content, and if people want more links - we suggest they add them to the DMOZ page. We should have only links that are of world-wide relevance or highly notable agencies/documents that aren't already used in the body as a reference, or linked in the disease box. Also, referring to this section of the talk page is inappropriate as a) it will one day be archived and accordingly be obsolete and b) consensus has not been reached. A single section with the invisible text means anyone trying to add links will see it when they edit, and anyone willing to ignore that invisible text will also ignore that message on the main page. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:17, 18 March 2010 (UTC)

I think you have lost sight of the general objective here, unless I'm the only one to have this goal: It is to provide the highest quality information, in encyclopedia format, for people who come here wanting to learn more. I treat PTSD professionally, and my clients have and do come to this article. I do not want them misled by material artfully provided by editors whose principal other contributions to Wikipedia are to articles about rock bands, video games, Irish pubs, and other critical topics (feeble attempt at humor, but not without a good deal of truth in it). What you have done takes us back the other direction.

• The DMOZ IS a link farm, albeit one set up by self-ascribed experts. Why send people into that semi-swamp when we can give them here some well-chosen sources of information assembled by experts in the field? That just makes no sense to me.
• "Most of the links were repetitive across countries, generic source search-engine style sites, professional associations, and the like." I assume you're referring to the links in the External Links section you deleted. Assuming that, then...
  • So, since when are the links in DMOZ not repetitive? The repetition you observed, across countries, was there deliberately (I set up this link list, so I know). When multiple national organizations, agencies, professional associations, etc., address the same problem, the degree to which they reach the same conclusion is of great interest. It is of the nature of what we call test-retest reliability in psychology. So, the repetition is justified, and certainly not excessive. Did you actually look at all the links? There's some very good material there, which supplements what's in the article.
  • These decidedly are NOT generic sites. If you'd actually done an internet search you'd know what I mean. I did a number, to find these sites, and most of what I got was junk. These were definitely not. I suspect part of the problem here is that this isn't your field, so you don't recognize professional legitimacy all that easily. I cannot imagine why else you so casually reject these sites. There are none better, I can say with confidence.
  • What's the problem with referring to professional associations? Their web sites a gold mines of information. And...who knows more about the subject? Again, I don't understand your point of view at all. You seem not to know this subject.
  • "We should have only links that are of world-wide relevance or highly notable agencies/documents that aren't already used in the body as a reference, or linked in the disease box." I agree with your first assertion! And...these links absolutely ARE of world-wide relevance. I say that as a professional in the field. What is your basis for an alternative view? There is no problem with putting some links which are referenced in the article in this brief link list. We are approaching 150 references. Few readers will plow through them to find these links. We do a service by selecting very good ones (which these were) and putting the in one place. Remember the objective I stated above? As to the references themselves, there's some real junk there. I'm in the process of reviewing the entire article, and replacing low quality sources with good-to-excellent ones, is such exist. If they cannot be found, the material they support needs to disappear. So, let's not yet give too much value to the reference list as a whole (and yes, there's some very high quality material there as well).

I have already addressed the efficacy of the template versus my little message, and don't need to repeat. My points do not appear to have been addressed in your comment. That there is "self-reference" involved is technically true, but so what? This is a minor style question at most. Actually it's a link to another Wikipedia page, and there are a lot of those on this page. Why do you pick on mine? You don't really say.

"A single section with the invisible text means anyone trying to add links will see it when they edit, and anyone willing to ignore that invisible text will also ignore that message on the main page." Your first assertion I agree with. Good point. But...if you'd read the rest of the material on the Talk page about this External References section, you'd have seen my point about how the structure I set up (which prevents the template from being reliably useful, as I've pointed out above), seems also to been a fence which has kept out link litter. THAT's a success story. It's working, so why mess with it?

Re: Consensus - is there consensus about deleting the section? Hardly. I think it provides excellent quality, useful, accessible information. I was not alone in thinking so. I think it stays until we reach consensus about what would be a better solution. Are you willing to work here for that better solution (if it can be found)? If so, I have a proposal for how we might do that.

Tom Cloyd (talk) 02:43, 18 March 2010 (UTC)

Edits have to be justified by our policies and guidelines, in particular avoiding self reference, and external links. Consider that you may be an expert on PTSD and treatment, but I would be far more of an expert on Wikipedia, particularly how to write an article. Content edits to the page should be made based on neutral depiction of reliable sources that give due weight to their standing in the relevant scholarly community, without giving undue weight to aspects you consider important or your own analysis of flaws or laudable characteristics. In other words, expertise is valuable because it points to sources, but it must be constrained by adherence to the policies and guidelines. I have also edited a large variety of medical articles on wikipedia, and developed some experience and knowledge for them. In this case, it doesn't really matter - these many links are unnecessary and inappropriate. This is a wikipedia-specific item.

The edit notice, which I removed again, is inappropriate, redundant to the {{nomorelinks}} and isn't going to stop anyone from adding more. This type of issue is best solved by regular patrolling - watching the page to vett new links for appropriateness.

The DMOZ is a linkfarm, but it is the one linkfarm pointed out by WP:EL as a normally appropriate one as the third point in WP:ELMAYBE; in fact, we have a template for it. I did not select it idly. We use the {{DMOZ}} becuase we are exhorted to keep links to a minimum - see the third item in WP:ELPOINTS. The DMOZ might be repetetive but it is one link on our page, as opposed to the 14 it replaced. The links are also highly, highly repetetive on this page - four treatment guidelines? Are there four approaches to treating PTSD? If so, this should be discussed in the body using inline citations referring to reliable sources. If there is only one main type of treatment, if you consider it absolutely vital to include and it is not repeating a DMOZ link or the {{infobox disease}}, put in one. The NIH is usually seen as a good source, but the WHO would also be a consideration. Four general resources? One is a self-published webpage to someone who does not appear on wikipedia and therefore may not be notable (and see in particular WP:ELNO point 11 which strongly limits the use of personal webpages, particularly if not by a notable person). There are also two links to education and advocacy groups, which Wikipedia:MEDMOS#External links discusses, as well as two links that are brief/a leaflet (and see WP:ELNO point 1). Short links that could be used as sources should be footnoted, not put in the EL section. There are no less than five organization sites - admittedly they could be expected to have expertise, but are they not redundant? Do they all have wildly different, but equally reliable information? At best I would include the istss site so long as it's not already in the DMOZ. The PILOTS database is also redundant to the DMOZ page so if nothing else, that should be removed and replaced with the DMOZ. For that matter, the ISTSS, ESTSS and NCPTSD are all redundant to the DMOZ PTSD associations page.

There may not be consensus to remove, but there are policies and guidelines which should inform our edits. The P&G are the longstanding consensus of the community, and should only be ignored with consensus. If nothing else, the use of 2 DMOZ pages can reduce the number of links significantly. Now some specific points:

"the degree to which they reach the same conclusion is of great interest" - for the main body, perhaps but really all that should be discussed is the scientific consensus. That many organizations agree is not particuarly surprising if there is good research converging on a conclusion, and just means you are linking redundantly (see again WP:ELPOINTS number 3). Test-retest reliability simply means your data is valid, which means you have a good reliable source (and you should since medical articles have higher standards). If a source is relaible, then just use it as a footnote. There's no reason to "convince" the reader by including a bunch of redundant links. If a point is controversial, this should be discussed in the body. Unreliable sources and links should simply not be used - we are an encyclopedia and shouldn't have shoddy sourcing.

Your comments about my lack of experience is relevant were we discussing sources (and even then it would be weak - if I can find reliable sources to support my edits, they should be included). This isn't about sources, it is about external links - please review that page, because that is what is relevant here. It's a wikipedia-specific issue, not a domain/knowledge specific issue. I will certainly defer to any source-based contentions you make in the main page, but please grant that I may know something about external links on wikipedia.

"the structure I set up...seems also to been a fence which has kept out link litter. THAT's a success story. It's working, so why mess with it?" Your EL selection starting point has been up since January 25th, less than 2 months. Your request to discuss on the talk page has been up for about the same amount of time, in addition to being an obvious candidate for link rot as the section is archived. It also appears on printed versions, screenreader versions, mirror sites that are not editable, and a burned copy for Version 0.5 and 1.0, none of which can be edited (making your plea irrelevant, distracting and confusing). Think about the print (and any noneditable) versions - the encyclopedia should be generic, not specific to wikipedia. Further, your plea has been removed twice. It will not work over the long term. ELs are a bugbear that all articles have to deal with - usually by regular monitoring and the occassional trim with extreme prejudice. We know what we're doing - ELs will never be perfect, and will never be fixed, and will always attract spam and nonsense, but can be kept to a useful minimum (which makes things much easier).

If you really want an answer to this, you should read WP:EL from top to bottom, and then on points where we disagree, we can go to either WT:EL, or a request for comment (in addition to more discussion on this page). You are an expert on PTSD, I'm a very experienced editor. I'm not flawless, but for the most part I know what I'm doing. And all my editorial experience is telling me that this is not the way to go. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:02, 18 March 2010 (UTC)

This is a far better version of the EL section as far as I'm concerned. 4 links instead of 14. I kept NICE and the APA as reasonable representative expert bodies, the WHO doesn't seem to have anything on PTSD generally otherwise that would be my preference. WLU (t) (c) Wikipedia's rules:^simple/_complex13:31, 18 March 2010 (UTC)

WLU - I sincerely appreciate the thoughtfulness of your reply. You appear to have carefully addressed my points (although how thoroughly and successfully I cannot yet say!). I clearly have some reading to do, before I respond in kind. We are likely close to resolving this matter. My goal is never to "win", but only to get to the truth of the matter at hand, and to come up with good solutions to problems. The world has real work for us to do, and we do well to get to it. I will return to this discussion, probably later today, and go forward. Right now, I have clients to attend to. I'll be baaaaack. Tom Cloyd (talk) 16:10, 19 March 2010 (UTC)

long delay - issue not forgotten - It's my busy season. I'm swimming as fast as I can. I still have studying (WP Policy, etc., reading ) to do. Eager to get to it. Tom Cloyd (talk) 00:42, 16 April 2010 (UTC)

Revision of Medication section in process - comment invited

I am working on a rewrite of this section, stimulated by my recently becoming aware of two possible additions to the section (one of which is suggested below - "interesting paper"). Looking at the section, I realized that it suffers from poor organization, which I believe I can remedy. My plan is to reorganize the existing material into this structure, which will allow for easy addition of new information without creating the distressing "information collage" effect that so easily occurs with someone just drops a sentence into a section:

• Classes of medication potentially useful in symptom management
  • Atypical anti-depressants
  • Heterocyclic anti-depressants
  • Monoamine-oxidase inhibitor (MAO)
  • SSRIs (selective serotonin reuptake inhibitors)
  • Miscellaneous
• Medications by symptom group affected
• Self-medication issues

I will drop these sections - Combination therapies (has only one sentence of real content, which is unsourced, and not very informative); and Substance dependence as an inhibitor of recovery - (this is about self-medication and its problems, and can reasonably go in the medication section, as I've indicated above).

PLEASE assist me with any comments you may have!

TomCloyd (talk) 19:05, 3 February 2010 (UTC)

Agree with your intent to reorganize this unwieldy section. Also wondering about the drug Propranolol, which I believe is a beta blocker. At one point "60 Minutes" devoted an entire segment to the drug's promise in treating PTSD, but I've since lost track of where that stands. Just a thought. MarmadukePercy (talk) 21:50, 3 February 2010 (UTC)

Incidentally, following my comment, I notice a user has added mention of propranolol, but from a casual reading of the addition, it's not up the standards of the rest of this piece, nor is the footnote reference on par with what I hope this article will contain. But I defer to your judgment on this one. MarmadukePercy (talk) 08:51, 4 February 2010 (UTC)

Thanks for comments. It is my intention to check all references for accuracy of substance and form of citation, as well as appropriateness of its use, since the problem you have pinpointed is just a bit too common in this article. Quality control police to the front, please! TomCloyd (talk) 18:40, 4 February 2010 (UTC)

I think the medication section is excellent. It's concise and not overly-complicated, but lays out the various remedies in understandable English. MarmadukePercy (talk) 20:54, 11 February 2010 (UTC)

"Medication" section major rewrite - current status

I have just uploaded a proofed draft of this rewrite. It's been a major project, and I have not completed reviewing all sources cited, but expect to complete this in the next several days. (Several serious errors in representation of source material content have been found and corrected.) I hope people like this rewrite. It's far more than a revision or re-editing, but a rewrite did seem called for, after I really got into the material.

Tom Cloyd (talk) 10:55, 9 February 2010 (UTC)

Revisions in the Diagnostic and Statistical Manual of Mental Disorders

Just noticed this interesting piece in today's Wall Street Journal on the subject.[9] Not sure how this might affect the PTSD category, but wanted to throw it out for the experts. MarmadukePercy (talk) 00:58, 11 February 2010 (UTC)

I'm well aware of this, and will be updating the article shortly, although my source will not be the WSJ (heh heh). Tom Cloyd (talk) 06:43, 11 February 2010 (UTC)

OK - I've written into the article material about the draft changes. What do you think? Tom Cloyd (talk) 08:48, 11 February 2010 (UTC)

Copyright problems with diagnostic criteria (alleged)

The American Psychiatric Association has not released its Diagnostic and Statistical Manual of Mental Disorders into public domain, but claims copyright. The Wikimedia Foundation has received a letter of complaint (Ticket:2010030910040817, for those with access) about the use of their diagnostic criteria in this and a number of other articles. Currently, this content is blanked pending investigation, which will last approximately one week. Please feel free to provide input at the copyright problems board listing during that time. Individuals with access to the books would be particularly welcome in helping to conduct the investigation. Assistance developing a plan to prevent misuse of the APA's material on Wikipedia projects would also be welcome. Thank you. Moonriddengirl ^(talk) 14:01, 11 March 2010 (UTC)

I protest! As a mental health professional specializing in treating PTSD, I use these diagnostic criteria daily, and know them very well. I wrote much of the disputed section. I also know US copyright law right well (for a non-lawyer). There is NO violation in the disputed section. One is ALWAYS allowed to paraphrase, and that's what's done there, except for very brief, clearly marked and credited quotes. And if one is going to flag this section, then why not also this article's lead-off section - "Signs and Symptoms", which contains a far more detailed discussion of the diagnostic criteria?

