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Drawing on the 2017 Las Vegas Shooting as a potent example of trauma, this article investigates how classifying post-traumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013) shapes cultural understandings of traumatization and survival in an era of gun violence. “PTSD” reproduces colonizing arrangements of power, as elucidated by an activity theory analysis of the DSM-5, the global authority on psychiatric diagnoses, alongside both diagnostic protocols for PTSD and PTSD discourse in news coverage of the Las Vegas Shooting. This rhetorical approach to the DSM-5 as a complex system of activity exposes conflicting effects: classifying post-traumatic stress as “mental disorder” qualifies traumatized survivors for medical treatment, while also pathologizing the debilitating, long-term trauma that mass shootings can cause. This potential conflict between alleviating and pathologizing suffering shores up an individual or biomedical model of health, in contrast to a public health model oriented around the health of populations, that may shame survivors and commodify their pain.