THE EVOLUTION OF PTSD

From Where I sit

How PTSD went from ‘shell-shock’ to a recognized medical diagnosis

The symptoms of post-traumatic stress disorder have been recorded for millennia, but it took more than a century for physicians to classify it as a disorder with a specific treatment.

BY ERIN BLAKEMORE

PUBLISHED JUNE 16, 2020

The battles were over, but the soldiers still fought. Flashbacks, nightmares, and depression plagued them. Some slurred their speech. Others couldn’t concentrate. Haunted and fearful, the soldiers struggled with the ghosts of war.

Which war? If you guessed Vietnam, the U.S. Civil War, or even World War I, you’d be wrong. These soldiers’ symptoms were recorded not on paper charts, but on cuneiform tablets inscribed in Mesopotamia more than 3,000 years ago.

Back then, the ancient soldiers were assumed to have been hexed by ghosts. But if they were treated today, they would likely receive a formal psychiatric diagnosis of post-traumatic stress disorder (PTSD).

Although the diagnosis has its roots in combat, the medical community now recognizes that PTSD affects civilians and soldiers alike. Patients develop PTSD after experiencing, learning about, or witnessing a traumatic event—defined as “actual or threatened death, serious injury, or sexual violence”—and their intrusive symptoms affect their ability to cope in the present.

Nearly seven percent of American adults will likely experience PTSD during their lifetimes, but it took hundreds of years, and the dawn of industrial-scale warfare, for society to recognize the deleterious physical and mental effects of experiencing, witnessing, or becoming aware of traumatic events.

"Traumatic hysteria"

Medical historians have documented many early accounts of what would now be classified as PTSD. There’s Herodotus’ description of an Athenian soldier who became blind after witnessing the Battle of Marathon in 490 B.C., and a Shakespearean monologue in Henry IV, Part 1 in which Lady Percy describes her husband’s sleeplessness and inability to enjoy life after fighting a battle. Then there are more modern descriptions, like accounts of Civil War combatants who developed what their doctors called “soldier’s heart.”

But though early physicians looked for a physical cause, it wasn’t until the 1880s that psychiatrists connected the symptoms to the brain. At the time, women who expressed vehement emotions were labeled with “hysteria,” a condition that supposedly arose from the uterus. When French neurologist Jean-Martin Charcot saw similar symptoms in men, he chalked them up to traumatic events—rather than biological destiny—and the term “traumatic hysteria” was born.

“The concept of trauma was entangled with feminine weakness from the beginning,” says Mary Catherine McDonald, a historian of PTSD who works as an assistant professor of philosophy and religious studies at Old Dominion University. And when World War I blasted onto the scene, it challenged a common conviction that psychological steadiness was a matter of personal character, masculinity, and moral strength.

Shell shock and combat fatigue

From aerial combat to poison gas, WWI introduced terrifying new combat technology on a previously unimaginable scale, and soldiers left the front shattered. Seemingly overnight, the field of war psychiatry emerged and a new term—shell shock—appeared to describe a range of mental injuries, from facial tics to an inability to speak. Hundreds of thousands of men on both sides left World War I with what would now be called PTSD, and while some received a rudimentary form of psychiatric treatment, they were vilified after the war. As historian Fiona Reid notes, “shell-shock treatment was constantly entwined with discipline” in militaries that had trouble aligning their beliefs in courage and heroism with the reality of men who bore invisible wounds.

By World War II, psychiatrists increasingly recognized that combat would have mental health ramifications—and concluded that too many men who were prone to anxiety or “neurotic tendencies” had been selected to serve in the previous war. But though six times as many American men were screened and rejected for service in the lead-up to the World War II, military service still took its toll. About twice as many American soldiers showed symptoms of PTSD during World War II than in World War I. This time their condition was called “psychiatric collapse,” “combat fatigue,” or “war neurosis.”

Military officials assumed that removing men from combat situations or treating them with injections of drugs such as sodium amytal would relieve their psychiatric distress. It didn’t work: Nearly 1.4 million of the 16.1 million men who served in World War II were treated for combat fatigue during the war, and the condition was responsible for 40 percent of all discharges.

