From shell-shock to PTSD, a century of invisible war trauma

In the wake of World War I, some veterans returned wounded, but not with obvious physical injuries. Instead, they have been reported to be more commonly associated with hysterical women – or more commonly, or some kind of paralysis or inability to communicate with no clear physical cause.

English physician Charles Myers, who wrote the first paper on "shell-shock" in 1915, theorized that these symptoms actually stem from a physical injury. He posited that repetitive exposure to concussive blasts caused brain trauma that resulted in this strange grouping of symptoms. But once you hit the test, his hypothesis did not hold up. There were plenty of veterans who were still experiencing the symptoms of shell-shock. (And certainly not all veterans who have seen this type of battle with symptoms.)

We now know that what is this post-traumatic stress disorder, or PTSD. We are now better able to recognize it, and treatments have certainly advanced, but we still have a full understanding of just what PTSD is.

The medical community and society at large are more easily accessible than others. This results in a system where symptoms are discovered and then matched with therapies that will alleviate them. This method works in many cases, for the past 100 years, PTSD has been resisting.

We are three scholars in the humanities who have each studied PTSD – the framework through which people conceptualize it, the ways to look for it, the medical therapies for it. Through our research, we have seen the medical model alone in the ever-changing nature of PTSD.

What's been missing is a different way of trauma that can be explained in different ways.

Nonphysical repercussions of the Great War

It has become clear that not everyone has suffered from shock-shell injury in the wake of WWI's had experienced brain injuries, the British Medical Journal provided alternate nonphysical explanations for its prevalence:

A poor moral and a defective training are one of the most important, if not the most important etiological factors: also that shell-shock was a "catching" complaint. – (The British Medical Journal, 1922)

Shell-shock went from being considered to a sign of weakness, of both the battalion and the soldiers within it. One historian estimates at least 20 percent of men developed shell-shock, though the figures are more likely to be affected by the disease.

Soldiers were archetypically heroic and strong. When they came to talk, remember, or with no physical reason for shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier had entered into the world.

Lewis Yealland, a British clinician, describes in his 1918 "Hysterical Disorders of Warfare" the kind of brutal treatment that follows from thinking about shell-shock as a personal failure. A1, including electric shocks to the neck, cigarettes put out on his tongue and throat, Yealland boasted of the patient, "You will not leave this room until you you never did; no, not before … you must be herve I expect you to be. "

Yealland then applied an electric shock to the throat so that it feels the patient reeling backwards, unhooking the battery from the machine. Undated, Yealland strapped the patient down to avoid the battery problem and continued to apply shock for an hour, at which point patient A1 finally whispered "Ah." water. "

Yealland reported this encounter triumphantly – the breakthrough of his theory was correct and his method worked. Shell-shock was a disease of manhood rather than an illness that came from witnessing, being subjected to and partaking in incredible violence.

Evolution away from shell-shock

The next wave of the study of trauma when second world war.

It was Abram Kardiner, a clinician working in the psychiatric clinic of the United States Veterans' Bureau, who rethought combat trauma in a much more empathetic light. In his influential book, "The Traumatic Neuroses of War," Kardiner speculates that these symptoms stem from the state of injury, rather than a soldier's flawed character.

Work from other clinicians after WWII and the Korean War suggested that post-war symptoms could be lasting. Longitudinal studies showed that they could persist anywhere from six to 20 years, if they disappeared at all. These studies returned some legitimacy to the concept of trauma that had been stripped away after the First World War.

Vietnam was another watershed moment for combat-related PTSD because of veterans in an unprecedented way. Beginning with a small march in New York in the summer of 1967, veterans themselves began to become activists for their own mental health care. They worked to redefine "post-Vietnam syndrome", but rather a normal response to the experience of atrocity. Public understanding of war itself had started to shift, too, as the TV screenings of the My Lai massacre brought to life in American living rooms for the first time. The veterans' campaign helped get PTSD included in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), the major American diagnostic resource for psychiatrists and other mental health clinicians.

The authors of the DSM-III deliberately discusses the causes of mental disorders. They were able to be used in many different ways by psychiatry and other psychiatry. These groups of psychiatrists would not be allowed to do so. – and did – come to agree on which patients had similar symptoms. So the DSM-III defined disorders, including PTSD, only on the basis of clusters of symptoms, an approach that has been retained ever since.

This tendency to agnosticism about the physiology of PTSD is also reflected in contemporary evidence-based approaches to medicine. Modern medicine focuses on the use of clinical trials in the treatment of osteoarthritis, but is more important in the treatment of disease.

Today's medicalized PTSD

People can develop PTSD for different reasons, not just in combat. Sexual assault, a traumatic loss, has a terrible accident – each might lead to PTSD. The U.S. Department of Veterans Affairs estimates about 13.8 percent of the veterans returning from the wars in Iraq and Afghanistan currently have PTSD. For comparison, a person is more likely to develop PTSD than a man in the civilian population is. PTSD is probably at least partially at the root of an even more alarming statistic: Upwards of 22 veterans commit suicide every day.

Therapies for PTSD today tends to be a mixed bag. Practically speaking, when they seek treatment in the VA system, they need to be offered either exposure or cognitive therapy. Exposure therapies are based on the idea that the fear of a traumatic event can be reduced to a number of traumatic events. Cognitive therapies working on developing personal coping methods and slowly changing unhelpful or destructive thought patterns that are contributing to symptoms (for example, the shame of one might feel and not succeeding a mission or saving a comrade). The most common treatment will include psychopharmaceuticals – especially the class of drugs called SSRIs.

Mindfulness therapies, based on becoming aware of mental states, thoughts and feelings and accepting them rather than trying to push them away, are another option. Other methods include EMDR therapy, MDMA-based therapeutics using controlled doses (Ecstasy), virtual reality-graded exposure therapy, hypnosis and creative therapies. The PTSD; These include neurotechnological innovations like transcranial stimulation and neural chips as well as novel drugs.

Several studies have shown that patients improve when they've chosen their own therapy. But even if they narrow their choices by the weight of the National Center for PTSD by Decision Aid, patients would still find themselves weighing five options, each of which is evidence-based but entails a different psychomedical model of trauma and healing.

This buffet of treatment options lets us set up our lack of understanding of how people experience trauma and respond to interventions so differently. It also relies on the pressure for psychomedicine to develop a complete model of PTSD. We reframe the problem as a consumer issue instead of a scientific one.

Thus, while the patient is in the same position, the ideal veteran is a patient who has an obligation to play an active role in figuring out and optimizing their own therapy.

As we stand here with the strange benefit of having 100 years of trauma-related trauma, we must be careful in celebrating our progress. What is still missing is an explanation of why people have different responses to trauma, and why different responses occur in different historical periods. For instance, the paraylsis and amnesia that epitomized WWI shell-shock cases are so rare that they do not appear in the DSM entry for PTSD. We still do not know enough how to experience trauma, war and gender. We have made incredible strides in the century since World War I, PTSD remains a chameleon, and demands our continued study.

This article was originally published on The Conversation. Read the original story here.