Prince Harry says he has PTSI not PTSD, so what’s the difference?

Prince Harry is always fighting the fight to destigmatise mental health problems

Hero image in post
photo: ITV
Hero image in post
photo: ITV

Prince Harry is always fighting the fight to destigmatise mental health problems

By Rhys Thomas10 Jan 2023
7 mins read time
7 mins read time

Mental health revelations are at the heart of Prince Harry’s memoir Spare. There’s panic attacks, paranoia about the press’s intrusions into his family’s life and description of his wife Meghan Markle’s struggle to handle, mentally, a cold welcome by assorted royal households and the press. That’s before we get onto the ayahuasca retreats and visits to healers.

And it’s all completely understandable for a man who lost his mother when he was just 12 and is clearly in the midst of issues (to put it mildly) with the rest of his family. What didn’t make initial sense, though, is Harry saying he was dealing with not post traumatic stress disorder but post traumatic stress injury around the time he, aged 20, asked a protection officer to see the images of his mother, Princess Diana, that paparazzi took of her as she lay dying in a Paris tunnel following a tragic car crash in 1997.

In a recent interview, ITV journalist Tom Bradbury asked the Prince if he had post traumatic stress disorder in the wake of his mother’s death in the context of him having “genuinely half-convinced yourself she was still alive and in hiding” until he was 23 and seeing her in his dreams. Harry corrected Bradbury, though, by saying “I refer to it as post-traumatic stress injury, because I’m not a person with a disorder. I know I’m not, you know?”

What is PTSD?

The loss of a loved one can be incredibly hard to take emotionally, whether or not the person dies in a tragic and unexpected circumstance or not. According to PTSDUK, losing a loved one is the most common type of traumatic event reported, and analysis of the World Health Organisation’s World Mental Health Survey in late 2016 by The University of Ulster, deemed there was a 5.2% risk of people developing PTSD or Complex PTSD (C-PTSD) after finding out about the unexpected death of a loved one.

This means PTSD isn’t uncommon following death, just over one in twenty are at risk of developing the disorder. But Prince Harry says he doesn’t have a disorder, and describes his condition as more of an injury. So what does this mean, and what is the difference between PTSD and PTS… I?

What is PTS?

Well the word injury is Harry’s own understanding of how he feels, which is perfectly valid, but we’ll get into that later. To understand PTSI you need to understand that, clinically, you can have PTSD without having a disorder, and it is simply called PTS, post-traumatic stress, it’s very similar to PTSD but is ultimately a different category of stress.

Post-traumatic stress manifests in a few ways, all to do with our stress hormones flooding our body, leaving us with a tendency to enter fight or flight mode far easier than we otherwise would. Often, in the case of PTS, this might mean we have nightmares related to the event or people involved, it can also mean we end up very upset, perhaps even overwhelmed if something reminds us of the situation which caused the stress. Stress management techniques like breathing exercises can help to relieve symptoms, and symptoms tend to start fading after a few weeks.

How is PTSD different to PTS?

PTSD is slightly different. Generally exercises like breathwork don’t tend to have much of an effect on PTSD symptoms, which will last longer. Generally, if the symptoms last for more than a month and affect daily life, it could be a case for considering PTSD instead of PTS. In either case, when it comes to diagnosis, it’s always best to see what a trained mental health expert thinks.

What does PTSI mean?

But Prince Harry mentioned post traumatic injury specifically, so what does that mean? Well, it is a recognised term, and there has been debate in recent years as to whether it’s worth considering changing the name from PTSD (disorder) to PTSI (injury). The consensus reached by three academics in the Journal of Military and Veterans’ Health was that “removing the word ‘disorder’ may remove some barriers to seeking diagnosis and treatment” but also that “there is a lack of evidence that altering the name would have an appreciable benefit for affected individuals.”

So this means that Prince Harry’s symptoms have been more chronic than those of PTS and he has had to deal with these issues for years, as he has openly said. However, he prefers the term injury to disorder. As he told Good Morning America, what he has suffered with “was very much PTSI, more of an injury than a disorder…I fully appreciate that for a lot of these guys and girls, not just in the military but across society as a whole, that people are diagnosed with Post Traumatic Stress Disorder (PTSD). But I’ve tried to reframe it as much as possible to say it’s an injury because you can actually heal from it.”

So his use of ‘injury’ over ‘disorder’ isn’t necessarily because he’s too macho to attach himself to the often stigmatised concept of seeking mental health support, but because he sees that you can heal from post traumatic stress. He might have been told so by a medical professional, or he might be applying new terminology to help destigmatise the condition.

What do we mean by destigmatising PTSD?

The debate around changing the name is very much tied up in whether a distinction between disorder and injury will help more people get the help they need with their mental health. Within the study, and in an article on The Recovery Village, which was medically reviewed by Dr Karen Viera of University of Florida College of Medicine Department of Biochemistry and Molecular Biology, it was said “The goal behind the PTSD name change is to encourage veterans to feel more comfortable opening up about their experiences and seek help sooner.”

In the same way that a few years ago the conversation about destigmatising mental health compared mental issues to physical injuries (i.e the argument that you’d go to the hospital if you had a broken bone, mental health is also health), the semantics of injury over disorder could bring veterans – and the wider public – less shame.

And while the post-traumatic stress Harry is speaking of isn’t related to his time in the armed forces, he was a veteran and has worked closely with them through his Invictus Games. Given the debate is recent, and Harry is very invested in discussions around wellbeing, the terminology will be familiar to him in this context, and he might find it useful and relatable to how he feels his stress presented itself.

How could the term 'post traumatic stress injury' help people?

Destigmatisation is objectively helpful. Prince Harry speaks vocally about mental health issues and wellbeing generally more than most men who share such a public spotlight. Whether it’s mentioning his praise of Dr Brené Brown (a self-help guru with clients including Gwyneth Paltrow, Jennifer Aniston and Oprah Winfrey), how therapy has helped him with anger (including following the alleged altercation with his brother Prince William which he recently revealed), or specifically around his post-traumatic stress injuries – which involved both cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR).

CBT and EMDR are both treatments for, to use its traditional name, PTSD, which suggests what Prince Harry has been experiencing goes beyond PTS. The semantics around the name speak to a bigger conversation around whether words such as ‘disorder’ are stigmatised, or whether people feel a sense of guilt around trivialising terms and therefore would welcome a middle ground, such as PTSI. The positive is that no matter where you stand on the fallout presented by him releasing his books, Prince Harry represents a minority of men who are aiming to be candid and vulnerable around mental health, and this is no doubt going to show men one way of doing the same.