Post-Vietnam syndrome

A growing recognition of the ubiquity of psychiatric injury during war prompted more compassionate approaches to traumatized veterans. “The soldier suffers in the modern war situation a privation hard to equal in any situation in civilian or even primitive life,” wrote psychiatrist Abram Kardiner, whose 1941 book The Traumatic Neuroses of War helped change views of what is now known as PTSD. But, despite a growing recognition of the unique stresses of combat, as well as studies that showed the effects of war could last for decades, soldiers continued to face out-of-date views on their ability to bounce back from combat-related psychiatric distress.

In 1952, the American Psychological Association published the Diagnostic and Statistical Manual of Mental Disorders (DSM), the closest thing psychiatry has to a bible. The handbook helps professionals diagnose mental illnesses and strongly influences everything from research to public policy to health insurance. But veterans’ symptoms were categorized under disorders like depression or schizophrenia instead of being recognized as a distinct diagnosis.

Enter “Post-Vietnam syndrome,” a term coined in 1972 by psychiatrist Chaim Shatan. By then, Vietnam veterans had been returning home for years, and many were beset by emotional numbness, volatility, flashbacks, and rage. In part because many experienced delayed symptoms, veterans had trouble accessing treatment and benefits despite their invisible wounds.

Increasingly, veterans turned to what psychiatrist Robert Lifton called “street corner psychiatry”—veteran self-help communities who often combined their healing with anti-war protests. Along the way, they met clinicians and researchers like Lifton and Shatan, who began to advocate for the DSM to include some kind of post-combat stress diagnosis. In 1980, “post-traumatic stress disorder” became a formal diagnosis in the DSM’s third edition. Twelve years later, it was also adopted in the World Health Organization’s International Classification of Diseases.

Invisible wounds

Today’s definition of PTSD is more inclusive than ever—and the condition is recognized among survivors of sexual abuse or assault, health crises and surgeries, natural disasters, bereavement, mass shootings, accidents, and more. PTSD is associated with everything from flashbacks and nightmares to

hypervigilance, problems concentrating, amnesia, dissociation, and negative beliefs about themselves or others.

With every passing year, researchers develop new treatments for PTSD and learn more about how trauma affects the brain and body. They are also grappling with the possibility that the effects of trauma and stress can be passed from one generation to the next through chemical changes that effect how DNA is expressed. A 2018 study, for example, found high mortality among the offspring of men who survived Civil War prison camps in the 1860s. Scientists are still sparring over an earlier study that suggested the offspring of Holocaust survivors inherited a different balance of stress hormones than their peers.

Other researchers, like Jessica Graham-LoPresti, push against the limitations of the official PTSD diagnosis itself. A clinical psychologist and assistant professor at Suffolk University, Graham-LoPresti studies the effects of systemic racism on African-Americans. “People of color experience a lot of symptoms in response to the frequency and pervasiveness of racism that mirror the symptoms of PTSD,” she says, noting that watching footage of police brutality can exacerbate the fears and stresses of lives already touched by pervasive racist experiences. “This is not new, but [this imagery is] causing a lot of hypervigilance, emotional responses of stress and anxiety, and feelings of helplessness and hopelessness.”

But though the current definition of PTSD considers experiencing or witnessing a single incident of racialized terror an inciting incident, it doesn’t allow for the macroaggressions and intergenerational dynamics African-Americans experience every day. “It’s a complicated conversation,” says Graham-LoPresti. “It is so new, and researchers of color are starting to get a lot of pushback because the field is so overwhelmingly white.”

As Graham Lo-Presti works to connect the dots between racism and PTSD, her colleagues are considering the potential effects of another pandemic: COVID-19. Psychiatrists are bracing for a flood of patients traumatized both by surviving the illness and losing their loved ones to it. In the wake of the SARS epidemic in Hong Kong in 2003, some patients and healthcare workers developed PTSD—and in a variety of studies, people who were quarantined exhibited more signs of post-traumatic stress than people who were not.

But that doesn’t mean that everyone who lives through a traumatic event will develop PTSD—or that those with post-traumatic stress disorder can’t find healing and joy. As with other chronic illnesses, PTSD can go into remission—and as the study of PTSD matures, researchers have come to appreciate the brain’s heroic attempts to heal itself after traumatic events.

“It’s such a destructive idea to think that PSTD is dysfunction,” says McDonald. “We’re getting it fundamentally wrong when we think it’s a sign of brokenness. It’s the sign of the impulse to survive.” 

https://api.nationalgeographic.com/distribution/public/amp/history/2020/06/ptsd-shell-shock-to-recognized-medical-diagnosis

Why does the Veterans Administration insist on getting this back-ass-wards?

