Post-Traumatic
Bush Disorder
A Suggested Addendum for the DSM IV

by Robert Lonoke

Editor's Note: The following diagnostic regimen has NOT been approved by, or for that matter even submitted to the DSM (Diagnostic and Statistical Manual of Mental Disorders) as such, but considering the press of world events and the headlong expansion of the American military presence in the Middle East and elsewhere, we felt it behooved us to help our readers get ahead of the global game.

If you or a loved one should exhibit the following symptoms, we urge you to print these pages and take them and the afflicted person to the nearest mental health facility for immediate treatment.

P.T.B.D.
(Post-traumatic Bush Disorder)

Symptomology

A. The person has been exposed to a traumatic event in which both of the following have been present:

1.
The person has experienced, witnessed, or been confronted with an event or events that involve the actual or televised appearance of George W. Bush, or has been in the presence of persons speaking favorably of the politics and/or religion of George W. Bush.

2.
The person's response involved intense fear, helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

1.
recurrent and intrusive distressing recollections of the event, including images, thoughts, perceptions, or aural hallucinations, typically evidenced by though not limited to behavior such as the inability to create English sentences that would at least get a "C" in 8th grade grammar, the compulsive desire to walk about in public with an American flag draped around one’s body, hours spent in front of a mirror practicing the military salute, elaborate plans to flee to Shreveport in case of a terrorist attack, or the inviting of obese homeless persons into the home, feeding them extravagantly and addressing them constantly as "My buddy Karl" or "Boy Genius." Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed in more childish ways.

2.
recurrent distressing dreams of the event, including though not limited to elaborate dream narratives involving bull-horn speeches to exhausted construction workers, victory parades in an open 2003 Thunderbird along the "liberated" streets of the capitals of oil-rich developing countries, or scenes of genuflection in the person’s presence by notable personages such as the Pope, Kofi Annan, or Bill Gates. Note: in children, there may be frightening dreams without recognizable content but whose fragments display oedipal, filicidal, patricidal, or castrative elements.

3.
acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated), including but not limited to the uncontrollable eating of pretzels, temper tantrums if the significant other tries to tune away from the Fox News channel, frequent long whispered telephone conversations allegedly with Katherine Harris and James A Baker, filling page after page of Big Chief writing tablets with words such as "Poppy," "Skull and Crossbones," or "ixnay on Frère Jacques." Note: in children, trauma-specific reenactment may occur.

4.
intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. Triggering items include but are not limited to the utterance of the words "Lone Star," "Crawford," or "evil"; overhearing the speech of any person with a twang reminiscent of fingernails dragged across a chalk board; the sighting even at a great distance of a Texas license plate.

5.
physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, including but not limited to projectile vomiting, catalepsy, or a top-of-the-lungs rendition of "The Battle Hymn of the Republic."

C.
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

1.
efforts to avoid thoughts, feelings, or conversations associated with the trauma, including but not limited to refusal to be in the same room with a copy of the National Review or the Washington Times, the strongly expressed belief that the happy-face patriotism of local TV anchors is an Islamic plot to undermine The American Way, or endless sotto voce recitation of the Gettysburg Address.

2.
efforts to avoid activities, places, or people that arouse recollections of the trauma, including but not limited to the oft-asserted belief that the capital of the United States was never moved from New York City, driving blocks out of the way in order not to glimpse any religious edifice whose name includes the word "Baptist," refusal to arrive at any sports event until after the playing of the National Anthem.

3.
inability to recall an important aspect of the trauma, including but not limited to the belief that by a special dispensation of the Supreme Court Bill Clinton is still president, detailed plans for a vacation trip to the East Coast highlighted by dinner at Windows on the World, or the fervently argumentative stance that the word "Chad" is always upper-case and refers only to a poverty-stricken African nation.

4.
markedly diminished interest or participation in significant activities, including but not limited to sexual intercourse, masturbation, or marathon Saturday night games of Texas Hold ‘Em.

5.
feeling of detachment or estrangement from others, including but not limited to the burning of one’s old Young Republicans membership card, daily emails to Clarence Thomas and Antonin Scalia urging retirement to Pago Pago, or uncontrollable paroxysms of rage at the sight of a Ford F-150 pickup.

6.
restricted range of affect (e.g., unable to have loving feelings), including but not limited to the inability to shake hands with any male in a dark suit, facial paralysis in the presence of any female wearing bright blue or red, or catatonic response to the words "my fellow Americans."

7.
sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span), including but not limited to public strolls wearing a sandwich board announcing that "The end is at hand," the firm belief that Windows XP is the last operating system that humanity will ever develop, or the commitment to memory of the entire book of Job.

D.
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
   1. difficulty falling or staying asleep.
   2. irritability or outbursts of anger (in addition to road rage, the person
       exhibits "hall rage," "den rage," bathroom rage," "kitchen rage," etc.).
   3. difficulty concentrating.
   4. hyper-vigilance (shutting of the eyes when in the vicinity of large
       ornamental lawn plants, especially any that might be referred to as
       a "bush," etc.).
   5. exaggerated startle response (jumping out of one's skin at the sight of
       anyone named George--in more severe cases the reaction is observed
       when a cash register drawer pops open unexpectedly, etc.).

E.
Duration of the disturbance (symptoms in B, C, and D) is more than one month.

F.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
   Acute: if duration of symptoms is less than three months
   Chronic: if duration of symptoms is three months or more
Specify if:
   Without delay onset: onset of symptoms at least six months after the
   stressor.

Treatment for PTBD

Many therapeutic approaches to PTBD patients have been attempted. Sadly, none have shown any marked success. Investigation of these universal therapeutic failures has revealed that the patients are still sufficiently in touch with reality to realize that the cause of their malaise will be easily re-elected in 2004 and that they thus have more years of active avoidance ahead of them. Furthermore, the belief is widespread among PTBD sufferers that once the present Bush is gone, Jeb is more than likely to replace him in the Oval Office for another eight years.

One new therapeutic approach is now being tried, consisting of total isolation from contact with the real world. A team of Disney Imagineers is currently at work, constructing a working replica of Dubuque circa 1953 on the outskirts of Auckland, where upon completion a carefully selected group of PTBD sufferers will be placed and studied.

Perhaps the best therapeutic option for mildly to moderately affected PTBD patients is group therapy. In such a setting, the PTBD patient can discuss traumatic memories such as the moment when they first heard That Twangy Voice, compare their various PTBD symptoms, and functional deficits with others who have had similar experiences. This approach has been most successful with persons who watch fewer than four hours of television per day or who read the editorial page of the Wall Street Journal only a couple of times a week and never listen to talk radio.

It is important that therapeutic goals be realistic because, in some cases, PTBD is a chronic and severely debilitating psychiatric disorder that is refractory to current available treatments. The hope remains, however, that our growing knowledge about PTBD will enable us to design interventions that are more effective for all patients afflicted with this disorder.

There is great interest in rapid interventions for acutely traumatized individuals, especially with respect to televised presidential speeches and/or news conferences. Widespread outbreaks of extreme PTBD symptomology were observed by public health officials for example following the presidnent's ultimatum speech on March 15, 2003. Emergency rooms and 911 switchboards were flooded with persons seeking help for friends or loved ones adversely affected by this event.