Post-Traumatic Stress Disorder among Victims of Organized Violence: A Report from Bulgaria

This study originated in the authors' curiosity about the applicability of the ICD-10 diagnostic category of post-traumatic stress disorder (PTSD) in the Bulgarian cultural context.1 It appeared from the beginning that the country's health-care system, plagued as it was by rigid bureaucratic thinking, would not easily accommodate a diagnostic category that did not fall neatly into either the mental or the physical domain. As we have stated elsewhere (Tomov et al., 1989), the division between the domain of the body and the domain of the mind in the socialist model of health care was extreme at all levels including medical training, diagnostic practices, health administration, and patient behaviour.

Having searched for a medical, or social, or mental-health, or any other setting in which we could anchor a study on PTSD, we finally discovered that child abuse, sexual abuse and even physical abuse were topics which were out of bounds in Bulgaria: propriety did not tolerate public or professional discourse on such issues. Our search also indicated that natural or man-made disasters in Bulgaria were typically experienced in terms of material and physical losses