Here's the link to the latest VA report on suicides. The breakdown of the numbers is excellent. The resultant conclusions are bull-crap! To read this report correctly, please start from the last page and work your way forward. Just another typical example of how this Government Agency works!
Cut/Paste this link to your Browser for the 46-page report; PDF format.
http://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf

http://www.nytimes.com/2016/08/25/nyregion/veteran-kills-himself-in-parking-lot-of-va-hospital-on-long-island.html?action=click&contentCollection=N.Y.%20/%20Region&module=Trending&version=Full&region=Marginalia&pgtype=article&_r=0

Please read the fourth paragraph
 of this Article more than once, and ponder it for a few minutes. This is my local VA Medical Center behaving badly, again.
How many times does this have to happen before some gets fires, or goes to jail??

VETERANS AFFAIRS IN NEED OF MAJOR OVERHAUL

WHAT’S UP, DOC?

A short essay outlining how the Veterans Administration

might reorganize its Medical system

We have heard the problems. Now, let’s get a viable solution. The United States Congress seems unable to figure this out, perhaps because so few of them have served in the Armed Forces. Those few who have served are in positions where they will never have to personally encounter the Department of Veterans Affairs medical system.

It is certain nice to have Congress appropriate funds to run the system. The fix involves a restructuring of the medical system from the bottom to the top. If you change the basic structure, you will change the culture. It is the culture, which stems from the structure, which has pushed the VA Medical System over the cliff. Why must Veterans put up with a medical system that hasn’t evolved since its inception under Herbert Hoover: July 21, 1930

The second consolidation of federal Veterans programs took place July 21, 1930, when President Herbert Hoover signed Executive Order #5398 and elevated the Veterans Bureau to a federal administration—creating the Veterans Administration—to "consolidate and coordinate Government activities affecting war veterans”. At that time, the National Homes and Pension Bureau also joined the VA. [1]

Note Bene: Check out the number of “Executive Orders” enacted by President Hoover!

Surprisingly, the fix is relatively simple, as all the necessary parts already exist within. I understand that Congress loves to create new stuff and put their signatures on it. But, there is no reason to re-invent the wheel. The structure of a typical VA Medical Center looks like, if you will, a large farm field with a row of grain elevators: aka Silos. The field represents the whole Medical Center. Each Silo represents a specific department within that larger farm field. Call the farm field the “system”. Let’s take a look at the relationship between the Silos.                  

VA Medical Center’s Silo Structure

Field of Dreams

This may not look like it is relevant to this argument on the surface, but, remember, this a bottom up scenario.

If you are a nurse, you work for the Director of Nursing [the Nursing Silo]. In your department you may have a specific Supervisor. Where you are placed in the Hospital depends on where your Supervisor and Director want you to go. Supervisors and Department Directors seem to allocate Human Resources without regard to any Nursing Specialty you may possess, so you chance ending up in a position for which you have little, or no, skill. Once in your allocated position, the Medical or Mental Health Department Directors and Supervisors have no effective say in what your role is in that specific Department. Any changes to your routine be initiated by your physical workplace Supervisor; must travel up the chain to that Department’s Director, then laterally to the Nursing Department Director, and then down that chain to your Nursing Department Supervisor. The final decision on any change, whatever that may be, goes back through the same channels it took to get to your Nursing Supervisor. This means that the person you work with on a daily basis is part of an entirely separate Silo and has no say over your duties, hours, or responsibilities in your actual workplace. This, then, translates into the inability of the Director of any specific medical or mental health Department to format and control the normal workday of the people who work in his/her department.

This type of Personnel insulation/isolation is detrimental to anyone trying to run any VA Medical Center program effectively. The history of how this became the norm is not important, any more. What is important is that a solution be found before the entire Department of Veterans Affairs is purposely allowed to implode and become “privatized”.

One technique of solving industrial, commercial, or institutional problems that I am familiar with is the application of the “Six Sigma”/”Kaisen” theory of looking at one scenario. You draw on all your human resources to implement the most lean, streamlined, efficient way to deliver your product.

You the work out any bugs, and, when you are satisfied you have problem solved, you simply duplicate the new structure as many times as you need to. In this case, you take one VA Medical Center and work your magic on just that unit. Once you have it running correctly and efficiently, you simply go Medical Center by Medical Center and duplicate the first restructuring in each of the remaining Medical Centers.

