From shell shock to PTSD: History of PTSD in Veterans

June is Post-Traumatic Stress Disorder (PTSD) Awareness Month. PTSD is a mental condition that can develop after experiencing or witnessing a life-threatening event, such as combat, natural disasters, car accidents, or sexual assault. Symptoms may include nightmares, uncontrollable thoughts about the event, emotional flashbacks, and avoidance of distressing memories.

According to the National Center for PTSD, about 6 of every 10 men (60%) and 5 of every 10 women (50%) will experience at least one trauma in their lives. While some individuals may recover within a few months, others may take years, or symptoms may even begin long after the event. PTSD can be treated through various therapy techniques and medication. It is crucial to acknowledge the significant effects of trauma and seek appropriate treatment rather than avoiding it.

PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. So, the history of what is now known as PTSD often references combat history.

Exposure to traumatic experiences has always been a part of the human condition, from prehistoric attacks by saber tooth tigers or twenty-first century terrorists, all likely led to similar psychological responses in survivors of such violence.

Accounts of psychological symptoms following military trauma date back to ancient times. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions.

Prior to U.S. military efforts, Austrian physician Josef Leopold in 1761, wrote about "nostalgia" among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.

Later on, the condition was thought to be rooted in a physical injury leading to the onset of symptoms. "Soldier's heart" or "irritable heart" was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these "cardiac" symptoms and described it as overstimulation of the heart's nervous system, or "Da Costa's Syndrome." Soldiers were often returned to battle after receiving drugs to control symptoms.

In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. At that time, some symptoms of present-day PTSD were known as "shell shock" because they were seen as a reaction to the explosion of artillery shells.

Symptoms included panic and sleep problems, to name a few. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Thinking changed when more soldiers who had not been near explosions had similar symptoms. "War neuroses" was also a name given to the condition during this time.

During World War I, treatment was varied. Soldiers often received only a few days' rest before returning to the war zone. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. In European hospitals, "hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis.

In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as "battle fatigue." As long surges were common in World War II, soldiers became battle weary and exhausted. Some American military leaders, such as Lieutenant Gen. George S. Patton, did not believe "battle fatigue" was real.

Up to half of World War II military discharges were said to be the result of combat exhaustion. CSR was treated using "PIE" (Proximity, Immediacy, Expectancy) principles, which required treating casualties without delay and making sure sufferers expected complete recovery so they could return to combat after rest. The benefits of military unit relationships and support became a focus of both preventing stress and promoting recovery.

In 1952, the American Psychiatric Association (APA) produced the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which included "gross stress reaction." This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. However, a problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.

Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in 1968, and instead, the DSM-II included "adjustment reaction to adult life" which was not sufficient enough to capture a PTSD-like condition, especially when this diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome (marked by incorrect answers to questions) in prisoners who face a death sentence.

It wasn’t until 1980 when the APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.

The DSM-III criteria for PTSD have been revised over the years to reflect continuing research. An important change is that PTSD is no longer an Anxiety Disorder. PTSD is sometimes associated with other mood states, such as depression, and with angry or reckless behavior rather than anxiety. PTSD is now in a new category, Trauma- and Stressor-Related Disorders.

PTSD includes four different types of symptoms: reliving the traumatic event (also called re-experiencing or intrusion); avoiding situations that are reminders of the event; negative changes in beliefs and feelings; and feeling keyed up (also called hyperarousal or over-reactive to situations). Most people experience some of these symptoms after a traumatic event, so PTSD is not diagnosed unless all four types of symptoms last for at least a month and cause significant distress or problems with day-to-day functioning.

The Department of Veterans Affairs (VA) is committed to provide the most effective, evidence-based care for PTSD. It has created programs to ensure VA clinicians receive training in state-of-the-art treatments for PTSD. The VA trains clinicians to use Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), which are proven to be effective treatments for PTSD.

VA's National Center for PTSD was created in 1989 by an act of Congress, and continues to be at the forefront of progress in the scientific understanding and treatment of PTSD. In addition to improving upon existing treatments, we are researching effective new treatments.

VA services are provided to all Veterans who completed active military service in any of the branches military, including the Merchant Marines during WWII; were discharged under other than dishonorable conditions; or were National Guard members or Reservists who have completed a federal deployment to a combat zone.

If you have experienced a traumatic event and are suffering from symptoms of PTSD, all VA Medical Centers provide PTSD treatment, and many locations around the county offer specialized PTSD programs. Locally in the Mat-Su, services are offered at the Mat-Su VA Clinic located at 865 North Seward Meridian Parkway, or call (907) 257-4854, ext. 1 for Mental Health services.