I especially protest the blanking of the "Proposed changes to current DSM-IV criteria" section. This is my own summary of the content of several pages of a public website, which is clearly cited. Not by any stretch of the imagination can this be a copyright violation. The material is published on a public website. Read the Terms and Conditions of Use page of the DSM-V website. It's brief, and even a cursory reading, to those familiar with copyright law, will reveal that there's nothing here that is unexpected, special, unusual, or beyond the sort of thing usually covered by that law.

I will be following up with this matter in the relevant venue. Tom Cloyd (talk) 14:32, 12 March 2010 (UTC)

Done - here Tom Cloyd (talk) 15:00, 12 March 2010 (UTC)

An investigation of the content at [10] suggests the diagnostic criteria are not a copyright concern. The material has been restored pending a more explicit identification of problematic text. --Moonriddengirl ^(talk) 23:58, 12 March 2010 (UTC)

THANK YOU! You have been outstanding in your responsiveness re: this article, at a time when I'm sure you were extremely busy handling the whole complaint. Re: "...pending a more explicit identification of problematic text" - that phrase assumes there IS problematic text, and at this point that argument has NOT been made - at least not in any way that is open to public examination. I have written hundreds of pages of text on mental health topics, in various venues, and never before has there been any allegation of copyright violation or plagiarism or any other irregularity. I remain confident that the section being examined in the PTSD article is without blemish of this sort. As for the rest of the article - I am in the process of very carefully reviewing/revising all of it, and hope soon to be able to make the same claim for the entire article.

I remain significantly distressed that I do not have access to the complaint that started all this. All I have is secondary report of a complaint, and none of THAT is specific to this article. I continue to think that the reaction to the complaint - the wholesale blocking of every discussion of mental illness diagnostic criteria was indiscriminant and presumptive, in the absence of any reasonable argument that a problem actually existed in the each of the individual articles blocked.

If the complaint, was given respect simply because it was from the APA (and that is mere rumor, at present), then we have an ad hominem argument. That is nonsense and unfair. Not YOUR doing, I know, and I will take my complaint elsewhere. I do not want this to happen again.

Finally, I am searching for my copy of the full-length DSM-IV, so I can assist with response to this complaint. I just haven't yet found the right box (I moved not long ago - still unpacking).

Tom Cloyd (talk) 02:30, 14 March 2010 (UTC)

Your help would be appreciated. The articles listed at the cleanup subpage and tagged for copyright investigation were each specifically named in the complaint we received. --Moonriddengirl ^(talk) 03:06, 14 March 2010 (UTC)

I would like to commend Moonriddengirl on the way she's handled this. She has been under the gun, unquestionably, as this is obviously a broad complaint. I too believe nothing will come of it, but I think Moonriddengirl has done exemplary work under the (difficult) circumstances. MarmadukePercy (talk) 03:23, 14 March 2010 (UTC)

I concur! Tom Cloyd (talk) 14:43, 14 March 2010 (UTC)

Thanks. It's been interesting. :) We're done with it on the Wikipedia side of things. An administrator with access to the source has helped speed through. Whatever happens from here is in the hands of our attorney and designated agent, who I do not believe intends any action barring additional communication that specifies what content is disputed. But one thing I would like to address is the "ad hominem" issue. If you do happen to take this further, Tom, I want to be sure that you are familiar with the DMCA, which privileges copyright owners in terms of making copyright complaints. (But I will add that the Wikimedia Foundation has chosen to permit anyone to raise copyright concerns rather than shelter exclusively under that act, which is wise since some prominent individuals have already challenged (though not legally) our right to do so. Not to mention the fact that if we did not monitor for copyright problems, we could face the requirement of deleting multiple articles wholesale if we did receive an official complaint. Keeping the problem from reaching that point is very much in our best interest.)

Anyway, there are special, legal considerations when an official spokesman protests the use of material on a website. See DMCA#Takedown Notice. (So far we've only received a formal letter of complaint, not an official takedown notice.) It is the Foundation attorney's job to protect the project as a whole. Whether he would see that mandate as requiring that WMF resources go into fighting takedown notices that may seem to be frivolous or complying with them, I don't know. But if a takedown notice is submitted and the Foundation does comply, the only option contributors would then have would be to submit a counter-notice (see relevant section in our article on OCILLA), at which point the APA would make a decision whether to pursue suit against the individual who does so. OCILLA has certainly been criticized, including for the fact that the individual who files the counter-notice is at greater risk than the copyright owner who files takedown.

This "ad hominem" (so to speak) approach in terms of online copyright management is encoded in the US law that governs us. WMF takes copyright concerns seriously when raised by anyone, but copyright concerns by copyright owners are a special case because they must be. --Moonriddengirl ^(talk) 12:55, 15 March 2010 (UTC)

Why does it say "Age-inappropriate sexual experience" instead of rape?

"Children may develop PTSD symptoms by experiencing bullying[9] or sexually traumatic events like age-inappropriate sexual experiences.[1]"

Why does it say that instead of simply rape? The Webster dictionary defines rape is having sex with who is below a certain age [11]. And what does age-inappropriate mean? Would it be less dramatic if the person was their own age, instead of significantly older? Dream Focus 06:30, 14 March 2010 (UTC)

I can respond to this. (Please see click my name below to go to my user page, so you can appreciate my background, which is relevant to my choosing to respond to you.) I don't have time to provide you with the reference citations which I'd like to offer, in responding to your questions (I'm too busy working on the article and related matters), but will respond using the knowledge I've acquired from many trustworthy sources in over 30 years of work in clinical and research psychotherapy, involving adults, adolescents, and children, many of whom had experienced what we call age-inappropriate sexual activity, often with negative consequences.

First, your questions are excellent ones. Please understand that casual language is often sloppy, and this won't help us here. What the law, or the dictionary, defines as rape may well be different in important ways from a medical or psychological definition. The dictionary you cite appears to be giving a pseudo-legal definition. There is no "right" definition. Linguists write definitions (and dictionaries which contain them) on the basis of how people USE words. Philosophers and other thinkers are free, of course, to stipulate definitions, as well. In formal, thoughtful writing, we usually stipulate definitions so that they help us with our thinking. They become tools, used to accomplish goals. That's why legal people see "rape" differently than, say, anthropologists, or therapists. And note that even in groups of professionals in the same field, definitions can differ significantly.

So, let me begin by saying simply that from my perspective rape is always inappropriate (!), and is AGE-inappropriate when it involves a sexually immature individual. Note that physiological sexual maturity bares only a loose relationship to legal sexual maturity, and for good reasons (which I won't take up here). If only some rape is age-appropriate, as opposed to simplyinappropriate, it is also true that not all age-inappropriate sexual behavior is rape - which I think should be obvious, upon a little reflection.

Age-inappropriate sexual experiences, in psychology/psychotherapy are those generally seen as those which involve an individual doing something sexual which is clearly not usual for their age. This can be tricky to distinguish, however. Clearly, many, if not all, infants and children explore their sexual organs, and each others', as well. This is normal, and generally harmless. At what point is something age-inappropriate occurring? There is no clear dividing line. It not dissimilar to the problem of distinguishing pornographic literature from erotic literature. No easy solutions.

That said, the key concept here is that sexual experiences involving children/adolescents who are not sexually mature can have immediate and/or delayed long-term negative consequences. This is clearly cause for concern. It is very important to note that not only are not all sexual experiences children have inappropriate, not all of them cause any problem at all. It depends upon the degree of involvement, the nature of the act, whether or not there was coercion, how the child felt about it at the time, the reaction of adults who came to learn of the event, and so on. Many factors influence the consequences of a sexual experience involving a child. We should never simply stipulate that something MUST be a problem (although this is commonly done in courtrooms). Rather, when we let the individual involved tell us of their experience, then we can know the real psychological consequences. Well-meaning people can create a problem where none existed, with a child. Some individuals come through quite serious experiences with very little if any damage. Others are greatly hurt by what appear to be modest experiences. And, regardless of the consequences, those of us who come to learn of a given experience may have good cause for concern. It would be nice if we could view all this in simple terms, but I don't think that would be accurate, useful, or intelligent.

Among the problematic consequences of age-inappropriate sexual behavior which we deal with in clinical psychotherapy are these:

• Lose of a child's sense of safety: Loss of control over what's done with your body is at the least unpleasant, and at worst traumatic. It may be difficult to feel safe in the world for some time after such an event.
• Loss of trust of key individuals in a child's life: A sexually inappropriate relative becomes an untrustworthy relative. Children need families they can trust. A sexual abuse incident is one way to lose a functional relationship with a sibling, or a parent, or a grandparent. This can have long term consequences.
• Outright psychological trauma: When there substantial levels of fear involved, and the child is unable to resolve these feelings. enduring trauma may result. This is how once acquires PTSD.
• Premature sexualization of the child: This is the problem non-professionals usually forget or ignore or have no awareness of. Children introduced to sexual experiences before they are ready or desirous of them, may come to think that sex is a part of emotional intimacy. This may lead them to be sexual with other children, or other adults, in unwanted and unacceptable ways, and in ways that can damage others as well. I once knew a very pretty, charming 10 year old girl who had been removed from a succession of foster homes because she couldn't keep her hands where they belonged. She had been "prematurely sexualized". She thought what she was doing was OK, and her behavior led to repeated social rejection. This sort of thing is far more common than most people realize, and definitely one of the reasons why we're concerned about age-inappropriate sexual behavior. It can lead to an child's experiencing themselves as unacceptable to others in general, which can lead to depression, self-medication with various psychotropic substances, and other long-term damaging consequences.
• Disturbance to individuals associated with the child:. Even when inappropriate sexual experiences are not a problem for a child, they can be for others. I dealt with a 9 year old boy once whose parents were quite upset because his female babysitter (age 13 - and not a relative) had climbed into bed with him late at night. They couldn't imagine that he wasn't somehow injured by this experience - clearly (one would think!) age-inappropriate sexual behavior. It turned out that he was only annoyed. He couldn't make sense of what she was doing, and got up, went downstairs, and slept on the family sofa. Problem solved. All I had to do was calm down the parents, so they wouldn't continue to disturb their son.

This is not intended to be a complete list, but I do believe it addresses major issues.

Relative to a hypothetical age-inappropriate sexual experience, you ask "Would it be less dramatic if the person was their own age, instead of significantly older?" It could well be, although "drama" is not the issue, as I'm sure you realize. The problem with older individuals is their misbehavior can lead to a needless and inappropriate distrust of all older people. Also, older individuals are likely to initiate more mature (and thus age-inappropriate) activities with younger individuals. At the same time one must note that in all cultures it is deemed appropriate for young sexually mature hetersexuals to pair off such that the male is older than the female -one major research effort determined that the age difference deemed ideal by many cultures was about 3.5 years (with the male being older).

I will conclude my remarks by saying that I'm concerned about the tendency in some families, communities, and schools, to pathologize the normal. Two six year old girls simulating intercourse, because they are curious and cannot make sense of why adults would do this, do not really need a semi-hysterical, or punitive, or any other negative reaction from adults. I could cite other cases, many of them not so easy to think about...and that's my point. A thoughtful examination of an event is a far wiser response than is a knee-jerk negative reaction of any kind. I prefer to act from knowledge rather than pre-drawn conclusions based on some principle rather than good data. It think that we don't yet have all the knowledge about age-inappropriate sexual experiences that we'd like to have. The situation is clearly better than it has been in the past, without doubt, but we're not finished our work, so to speak.

I hope my responses are useful to you. Thanks for your great questions!

Tom Cloyd (talk) 14:26, 14 March 2010 (UTC)

Concerning my deletion of "Cultural References"...again [2010.03.14]

Response to re-insertion of "Cultural references" section, and some of its former content, by user at IP address 86.26.0.25 (do you have a name?):

I have undone your reinsertion of this section, for these reasons:

This is a poor way to deal with the deletion issue

The issue of deleting the section was broached on this talk page some time ago, and open for discussion here for months. This discussion is still on this page, and easily accessed via the page Table of Contents and your browser's search functionality. My objections to the section were agreed to, and there was not a single sustained objection. After considerable passage of time, I removed the section. This was a reasoned action, carefully thought out, and taken only after a generous opportunity for discussion was provided.

These has been no comment or response to this action, until now. Your action is disrespectful. In reasoned discussion, a decently supported assertion stands until rebutted. In the original discussion of the question of the deletion of this section, I made a number of such assertions. You have rebutted none of them. Ignoring them is not your solution, believe me. Doing an end-run around this discussion is not a good idea, as hat reduces the dispute to something akin to a shouting match, rather than an exercise in reason. PTSD is a serious subject. We have to do better than that here, I think.

