Friday , October 22 2021

From shocks to PTSD, the century of invisible war trauma


After the First World War, some veterans returned the wounded, but not because of obvious physical injuries. Instead, their symptoms were similar to those that were previously associated with hysterical women – most often amnesia, or some kind of paralysis or impossibility to communicate without a clear physical cause.

An English doctor, Charles Myers, who wrote in 1915. The first article on shock shocked the hypothesis that these symptoms actually result from a physical injury. He stated that repeated exposure to shock caused brain injury that caused this strange group of symptoms. But once put to the test, his hypothesis could not stand. There were many veterans who, for example, were not exposed to war-related shocks in trenches who were still experiencing symptoms of shock. (Certainly not all veterans who saw this kind of battle returned with symptoms.)

Now we know that what the veterans of the fight encountered was probably what we now call post-traumatic stress disorder, PTSD. Now we are able to recognize it better, and the treatment has certainly developed, but we still do not have a full understanding of what PTSD is.

The medical community and the whole society are used to looking for the simplest cause and cure for any ailment. In this way, a system is created in which symptoms are detected and cataloged, and then adapted to therapy that will alleviate them. Although this method works in many cases, PTSD has resisted for the last 100 years.

We are three humanities researchers who have individually studied PTSD – the framework by which people conceptualize them, the ways in which researchers study them, the therapies that the medical community is inventing for them. Thanks to our research, each of us has seen that the medical model itself does not adequately reflect the ever-changing nature of PTSD.

What was missing is a coherent explanation of the trauma, which allows us to explain the different ways of manifesting symptoms over time and can vary in different people.

Nonphysical repercussions of the Great War

When it became clear that not everyone who suffered a shock after the First World War had suffered brain injuries, the British Medical Journal provided alternative, nonphysical explanations for its prevalence:

Bad morale and faulty training are one of the most important, if not the most important, etiological factors: also this shock related to the missile was a "catchy" complaint. – (The British Medical Journal, 1922)

The shock caused by the shell ceased to be considered a valid physical trauma, a sign of the weakness of both the battalion and soldiers within its range. One historian estimates that at least 20 percent of men have developed a shock, although the figures are muddied due to the doctor's reluctance at that time for brand veterans with a psychological diagnosis that could affect disability compensation.

The soldiers were archetypically heroic and strong. When they returned home unable to speak, walk or remember, without the physical causes of these deficiencies, the only possible explanation was personal weakness. The methods of treatment were based on the assumption that the soldier who started the war as a hero behaved like a coward and had to be torn out of it.

Electric treatments were prescribed in psychoneurotic cases after the First World War. Photo by Otis Historical Archives National Museum of Health and Medicine

Lewis Yealland, a British clinician, described in his 1918 the "Hysterical Disorders of Warfare" a kind of brutal treatment that stems from thinking about shell shock as a personal failure. After nine months of ineffective treatment of patient A1, including electric shocks around the neck, cigarettes stuffed into his tongue and hot plates placed at the back of his throat, Yealland boasted to the patient saying: "You will not leave this room until you are talking as well as you do no, not before … you must behave like a hero I expect from you. "

Yealland then applied the shock to the throat so strongly that he sent the patient back, pulling the battery away from the machine. Undeterred, Yealland tied the patient down to avoid a problem with the battery and continued the shock for an hour, after which the patient A1 finally whispered "Ah." After another hour, the patient began to cry and whispered, "I want a drink of water."

Yealland triumphantly reported this meeting – the breakthrough meant that his theory was correct and his method worked. Shell shock was a disease of masculinity, not a disease that came from witnessing, surrendering, and participating in unbelievable violence.

Evolution away from shock shocks

The next wave of research on trauma took place when in the Second World War there was another influx of soldiers who had similar symptoms.

It was Abram Kardiner, a clinician working at the United States Veterans & # 39; Bureau psychiatric clinic, who thought through the trauma of the fight in a much more empathetic light. In his influential book, The Traumatic Neuroses of War, Kardiner speculated that these symptoms stem from psychological trauma and not from a defective soldier figure.

The work of other clinicians after the Second World War and the Korean War suggested that post-war symptoms may be long-lasting. Longitudinal studies have shown that symptoms may last from 6 to 20 years, if they disappear at all. These studies restored a certain legitimacy to the concept of war trauma, which was removed after the First World War.

