Discussion: treatment of prolonged posttraumatic stress disorder--learning from experience.

Reports of limited treatment effect in Vietnam veterans with PTSD are discussed. Survivors of multiple traumata who suffer from complex PTSD and who live in poverty and distress may not properly represent the general case of PTSD. Yet the lessons learned suggest that attempts to treat prolonged PTSD by rederessing causation are ineffective. The appropriateness of targeting symptoms is also challenged. Previously heralded rethorics of healing trauma should be replaced by careful assessment of residual disability in a social context. Recognizing treatment-resistance in PTSD could lead to favorably investigating interventions of modest effect, to shifting from exploration to rehabilitation, and to redefining outcome measures such that changes in a variety of domains are appreciated.