In the wake of World War I, some veterans returned injured, but not with obvious physical damage. Instead, their symptoms…
In the wake of World War I, some veterans returned injured, but not with obvious physical damage. Instead, their symptoms resembled those previously associated with hysterical women – usually amnesia, or some form of paralysis or inability to communicate without clear physical cause.
The English doctor Charles Myers, who wrote the first thesis on “Shell shock” in 1915, theorized that these symptoms were actually due to physical damage. He suggested that repetitive exposure to brainwashing blisters caused brain trauma that resulted in this strange grouping of symptoms. But once tested, his hypothesis did not stand up. There were plenty of veterans who had not been exposed to the brainwashing of the Brain Wars, for example, who still experienced the symptoms of scallops. (And certainly not all veterans who had seen this kind of battle returned with symptoms.)
We now know that what these combat veterans were facing was probably what we today call post-traumatic stress disorder or PTSD. We can now recognize it, and treatments have certainly advanced, but we still do not have a full understanding of what PTSD is.
Medical society and society at large are used to searching for the simplest cause and cure for a given disease. This results in a system where symptoms are detected and cataloged and then matched with therapies that will alleviate them. Although this method works in many cases, PTSD has been resistant in the last 1
We are three researchers in the humanities who individually studied the PTSD framework for which people perceive it, how researchers study it, therapies the medical community prepares for it. Through our research, we have all seen how the medical model alone fails to adequately account for the ever-changing nature of PTSD.
What is missing is a coherent explanation of trauma that allows us to explain the different ways in which its symptoms have manifested over time and may differ in different people.
Nonphysical Impact of the Great War
When it became apparent that not everyone who suffered from scallops in the wake of WWI had experienced brain injuries, the British medical journal provided alternative nonphysical explanations for its occurrence: 19659002] Bad moral and defective training is one of the most important, if not the main etiological factors: also that scallop was a “catchy” complaint. – (British Medical Journal, 1922)
Skalchock went from being considered a legitimate physical injury to be a sign of weakness, both the battalion and the soldiers in it. A historian estimates that at least 20 percent of men developed shock shock, although the numbers are dim due to the doctor’s dislike at that time to brand veterans with a psychological diagnosis that may affect invalidity compensation.
Soldiers were archetypal hero and strong. When they came home can not speak, go or remember, without the physical reason for the shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier who had been in war as a hero now behaves like a coward and had to be snapped out of it.
Lewis Yealland, a British clinician, described in his 1918 “Hysterical Disorders of Warfare” the kind of brutal treatment that comes from thinking of scallop as a personal failure. After nine months of failing to treat patient A1, including electrical shock in the neck, put cigarettes on their tongue and hotplates placed on the back of the throat, Yealland told tell the patient: “You will not leave this room until you is talking as much as you ever did; no, not until … you have to behave like the hero I expect to be. “
Yes, then an electrical shock applied to the throat so strong that it sent the patient’s swing backwards, and chopped the battery out of the machine. Undantredt, Yealland lowered the patient to avoid the battery problem and continued to apply shock for an hour, at which time the patient A1 finally whispered “Ah”. After an hour, the patient began to cry and whisper: “I want a drink of water.”
Yealland reported this meeting triumphantly – the breakthrough meant that his theory was correct and his method worked. Skelchock was a men’s disease rather than a disease that came from, witnessed, exposed to incredible violence.
Evolution removed from scallop
The next wave of the study of trauma came when the Second World War saw another influx of soldiers who treated similar symptoms.
It was Abram Kardiner, a clinician who worked at the US Veterinary Clinic’s psychiatric clinic, as a reassessed combat trauma in a much more empathetic light. In his influential book, “The Traumatic War Tracks”, Kardiner speculated that these symptoms stem from mental injury, rather than the wrong character of a soldier.
Work from other clinics after World War II and the Korean War suggested that post-war symptoms could last. Long-term studies showed that symptoms could persist anywhere from six to 20 years if they disappeared at all. These studies returned some legitimacy to the concept of combat trauma that had been removed after World War I.