YOU have to do better. In responding to you here, at length, I give you far more respect than you gave me. I do this not only because I believe strongly in reasoned discussion, but also because we really do need to produce a high quality article on PTSD, here. Many who come here come for information about a disorder they or someone they know is experiencing. To provide them with an article poorly written and poorly sourced is unacceptable to me, as a psychotherapist specializing in PTSD.

This "Cultural references" section was labeled for months as needing legitimate sources; there was no response to this. Not one. Since I know of no such sources myself, and the section had become a laundry list of everybody and their dogs' ideas about popular culture documents which, it was claimed (always without acceptable sources) involve PTSD, I deleted it. It was a carefully done, fully explained action. Several other editors agreed with me about the illegitimacy of this section, in this article (some did it without appearing on this page). There were no solid, enduring objections. I would have been very open to them, had there been.

The material re-inserted still does not meet acceptable standards

As presented, is little more than an advertisement for a single movie. The WP article you cite, about the movie, could also be characterized as an advertisement for the movie. Citing of WP articles to support material in other WP articles is poor practice at best. The article itself does not mention PTSD, posttraumatic stress, flashback, trauma, or anything else clearly indicating that mental illness of this sort if a subject. There are no secondary sources introduced which do this, either. That this has anything do with PTSD at all is an interpretation- an original contribution - not allowed here.

The statement "Posttraumatic stress disorder is the central subject of the Israeli film..." is totally unsourced, beyond the long, thoughtful film review that is on the Commentary magazine website. THAT article, itself is unsourced, and its author is a writer, not a mental health specialist of any sort.

The one mention of PTSD in the review is this, in the review's very last section: "Although acute war-related PTSD is largely a function of personality and intensity of combat, the syndrome’s chronic form, it is widely recognized today, involves social factors, too, and occurs inversely to a veteran’s ability to think positively of his military experience and take pride in it." An interesting statement, and, as far as I know (and psychotherapeutic treatment of PTSD is my field) at least partly true, but where are the sources? Such a statement, made here, would need sources. That need still exists, irrespective of its appearing in another document. The writer is not a trained and qualified cultural historian. He's a film reviewer.

How are we to verify his other statements? Films, video games, and the like, are not like books and scholarly journals, which may either be obtained at a local university library or on inter-library loan. Access is often difficult or impossible. To verify a film as a source one must watch the entire film, unless specific episode timings (e.g., "...at 23 minutes into the film, we see..."). Even worse, the writer cannot legitimately say the film is about PTSD, and cite the film as evidence. Is it about PTSD because it says it is? That doesn't work, in scholarship.

The film is the object of discussion in the review, and here. In claiming that PTSD is the subject of this file, another source besides the file must be cited, else we're again caught in the problem that always come up when using Primary Sources: citing primary sources necessarily puts a writer in the position of being an interpreter. The writer of this review does not appear to be qualified to make such interpretations - IF that's what he's doing, which we cannot tell, as this is a popular style article, not a scholarly article. So, this review is simply not an adequate cultural history document. It's a film review. The standards are quite different for the two fields.

How to make "Cultural references" a legitimate section of this article

I no longer think this topic belongs here under any circumstances. Seesection for more on this.

Operate according to accepted standards of scholarship. A central problem with this section has been that those contributing to it seem to have, at best, only a vague idea of how scholarship is done. You ask that we "tidy up" this section, rather than deleting it. With what? I have no contact with sources which would allow me to do that; apparently no one else does, either. And, that's not my job, as I've said in this discussion before. It's the job of whoever wants this material here. That why it was marked for weeks (months, actually) as needing better sources. When "they" didn't "tidy it up", I scrapped it. Good riddance to bad rubbish, which was what it was, due to poor or completely absent sourcing.

Find and use some acceptable sources. You say "this is wikipedia, not a medical textbook -therefore a section on cultural references is relevant". Well, these days, it's relevant in psychiatric textbooks, too - but only if adequately sourced. Relevance is not the problem, and has never been a central issue in the dispute. The problem is technical: no acceptable sources for the material have been found. I'm not interesting in pursuing the matter. All my time is devoted to tuning up the clinical material. I would love for someone to find a first class discussion of PTSD as a cultural phenomenon, and bring it here. I know of no such source.

Better understand the nature of the game here (i.e., what it means to produce a quality article). When I came to this article, I found two areas that had become essentially discussion forum bulletin boards: the Cultural References section, and the External Linkssection. Before I became active in article editing, someone else deleted the External links section. I then went to work examining the sources in "Cultural References", found them deficient, asked the editorial community for remediation, got none, and took action.

I later restored the External Links section, but in a carefully thought out new format. It now has sections whose titles clearly indicate their content - and also exclude unrelated content. This structure has served to keep people from simply sticking their favorite external link onto the list, which was what was occurring before. In other words, the section structure and titles clearly indicate the nature of the whole section: it's not a mere list, but a carefully thought out limited list of (hopefully) highly useful external links. I also posted a plea, at the beginning of the section, for respect of this structure and what it's trying to do. This has so far, worked.

"Cultural references" as a section needs this sort of controlling and directing structure, and it is to be found in the customary standards of scholarship. There is a great deal of material about these standards in Wikipedia itself. One would do well to begin withWikipedia:No original research, giving particular attention to the sectionsecondary and tertiary sources

Until someone comes up with material for a Cultural References section which meets accepted Wikipedia standards, I will continue to object to its appearance here.

Tom Cloyd (talk) 13:08, 15 March 2010 (UTC)

No one reads things that are that long, so you are basically just talking to yourself. Do you sincerely doubt those movies listed deal with the issue? You erased a lot of information[12] which should be easy enough to find sources for. I'm using Google news now to search for the names of the films, and looking for the name of the films, and "post traumatic stress disorder".

• http://ptsdcombat.blogspot.com/2006/03/at-movies-film-and-ptsd.html
• http://newsblaze.com/story/20100310110353mill.nb/topstory.html reviews Green Zone, which is a movie about Post traumatic stress disorder caused by the war in Iraq. Its directed by Paul Greengrass who did the The Bourne Identity series, and stars the star from those films, Matt Daemon.
• The Deer Hunter has plenty of mention of it being about post traumatic stress disorder affecting soldiers returning after the Vietnam War. [13] Google News search shows plenty of results, the summaries of major news papers telling what needs to be said, but most of the articles are pay per view to read the whole thing.
• Google news search reveals this[14]

"The movie industry in particular, with their profit-driven mentality, portrayed Vietnam veterans as mal-adjusted losers who were prone to violence and preferring to live off the grid. Movies such as Rambo, Apocalypse Now, Deer Hunter, Platoon, Full Metal Jacket and The Green Berets did unbelievable harm in creating unjustified suspicion on Vietnam veterans’ ability to function rationally once back home, in college, home or in a work environment."

That list a lot of the films as having PTSD.

• [15]The movie Stop-Loss gets some results.

"Like the post-Vietnam dramas of 30 years ago (particularly The Deer Hunter), Stop-Loss seeks to show the horrors of war not by depicting battles but by peering into the minds of the soldiers who survived them. Yet Peirce's attempts to show Steve's PTSD hallucinations"

• Searching for the word "film" instead of the name of any movies[16] reveals some promising results, different war movies listed about PTSD. I'm going to do some work on the article now. Dream Focus 16:33, 15 March 2010 (UTC)

I have deleted this section again. It is slipshod and not a worthy addition to an otherwise serious article. It belongs somewhere else entirely. MarmadukePercy(talk) 16:49, 15 March 2010 (UTC)

Showing how it is in notable works of fiction, especially the movies that are specifically about it, should be mentioned. I'm working on it now, so please stop reverting it. DreamFocus 16:57, 15 March 2010 (UTC)

Notability does not need to be established for a mental health condition. Nor does a trawl through google do anything for this piece whatsoever. MarmadukePercy(talk) 18:08, 15 March 2010 (UTC)

Mentioning the documentaries dealing with this specifically will help people. Mentioning movies that millions have seen, and explaining clearly, yeah, that's what this condition is, does well for the article. Showing how its been portrayed in the media over time, shows how society's view on it has changed, since most people know only what they've seen on television or the movies. Dream Focus 18:28, 15 March 2010 (UTC)

"Mentioning the documentaries dealing with this specifically will help people." Yeah, it will generally help them become misinformed. I do NOT want people getting information about ANY mental health disorder from movies. These are NOT documentaries, and they are not done to inform, but to entertainment. Aside from, the question NOT answered yet is whether any of them really have to do with PTSD. Who makes that call? It cannot be any of us here (original contributions are not allowed). It cannot be a film reviewer, or video game expert or the like (unqualified). It cannot be someone associated with the movie (a Primary Source cannot be cited in support of such a claim - where's the authority?).

I think you really don't know how scholarship is done (I'm quite willing to be proven wrong, though). And I'm sure you don't really know about this topic. For example, do you understand the difference between posttraumatic stress and posttraumatic stress disorder? That some file illustrates the first (not hard to do) says nothing about whether or not it portrays the second. As I've already said in this discussion, prior to this, when I do an assessment for PTSD, it takes over an hour and is a careful, deliberate process. I don't accept it that someone had PTSD just because they say they do. Why should we treat movies any differently?

I agree with MarmadukePercy - this material does not belong here. This is an article about a mental illness diagnosis. Its mention is the popular press is grist for some historian of popular culture - certainly it's a legitimate topic, but is off-topic in this article. I don't know of anyone who writes about the popular perceptions of mental illness (but then, that is not my field, either). I don't doubt that there's something out there - maybe a dissertation or Master's thesis, or some articles in journals devoted to the cultural anthropology of industrial society. All material of this sort will generally make its way onto the Internet only after being published in the traditional ways. I suggest you'd do better if you searched via Google Scholar, or just went to a good university library. But do you really know what you're looking for? So far, I don't see evidence of this.

Fundamentally, it's about not misleading or mis-informing people. An example: Last November, TIME magazine did a piece about PTSD on a military base. Half the article was about 3 soldiers who gotten violent and hurt other people and property. This is a main-line journalistic outlet, yet it's seriously misleading people. Most people with PTSD are far, far from violent. It's a complete misrepresentation, which feeds ignorance, while selling magazines. This article IS a primary source, as are your movies, but not for learning about PTSD. It's about something else altogether. "PTSD in popular culture" is not about "PTSD". I don't know how to make it any clearer. Tom Cloyd (talk) 19:38, 15 March 2010 (UTC)

While reference to movies I think are about PTSD would be an original work, reference to other's work about how PTSD has been referenced in movies seems relevant and beneficial to the article. THI (talk) 05:07, 17 March 2010 (UTC)

Have you bothered to read the material you're defending? The movie Gran Torino is mentioned, but there is no explicit reference in Gran Torino to PTSD. The same is true of some of the other films mentioned – and that's not even considering the banal reference to video games. Under your definition of pop culture references, any movie or video game that deals with violent themes or warfare might merit inclusion. That opens the floodgates to all sorts of subjective speculation. Which is why it's best this article hew to the medical and psychological underpinnings as much as possible. The subject is confused enough without throwing in a grabbag of pop culture references a la MTV. MarmadukePercy (talk) 18:47, 17 March 2010 (UTC)

I have again deleted this section. Here's why.

Legitimate objection (because it's conformant to accepted Wikipedia policy) has been made as to the sources cited. I've examined every one. All of them are movie reviews, without exception. Movie reviewers write legitimately (we hope) about movies, not PTSD. Whether or not PTSD is actually portrayed in these movies is a question to be answered by someone qualified to make the call. It is unlikely that any movie would ever actually provide enough information to make the diagnosis. I know. I just did it - 45 minutes ago, with an adult survivor of childhood sexual abuse. It took over two hours. So, I reassert the objection. It must addressed.

The legitimate objections I have raised as to source quality must be addressed. Also to be addressed is the question of whether cultural history topics belong here just because the content happens to be (allegedly) PTSD.

