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As a result of the First World War, some veterans returned wounded, but not with obvious physical injuries. Instead, their symptoms were similar to those previously associated with hysterical women – most commonly amnesia, or some kind of paralysis or inability to communicate without obvious physical cause.
The English doctor Charles Myers, who wrote the first article on "shell-shock" in 1915, hypothesized that these symptoms actually came from a physical injury. He postulated that repeated exposure to shock explosions caused brain trauma that had resulted in this strange group of symptoms. But once put to the test, his hypothesis did not resist. For example, many veterans who had not been exposed to the explosive explosions of trench warfare were still experiencing the symptoms of shelling shock. (And certainly not all veterans who had seen this kind of battle came back with symptoms.)
We now know that veterans were probably faced with what we now call post-traumatic stress disorder (PTSD). We are now better able to recognize it and treatments have progressed, but we still do not understand what PTSD is.
The medical community and society in general are used to finding the simplest cause and cure for their disease. The result is a system in which symptoms are discovered and cataloged, and then associated with therapies that will mitigate them. Although this method works in many cases, PTSD has been resilient for 100 years.
We are three social scientists who have studied PTSD individually – the setting in which people conceptualize it, the way researchers study it, the therapies developed by the medical community. Throughout our research, each of us has seen how the medical model is failing to accurately account for the ever-changing nature of PTSD.
What is missing is a coherent explanation of the trauma that allows us to explain the different ways in which its symptoms have manifested themselves over time and may differ from person to person.
Non-physical repercussions of the Great War
Once it became clear that all people who had suffered head trauma after the First World War had not suffered brain damage, the British Medical Journal provided other non-physical explanations. to its prevalence.
Bad morale and poor training are one of the most important, if not the most important, etiological factors: this bombing shock was a "catching" complaint. – (British Medical Journal, 1922)
Shell's shock, considered a legitimate physical injury, became a sign of weakness for the battalion and its soldiers. One historian estimates that at least 20% of men have developed a state of total shock, although the figures remain obscure because of the reluctance of doctors at the time to impose on veterans a psychological diagnosis likely to Allocate compensation for disability.
The soldiers were archetypically heroic and strong. When they returned home unable to speak, walk or remember, without any physical reason for these failings, the only possible explanation was personal weakness. The methods of treatment were based on the idea that the soldier who had entered the war as a hero behaved now as a coward and had to be removed from it.
Lewis Yealland, a British doctor, described in his book "Hysterical Disorders of War" of 1918 the type of brutal treatment that resulted from the idea that shock by a shell was a personal failure. After nine months of unsuccessful treatment of the A1 patient, including electric shocks to the neck, cigarettes spread over the tongue and hot plates placed at the back of the throat, Yealland is touted to tell the patient : "You will not leave this room talking as well as you have never done; no, not before … you must behave like the hero, I'm waiting for you to be.
Yealland is touted to tell the patient, "You will not leave this room until you speak as well as ever; no, not before … you must behave like the hero, I'm waiting for you to be.
Yealland then applied an electric shock to the throat so hard that the patient was sent back, picking up the battery from the machine. Undeterred, Yealland stuck the patient to avoid the battery problem and continued to apply shock for an hour. Patient A1 finally murmured "Ah". After an hour, the patient started to cry and whispered, "I want to drink a glass of water."
Yealland reported this encounter triumphantly – this discovery meant that his theory was correct and his method worked. Shell-shock was a human illness and not a disease due to witnessing, experiencing and participating in unbelievable violence.
Evolution away from shocks
The second wave of trauma studies came when the Second World War saw another influx of soldiers struggling with similar symptoms.
Abram Kardiner, a clinician from the US Veterans Office's psychiatric clinic, has rethought combat trauma in a much more empathic way. In his influential book, "The Traumatic Neuroses of War," Kardiner assumed that these symptoms stemmed from a psychological injury rather than from the flawed nature of the soldier.
The work of other clinicians after the Second World War and the Korean War suggest that post-war symptoms could linger. Longitudinal studies have shown that symptoms can persist for six to 20 years if they disappear at all. These studies have given some legitimacy to the concept of combat trauma that was set aside after the First World War.