UNDATED FILES FOTO – US Marine in a reconnaissance mission during the Vietnam War comes down when marines move through low leaves in the demilitarized zone Photo by Reuters

Vietnam was another breakthrough in the fight against PTSD related to the fight, because the veterans began to defend themselves in an unprecedented way. Starting with a small march in New York in the summer of 1967, veterans themselves began to be activists in their own mental health care. They worked on redefining the "post-Vietnamese syndrome" not as signs of weakness, but rather as a normal response to the experience of cruelty. The social understanding of the war itself has also begun to change, because the television coverage of the My Lai massacre has for the first time triggered a horror of war in American salons. The veteran campaign helped to incorporate PTSD into the third edition of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-III), the main American diagnostic source for psychiatrists and other mental health clinics.

The DSM-III authors deliberately avoided talking about the causes of mental disorders. Their goal was to develop a handbook that could be used by psychiatrists using radically different theories, including Freudian approaches and what is now called "biological psychiatry." These groups of psychiatrists would not agree on how to interpret the disorder, but could – and did not – agree which patients had similar symptoms. Thus, disorders defined in DSM-III, including PTSD, are based only on symptom clusters, an approach that has been preserved so far.

This tendency towards agnosticism in the field of PTSD physiology is also reflected in contemporary approaches to evidence-based medicine. Modern medicine focuses on the use of clinical trials to show that the therapy works, but is skeptical about attempts to link the effectiveness of treatment with the underlying biology.

Today's mediated PTSD

People can develop PTSD for a variety of reasons, not just in combat. Sexual assault, traumatic loss, terrible accident – anyone can lead to PTSD. The US Department of Veterans estimates that 13.8 percent of veterans returning from Iraq and Afghanistan now have PTSD. For comparison, a male veteran of these wars is four times more likely to develop PTSD than a man in a civilian population. PTSD is probably at least partly at the root of even more alarming statistics: upwards of 22 veterans commit suicide every day.

Therapies for PTSD today seem to be a mixed bag. Practically speaking, when veterans are looking for PTSD treatment in the VA system, the policy requires offering either exposure or cognitive therapy. Radiation therapy is based on the assumption that anxiety reaction, which causes many traumatic symptoms, can be weakened by repeated exposures to a traumatic event. Cognitive therapies work to develop personal coping methods and slowly change unnecessary or destructive thought patterns that contribute to symptoms (for example, shame that may seem to have failed to complete a mission or save a companion). The most common treatment that a veteran will probably receive will include psychopharmaceuticals – especially drugs called SSRI.

Troy Yocum, a veteran of the Iraq war, crosses the George Washington Bridge from New Jersey to New York in the company of the governing body of the Port of New York and New Jersey. On June 15, 2011, Yokum travels over 7,000 miles across America to raise awareness of serious problems. American military families are waiting for soldiers returning home from deployment abroad with Post Traumatic Stress Disorder (PTSD) and raise funds to help needy families military. Photo: Mike Segar / Reuters

It is believed that mindfulness therapies based on becoming aware of mental states, thoughts and feelings and accepting them instead of trying to fight or repel them are another option. There are also other alternative test methods, such as eye desensitization and reprocessing or EMDR therapy, therapies with controlled doses of MDMA (Ecstasy), virtual reality exposure therapy, hypnosis and creative therapy. The army finances a lot of research into new technologies to deal with PTSD; These include neurotechnology innovations, such as transcranial stimulation and nerve 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 limit their choices to those that are supported by the National Center for PTSD through the online help center, patients will still weigh five options, each of which is evidence-based but involves a different psychomedality. model of injury and healing.

This cure of treatment options allows us to put aside our lack of understanding of why people experience trauma and respond to interventions in such a different way. It also reduces the pressure on psychomedicine to develop a complete PTSD model. We pass the problem as a consumer issue, not a scientific one.

So while the First World War was about soldiers and punished them for their weaknesses, in the modern era, a great PTSD veteran is a health care consumer who has an obligation to play an active role in discovering and optimizing his own therapy.

When we stand here with a strange benefit from the perspective of time that accompanies 100 years of studying trauma associated with struggle, we must be careful to celebrate our progress. There is still no explanation why people have different reactions to trauma and why different reactions occur in different historical periods. For example, paraylsis and amnesia that embody the shock cases of the First World War are now so rare that they do not even appear as symptoms in the DSM record for PTSD. We still do not know enough about how PTSD's own experiences and understanding are shaped by wider social and cultural views on trauma, war and gender. Although we have made amazing progress since the First World War, PTSD remains a chameleon and requires our further research.

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

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