THE HARMONY OF ILLUSIONS

A stringent critique of the diagnosis of post-traumatic stress disorder (PTSD), which came into vogue after the Vietnam war. Despite his skeptical subtitle, Young (Anthropology/McGill Univ.) doesn't doubt the existence of PTSD. However, he offers convincing evidence that this diagnosis is of recent vintage- -largely in response to the experiences of Vietnam veterans—and that it is used most imprecisely, ``glued together by the practices, technologies and narratives with which it is diagnosed, studied, treated and represented.'' Young painstakingly traces the evolution of the concept of trauma, from studies of 19th-century victims of railroad accidents who suffered ``traumatic memory'' to the many incidents of ``shell shock'' during WW I to the contemporary idea of PTSD, developed largely during the 1970s and '80s. He notes that this diagnosis is used far more broadly than past formulations. For example, veterans often are labeled as suffering from PTSD not for war-related traumas they have suffered but for recurrent aggressive feelings or guilt deriving from acts they committed against others, even if these feelings developed years after the original acts occurred. Young drives this point home by providing excerpts from group and clinical evaluation sessions at an unnamed VA hospital specializing in PTSD, whose therapists sometimes seem to bandy about the label as freely as some of their colleagues elsewhere do the diagnosis of ``borderline personality disorder.'' Young's work is scientific in the best sense, i.e., clear, precise, and free of jargon and polemics. However, this is also a difficult, even formidable book, which at times digresses to somewhat tangential psychiatric matters. But if it is not for the general reader, Young's work will provide rewarding reading for clinicians, as well as for academics and other specialists interested in PTSD and, more generally, in the nature and pitfalls of contemporary psychiatric diagnosis and treatment. (5 line drawings)