The individual repeatedly doing an end run around this discussion is headed for formal dispute resolution real quickly, if this brute force response continues. Trust me on this.Tom Cloyd (talk) 20:15, 15 March 2010 (UTC)

Are your objections legit ? In dealing with the cultural aspect (not medical aspect) of something, the experts are cultural experts. If legit film critic explains film is about PTSD then that is legit source for the cultural aspect of PTSD. If you don't like the portrayal (and I'll bet your right) likely there is material explaining all that you can reference, in important part of cult. section on cultural mis-information etc. That is something you'll need to add, you can't just delete the legit cultural sources because you don't like the message.THI (talk) 05:19, 17 March 2010 (UTC)

"In dealing with the cultural aspect (not medical aspect) of something, the experts are cultural experts." In your sentence "cultural" is ambiguous, and you are either making illegitimate use of this or don't understand it. Sure, film is generally considered part of an industrial society's cultural product. Film critics write about film. What they write is Primary source material (seesecondary and tertiary sources) for culture history. All that legitimately could be done with such material HERE is to list it. But why do that? This is is NOT a cultural history article. What is needed is not "culture experts" in the sense of 'an expert on film', butculture experts such an anthropologists or historians of current history. Do you understand the distinction? It's absolutely critical (and certainly valid). Of the sort of expert needed here, not one has been produced, so far. Tom Cloyd (talk) 16:43, 17 March 2010 (UTC)

I strongly disagree with the blanking of the cultural section. (i) (User:MarmadukePercy): If we're unhappy with the content of a section, which we nonetheless accept as a valid section, it's our duty to improve its content - deleting a valid section of an article, because its content isn't up to scratch, is a lazy short-cut. If you can't be bothered to improve it, it's still desirable to keep the section, and leave it to other editors to come along and work on its content. Wikipedia is a work in progress. (ii) (User:Tomcloyd): Please be more concise, it's difficult to read all your stuff, especially when you litter your prose with idiosyncratic American phrases like "better understand the nature of the game here". Cultural references have always been a key characteristic of wikipedia. We're not here to hand out medical guidelines, and it would be irresponsible to suggest otherwise. (iii) Ironically a problem is highlighted by the fact that you reject newspaper sources because they refer to PTSD in a way which doesn't quite conform to your own definition of the term. You want to push a revisionary, DSM-approved definition of the disorder. The ordinary use of it in pop culture is wider. For this reason precisely a section on the use of it in pop culture would be clarifying. It's a strange form of censorship to object to the inclusion of the section because you disagree with the presentation of the disorder in certain films (how is this different to Louis Napoleon, objecting to Madame Bovary because he disagreed with its presentation of marriage?) People are not total idiots, they can distinguish between different forms of language, between fictional presentations and DSM definitions. Avaya1 (talk) 15:04, 14 March 2010 (UTC)

Your premise is flawed. I do not accept this as a valid section. To me the pop culture references are trivial and look more like an editor is padding the piece, instead of adding genuine content. I take umbrage at references to video games in a piece on a serious mental health issue. Needless to say, your comparison to Louis Napoleon objecting to Madame Bovary falls wide of the mark when one is discussing Grand Theft Auto and its ilk. MarmadukePercy (talk) 19:10, 16 March 2010 (UTC)

What you find as 'light' may be some readers' doorway into this topic. If you think the topic is important, worth having different doors the reader can enter by. Many people relate to films. The section can help certain types of readers relate to and gain insight from what is a not so simple, but important topic. THI (talk) 05:19, 17 March 2010 (UTC)

As I have already stated, this article is not about the cultural history of a mental illness diagnosis. The only insight people might gain from what you propose putting here would have to do with cultural history of the topic, not the topic itself. I admit that it's a technical distinction, but that's precisely why the two topics need to be clearly labeled and kept separate - because the casual reader (for example, your average film fan) might well NOT make the distinction. From that error, misunderstanding will surely arise.

Film is NOT a good place to learn about PTSD. (I can say this, as a clinical expert. See my Wikipedia user page for my professional website, where I've written extensively on this and related topics.) And, relative to cultural history, where are the sources from which one might construct a section or article on this topic? I have repeatedly asked for them. Not one has been provided. What exactly about the distinction between Primary and Secondary sources do you and others taking your position here not understand? This is becoming tedious, and a time waster. Tom Cloyd (talk) 15:49, 17 March 2010 (UTC)

Film is a great place to learn about PTSD in cultural, as opposed to medical (used loosely here) terms. Keeping the article sourced is helpful. Sourcing to information explaining how PTSD is misrepresented in film, etc. seems helpful to the article. Throwing in heated comment about primary vs. secondary sourcing when that has nothing to do with the issue at hand, seems to be more an emotional argument. Also, complaints that others' viewpoint when different from your own are 'tedious' and 'a time waster' seems disrespectful to the views of others. If an article is the result of discussion and consensus, the 'waste of time' of hearing others' views and coming to consensus seems...part of the process. I find it wise to assume that every other editor worked on their first doctorate while in their teens. THI (talk) 18:32, 17 March 2010 (UTC)

"Keeping the article sourced is helpful." No, it's required. You should know that, if you intend to edit Wikipedia.

"Sourcing to information explaining how PTSD is misrepresented in film, etc. seems helpful to the article." That would be true, if anyone would come forward with such references. Hasn't happened. But, since PTSD as a cultural phenomenon is not the subject of this article, those sources, if found, really belong elsewhere.

"Throwing in heated comment about primary vs. secondary sourcing when that has nothing to do with the issue at hand, seems to be more an emotional argument." No, it's about the rules of scholarship - by which Wikipedia does play. They have everything to do with the issue at hand. I think we're having an educational problem here. You've just not been taught how scholarship is done, and you don't recognize that an article on a serious, complex subject like this one is necessarily an exercise in scholarship. If you go forward, here, ignoring that, what you contribute will simply be removed, with justification. That's how Wikipedia's done, according to its policy statement, which it rather clear you haven't studied. I've already provided references on this material.

What's tedious is not disagreement, but poorly conducted disagreement. I make assertions. They are ignored. I write at length, so as to be well understood and head off confusion. I get complaints about people not wanting to take the time to read what I write. That is tedious. This is NOT a social network site, where anything goes. Far from it.

Tom Cloyd (talk) 18:52, 17 March 2010 (UTC)

"If we're unhappy with the content of a section, which we nonetheless accept as a valid section, it's our duty to improve its content..." Oh really? Why? Where did you get that idea? You have it completely backwards, as I've already stated elsewhere. Instead, it is the duty of those who put material here to see that it's adequately sourced. It wasn't. I asked for such sourcing. None was produced (in part because I don't think it exists). I finally removed the section. My justification is on the record and in agreement with the most basic Wikipedia policy: article assertions my be adequately sourced.

You cannot avoid sourcing; you also cannot provide just any source. If that were not true, I could provide my dog as a source for the statement I just made, and that would conclude the conversation. Please 'get with the program' (i.e., go get an understanding of the basic rules by which Wikipedia operates). I have better uses for my time than to continue saying here the same things over and over. Read what I have written. Reply to it thoughtfully, if you can, or stand aside. We have work to do here.

And...we do NOT accept the validity of this topic in this article. That what this section -"Cultural References" - why this topic does not belong here at all is all about. How could you have missed it?

"Cultural references have always been a key characteristic of wikipedia." Again, the ambiguity of your use of "cultural" makes the meaning of your sentence impossible to grasp. In a sense, everything in Wikipedia is a cultural reference. However, discussions of pop culture in articles on formal DSM mental illness diagnostic categories??? Find me one other instance of this in Wikipedia (I've looked, and not found any). I'd be stunned to see one that was done right. Take that as a challenge. Go for it.

"We're not here to hand out medical guidelines," First, PTSD is a psychological disorder, not a medical disorder. It's a problem with the organization of information in the mind, not an organic malady of the brain. A few organic side-effects of PTSD have been identified, and more will likely be seen in the future. They are not causal, but are effects. So, "medical" is poor word choice here. Second, we're hardly "handing out guidelines". That trivializes what's being attempted here. My concept of this article, when up to the proper standards, is that it will summarize quality Secondary and Tertiary sources directly addressing the mental illness known as PTSD. Achieving this will involve scholarly synthesis, not the crafting of guidelines. For example, we will summarize the best knowledge about proposed and validated treatments, but not tell HOW to treat. A scholarly summation is not a guideline.

"You want to push a revisionary, DSM-approved definition of the disorder." I'm not pushing anything except good scholarly method, and that I decidedly AM pushing. The DSM is the source of the definition of the disorder, and there's nothing revisionary about it. It's where the term PTSD was first defined, and still is the key primary source for the formal definition. It is THIS "PTSD" that this article is about, and no other. You seem not to grasp this. Want to write about popular culture? Cool. Do it. Elsewhere. That would be fine and appropriate, but you would still be bound by the standard article quality expectations in force here at Wikipedia. Since no one's yet met those expectations HERE with this "cultural" material, I don't expect moving it to another article would magically fix the problem. In any case, it doesn't belong here.

I think you fundamentally do not understand the topic of this article...and you never will if all you do is watch films and television, and read articles in the popular press. You'll need instead to do what I did: spend years at a university studying the general topic, then acquire some practical clinical experience with it. Then you'll grasp my position. That said, you canget the rudiments of good scholarship just from carefully studying some of the material here at Wikipedia - I've already provided links to some of it. However, since I'm already fielding complaints here about the length of my prose on this page, I don't think you will hold up well under the strain of more reading. Of course, you could prove me wrong, if you like. That's be great. Go for it.

"It's a strange form of censorship to object to the inclusion of the section because you disagree with the presentation of the disorder in certain films..." Not a correct reading of my position. I object to the presentation of the "cultural material" HERE in this article. I couldn't care less what the films are saying. My point is that YOU or I 'cannot' talk about this cultural material - the films, for example,because that would be an original contribution. You cannot use film reviews because they's about art, not culture in the anthropological or historical sense. You really, really need to think about this. I think doing that will lead to resolution of the problem you're having with my position. No one's trying to censor anything. We're just trying to stay on-topic in the article, and the topic is not culture history. The article is already rather long, and we haven't gotten the clinical material well presented yet. adding an ancillary section, for which no good sources have yet been found, simply makes no sense.

Tom Cloyd (talk) 16:43, 17 March 2010 (UTC)

Tom Cloyd, please read WP:TLDR - you might find it interesting. I am also quite loquacious, but I try to justify my edits by references to policies, guidelines and in some cases essays. Experienced editors will find this far more convincing, and you can be far briefer. May I suggest you refer to the following wikipedia-specific pages:WP:TRIVIA, WP:HTRIV and WP:IPC. I for instance, will not bother reviewing this section, but may I refer you to Project MKULTRA#Popular culture, which I see as a rather reasonable example. WLU (t)(c) Wikipedia's rules:^simple/_complex 12:52, 20 March 2010 (UTC)

(outdent) I think WLU is giving good advice to you TOM; arguing at length based on emotional connection to the subject matter and by ones own personal logic is long winded and further carries much less weight than policies and guidelines. Your replies can be at times too long for readers. Wikipedia in general has a bias against popular culture/trivia sections and as this article is being aimed for A class article or even possible a GA article I support Tom's position with regard to not including it, although I am open to persuasion. MKULTRA is a subject matter that has a prominant position in popular culture and a limited position in scholarly research (I would imagine, not completely sure) so I think that it is an apples and oranges comparison. I hope that I have not treaded heavily on WLU's or Tom's toes here, just expressing an honest opinion. :)--Literaturegeek | T@1k? 14:07, 20 March 2010 (UTC)

I very much don't want Tom to leave, as he appears to be an experienced clinician with PTSD with good knowledge of the literature - incredibly valuable. I do hope he sees our attempts to work on the page as an effort to use our good knowledge of Wikipedia to reach good, or even featured article status - and remember that FA is a Wikipedia-specific goal and therefore will require people who know the encyclopedia as well as Tom knows PTSD.

MKULTRA does a nice job in my opinion, of having minimal inclusions of pop culture appearances (which satisfies fanboys and does given an impression of the topic's impact on society) but lacks lengthy discussion of each example. I see it as a reasonable compromise between no trivia and a massive trivia section. My personal rule of thumb is if X is amajor plot point in Y film, it could be included in the article on X - but generally only as a brief mention. As the list of trivia gets longer, the explanations/references get shorter while the criteria gets stricter. MKULTRA and PTSD aren't strictly comparable (and MKULTRA is a great plot driver), LG is correct, but the principle used in MKULTA is in my opinion a good one. An alternative could be a standalone list, Posttraumatic stress disorder in popular culture. Not a terrible option either - this page would just feature a WP:ALSO link. Remember too that a large trivia section is evidence of how important the topic is in the public awareness. Not a bad thing to have! Even better would be a scholarly discussion of how PTSD appears through the lens of popular culture, I bet there's a lot of interesting misunderstandings to be found there. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:23, 20 March 2010 (UTC)

If this article is to have a list of pop culture references, it should be a stand-alone list in my opinion. And no disrespect intended, but I hardly think an issue as widely mentioned in the popular press as this needs a trivia section to indicate how important the topic is. I see such lists mostly as padding and dumbing down, particularly when it comes to topics as weighty as this. MarmadukePercy (talk) 14:31, 20 March 2010 (UTC)

My quick response ('cause we all seem to be here at the same time):

• I know I can be verbose. In part that's out of a desire to be thorough, and in part it's because that's the way my brain naturally works. I expect people to be able to read and think. If you could compare my first drafts to what you actually GET you'd be grateful for the latter! I CAN edit down, but it take time, and I usually have more critical issues to get to. I do the best I can.
• Please note that I have a strong desire to converse, rather than dictate or do power plays. When I make a point, I expect a reply to that point, and in my replies I try to address specific key points someone else has advanced. That's how good argumentation is done, and not by doing end-runs around an adversary's assertions (which is bad form and bad manners). Take my style as a mark of respect for the people I'm talking to, because it is. Good argumentation is often arduous and time-consuming, and it's also likely to lead to a solid result. It's how research, and science in general, is done - cultures in which I'm well trained. Those who can't stand the heat probably shouldn't be in the kitchen. When we can be terse and get the job done, let's. Otherwise, let's just get the job done. That's what I'm trying to do here.
• I appreciate all referrals to WP's various policy statements, etc. I will follow up on all of them, period. I'm still learning this stuff. However, I see little need to lean on policy when I'm expressing a sound argument, such as the distinction between culture history as a discipline and the culture itself as data, Any college graduate should understand that distinction, and WP doesn't need to have a policy about it, surely.
• That I argue emotionally at times is likely true. If you saw what I see, daily, in the real world, you likely would also have some feelings about it. (I'm posting a blog entry later today mention of which I'll make here, to give you some insight on this.) However, my arguments are, I think virtually always arguments, not emotional protestations. I'm well aware of the difference. I ask myself to make sense, and I'm more than willing to be confronted if/when I do not. Have at it!
• WLU, I DO indeed see your "...work on the page as an effort to use our good knowledge ofWikipedia to reach good, or even featured article status..." I'm glad you're here. And it's OK with me for us to be at odds at times, both because you make sense enough of the time to deserve my respect and because you clearly are acting in good faith. You're quite right in saying that getting to FA status here "...will require people who know the encyclopedia as well as Tom knows PTSD." So, let's work for this goal together.
• "...Wikipedia in general has a bias against popular culture/trivia sections..." I find that reassuring. For me, it's about priorities. And in the past 2 weeks, virtually ALL my time for this article has been spent keeping the barbarians at the gate. Why do people think that possession of a keyboard qualifies one as an editor of the substance of this article? I don't understand this. Is this an effect of the Internet's social networking culture? Begone, dammit.
• Re: PTSD in popular culture: again, we need priorities. There is a crying need to get out to the public accurate current information about PTSD and its treatment. This article is not far from being adequate, but it's not there yet. The problems do NOT have to do with lack of mention of "PTSD in popular culture". When you say "Even better would be a scholarly discussion of how PTSD appears through the lens of popular culture, I bet there's a lot of interesting misunderstandings to be found there...", I totally agree. I've already said several times on this TALK page that this seems like a very legitimate topic. Now, someone needs to find some decent scholarly references on it (as I've previously said). I simply have bigger fish to fry, so it won't be me. A great topic, though, and not one the "have keyboard - brain optional" crowd can ever address. Playing "World of Warcraft" (name right?) does take a lot of time, you have to understand...
• "I very much don't want Tom to leave" - Thank you. It would help greatly if I could get back to work here. Doing well by this subject is very time-consuming.

