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Dante Lawson

Professor Lori Bedell

CAS 137H

7 November 2016

The Evolution of Post Traumatic Stress Disorder

Depression, helplessness, mood changes, unwanted flashbacks, nightmares, and loss of

self. These things are just a few of the symptoms associated with post-traumatic stress disorder,

or as it is commonly referred to as, PSTD (mayoclinic). About 8% of the entire population of the

United States will suffer from PTSD at some point in their lives (Friedman). That means around

26,000,000 people in one lifetime will suffer from this mental disorder. In any given year,

around 8 million adults will suffer (Friedman), and those are just the documented cases.

According to the Nebraska Department of Veteran affairs, many people do not realize that they

have PTSD or if they do know, they refuse to seek treatment (Nebraska VA). That means there

are countless people that will not come forward who could add to the statistics. PTSD is not just

confined to the United States; the phenomenon reaches all over the world and can affect anyone.

This includes military personnel and civilians. Despite the residual ideology of the mental health

stigma, the emergent ideology that it is okay to have these disorders has allowed for many more

people to come forward and seek help than in the previous years. There has been a 26% rise in

veterans seeking help over the last year in the United Kingdom alone (Forces.tv). This worldly

recognition of PTSD along with the efforts to combat the illness has not always been the case.

There once was a view that suffers of this mental illness were nothing but cowards with poor

discipline (PTSD Support). The history of PTSD is full of misconceptions and uncertainties.

While PTSD is not solely the result of war, war has played a significant role developing the
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psychiatric terminology surrounding PTSD and in shifting it from an unrecognized psychological

trauma to a chronic psychiatric disorder that has become widely acknowledged with increasing

diagnosis and treatment options.

Historical Chronology of Terms. The concept of psychological trauma has been

developing since the early eras of humanity. We see in the famed Epic of Gilgamesh that our

hero is changed forever after the death of his friend Enkidu. Gilgamesh presented early signs of

psychological trauma throughout the story that suggest that these symptoms are a part of the

human experience (Crocq). Shakespearean literature is also abundant with post-traumatic like

symptoms. Plays such as Macbeth and The Rape of Lucrece display sleep disorders and the rape

syndrome which both encompass symptoms that are similar to PTSD (Ben-Ezra). Before the

modern term of PTSD was established, there were a lot of different names used to generalize the

same type of condition. For example, during the French revolution and Napoleonic wars, military

physicians observed symptoms similar to what we now know as PTSD. The soldiers were

collapsing into a stupor after bomb shells past them. These observations led to what was known

as the vent du boulet syndrome. That translates into the ball of wind syndrome. Soldiers

were not physically harmed, but emotionally affected just by the sound of the cannonballs. The

Industrial Revolution brought psychological trauma to the civilian population due to the

introduction of disasters caused by railroad accidents. At the time doctors were stunned by the by

the psychological symptoms displayed by the victims, and this caused differences in opinion

about what that main root of the problem was. Many believed in the organic theory which meant

that the mental symptoms were caused by lesions of the spine or brain. This believe coined the

terms railway spine and railway brain. The opposing view was that the symptoms were

caused by the emotional shock of the incident (Crocq). This controversy was mainly caused by
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the lack of knowledge about what psychological trauma was and misconceptions about how it is

developed.

World War I brought about a change in the way the world addressed psychological

trauma. It was the beginning of modern warfare, and it led to a host of new discoveries. It is

noted that, the concept evolved that the high air pressure of the exploding shells caused actual

physiological damage, precipitating the numerous symptoms that were subsequently labeled

shell shock (PTSD Support). War Neurosis was another term coined during this time. The

symptoms associated with both labels included sleep disorders, anxiety disorders, and other

PTSD like ailments. The modernization of warfare coincided with the advancements in modern

psychiatry. As time progressed, there were constant developments in how these trauma induced

symptoms were defined. During World War II, Combat Stress Reaction and Battle Fatigue were

introduced. The symptoms of these included extreme exhaustion that led to the discharge of

several soldiers during WWII (Friedman).