Vietnam was another turning point for combat-related PTSD, as veterans began to defend themselves in unprecedented ways. Beginning with a short walk in New York in the summer of 1967, the veterans themselves began to become activists for their own mental health care. They worked to redefine the "post-Vietnamese syndrome", not as a sign of weakness, but rather as a normal response to the experience of the atrocity. The public's understanding of the war itself began to evolve, with the widely televised accounts of the My Lai massacre making for the first time the horror of war in the American living room. The veterans campaign included PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the leading US diagnostic resource for psychiatrists and other mental health clinicians.
The authors of the DSM-III have deliberately avoided talking about the causes of mental disorders. Their goal was to develop a manual that could be used simultaneously by psychiatrists adhering to radically different theories, including Freudian approaches and what is now called "biological psychiatry". These groups of psychiatrists would not agree on how to explain the disorders, but they could – and – have reached agreement on patients with similar symptoms. Thus, the DSM-III has defined disorders, including PTSD, solely on the basis of clusters of symptoms, an approach that has been preserved ever since.
This tendency to agnosticism about the physiology of PTSD is also reflected in current approaches to evidence-based medicine. Modern medicine focuses on the use of clinical trials to demonstrate that the therapy works, but remains skeptical about attempts to associate the effectiveness of treatment with the underlying biology of the disease. 39, an illness.
Today's medicalized PTSD
People can develop PTSD for a variety of reasons, not just in combat. A sexual assault, a traumatic loss, a terrible accident – everyone can lead to PTSD. The US Department of Veterans Affairs estimates that about 13.8% of veterans returning from wars in Iraq and Afghanistan are currently suffering from PTSD. For comparison, a veteran of these wars is four times more likely to suffer from PTSD than a man in the civilian population. PTSD is probably at least partly at the root of an even more alarming statistic: 22 veterans commit suicide each day.
Therapies for PTSD tend to be a mix. In practical terms, when veterans seek treatment for PTSD in the VA system, the policy requires either exposure or cognitive therapy. Exposure therapies are based on the idea that the fear reaction that causes many traumatic symptoms can be mitigated by repeated exposures to the traumatic event. Cognitive therapies develop personal coping methods and slowly alter unnecessary or destructive thinking patterns that contribute to symptoms (eg, the shame that one might feel about not carrying out a mission or save a comrade). The most common treatment that a veteran will likely receive will include psychopharmaceutical products – especially the class of drugs called SSRIs.
Mindfulness therapies, based on awareness and acceptance of mental states, thoughts and feelings rather than trying to fight or repel them, are another option. Other alternative methods are also under study, such as desensitization and reprocessing of eye movements or EMDR therapy, therapies using controlled doses of MDMA (ecstasy), exposure therapy to reality virtual, hypnosis and creative therapies. The army funds a wealth of research on new technologies to fight PTSD; These include neurotechnological innovations such as transcranial stimulation and neural chips, as well as new drugs.
Several studies have shown that patients improve the most when they choose their own therapy. But even if they limited their choices to those backed by the weight of the National Center for PTSD using the online treatment decision-making process of the center, patients would still be faced with five options, each based on evidence but with a different psychomedical aspect. model of trauma and healing.
This buffet of treatment options allows us to put aside our lack of understanding of why people experience trauma and respond so differently to interventions. It also relieves the pressure of psychomedicine to develop a complete model of PTSD. We are reformulating the problem as a consumption problem rather than a scientific one.
So, while the First World War was about soldiers and punishing them for their weakness, in contemporary times the ideal veteran patient with PTSD was a health care consumer who had to play an active role in determination and optimization of one's own therapy.
As we stand here with the strange benefit of the backtracking we have accumulated after 100 years of studies on combat-related trauma, we need to pay attention to our progress. What is still missing, is why people respond differently to the trauma and why different reactions occur during different periods of history. For example, the paraylsis and amnesia that characterize the shell shock cases of the First World War are now so rare that they do not even appear as symptoms in the DSM entry for PTSD. We still do not know enough about how soldiers' experiences and understanding of PTSD are shaped by broader social and cultural conceptions of trauma, war, and gender. Although we have made incredible progress in the century since the First World War, PTSD remains a chameleon and demands continued study.
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