• WLU, that External Links section you deleted took me almost a day and a half to do. I reviewed a great many sites, and then reviewed virtually every page of those I decided to keep. It was an extremely thoughtful exercise, done for reasons I still don't think you appreciate. Your removal of it looked like legalistic vandalism to me. I'm still reviewing your comments, and my view are moderating. I'll get back to you on this. My point, however, is that while I do this, all work is stopped elsewhere.
• The section on medication is now the best I have ever seen anywhere. It cost me four day nonstop work. It's meticulously sourced. No one's messed with it because I think very few people are willing to pay the price of admission. I am, which is why it got done. You CAN wear me out. If I make very major contributions here, and, of course, do not get author attribution, AND have to perpetually fight off no-nothings with keyboards, I may have to reconsider the wisdom of my getting involved. Tell me, has any other Mental Health Professional ever made significant contributions to this article? I don't think so. I may be a very precious resource. I do get some help from several people (very much appreciated). I could use more - and, yes, cleaning up the article per WP policies, etc., is likely to be helpful, I think.

Tom Cloyd (talk) 15:33, 20 March 2010 (UTC)

I have had this article watch listed for 18 months or so and you are correct that no professional or even enthusiastic lay person became involved in developing the article. It was mostly drive by ip editors and one day wonder established editors adding a sentence here and a sentence there so I was quite pleased to see you develop this article to its current standard. It can be very disheartening to see a days work removed, however, this is part of the program on "the encyclopedia which anyone can edit". A good understanding of guidelines and policies will reduce the chances of wasting your time doing edits. I used a lot of primary sources when I first joined wikipedia and wasted months and months of work which I then had and continue to have to resolve by finding secondary sources. You may do well to install WP:TWINKLE and to reverse edits and appropriately warn those engaging in vandalism, insertion of spam links, original research etc; just be careful not to template the regulars if using this tool. I rarely initiate conversations on talk pages but rather revert or edit in combination with an edit summary explaining my changes or if necessary, the use of the twinkle tool. Your post above is very long which then requires lengthyish replies from other editors, so I think you are at risk of driving yourself away, but if you take on my and WLU's suggestions you can edit with less time wastage and with less stress.--Literaturegeek | T@1k? 16:02, 20 March 2010 (UTC)

Will check out "Twinkle". Will work on brevity (not a new idea!). I do appreciate suggestions from you and WLU (and as a consequence have some studying to do). Over and out.Tom Cloyd (talk) 17:00, 20 March 2010 (UTC)

Dawning light. OK, I think I get it. My anthro. background informs me that legalismsfunction to short-circuit conflict and speed up conflict resolution. You are both suggesting I employ them more here, "policy" and the like being the legalisms of WP-land. That actually makes sense! If it can free me for more actual work on the article I'm totally on board. So...will shift to the other foot and give it a whirl. Just might work. Tks.Tom Cloyd (talk) 17:20, 20 March 2010 (UTC)

"Cultural References" - why this topic does not belong here at all

We're not thinking clearly here. "Cultural References" has something to do with culture (I have a Masters in Cultural Anthropology, as well as one in Counseling Psych., so I'm on home turf here). That's a completely different topic from mental illness/health.

What it ideally would address is something like "Mental illness as a concept in the popular culture of the First World (Industrial society, etc.)" That's a great topic. It's also not what this article is about at all.

But beyond that, "Cultural references" is tiny piece of this larger topic. It would be a recitation of, well, popular cultural references (we wouldn't want to address the culture of professional mental health - that's the topic of THIS article). So, let's say I have 50 such "references". They would be what? Movies, short stories, etc., which purport to be about PTSD in some way. The subject is not PTSD itself, but how these materials portray, refer to, handle, etc., PTSD, which is the "culture" part of the topic. In other words, I'd have a set of instances where people are revealing what they THINK PTSD is about. A great topic, I think. Also notwhat this present article is about. And...it's just a list of references, nothing more.

That basically is what I found when I came initially to the "Cultural References" section. Titles, and references to reviews. All primary sources for someone to do culture history with -which no one was doing, by the way. If someone can find material which actually talks ABOUT popular culture and PTSD, instead of BEING popular culture and PTSD, we begin to have something. But...not for this present article.

Please, let's get this straightened out, and get back to actually producing a quality article about PTSD. Tom Cloyd (talk) 20:50, 15 March 2010 (UTC):

Adding the pop culture commentary to this piece is akin to the old expression: Bad money drives out good. It is a disservice to the encyclopedia, and an immense disservice to anyone who comes to wikipedia to find out more about this condition. I fully support excising this triviality from an article on such a weighty topic. MarmadukePercy (talk) 21:03, 15 March 2010 (UTC)

This guideline may be relevant,WP:TRIVIA. This article is a B class article, well developed, I think that trivia sections should not be added.--Literaturegeek | T@1k? 21:59, 16 March 2010 (UTC)

Interesting. Wasn't familiar with that article. Thanks for the reference, and for your support. I would like to clarify that for me the issue is most centrally about not misleading anyone. Popular references to "PTSD" are full of inaccuracies, most of which are prejudicial to victims of PTSD. If, in this article, we refer people to these references they may well have no awareness of the inaccuracies they are encountering, some of which are rather subtle. We then become parties to perpetuating prejudicial myths. I am strongly opposed to this. My whole reason for being involved with this article has to do with making available to people who come here the best possible information. They deserve nothing less, and I will settle for nothing less.

Thanks again for your comment.

Tom Cloyd (talk) 23:34, 16 March 2010 (UTC)

Thanks for the very useful ref, Literaturegeek. MarmadukePercy(talk) 23:43, 16 March 2010 (UTC)

Here I am, cluttering your Talk Pages again, but I couldn't resist. The Cultural References section or concept is not without merit, however an encyclopedia article has to be necessarily concise. Thus it is at least a matter of good database management that the PTSD (or some other topic) article be footnoted in the Pop Culture, (i.e. Film Title) page first - not the other way around.

Modern literature and film, at least, influences the public's and perhaps the patient's perception of a disorder or syndrome thus may affect a person obtaining proper diagnosis or treatment(??). But even then a separate article would be a good idea if only in the interest of breivity. Further, a screenplay is a theatrical device and is deliberately subjective, as opposed to much drier, less dramatic scientific descriptions. Some of the contributors might be onto something, but their observations belong in an article in the film and theatre genre, not clinical medicine or scientific categories.

I had to drop in since I thought my "Catch 22" reference was a victim of collateral damage in this discussion. Turns out it was cut mostly because it began to display the traits of clutter- good - I concur! However I should point out that the "Catch 22" concept is a little special. Whether derived from the novel or the film the concept has made it way beyond pop culture and into "Logic" [17] and dictionaries[18]. Even then, IF the novel or film had any meaningful reference or illustrative trait, then the cross reference to PTSD belongs in the "catch 22" items not the other way around.

As an analogy, the Catch 22 Film also shows some good footage of B-25 Mitchells (used in the Doolittle Raid) but to discuss B-25's in the article on the film makes no sense - except as a footnote, maybe.

Pete318 (talk) 18:27, 23 March 2010 (UTC)

Re: resetting dates to non-controversial format [2010.03.30]

Earlier today, a nameless editor reset two dates in the article from BCE to BC. This is provocative of a debate we don't need to have here. I have reset them to BC/BCE.

There has already been an extended debate (in May 2005) on which format to use. Consensus was not reached.

Wikipedia's Manual of Style (dates and numbers)states: If an article has been stable in a given style, it should not be converted without a style-independent reason... , and ...when either of two styles is acceptable, it is inappropriate for an editor to change an article from one to the other without substantial reason... This "nameless editor" offered no justification for the change, which I find inappropriate, at the least.

It is my personal opinion that the less Christian-centric BCE format is preferable, as it suggests a point of view more open to the diverse world we, and Wikipedia, inhabit. I am also aware that, to some of us at least, there appears to be an emerging consensus in most academic writing that the "BCE/CE" format is preferable - for the same reason (neutrality of viewpoint).

My resetting of the date to a format that reflects both formats is an attempt to acknowledge that at the present time, in this context, there is not consensus as to the preferred format.

Let's give our limited energy to more important matters.

Tom Cloyd (talk) 20:03, 30 March 2010 (UTC)

Guernica!

This simply takes my breath away. Your placement and size choice are perfect, to my eye. The low-intensity colors of the original come through beautifully. But, it's the emotional impact that is most powerful to me. I almost have trouble reading into the article after being confronted by this visceral image.(I probably know too much about PTSD!) There are few paintings in all of art that even approach the power of this one. I'm so very pleased to see this here. I hope others are as well. It really works. Thanks. Tom Cloyd (talk) 01:54, 11 April 2010 (UTC)

Many thanks. I am glad that it strikes you that way. To me the image bespeaks the pain and confusion of war and other suffering inflicted by human hands.MarmadukePercy (talk) 01:58, 11 April 2010 (UTC)

It is a great image. Would be best however to place it in the disease box IMO. This will keep the formatting consistent with the rest of the medical topics.Doc James (talk ·contribs · email) 09:38, 11 April 2010 (UTC)

I'm all for consistency, but in this case I see a problem. The image's meaning lies in a wealth of details. In real life (I've seen it) it's quite large, Reduced to its present size, one can still quickly be drawn in to the details, not to mention the subtle coloring. I fear that reducing it to the width of the disease box would make it a virtual postage stamp, and its real impact would vanish. Is there any substantive problem with leaving it as it is, so far as you know? Tom Cloyd (talk) 11:38, 11 April 2010 (UTC)

Reducing the image to a postage stamp will rob it of its power. I agree with Tomcloyd that the wealth of detail is what matters. Also, from a graphics standpoint, the page is far stronger with the image as it is.MarmadukePercy (talk) 17:15, 11 April 2010 (UTC)

I think the painting is distracting and it radically breaks from the format of similar articles. Maybe it could be included later. I think it would fit perfectly under psychological trauma. I just don't think it should be the first thing you see. It looks unprofessional. —Preceding unsignedcomment added by 199.76.185.25 (talk) 23:00, 14 April 2010 (UTC)

In scholarly method, we have consensual standards. In selection of art for expositions of scholarly discourse, we do not. Therefore, there will be contention about selections made. There certainly has been over at Major depressive disorder. I suggest that where art is involved, there will always be disagreement. (For a time in my life I was a professional artist, and saw this first hand!) Those who do not like a given selection will find it jarring and, yes, distracting. I don't know how to prevent this.

Some of the good reasons for accepting this illustration, as well as some of the arguments against, have been laid out [19], and you might want to review them.

You should know that the association of fine art with psychology, and also with medicine, is long and rich. Most undergraduate textbooks make liberal use of photographic and fine art. The cover of the weekly Journal of the American Medical Association (JAMA) is notable for its frequent of fine art depicting medical activities or people who might be patients, or sometime simply beautiful art that has no clear connection with medicine at all. Their art selection is the first thing one sees when picking up the journal. We're on very solid ground when we illustrate this article with a major work of art. (My basis for knowing this is my present status as a professional psychotherapist, and the fact that I receive weekly emails from JAMA with their cover and contents listing.)

The format of other similar articles is not something that is required, howsoever a good idea it may be. Conformity is not an essential virtue.

When you say the selection is "unprofessional", you must say more. Saying only that is simplename calling. Provide more specificity and your comment could be useful to us. Can you?

Tom Cloyd (talk) 04:07, 15 April 2010 (UTC)

Hey. Sorry. The unsigned comment above was mine. I don't guess it matters now re the comment below by carl. But it wasn't the use of the painting per se that I was commenting on. It was the gravity given to the painting by placing it centered at the top of the page. the MDD article uses their image a little more tastefully in a way that does not detract from the text of the article, it make it seem like you've reached a page about Picasso instead of PTSD.

Granted, the width of the image causes some problems in relation to the type of usage in the MDD article. Again, I'm not against using it, I'm against giving it such a prominent place on the page. It is not the focus of the article, it only tries to give insight into the subjective experience of the disorder. That's fine, but it warrants a more subordinate placement relative to the actual encyclopedic content.