One of the largest developments in the way this condition was understood occurred when

the American Psychiatric Association produced the first Diagnostic and Statistical Manual of

Mental Disorders (DSM-I) in 1952. In the DSM-I, Gross Stress reaction became the term used

for any psychological trauma. It was not until DSM-III was published in 1980 that PTSD was

defined in modern terms. Notably, this occurred shortly after the Vietnam War when veterans

were returning home affected by the war (Friedman).

Although there a several terms that have been used to describe illnesses that displayed

PTSD-like symptoms, there are those who argue that PTSD is a brand new. They say that PTSD

is a concept grounded in time in and culture (Vaughanbell). As such, they are saying that until

now there have been no disorders quite like PTSD. The modern era has shaped the illness
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through the particularities and evolution of todays culture. In other words, the societal changes

in peoples values and actions created PTSD. For example, 150 years ago there were no such

things as airplanes. That means that events like 9/11 were not even feasible. Modern terror has

created a new breed of psychological trauma that was nonexistent until now. Over the years,

several studies have been conducted that systematically analyzed the historical record of

psychological trauma. These studies found no claim that exactly matched the current model of

PTSD.

Historical Chronology of Treatment. Treatment of PTSD and its effectiveness on its

patients has developed over the years, and it continues to grow. The diagnosis process has

dramatically changed since the older days to include a broader range of people and causes.

Hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis during WWI

in European countries (Friedman). During the Lebanon War, Israelis were treated using "PIE"

(Proximity, Immediacy, Expectancy). This means the psychological casualties were treated

within close proximity to the combat zone, right after the first symptoms appeared, and with the

expectation of returning to combat after treatment was complete. This form of treatment allowed

soldiers to rest for a few days while they received some psychiatric help. After this short period

of recovery, soldiers were forced to return to duty without delay. This method for treatment was

abandoned after some time because it was realized that there was a lack of evidence for its

effectiveness (Solomon). Despite the history of unsuccessful methods of treatment, exposure

therapy and the rewind technique have both seen major progress in improving the symptoms of

PTSD. In exposure therapy, patients are exposed to their fears in a safe environment in hopes to

reduce the fear and decrease avoidance. The therapy has been scientifically proven to be a

helpful treatment in the treating of PTSD (Div 12). The rewind technique is a method that
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reprocesses traumatic memories by getting patients to recall their traumatic event and then

asking them to think about the incident in reverse. They repeat these steps several times while

being guided by a professional until the memory has been reprocessed as a low-arousal memory

(Gleeson).

As the criteria for diagnosing PTSD expanded to include a larger number of people, this

has also led to a problem with over diagnosing. People are getting diagnosed with PTSD that

may only have a smaller scale psychological stress disorder. In a 2012 interview, Army officer

Matt Stevens said, Clinicians arent separating the few who really have PTSD from those who

are experiencing things like depression or anxiety or social and reintegration problems, or who

are just taking some time getting over it (Dobbs).

Key Events That Catalyzed the Shift. As previously mentioned, WWI began the era of

modern warfare. New technologies and weapons change the way they fought, and this caused

never before seen symptoms to arise in soldiers. For the first time in history, war was fought

using innovations such as tanks, machine guns, and poisonous gas (Eiss). These developments in

technology were not only weapons of mass destruction that caused a large number of casualties,

but also psychological weapons. Poison gas became the most important psychological weapon of

the war because soldiers devoted much of their time to guarding against their possible deaths

(Eiss). Due to the unexpected nature of a poison gas attack, many soldiers were unsure on how to

combat the weapon. As a result, stress wash high and soldiers were affected psychologically.

Traumatized from the war, many soldiers found it difficult to return to civilian life. There was an

upsurge in violence and drunkenness by soldiers trying to forget their past and the trauma they

endured (Gammage). Due to this problem that needed to be fixed, new techniques for dealing

with psychological trauma began to emerged. They became more prevalent after WWII.
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During the era of WWII, combat styles evolved again. Soldiers were forced endure long

surges of fighting which took large tolls on their mental capacity (Friedman). Instead of trenches,

men fought in hand dug foxholes that would normally fit two. This new form of fighting strained

men so much so that they lost their fighting effectiveness after 90 days (Ramsay). The

psychological impact on soldiers all over the world was huge and the only treatment that was

known was the PIE method. The ineffectiveness of this treatment was very influential in

developing the more modern treatments of PTSD. The communal awareness of the side effects

of the war was also a large factor in the development of new treatments. Although this was after

