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Fiona Duxbury's thoughtful response to my critique of the burgeoning medical preoccupation with domestic violence is a welcome departure from the familiar resort of promoters of this trend to evasion and caricature of opposing arguments.1,2 However, I believe that her advocacy of medical interventions in this area is based on a series of dubious assumptions and that such interventions may do more harm than good.
Dr Duxbury assumes that post-traumatic stress disorder (PTSD) is a coherent disease entity, linking First World War soldiers with ‘shell-shock’ to contemporary victims of ‘intimate partner abuse’. But this is ahistorical: as Professor Simon Wessely has recently insisted, ‘shell shock is not just another name for PTSD’.3 It is well known that the official acceptance of the diagnosis of PTSD was the result of a campaign in the U by veterans of the Vietnam War. As psychiatrist Derek Summerfield has observed, this label ‘legitimised their “victimhood”, gave them moral exculpation, and guaranteed them a disability pension’.4 Summerfield notes that a diagnosis originally associated with extreme experiences ‘has come to be associated with a growing list of relatively commonplace events’, including accidents, muggings, difficult labours, verbal sexual harassment, receiving bad news. Paramedics attending road accidents, police and firefighters on duty at disasters, even doctors treating bomb casualties have all been diagnosed with PTSD. For Summerfield, PTSD ‘has become the means by which people seek victim status — and its associated moral high ground — in pursuit of recognition and compensation’.
Dr Duxbury assumes that naming a patient's experience as PTSD has a liberating effect, although she cites no evidence in support of this extravagant claim. The fact that many welcome this diagnostic label merely confirms the ascendancy of the culture of victimhood in contemporary society. Dr Duxbury further assumes that providing social, medical or psychological ‘support’ is beneficial. But for many, diagnosis is likely to lead on to prolonged courses of medication or psychotherapy, both interventions of doubtful efficacy and carrying significant risks of adverse effects. ‘Social’ support is likely to take the form of intervention by the police, the courts and child protection agencies, which in my — considerable — experience, is often damaging to the patient and her wider family relationships.
It is true that I present medical and social approaches to problems of family life as alternatives. Medicalising domestic violence invites professional intrusion into personal and family life in ways that are corrosive of the individual autonomy and civil liberties of all family members, female as well as male. But it is the development of women's autonomy — in both the public and the private realms — that has been crucial to the progress towards more egalitarian and less abusive relations between the sexes that has taken place over the past half century.