Timothyjwood (talk) 16:59, 15 April 2010 (UTC)

Non-free image policy

Not realizing there was a discussion about this, I removed the image for a different reason: it is not in alignment with our Non-free image policy. The Guernica image is copyrighted and non-free, and we cannot use copyrighted non-free images as decorations at the top of articles. It is true there there may be some tangential relationship, but the article does not discuss the painting at all, and the use of the image at the top of the article, above even the infobox, is not necessary for reader understanding of this topic. — Carl(CBM · talk) 15:30, 15 April 2010 (UTC)

I'm not familiar with all the wikipedia policies for images, but if that is the case, then I can understand the removal of the image. But let's be clear: the image was not placed as 'decoration' of any sort. This is way too serious a topic for that. It was placed there, as publishers often do, to enhance the text and draw the reader's attention.MarmadukePercy (talk) 18:15, 15 April 2010 (UTC)

Yes, I'm sorry, I chose my words poorly. Non-free copyrighted images are permitted in limited circumstances as discussed at WP:NFC. For paintings such as Guernica, if the article discussed relationships between the painting and PTSD, that would be an argument for using the image in the context of the commentary. However, if the article does not mention the painting, we can't use the painting as a general illustration, because of our policies on non-free copyrighted images. — Carl (CBM · talk)19:16, 15 April 2010 (UTC)

• I agree with Carl's assessment. --Hammersoft (talk) 19:33, 15 April 2010 (UTC)

You appear to be more informed about these matters than am I. I'll go read up on them. You make sense to me.

What is your source for the assertion that this image is copyright? Are you referring to the painting or the photograph of it, either of which could be copyrighted...? You need to document your assertion. (And we need to do our research to verfify that it is NOT copyrighted, of course.)

As to the issue of image placement, I can give a great many examples of prominent use of art in psychological and medical writing simply to catch the reader's eye, or to raise questions (thus drawing them into a document), etc. The easiest one to reference would be the Journal of the American Medical Association, which I've already mentioned elsewhere. If we can find a way to use it, and the image size can be preserved, I would certainly be willing to look at placing it lower, but I'm not sure there's a compelling argument to do this. We need to settle the copyright issue first.Tom Cloyd (talk)22:29, 15 April 2010 (UTC)

Published in 1937 outside the US and still in copyright in spain/france. Copyright will likely expire in the US in 2032.©Geni 00:22, 16 April 2010 (UTC)

not good enough - It was created, not published (minor point). Major point: You are only asserting, not documenting. That's of no value. Sources, please. Tom Cloyd (talk) 00:58, 16 April 2010 (UTC)

The painting was created in Spain in 1937. Spain signed the Berne Convention on copyright in 1887. Under the Berne Convention, copyright is automatic upon creation of a work, and has a minimum duration of fifty years beyond the death of the author. The author died in 1973. Therefore, in all countries that are signatories to the Berne Convention, Guernica will be copyrighted until at least 2023. --Carnildo (talk) 01:30, 16 April 2010 (UTC)

I don't dispute the image is under copyright. Nevertheless, it illustrates other wikipedia entries. I cannot imagine a better illustration of the terrors inflicted by war, rape, child abuse and other causes of PTSD than this image. It mirrors the state of mind of those who have been traumatized better than any photograph I've seen. I consider that a fair use rationale.MarmadukePercy (talk) 02:32, 16 April 2010 (UTC)

• It's an insufficient rationale. There are many images which might be tightly tied to a given subject. It doesn't make it legitimate to use it here under our non-free content policy. Take for example File:WW2 Iwo Jima flag raising.jpg. This is one of the most famous war photos in history. It is tightly associated with World War II. Yet that image is not used on the World War II article, nor is it used on Battle of Iwo Jima. This article, prior to the removal of the image, made no mention whatsoever of the artwork. Further, failing the location of secondary sources associating this artwork with this disorder, placing the image on the article constitutes original research. You might think it a wonderful illustration for the article. What you and I think really doesn't matter. What matters is if we can verify this artwork has a strong association with PTSD via reliable secondary sources. That doesn't exist at this time in the article. Find it, and maybe there will be a valid rationale (no guarantees though; there's a rationale for the Iwo Jima flag raising image on the battle article, but it's not there and for good reason). --Hammersoft (talk) 12:49, 16 April 2010 (UTC)

This is such a source: "Painters have often attempted to communicate traumatic emotions through their transformation of traumatic imagery – for example, Rembrandt's depiction of Lucretia's condemning herself to suicide after rape; the plight of the unrescued disaster victims in Gericault's Raft of the Medusa, and Picasso's communication of terror, the grotesqueness of a dismembered body and agonizing grief after the bombing of civilians in his depiction of Guernica. Writers have provided detailed personal accounts of their own traumatic experiences – for example, Samuel Pepys' description of his personal reactions to the Great London Fire of 1666, and Maxim Gorky's autobiographical remembrances of child abuse and witnessing of spousal abuse." This is excerpted from Core Readings in Psychiatry: An Annotated Guide to the Literature, published by American Psychiatric Publishing Inc.[20] MarmadukePercy (talk) 18:35, 16 April 2010 (UTC)

Incidentally, here are the other two works referenced in the psychiatric text: Gericault's Raft of the Medusa[21], and Rembrandt's Lucretia[22]. I find Guernica the strongest of the three images. MarmadukePercy (talk) 18:59, 16 April 2010 (UTC)

Both of these could be used without problem, since they are no longer under any copyright. Guernica, alas, cannot. Even under our policies that allow for contextual significance, you couldn't use it here because we have the article Guernica (painting) and readers can always go there to see the painting and we always try to restrict the usage of non-free items to locations where they are absolutely necessary. howcheng {chat} 01:51, 18 April 2010 (UTC)

bingo - subject to verification, that's precisely the documentation needed. Thanks. Which leaves us with the fair use issue. More research needed.Tom Cloyd(talk) 03:11, 16 April 2010 (UTC)

WP does not worry about fair use (in fact, I would suspect there is no problems with the image per fair use laws in the US as was used). WP instead has a stronger standard, the free content mission and the minimization of non-free content where it is only essential to improve the understanding of articles on which the image is used on. Very difficult to assert here if its mostly decorative. --MASEM (t) 13:23, 16 April 2010 (UTC)

Section on signs and symptoms of PTSD

We still need a section on the signs and symptoms of PTSD.Doc James(talk · contribs · email) 22:12, 18 May 2010 (UTC)

The problem as I see it is that this concept is alien to the profession. Only physicials think in terms of this concept. The literature does not contain the distinction, except in psychiatric textbooks where it's given a tip of the hat, after which the discussion is solely of symptoms. Look at Kaplan and Sadock Synopsis of Psychiatry (7th ed., 1994 - DSM-IV current). Ch. 8 -"Typical signs and symptoms of psychiatric illness defined" is very thorough in its exposition, but is a general treatment of all diagnoses. But in Ch. 16.5 - "Posttraumatic Stress Disorder and Acute Stress Disorder" the distinction vanishes. The phrase does not appear. It's likely relevant to diagnoses like psychosis and some others where there are overt signs, but PTSD? I don't think. No one talks about the "signs of PTSD". It might be useful if they did, I think, but it just isn't seen.

In the real world of research on, diagnosis of, and treatment of PTSD, the distinction between signs and symptoms simply is not used. I was never taught it, I do not encounter it in the literature, and I only see it coming up on websites when some psychiatrist decides to trot it out, typically using it to title a section where only the DSM diagnostic symptoms are listed. This use of the phrase "Signs and Symptoms" may comfort physicians, but confuses health care consumers, and is meaningless to the vast majority of psychotherapists. So, why continue to expose people to what has become an anachronism? Where's the benefit? I really don't see it.

Any thoughts?

Tom Cloyd (talk) 22:28, 18 May 2010 (UTC)

We could use the term "characteristics" if you prefer. See WP:MEDMOS for typical section headings or ordering.Doc James (talk ·contribs · email) 22:33, 18 May 2010 (UTC)

Nice word. Personally, I LIKE the "signs and symptoms" notion. But if we do something that people don't expect it's close to being an "original contribution", which has obvious problems.

Can you help me understand the problem you're having simply with staying the "symptoms"? If I understand the DSM committee, the long range issue has been to focus people's thinking on operationalized concepts, so as to rid the profession of conceptual baggage that simply was not moving us toward better care. I think this is an excellent notion. Historically, the problem was that traditional psychoanalysis had become a dogma, at the precise time that scientific psychology was producing science-based psychotherapy. Ideas that could not be operationalized were (properly I think) deemed ill-advised. For example, given that a person has had a serious auto accident, and post-accident has acquired alcohol dependence, and appears to relatives to sleep poorly, and is also seen to be depressed in ways that cannot be accounted for by the alcohol use, we have clear signs of possible PTSD. Clinically, though, this isn't useful. We don't fish for clients this way. We go after symptoms directly, because it's so easy to do, and more reliable as indications of the disease. So, focus on symptom alone is what you see.

Where that leaves us that for all intents and purposes there ARE no signs. There well may be a paper somewhere which attempts to delineate such signs, but its content certainly doesn't have the formal validity of the DSM symptoms, so how could we justify bringing that material into the article, except possibly in a section addressing something like "Alternative concepts of the disease". At best, this all would be seriously tangential, I think, hence my thought that it has little merit.

So, we seem to have two problem: the "original contribution" issue, and the sources issue. WHO says what the signs are? I've never even seen a "signs of PTSD" list. Not once. I'd be fascinated to find one.

Unless I've missed something, where that leaves us is that we can't bring the concept into the discussion. As for "characteristics", how would that be different from the DSM Sx, and what would be our source citation?Tom Cloyd (talk) 23:48, 18 May 2010 (UTC)

A further thought: I know of discussions of the "impact of PTSD", or the "functional consequences of PTSD". This might be useful to take up, and there are available citations. However, this is conceptually distinct from data, traditionally referred to as "signs", used for diagnosis of diseases other than PTSD. Tom Cloyd (talk) 23:54, 18 May 2010 (UTC)

If we look at other pages such as Major_depressive_disorder#Symptoms_and_signs we see that they have the signs and symptoms section is more general language and than the diagnosis section based on criteria from the WHO and DSM. Poor eye contact / flat affect would be signs of depression, well easy startling might be signs of PTSD. In one of the few cause of PTSD that I saw the person definitely had serious symptoms ( he had been chanced by a bear for 5km through the wood and whenever he stoped to look back the bear was right there, he I must say was not able to work as a lumberjack again ). Doc James (talk · contribs ·email) 00:02, 19 May 2010 (UTC)

I don't see the two problems I delineated above being addressed here:

• Since S&S is not a part of the literature of PTSD, adding it here, with whatever basis, is an original contribution. Can't do that.
• Since S&S is not a part of the literature of PTSD, we have no sources to use to justify the addition of such material to the article.

I don't see how to get past these problems, and I've thought about this a lot. Other diagnoses have different literatures. I'm addressing the problem we have here, which has to do with Wikipedia's "rules", and our need to use scholarly method in our contributions.

If these problems could be solved, I'd be fascinated to see how it might be done. Personally, I'm baffled.Tom Cloyd (talk) 02:15, 19 May 2010 (UTC)

(undent) Here are some refs for signs and symptoms of PTSD[23] and[24] Doc James (talk · contribs · email) 00:55, 26 May 2010 (UTC)

Terrific. I'll be most interested to investigate. However, it won't be for a week, as I'm prepping for a flight out of here and will be gone until Tuesday next. Will put this on my list to get to quickly upon return. Am really curious.Tom Cloyd (talk) 16:43, 26 May 2010 (UTC)

No worries Tom Wikipedia is not going any where and will be waiting for your return :-) Doc James (talk · contribs ·email) 16:46, 26 May 2010 (UTC)

Review of articles you point me to. First, thanks for your patience. My trip has led to a life changing decision. I'm moving my practice and residence to extreme southern Utah in 6 weeks. My schedule has gotten even more crowded than before, but it's all in all a good thing.

• Posttraumatic Stress Disorder: Clinical Features, Pathophysiology, and Treatment, a legitimate journal article, fairly consistently uses the phrase "symptoms and signs", in speaking of various aspects of PTSD. But this is only a substitute for "symptoms", and appears to serve no real purpose. At no point are "signs" delineated from symptoms, and in fact the disease features detailed are merely the usual DSM diagnostic symptoms we know. There is not new content here, in this particular area of our present interest.

• Posttraumatic Stress Disorder is professionally authored content on a website targeted to a non-professional audience. It refers to "signs" twice - once in the section header. It then specifically refers to the third symptom group in the DSM diagnostic symptom grouping as "signs" - this is anomalous, and not how the DSM or other authorities refer to these disease features. Kaplan and Sadock (1994) - referred to above - define "signs" as "objective findings observed by the clinician" (p. 300). No surprise there.

The problem is this: the disease features summarized in the webpage content - "chronic physical signs of hyperarousal, including sleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, increased tendency and reaction to being startled, and hypervigilance to threat" are never going to be merely observed by a clinician. They are elicited in an assessment interview, which makes them symptoms, not signs. I grant that in rare cases SOME of them could be merely observed, but that is not characteristic practice. We're not interested, for example, in "trouble concentrating, irritability, anger, poor concentration" (the disease features we might observe in an office setting) seen in the office but in that which occurs chronically in the client/patients life in general. It is THAT context which allows the diagnosis of the disorder. They MUST appear there, and to get that information it must be reported, not observed, and thus become not signs but symptoms. A broken leg or rash seen clinically may be presumed to exist at home as well; not so with concentration problems or anger, for example.

