The Czar received this. It is indeed well worth reading; especially the parts that compliment the Czar.

I am the wife of MC, one of your “operatives.” I enjoy your website as much as he does; in fact, I’m the one who steered him to you. I do not, however, enjoy the smug look on his face when his comments make it onto your blog. His ego does not need any more stroking.

That being said, I’m writing to comment on your PTSD post. I am a clinical psychologist and specialize in assessment and diagnosis. I’ve worked at VA’s and other places with very seriously ill people (but am now in private practice). I concur that the notion people can acquire “vicarious” PTSD is highly doubtful (though, as you noted, many in the mental health community find it quite plausible). I also agree that, even among those who have been exposed to trauma, the diagnosis is sloppily and liberally used.

However, I wanted to put in my two-cents’ worth about it as a disorder: It does exist, and not in “negligible” quantities. It is more than just “a rape victim being afraid to leave her apartment” (which would more properly be labeled anxiety and/or agoraphobia). PTSD also includes recurrent, unwanted, and intrusive ideations, hypervigilent behaviors, and other things that I’m sure you have read about in the DSM-IV. The amygdala is involved, but so are many other brain areas and pathways that clearly light up on PET scans and other imagery.

Overall, I don’t have much of a problem with the gist of your post. Just wanted to share my thoughts on the fact that PTSD (when PROPERLY applied as a diagnosis) is very real and perhaps not as rare as you implied. However, mostly I’m emailing you because I wanted to be able to tell my husband that he’s not the only one around here who can converse intelligently with the Czar.

PTSD (when PROPERLY applied as a diagnosis) is very real and perhaps not as rare as you implied.We love substantive fan mail here. SC distinctly qualifies as a substantive writer, and we are pleased she enjoys our site. And thank you for sending MC our way; he is a trusted and loyal operative, which you will appreciate when you suddenly find yourselves in sole, undisputed possession of Mali. It can get quite beautiful there, and we give this to you as a gift for your loyalty. Actually, SC’s mail was so good we might just throw in Mauritania. Just for her. Something nice for a nice lady. MC need not even know about this.

The Czar wishes to clarify that he does not dismiss a rape victim’s panic attacks as imaginary (which SC does not suggest, but in case others do…), but as something quite real with a fairly clear cause (neuroscientifically speaking, of course). The Czar is worried that readers might think him dismissive of a rape victim’s fears. The opposite is the case: he too has seen the effects of many violent crimes on people. But SC and the Czar may agree that PTSD is so broadly applied that thousands of real treatable disorders are masked by a popular term that has been distorted into near untreatability.

PTSD is also a numbers thing. The number of people who have it as opposed to the number of people who claim it is quite low. But even if this is a mere 1%, that still leaves many thousands of people who really have it, which Dr. SC would likely underscore.

SC should write in more often, particularly because the Czar really enjoyed her contributions, and anything that annoys MC around the breakfast table must be a good thing. Next time you both are in Muscovy, you will be given a free fish. Look forward to seeing you both at the Gormogon Castle holiday party. When Sleestak greets you at the door, be sure to tell him who you are so that you both get a nice table close to the front.

And you never want to sit in the last four rows.

The Czar of Muscovy

Божію Поспѣшествующею Милостію Мы, Дима Грозный Императоръ и Самодержецъ Всероссiйскiй, цѣсарь Московскiй. The Czar was born in the steppes of Russia in 1267, and was cheated out of total control of all Russia upon the death of Boris Mikhailovich, who replaced Alexander Yaroslav Nevsky in 1263. However, in 1283, our Czar was passed over due to a clerical error and the rule of all Russia went to his second cousin Daniil (Даниил Александрович), whom Czar still resents. As a half-hearted apology, the Czar was awarded control over Muscovy, inconveniently located 5,000 miles away just outside Chicago. He now spends his time seething about this and writing about other stuff that bothers him.