It's an interesting question. As a matter of pure RP it's hard to see how this ought to be the player's decision; people with PTSD didn't ever choose to have PTSD.
The thing is that they have more than once given players the option of deciding if Shepard had PTSD. An example is a dialogue option during the Sole Survivor's personal mission.
During the free-for-all discussion we had a while back, the topic came up so here is some of my thoughts and opinions on it: it can be seen below.
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The dream sequences were also mandatory and so took the choice of how Shepard experienced loss and dealt with it out of the players' hands which is unnecessary, in my opinion as the below quests has shown it can be expanded upon while the option to do so rest with the player.
In my opinion, we should not have had to play through the dreams but instead have the option of talking to our companions about dreams or similar indications of post-trauma stress; if we go with the dreams, it should be up to the player to decide what the dreams were about and entailed through the ensuing dialogue and the effect it has on them thereby providing the oppertunity to actually explore the emotional and psychological impact the dreams have and allow for optional relationship building.
If Shepard refuses to talk to the companion about it then that provides a neat option of roleplaying and character building as well: One Shepard might have dealt alone with their grief for so long that, that is what they always do.
Quests like "I Remember Me" from the first Mass Effect, I feel, are the better way of humanizing Shepard and allow the players options in how to humanize Shepard.
I made a post about this a long while ago and thankfully, I could find it;
I remember the Sole Survivor's personal quest in Mass Effect 1 where near the end of it this happens:
Corporal Toombs: "Just as long as he goes to trial. Maybe the screaming will stop now. I don't know"
Shepard (I do. It dosen't.): "All you can do is keep going. "
Although the actual line could have matched the paraphrasing a bit better, in my opinion, I still feel that this exchange and the Colonist' exchange with Talitha in the "I Remember Me" quest was so much, much better than the symbolic dreams in Mass Effect 3. These exchanges felt more human than those dreams did. The dreams felt... artificial in a way. I am not sure how to describe it. They lacked the emotional impact that these quests had to me.
I think "I Remember Me" might be my favorite quest in the entire Mass Effect series. Even the title gets to me.
Basically, options and dialogue.
Note: this is my opinionated opinion. My personal dislike of the dream sequences and similar scenes do not extend to the people who like them.





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