That said, the other issues I raise above also must addressed: Nowhere have I seen a thoughtful statement of the "signs of PTSD" (so we have nothing to cite), and even if it existed it would still be so anomalous as to hardly be worthy of citation. The most notable authorities, not the least of which is the DSM itself, speak only of symptoms. That's the only practical thing to do, for reasons I just outlined. Speaking of "signs" may conform to customary practice in other areas of medicine (but not psychology, where the distinction is essentially non-existent), but that's all it does. Achieving that conformity does violence to expected practice in mental health and psychiatry when speaking/writing of this disorder - and that is demonstrable (by drawing a representative sample of the relevant literature and producing a summary of its characteristics).

So, I remain resigned to the proposition that the "Signs and symptoms" distinction does not belong in this article. I don't thing we can rationally arrive at any other conclusion. It may appropriate with other mental illness diagnoses. I don't take that up here, as I'm devoting myself solely to this article.

As for the notion of beginning with a "Characteristics" section, I have no problem whatsoever with that - other than that any reference we could use which readily comes to mind talks of symptoms, and we'd just be calling it characteristics here. It does seem possible, however, that this problem can be solved. I'll look into it tomorrow. I do have some ideas.Tom Cloyd (talk) 09:35, 16 June 2010 (UTC)

Article lead inadequate

The lead could do with better summarising the article content, per WP:LEAD. I think if this was done and the signs and symptoms done as well, the article could bee nominated for good article review and hopefully then promotion. :) I will try and improve the article when I get a chance but I am busy at the moment.--Literaturegeek | T@1k? 22:58, 31 May 2010 (UTC)

I suggest that it is significantly premature either to rewrite the lead or to submit the article for Good Article review/promotion. I have aplan for article development, most of which has been available here for review and comment for 5+ months. There has been little or no comment on or objection to the vast majority of it. It proposes significant improvements, including the checking of all references. This is important work to be accomplished before asking for "promotion". I have found significant problems with too many citations, so I think this work is mandatory.

As for the "signs and symptoms" issue, I have written about this inSections. The discussion is ongoing. At present, as a professional who treats PTSD as a specialty, I have serious reservations about adding such a section to the article. We need to reach clarity and then consensus on this issue before acting, I urge.

I have not gotten much past the plan proposal, to date, largely because the Jan. - May period is my absolute busiest, professionally, of the year. I'm just coming out of that time, and am very eager to get to work here. I suggest that we accomplish this work, or most of it, prior to rewriting the lead and submitting the article for promotion. What needs to be done is not controversial - mostly fixing silly errors and improving the writing. THEN we'll be positioned well for promotion - which surely is less important than simply getting the article right. I would already have started this period of much more active work on the article but for my having just spent a week in the high mountains of Utah, consulting on professional matters with a colleague. I returned less than 48 hours ago, and have yet even to unpack. Today, I'll re-engage with this article.

Am I making sense?

Tom Cloyd (talk) 13:56, 3 June 2010 (UTC)

Nomenclature: "DSM-V" or "DSM-5"

Lova Falk reverted my reversion of her edit which changed DSM-V to DSM-5. I was sure this was incorrect, as the edition of the DSM has always been denoted by a Roman numeral. Lova ( nice userpage, Lova!) has provoked my curiosity by holding her ground on this issue. As it turns out, she's correct.

I went to Amazon to see what the usage was in book titles which already exist and which are proposed for publication. Predominantly, "DSM-V" is used. However, at the American Psychiatric Website devoted to the upcoming revision of the DSM, one sees predominantly "DSM-5". But "DSM-V" is still used there, so one is left with a confusing sense of where things are going.

I called the American Psychiatric Association in Arlington VA. I was told that the official nomenclature IS "DSM-5". This is being done, I was told, so that revisions for the document could be titled "DSM-5.1" etc., rather than the more awkward "DSM-IV-TR" which has been used in the past.

I was told that explanation of this change could be found at the http://dsm5.org website. I haven't yet found it, and would like to. I should think it would be prominent, but doesn't appear to be.

So, DSM-5 it is. Thanks for the correction, Lova.

Tom Cloyd (talk) 16:11, 11 June 2010 (UTC)

You're so welcome Tom! Thank you for your praise for my userpage. And I'm a bit proud to tell you that I located therequested link :) Lova Falk talk 18:08, 11 June 2010 (UTC)

Oh, that's excellent. I was a bit time constrained and couldn't take more time to find this. Now we can support ourselves with a citation, something I'm a bit compulsive about.

I see you're a school counselor. I've love it if you were to take an interest in this PTSD article. Treating PTSD is my specialty, and I have a large commitment to elevating this article to the highest possible standard. My plan for so doing is covered on this page - higher up. I'm the only mental health professional working on the article, so if you were to take ant kind of active role it could only be very helpful. Interested? Tom Cloyd (talk) 18:34, 11 June 2010 (UTC)

No thank you! I'm not ready (yet?) to commit to specific articles. However, PTSD is on my watchlist and I'll keep an eye on it, and do my occasional edits. As you can see. :) Lova Falk talk 08:14, 12 June 2010 (UTC)

OK. It's still a distinctly valuable function for someone to edit me over my shoulder, as it were (as you just did). I can overwork things sometimes, and getting edited back to a leaner version can be a good thing. So, at whatever level you can participate, I welcome it. I hope to back some substantive edits today, so you soon may have your hands full!Tom Cloyd (talk) 19:07, 12 June 2010 (UTC)

Bolding in management section

I find the bolding in the management section distracting and would recommend its removal as per[25].Doc James(talk · contribs · email) 19:53, 12 June 2010 (UTC)

I assume you're referring to the bolded paragraph leads (initial phrases) with which the paragraphs addressing specific pharmaceuticals in the "Medication" subsection begin. If so, here's why I did it this way:

• Paragraph leads may indeed not often appear in Wikipedia, but they are common in a great many other publications. For example, they are all over my copy of Kaplan and Sadock's Synopsis of Psychiatry (7th ed.). (Example: see pp. 223ff - "Adult Personality Assessment".)

• They are a great way to clue the reader about the topic of the paragraph, when it has a single focused topic, as these do. In the cases of these paragraph, the paragraph topic simply MUST be named.

• They avoid elevating the content of the lead to the status of a header, which in Wikipedia has serious consequences for the length and amount of needless detail in the page contents listing at the beginning of the article. I wanted to avoid these consequences.

I fundamentally don't really understand the objection. These paragraph headers clearly aid in the hierarchical organization of the section, and that is something which is strongly recommended in most treatises on writing for the Internet which I've studied. They make the content more immediately accessible to the reader, by embedding an outline in the content, just like headers do. Where is the "distraction" to which you refer?

So, I hope you see that I was just following a well-established tradition in writing, technical and otherwise, and with clear and well thought out intent. The Style Manual section to which you refer simply does not address the considerations I detail above, taking up only more general issues of text bolding. It also does not advise against the usage I employ here.

Given these considerations, I think the paragraph headers should remain. Am I making sense? Tom Cloyd(talk) 08:52, 16 June 2010 (UTC)

Removing all references??

Hi Tom, I'm really surprised at your undoing my edit. I did not remove all references, I undid one reference after a sentence that has two additional references. Why keep a bad reference when there are two good ones?? Furthermore, I wikilinked bullying with this mobbing reference, so the reader can simply click on bullying and will get to the mobbing article.Lova Falk talk 16:51, 17 June 2010 (UTC)

I agree with your removal of the wikipedia link used as a reference. I was considering reverting Tom but then saw this post, so shall wait for him to answer this posting section first for his reasoning.--Literaturegeek | T@1k? 16:57, 17 June 2010 (UTC)

Lova - I was slow to see what you were doing, and was concerned only with what appeared to me to be the loss of possible path to a good reference (see my comments below). Sorry! I have no problem with your wikilinking "bullying", other than that it didn't go to the bullying article, but to the mobbing article. I have inserted both links into the article now. Looks like a good solution to me - not a citation, just a link. You agree??? Tom Cloyd (talk) 19:50, 17 June 2010 (UTC)

About my reversion. Hi folks. Sorry to be slow getting to the explanation of my edit, which I promised. I was writing it when my professional life intruded and kept me busy for a while. I'm back now. Here's my thoughts:

The sourcing Lova removed was one of only two sources for an assertion that formerly had been placed in its own paragraph, at the end of this section of the article (this was the article before I started this revision). I improved narrative flow by merging that assertion with another very similar one, and merging the sources as well. The topics (plural) arechildren AND adults - and sources address each separately. In the merged version, this is no longer obvious, I admit.

I am well aware that there are multiple instances of use of poor-to-unacceptable sources in this article. In my overview of work to be done to elevate the quality of this article, this matter receives considerable attention. Please seeList of specific tasks for detail on this.

When a poor or unacceptable reference is found in the article, as was done by Lova Falk on 2010.06.16, in the Causes > Psychological trauma section of the article, the solution is NOT to delete the reference citation, leaving an assertion poorly sourced or not sourced at all, but to improve the source, if possible. This will require a little research, for which one may not have time at the moment the sourcing problem is found.

Since I am engaged in a section by section review of the article, looking at extant sources, reduction of these sources to summary narrative (producing the article text), and overall completeness of each section, given the state of the literature in general, I expect to sweep up and remedy all or most sourcing problems in due time. This orderly walk through the articles sections is a far superior approach to fixing each problem as it comes to ones attention, as it involves consideration of a whole set of sources relevant to an article section, rather than a series of mere topical fragments. This whole-section review was accomplished by me some weeks back when I rewrote the entire medication section, resulting in a much improved discussion of the topic (I think!).

So, I ask that editors consider the virtues of the following procedure, when they find an example of poor sourcing in this article:

• if you have, or can easily locate, a better source, substitute it.
• if you don't have time to fix the identified problem, please do NOT remove the inadequate citation, as it may be a quick path to an adequate source, when someone has time to fix the problem in the future.
• if you can flag the problem it would be helpful. Some potentially useful possibilities can be found onhere. (I have flagged this problem, now.)

My goal here is simply to produce a solid, professional-level article as efficiently as possible. Deleting the reference, in this case, removed a link to a page where adequate references might well be found. Later, an editor coming to this section will not see the reference, and will not look for that reference. That was my only concern. I have now gone to the cited Wikipedia article and found an entirely appropriate reference, as I expected I would. It is now cited in the PTSD article. Tom Cloyd (talk) 19:08, 17 June 2010 (UTC)

Hi Tom, you say that there are only two sources, my view would be that you only need one source and using wikipedia as a source, violates WP:RS and WP:NOR. If the other source does not reference the comment, the thing to do is to add a {{fact}} tag (citation needed); but again if the remaining source covers the text written then adding a fact tag is unnecessary. I think that you should undo your revert.--Literaturegeek | T@1k? 19:15, 17 June 2010 (UTC)

You give me only two choices: leave the original text completely alone, or fix all obvious problems. I didn't want to do the first, and had not the time to do the second. I chose a third alternative, knowing that I'd return in the future and review not just the sourcing for this one assertion but for all in the section - a better idea. I fixed the obvious narrative flow problem, and left the citation problem for later.

Lova excised a clearly bad citation, and in so doing removed the path to what turned out to be a very good citation for the part of the assertion pertaining to adults. I merely suggest that less formalism and more substantive scholarship would be an better strategy. If someone inserted a citation to the Mobbing article, they must have thought there to be something of value there. Before wiping out that citation, we should investigate that possibility. This, to my mind, is far more important than merely achieving a superficial alignment with Wikipedia "policy". Legalisms are easy and quick (and often a fine idea). Careful scholarship is a better idea, I suggest. It's just more work, often, which is why I only did part of the job originally. I do what I can with the time I have, then come back later to do more. Today I had time to locate the good reference in theMobbing article, and it's now in the PTSD reference list. Tom Cloyd (talk) 19:31, 17 June 2010 (UTC)

Interesting BBC News article - Tetris

Just thought this'd be interesting, and perhaps useful for the article: http://news.bbc.co.uk/2/hi/health/7813637.stm Aar  ►  23:52, 14 July 2010 (UTC)

It is interesting, and fortunately the primary source reference is online, at a reliable location:Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science.

OK - have just reviewed the source article. This is cognitive psychology research. Its application to PTSD attenuation or treatment is unknown. All we have is speculation. The sample is unconscionably small (20 in control, 20 in treatment condition). This does not warrant inclusion in the article, at this time, in my opinion. Our time is better spent editing the main assertions of the article and the sources upon which they are based. Tom Cloyd (talk) 05:17, 15 July 2010 (UTC)

Behavior therapy not the same as cognitive behavior therapy

These types of thereapy are distinguishable by case conceptualization, interpretation of change, and techniques used. Exposure is a behavior therapy technique. 72.92.4.43 (talk) 21:59, 17 July 2010 (UTC)

Um...The assertion that "Behavior therapy not the same as cognitive behavior therapy" states the obvious. ALL distinct types of therapy are distinguishable by how they conceptualize cases, etc.

Let's talk about the conceptualization of exposure: Notwithstanding how it might have been conceptualized historically by various writers, it is certain possible and reasonable, in the age of neuropsychologically informed and developmentally structured psychotherapy (see Alan N. Schore - Affect dysregulation and disorders of the self and Affect regulation and the regulation of the self, for example) to conceive of exposure as a cognitive behavioral treatment. Why would you NOT do this? What is advantage? Skinner himself argued that behaviorism was only a research strategy, and not a stand-alone model of behavior and how it comes to be. Tom Cloyd (talk) 23:54, 17 July 2010 (UTC)

I have OCD and PTSD... I have for many years. i have not dealt with it I did not want to believe it. But now I am forced to believe it, it has affected my life and continues to ruin my life. It controls my mind and i hate the thoughts and reliving the trauma everyday. There is no way around the reminders they are everywhere i can not leave home or turn on the t.v without seeing reminders. I do not have friends I rarely go out I can not have a normal relationship. Medicine does not help. Sooooo what does everyone else do I am at a loss and I am tired of pretending it is not ruining my life. —Preceding unsigned comment added by68.189.48.124 (talk) 20:03, 4 August 2010 (UTC)

A gentle reminder - this is not a forum for discussion of anything but the Wikipedia PTSD article.