I want to include one excerpt from:

Eric Whitney, Montana Public Radio and Michael Tomsic, WFAE

“Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors” [2]

Congress and the VA came up with a fix: Veterans Choice, a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

This winter, when Montana Sen. Jon Tester sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.

But he says he's mired in bureaucracy. "The VA can't do it in seven months, eight months? Something's wrong," he says. "Three hours on the phone," trying to make an appointment. "Not waiting," he says, "talking for three hours trying to get this thing set up for my new hearing aids”.

........Meanwhile, though, Veterans continue to wait. "If I knew half of what I knew now back then when I was just a kid, I would've never went in the military," says Bobby Wilson. "I see how they treat their veterans when they come home."

This is part of collaboration with NPR's Back at Base project, local member stations, and Kaiser Health News.

Many Veterans, me included, have friends and acquaintances who could sit down at a table for a week and hash out the details of a solution to this mess. Almost to a person, they have said, “All the Government has to do is ask.” Believe me! If I can identify the problem and start the ball rolling toward a solution, then far better minds than mine would have no problem, whatsoever, in completing the task of restructuring the Department of Veterans Affairs in very short order.

Some may ask why Veterans are trying to hold on to the VA Medical system. The answer is both simple and complex. The simple part is that most Veterans feel more at ease dealing with their medical and mental health conditions when they are in the company of other Veterans. The complex part is Veterans don’t feel the “private sector” (civilians) necessarily understand what they’ve been through and the types of conditions involved. The “privatization” of the VA system will discourage any Veteran from seeking medical, or mental health, treatment. Consider what is already happening; the break-up of families, substance abuse, the venting of anger and frustration, and suicide. Is this what we really want for those men and women, who volunteer to defend this Country?

And, what will be the inevitable larger, big-picture problem? Young men and women will see how Veterans disrespected, mistreated, and lied to. The resultant plummeting of Armed Forces recruitment and enlistment will leave this Country without a means of defending itself, let alone others.

^{[1] http://www.va.gov/about_va/vahistory.asp}

^{[2] http://www.npr.org/sections/health-                                                 shots/2016/05/16/477814218/attempted-fix-for-va-health-delays-creates-new-bureaucracy}

^{further suggested reading:}

^{1)  More Than Medicine (Why the VA matters), by Joseph J. Frank - The       American Legion Magazine, June                                                                 2016 http://www.legion.org/magazine/232777/more-medicine}

Change is good.

I used to be of the mind that change was something undertaken as a last resort, when nothing else seemed to be working. I am glad to report I have a different point of view on this subject, now. Yes, I have changed my thinking on this whole matter of change. The change I am referring to is happening inside of me, to me, for me, and is aimed at releasing the “me” that has always been here. It has been the “me” that I have kept tightly sealed somewhere deep inside for a very long time.

As this “me” emerges there are, undoubtedly, going to be those around me who are caught off guard, bent a little out of shape, or simply decide they can’t possibly deal with it at all. I have carried a self-resentment for years because I felt the need to keep certain aspects of my personality in a lock-box. I tried hard to be accommodating to the point that people around me felt it was all right to take advantage of my good nature and seeming lack of assertiveness. This invariably sent me to a position of some degree of disadvantage and resultant anger, as people thought I was giving them an open invitation to use me as a doormat and impose their will and philosophy on me. When the anger boiled over, most folks were not comfortable and tended to run for the hills.

It turns out that I actually possess my own will and philosophy; my own thoughts and feelings; my own sense of right and wrong. It turns out that, with the help of a handful of very caring people, I have discovered where I had all this buried, and how to bring it all back to the surface from the depths. These folks have allowed me to discover and acknowledge how, where, and when I got my philosophy, my thoughts, my feelings, my sense of right and wrong, and my ability to weigh things fairly and equally. They allowed me to discover where all that was hidden and that it was all right to fetch it and bring it all to the surface once again. They allowed me to reach back and discover when I had enjoyed these personality attributes to their fullest, and allowed me to accept the idea that it was a good thing to let these attributes see the light of day once again.

