Short History of PTSD

Many of us are battling many kinds of demons. Some of us can control the demons and others cannot. It isn’t that people don’t try; rather, they just can’t take control. Demons come in many different forms, heroin, alcohol, drugs, anger, bullying, punishing, screaming, stealing are all examples of demons.

It is not that PTSD is a new problem or something we just discovered. PTSD, as we call it today, has been around for a few thousand years. Many authors including

Homer, (the Iliad), William Shakespeare (Henry IV), and Charles Dickens (A Tale of Two Cities) wrote about traumatic experiences and their symptomology.
In talking about post traumatic stress disorder, we can go back to the Great Fire of London in 1666. In the Diary of Samuel Pepys, “the fire burned for three days, and the King ordered Pepys on the second day to bring a message to the Lord Mayor: Any houses in the way of the flames should be demolished to create a fire break, (since wooden houses in a dense city were like tinder). Even during the fire he began to forget events during the day, including meals and he inserted some details afterward in the margin of his diary. He had nightmares afterward, and various ideas and physical situations brought forth anxious feelings for about eight months. The great London diarist doesn’t write down a remedy for his condition. He doesn’t even seem to notice that he has a condition, though he does describe the suicides of other Londoners after the fire.

The American Civil War, (1861-65) and the Franco Prussian War (1870-71) appear to mark the start of formal medical attempts to understand the malady. European descriptions of the psychological impact of railroad accidents appear to have added to our understanding of trauma.

The Austrian physician Josef Leopold (1761) wrote about “nostalgia” among soldiers. Among those who fought, some reported missing home, feeling sad, sleep problems, and anxiety. This model of “nostalgia” lasted through the American Civil War.

In studying Civil War soldiers, symptoms that were called “soldier’s heart” or “irritable heart” were marked by a rapid pulse, anxiety and trouble breathing. US 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 the symptoms.
It was thought that physical injury led to PTSD like symptoms was supported by European reports of “railway spine”. Railway accidents caused passengers to die with injuries to the central nervous system. Charles Dickens wrote about a train accident that he was involved in 1865, which caused symptoms of sleeplessness and anxiety secondary to the trauma.

President Wilson in 1919 proclaimed November 11th as the first observance of Armistice Day. This is the day that WW1 ended. In those days, the symptoms that we call PTSD were called “shell shock”, because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Other soldiers not being near to the explosions have similar symptoms. They were termed, “war neuroses”. Treatment was varied for these illnesses. Soldiers received a few days of rest and then had to return to the war. Those with severe or chronic symptoms, had treatments focusing on daily activities (ADL – activities of daily living) to increase functioning. In European hospitals, hydrotherapy, ECT and hypnosis were utilized.

During WW2, the shell shock diagnosis was replaced by “Combat Stress Reaction” (CSR), also known as “battle fatigue”. General George Patton, the famous WW2 battle leader did not believe in “battle fatigue”. He thought that those soldiers who complained of battle fatigue were “faking it” and were just afraid of war. Up to 50% of World War 2 military discharges were said to be the result of combat exhaustion or Combat Stress Reaction. The troops were treated using“PIE” (Proximity, Immediacy, and Expectancy) principles. PIE principles required treating casualties without delay and insuring that the sufferers expected complete recovery so they could go back to the battle.

Gross Stress Reaction was included in the first DSM (Diagnostic and Statistical Manual of Mental Disorders) listing in 1952. The diagnosis was suggested for people who were relatively normal, but had symptoms of traumatic events or combat. A difficulty was that the diagnosis assumed that reactions to trauma would resolve quickly. If the symptoms were still present after 6 months, another diagnosis had to be made.

In DSM 2, (1968), adjustment reaction to life was used to describe the PTSD appearance. This diagnosis was limited to three kinds of trauma:

  1. Unwanted pregnancy with suicidal thoughts
  2. Fear linked to military combat, and
  3. Ganser Syndrome ( marked by incorrect answers to questions in prisoners’ who face the death sentence

In 1980, the American Psychiatric Association added PTSD to the DSM 3, which came out of research involving returning veterans from Viet Nam, Holocaust survivors, sexual trauma victims, and others. This is when the association of war and post military civilian life was established.

The DSM revision in 1987 (DS 3-R), DSM 4 (1994) DSM 5-TR (2000) and DSM 5 (2013) had PTSD revised based upon continuing research. What may have not been clear initially is that PTSD is more common than originally thought. Recent statistical data supports about 4% of American men and 10% of American women will be diagnosed with PTSD in their lifetime.

In the DSM 5, our current manual, PTSD is no longer associated with an anxiety disorder. Sometimes it accompanies depression, angry and reckless behavior, and other factors. Now, it is found in Trauma and Stressor related Disorders. Accordingly, PTSD has four different kinds of symptoms:

  1. reliving the traumatic event (re-experiencing or intrusion)
  2. avoiding situations that are reminders of the event
  3. negative changes in beliefs or feelings, and
  4. feeling keyed up (hyperarousal or over reactive to situations)

PTSD is not diagnosed unless all four types of symptoms last for at least 30 days and cause distress in ADL’s (activities of daily living).

References
1. PTSD: National Center for PTSD. (2018, September 14). Retrieved November 15, 2018, from https://www.ptsd.va.gov/understand_tx/index.asp 1a
2. Research and clinical issues in trauma and dissociation: Ethical and logical fallacies, myths, misreports, and misrepresentations. (2017, April 23). Retrieved November 15, 2018, from https://www.sciencedirect.com/science/article/pii/S2468749917300455
3. Pepys, S. (2013, September 02). Great Fire of London. Retrieved November 15, 2018, from http://www.bookofdaystales.com/great-fire-of-london/
4. Editors, H. (2017, October 02). PTSD and Shell Shock. Retrieved November 15, 2018, from https://www.history.com/topics/inventions/history-of-ptsd-and-shell-shock



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