Vietnam was another water center for Combat-PTSD because veterans began to advocate for themselves in an unprecedented way. Beginning with a small march in New York in the summer of 1967, veterans themselves became activists for their own mental healthcare. They worked to redefine “post-Vietnam syndrome” not as a sign of weakness, but rather a normal response to the uprising experience. The public understanding of the war itself had also begun to shift, as the massive television accounts in the My Lai massacre for the first time bring war of war in American living rooms. Veterans’ campaign helped to include PTSD in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), the major American diagnostic resource for psychiatrists and other psychiatric clinics.
The authors of DSM-III deliberately avoided talking about the causes of mental disorders. Their goal was to develop a manual that can be used by psychiatrists following radically different theories, including freudian approaches and what is now known as “biological psychiatry”. These groups of psychiatrists would not agree on how to explain disturbances, but they could – and did – agree on which patients had similar symptoms. Thus, DSM-III-defined disorders, including PTSD, exclusively based on symptom clusters, defined an approach that has been maintained since then.
This tendency to agnosticism around the physiology of PTSD is also reflected in contemporary evidence-based approaches to medicine. Modern medicine focuses on using clinical trials to show that a therapy works but is skeptical about attempts to link treatment effectiveness to the biology underlying a disease.
Today’s Mediced PTSD
People can develop PTSD for a variety of reasons, not just in combat. Sexual abuse, a traumatic loss, a horrible accident – each can lead to PTSD. The US Department of Veterans Affairs estimates approximately 13.8 percent of the veterans returning from war in Iraq and Afghanistan currently has PTSD. By comparison, a male veteran of these wars is four times more likely to develop PTSD than one in the civilian population is. PTSD is probably at least partly the root of an even more alarming statistics: Up to 22 veterans commit suicide every day.
Therapy for PTSD today tends to be a mixed bag. Practically, when veterans seek PTSD treatment in the VA system, the policy requires that they be offered either exposure or cognitive therapy. Exposure treatments are based on the idea that the fear that causes many of the traumatic symptoms can be attenuated by repeated exposures to the traumatic event. Cognitive therapies work to develop personal management methods and slowly change unwanted or destructive thinking patterns that contribute to symptoms (for example, the shame you may feel unable to complete a mission or rescue a companion). The most common treatment a veteran is likely to receive will include psychiatric drugs – especially the class of drugs called SSRI.
Mindfulness therapies, based on becoming aware of mental states, thoughts and feelings and accepting them instead of trying to fight them or drive them away, is another option. There are also more alternative methods studied, such as desensitization and eye movement or EMDR therapy, controlled doses of MDMA (Ecstasy), virtual reality-graded exposure therapy, hypnosis and creative therapies. The military is funding a wealth of research on new technologies to address PTSD. These include neurotechnical innovations such as transcranial stimulation and neural fields as well as new drugs.
Several studies have shown that patients improve most when they have chosen their own treatment. But even though they limit their choices to those supported by the National Center for PTSD’s weight by using the Center’s online treatment decision, patients will still weigh five ways, each of which is evidence-based, but brings another psycho-medical model for trauma and healing.
This buffet of treatment options allows us to set aside our lack of understanding of why people experience trauma and respond to actions so differently. It also relieves the pressure on psychomedicine to develop a complete model of PTSD. We reframe the problem as a consumer question instead of a scientific question.
Thus WWI was as if WWI was about soldiers and punished them for its weakness, in the modern era, the ideal veterinary patient is a healthcare consumer who is required to play an active role in calculating and optimizing his own therapy.
When we stand here with the strange success of the follow-up that comes with 100 years of study of comb-related trauma, we must be careful to celebrate our progress. What is still missing is an explanation of why people have different responses to trauma and why different responses arise in different historical periods. For example, paraylsen and amnesia as epitomized cases of fall victims in WWI are now rare so that they do not even appear as symptoms in the DSM procedure for PTSD. We still do not know enough about how the soldiers own experiences and understandings of PTSD are shaped by the broader social and cultural views about trauma, war and gender. Although we have made incredible progress in the century since World War I, PTSD is still a chameleon and requires our continued study.
This article was originally published on The Conversation. Read the original story here.