Now, as to your concern - I'm a mental health professional, and as such I say to you: Get professional help, from someone who treats OCD and PTSD. This may require dealing with two different individuals. Both OCD and PTSD are highly treatable in most cases. Tom Cloyd (talk) 18:49, 11 August 2010 (UTC)

I have issued a warning to Tomcloyd for the extremely inappropriate post above, and will hope that his behavior will change. SandyGeorgia (Talk) 00:09, 15 August 2010 (UTC)

Inappropriate? How? I see no need for behavior change. I'm in a position to give good advice and I did so. It was an appropriate and compassionate act, in my view. If you wish to argue otherwise, please execute that argument rather than merely casting unfounded aspersions, which looks to me like irresponsible use of your skills. Tom Cloyd(talk) 21:58, 18 August 2010 (UTC)

Removal of image improperly placed in disease infobox, with misleading and incorrect caption

This image should NOT be injected into the disease infobox. It appears to have intended to illustrate the article, not the infobox, which has no place for illustrations anyway.

The provided image caption has serious problems.

• The thousand yard stare is a folkloric term of dubious significance. How is it distinguished from the effect of simple fatigue, for example?
• To say that it is a symptom of PTSD is simply wrong. Since it isn't a concept used in professional mental health, OR in the formal criteria list for PTSD, this cannot be a supportable statement.

Finally, by a ratio of 2:1, PTSD victims are women (the PTSD article states this, and gives references). We need an illustration reflecting this, rather than one which perpetuates the stereotype of PTSD as a military-conflict-consequence, most commonly seen in male soldiers. In truth, most PTSD has nothing to do with military, nor with men.Tom Cloyd (talk) 20:07, 14 August 2010 (UTC)

Conflict of interest (COI) issue with this article?

Considering the misrepresentation of some sources here,[26] and the failure to cite up-to-date secondary reliable reviews such as the one I listed above (PMID 20051310), I am concerned that a WP:COIhasbiased this article and it should be reviewed and rewritten to conform to WP:MEDRS, eliminating opinion that may have crept in via overreliance on primary sources:

• WP:COI: "Adding material that appears to promote the interests or visibility of ... their business or personal interests, places the author in a conflict of interest."
• http://en.wikipedia.org/w/index.php?title=Wikipedia:Fringe_theories/Noticeboard&diff=prev&oldid=373568655
• http://tomcloyd.com/lib_iudb06263-symptom-mngment.html

SandyGeorgia (Talk) 05:40, 15 August 2010 (UTC)

Point by point:

• "...misrepresentation of some sources..." - according to you. They are not my sources, and I have not yet reviewed ANY of this section, as I indicated ina major, highly visible section of this Talk page.
• "...failure to cite up-to-date secondary reliable reviews..." - this is the first problem I have listed above, as of many months ago.
• "...COI has biased this article..." - well, if so, you give no evidence that I, Tom Cloyd, am the culprit. This is especially unlikely given that I pointed out problems with sourcing many months ago. If you wish to pick on me, go for the sections which I've actually written or re-written - which I've plainly noted. Where? Well, I've already pointed you to the relevant section of this page twice. One thing you cannot easily accuse me of is opacity, I think.
• "...it should be reviewed and rewritten to conform to WP:MEDRS..." - Use caution here. Psychology/psychotherapy is NOT a division of medicine. Medicine has to do with material aspects of the body and mind. Psychology and psychotherapy has to do with learning and relearning, or as Freud put it "habilitation and rehabilitation" (don't have the source on this). I most certainly did NOT train at a medical school, or in a department of one. WP:MEDRS seems to be a fine document, but does not specifically address psychology or psychology/psychotherapy journals.
• "Adding material that appears to promote the interests or visibility of ... their business or personal interests, places the author in a conflict of interest." - Necessarily? Nonsense. I practice in a very specific location. Like other health care providers, the people I serve have historically come from this local area, with extremely few exceptions. I've never had anyone contact me as a result of my contributions to PTSD. If I'm trying to promote my business, I'm doing a spectacularly poor job of it.
• reference to "fringe theories" noticeboard - just because someone claims on this page that something is "fringy" isn't evidence of the claim. My involvement in the cited discussion was invited, and was offered to quickly present an informed point of view. I rarely use EMDR at this time, but have serious, professionally derived knowledge of it. The claim that it's a "fringe theory" is simply ignorant, and I said so. The "controversy" claim re: EMDR is self-perpetuating, like the claim that President Obama must be Muslim because people keep asking if he is. To suggest that my rejection of shoddy claims about EMDR promotes anything personal is nuts. I use EMDR maybe once every two months.
• http://tomcloyd.com/lib_iudb06263-symptom-mngment.html - this is baffling. If you're going to show my professional involvement in PTSD treatment, and thus my sure and certain COI (!), how about citing a page on my website where I actually WRITE about PTSD, which I do NOT on the page linked to. This looks like yet another case of your not doing your homework - not that it would have helped your core argument.

So, you're out to discredit me because I contribute significantly (I hope) to something I actually know and care about? The implication is that the proper thing for me to do would be to contribute, say, to the article on tornadoes (about which I know nothing), using some obfuscating name like HotWarmAir. I don't follow this logic (?) at all. My profession values honesty and transparency, so I use my own name at WP, and link to my WWW contributions so that my biases may be fully revealed. For this you would punish me, it appears. As I said...utterly baffling.

Tom Cloyd (talk) 06:26, 21 August 2010 (UTC)

"Signs and symptoms" and "Prognosis" WP:MEDMOS sections needed

Sections for "Signs and symptoms" and "Prognosis" are missing: the reader should be told what the signs and symptoms are in the second section of the article. SandyGeorgia (Talk) 23:35, 16 August 2010 (UTC)

Re: Signs and Symptoms, I believe this issue has been well-addressed previously on this page. I don't think we have a better solution than the article now offers, for the reasons given in this prior discussion.

As to the need for a "Prognosis" section, this has been noted for months in the second section of this page, which outlines proposed revisions to the article. I agree that this section is needed, and it will appear here, I fully expect.

Tom Cloyd (talk) 22:18, 18 August 2010 (UTC)

ICD-9 vs ICD-10 referenced in article

An inline comment (now removed) was very recently inserted in the lead which asked why ICD-9 was referenced and not ICD-10. A great question. The answer has two parts:

• even now (late August 2010), the USA has yet to fully implement ICD-10. Full implementation by all relevant parties is not required until 2013. (For more on this see ICD-9, and themajor relevant source.
• as I've suggested in my outline for article revision, this PTSD article is overly USA-centric. Were it not so, ICD-10, already used by much of the non-US world, would be more prominent in the article. I think this is a flaw that should be corrected, and plan on fixing the problem.

Tom Cloyd (talk) 07:17, 21 August 2010 (UTC)

Very long interval (40 years) between date of trauma and beginning of serious disorder

I decided to write the following since I'm sure from definitions appearing here on WIKIPEDIA and on other sources that my problem is actually an instance of PTSD. I wish to leave a trace of my personal experience, in case it might be found that this type of event is found to be more frequent than believed up to now. I will not describe in detail the nature of the trauma, even if from what follows it may be inferred. On February 1967 I experienced what could be described by "feeling the whole world crumbling under my feet", following the behaviour of another person. In a period of 3 months I managed to overcome the bad feelings associated with it. I felt normal, I returned several times on the location of the event without trying to avoid it (while today I would never go there). During a vacation trip in 2006 it happened to arrive late at a certain hotel which revealed to be of very low quality. It was decided to stay there anyway for one night. My bed was very uncomfortable. I could feel all the springs torturing my body. The result was a night totally sleepless. During that night the memory of that trauma came back to my mind. I went on trying to remember all the details. From that moment until today (November 23rd, 2010) I think to that event every day, several times a day. I make movies in my head about it and of course I feel very bad. I am on treatment with Zoloft but still do not see improvements. I would be interested to know of similar cases, since the definitions of the disturbance refer normally to much shorter periods of time.paolo de magistris 15:16, 23 November 2010 (UTC)

While offering a gentle reminder that. as it says at the top of this page, "This is the talk page for discussing improvements to the Posttraumatic stress disorder article...", I want to offer a minimal response that may be of some use to you.

As a clinician who treats PTSD, I have rather commonly seen instances of recollection of what appear to be past events, which, upon recalling them, lead to seriously disturbing feelings. First, realize that human memory is not a video/tape recorder, ever. Memory is always sketchy, and details tend to be modified according to the needs and circumstances of the moment; this is the repeated finding of careful research on the subject.

What's critical to attend to is the disturbance, if any, experienced in the present by the recollection. This indicates that the memory, accurate or not, is not fully processed. If about a year has gone by since the event, and the disturbance remains, it is likely to remain disturbing unless one obtains appropriately skilled professional help - someone who knows how to resolve traumatic memory.

Revisiting memories is a common event as we age, and we may thus discover disturbances we have successfully ignored until now. The fact that your memory comes to you now daily strongly suggests that it is traumatic in nature, and that professional help is needed. I recommend that you find a mental health professional specializing in trauma treatment.

Zoloft is not a treatment for traumatic memory. It is a management tactic. It is not likely to assist you in fully resolving the memory. As the PTSD article correctly says, "A variety of medications has shown adjunctive benefit in reducing PTSD symptoms, but 'there is no clear drug treatment for PTSD'". The same is true for single traumatic memories which do not produce symptom clusters qualifying one for a PTSD diagnosis. So, do not expect medication to resolve your problem. Good treatments for PTSD exist, and they work equally well for single traumatic memories. I encourage you to review the article and then seek out such treatments. I think you'll be pleased with the results. Best of luck in your quest!

Tom Cloyd (talk) 20:32, 23 November 2010 (UTC)

Re: removal of {{Primary sources}} tag

This tag has bothered me for some time, as it appears to cast an pall over the entire article which hardly seems justified. It simply is not true that "This article needs references that appear in reliable third-party publications." It HAS such references, aplenty. What is needed is simply more of them: there are references in the article which are of inadequate quality, and this needs to be fixed. But saying this is NOT the purpose of this tag, according to its documentation, to wit: "This template also has two optional fields. The first permits the user to specify whether the entire article or a specific section inappropriately relies solely on primary sources." Usage of the tag in the PTSD article is clearly of the first sort -appearing to state that the entire article lacks "...relies solely..." on primary sources - which is obviously incorrect. Thus the tag incorrectly suggests to readers that the article is deficient in a way that it is not. To mislead in this manner is neither helpful nor ethical.

Beyond this problem is the issue of redundancy. The tag was placed in August of 2010. Months earlier, a detailed examination of the article's deficiencies was prepared and posted for comment on this Talk (Discussion) page (the current version has a date reflecting its most recent revision, not its original date, which was considerably earlier). In this statement, multiple references were made of the sourcing problems in the article. The analysis was carried forth section by section. For someone to show up many months later and flag the entire article as if something new had been found simply reflects inadequate review of existing and prominently posted comment about the article. The assertion made had already been made, thus was redundant, and thus was not needed. My removal of the template tag resolves both these problems.

Tom Cloyd (talk) 04:49, 25 November 2010 (UTC)

Racism in the article

In the article you can read the following:

Hispanic ethnicity, coming from an unstable family, being punished severely during childhood, childhood asocial behavior and depression as pre-military factors War-zone exposure, peritraumatic dissociation, depression as military factors Recent stressful life events, post-Vietnam trauma and depression as post-military factors

They also identified certain protective factors, such as: Japanese-American ethnicity, high school degree or college education, older age at entry to war, higher socioeconomic status and a more positive paternal relationship as pre-military protective factors Social support at homecoming and current social support as post-military factors.[50] Other research also indicates the protective effects of social support in averting and recovery from PTSD.

So you are saying that japanese persons are better than hispanic persons.

Please remove it. —Preceding unsigned comment added by 189.113.250.139 (talk) 00:08, 25 December 2010 (UTC)

You misunderstand. This issue has come up before, raised by people who didn't read the section carefully.

The cited section summarizes a study which found epidemiological associations between certain ethnic variables and certain mental illness outcome variables. The study was published in the Journal of Traumatic Stress, which is itself published by a very respected professional organization, The International Society for Traumatic Stress Studies. Assertions of fact (or, in this case, inductive conclusions from empirical research) can never be prejudicial so long as they are either true or made in good faith. Men, as a group, ARE taller than women. This is a non-prejudiced statement because it correctly represents numerous research findings. Mere assertion of difference hardly equals prejudice. It is, rather, a matter of HOW the assertion of difference is arrived at which makes it prejudiced or not.

I see no reason to alter the text as written.

Tom Cloyd (talk) 21:47, 26 December 2010 (UTC)

Oh, now I understand it, thanks. 189.113.250.139 (talk) 18:55, 3 January 2011 (UTC)

Excellent. I hope we can all appreciate both your alertness to the possibility of prejudicial statements AND the possibility of making a valid assertions of differences between groups - valid because they have demonstrable empirical basis.Tom Cloyd (talk) 23:43, 3 January 2011 (UTC)