With a lot of help and support, I have allowed myself the luxury of becoming clean and sober. I have allowed myself to become free of psychotropic drugs. These newfound freedoms have made it possible to finally assert myself and stand up for what I want and need. I have a new respect for the eighteen, or so, inches around me, which is all I have the ability and right to control. I have let go of the idea that what others think, feel, or do has anything to do with me, what I am able to control. People make their own decisions, and no one else has any real or perceived control over that. Therefore, what anyone may think about me, I have absolutely no control over. What I do have is control over the way I act, react, and conduct my own life, and I am learning that that alone can be a full-time job. With that in mind, I consider myself to be fully employed. I accept the premise that change is good.

 

some ways to demonstrate assertiveness:

 - no more acceptance of rude, bigoted, politically ridiculous, factually inaccurate emails and/or statements to your face

 - no saying yes simply for the reason of “making nice” with other people; if your real answer is no, say no

- immediate vocal disagreement with anything directed at you that you don’t like, or believe in.

- honesty, over trying to smooth over any situation; even if that honesty doesn’t sit well with others

- no expectations of anyone ever agreeing with you on anything; what matters most to you is what you think and feel, not what anyone else thinks, or feels about you.

- You only control your own space; make good use of it

- show empathy when needed; but, not to the point anyone perceives you as weak

- never fear stating who you are, what you think, and how you feel

- tone the anger and aggression down to an assertive level not to be mistaken as a personality flaw to be exploited, or abused

Brought to you by Fox Noise

Well, it’s Saturday afternoon, and I thought it might be nice to get horizontal on the big couch and watch some television. I was surfing through the channels when, low and behold, I caught a wave at Fox Cable Network News. The “show” that was airing at the time was a re-run of “The Five”. Those of you who watch Fox News already know who the five panelists are, and the rest of us really don’t give a damn. I could only watch about twenty minutes of this show, as I was doubled over in laughter and fell from my perch on the big couch more times than I care to remember.

Very loosely, the main topic of discussion was that of street violence and the efforts at small arms gun control. The panelists started out with three bad people who have been up front in the News lately. First up was a discussion about the South African paraplegic Olympian who allegedly shot his Super-Model girlfriend. It didn’t take the Fox Noise Makers more than thirty seconds before arguments centering around Apartheid took over the conversation. It was at this point that I figured I had better stay tuned to see where this path was going to lead. Well, sure enough, it lead to the college student in Georgia who went on a rampage killing anyone who even resembled a white person. Stating Anthropology as his college major, he obviously blamed his curriculum for creating the rage inside him to boil over. He claims he was trying to get even for the slave trade in this Country. Then came their “Piece d’Resistance”. Center stage shifted to the ex L.A. cop turned murderer. Immediately the claims of liberal bias were leveled at the 47% of this Country who have put this man up on a pedestal, and are using him to point out all the conservative short comings of our Society.

Appropriately sprinkled throughout this panel discussion was black-on-black crime, white-on-black crime, the ACLU’s unconditional love of criminals of any color, or gender, and President Obama’s attempt to quell his detractors by showing up in Chicago to speak about gun control. I won’t get into the statistics that were quoted, because I don’t want anyone falling off their perch in uncontrollable laughter. Of course, the rightwing mantra was repeated over and over again, “The Government wants to take your guns!” As I exited stage left, there was an equally humorous advertisement about how “Obama-Care” is about to deny everyone in this Nation medical care of any type, and how “Obama-Care is about to bankrupt every business, large and small.

I have one small request of Rupert Murdoch; “Please rename Fox News as The Comedy Channel II.” I think your ratings might actually go up.

After brother’s suicide, a helicopter pilot moves into chaplaincy

From: The Army Times

 

By Meghann Myers - Staff writer
Posted : Tuesday Sep 25, 2012 14:45:40 EDT

Top of Form

Bottom of Form

Almost as soon as Chief Warrant Officer 2 Jeremy Cover enlisted in the Army 10 years ago, suicide was front and center.

“One of the guys in my class had mentioned he wanted to hurt himself,” Cover said. “I was assigned as his battle buddy, so I went with him all day to his [behavioral health] visits.”

As a young soldier, he was a little irritated that he’d been called to take time out of his few free hours a day to babysit a fellow private. They didn’t say a lot to each other at the time, but Cover blames that on his inexperience.

Open this link to read complete story:

http://www.armytimes.com/news/2012/09/army-cover-after-brothers-suicide-chaplaincy-092512/