WWII, the book, Band of Brothers written Stephen E. Ambrose in 1992 helped depict the

struggles soldiers faced and allowed for a larger societal understanding (Ramsay). One of the

lines in the book says, The experiences of men in combat produce emotions stronger than

civilians can know, emotions of terror, panic, anger, sorrow, bewilderment, helplessness,

uselessness, and each of these feelings drained energy and mental stability (Ambrose p.203).

Society after WWII was very responsive to the returning soldiers, When the soldiers returned

home from World War II, they were treated as heroes (Moffett). Sadly, this was not always the

case, especially in the following war.

The Vietnam War was by far the biggest cause of the paradigm shift of PTSD. It changed

the way the world viewed the disorder. The Vietnam War was different from any of the wars that

proceeded it. So much so that after the war, veterans were harshly visible. Nearly 3 million U.S

veterans were affected by the consequences of the war (Goldberg). For the first time people,

could see what the war was really like from their television screens. This type of transparency

had a negative impact of the returning soldiers. Veterans came home in defeat and witnessed

antiwar marches and protests (Moffett). Not only did veterans return home with psychological
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damage from the war, but upon returning home, they were greeted with a lack of support. The

antiwar civilians saw them as baby killers, psychos, and drug addicts. This persona developed

from events such as the My Lai Massacre in which US soldiers, led by Lt. William Calley, killed

over 300 unarmed civilians including women, children, and the elderly (PBS). While events such

as these were tragedies and elicited mixed responses, the aftermath of Vietnam was crucial in

helping people understand the strain war caused on our soldiers. In the early 1980s there were

reports of extraordinarily high rates of suicide among Vietnam veterans that appeared in

literature and mass media (Fontana). Many soldiers felt as though they there were left no choice

due to the harsh treatment they were receiving from their communities and the lack of

professional treatment they were receiving from the military. Movies such as Deathdream (1972)

and Platoon (1986), were also influential in shaping societal views about Vietnam and PTSD

(OCallaghan). By being able to visualize the actual struggles of the war, awareness of the

psychological damage caused by Vietnam was spread. This prompted people to come to the

realization that post traumatic symptoms are not a short-lived illness, but manifest as a chronic

disorder that needs serious attention. This also ties back in with the advancements in psychiatry

coinciding with the modernization of society. If it were not for the creation of technology like

film, PTSD may not have developed into what it is today.

Even after the progress made in understanding PTSD during the aftermath of Vietnam,

the psychological trauma is still being developed. The most recent developments are credited to

the operations in Iraq and Afghanistan. These wars caused many soldiers to return home with a

variety of mental incapacities. There are studies that indicate that Veterans returning home from

Iraq and Afghanistan with a history of moderate traumatic brain injury (mTBI) have a probable

PTSD frequency of 33% to 39%, and as many as 20% of returning service members report
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suffering from a mTBI. Despite the large numbers of affected soldiers, there is a positive

outlook. Many soldiers are now being diagnosed easily and affectively treated. New treatments

are developing constantly and soon there should be a treatment that allows patients to access

repressed memories and actively explore and reprocess their past traumas safely (Gleeson).

Conclusion. Throughout the years, PTSD has shifted from a seemingly unheard of mental

disorder, to a chronic psychiatric illness due to the development in psychiatric terminology and

keynote wars which have led to a better understanding in treatment and diagnosis. Throughout

history there have been many people afflicted with some sort of psychological trauma. Spanning

from early human history to present day, it is seen that possibility of developing psychological

damage is a part of life. While initially there may not have been effective treatments, the

progression of society has led to the progression of the knowledge of the disease. Psychiatry has

become effective in lessening the symptoms of the disorder. The future for PTSD is bright. There

are many researchers looking for better ways of treatment that will allow suffers to recover from

their trauma and live normal lives. Post-traumatic stress disorder is a serious illness, and it needs

to be addressed as such. It may have taken a while, but society is finally taking steps in the right

direction.
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