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PTSD en Shell Shock

PTSD en Shell Shock


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PTSD, of post-traumatiese stresversteuring, het tot die publiek se bewussyn gekom toe die American Psychiatric Association die gesondheidskwessie in die 1980's by sy diagnostiese handleiding van geestesversteurings gevoeg het. Maar PTSS - wat by vorige generasies bekend was as dopskok, soldaat se hart, bestryding van moegheid of oorlogsneurose - het wortels wat eeue terug strek en was alombekend in antieke tye.

PTSD Simptome

Post-traumatiese stresversteuring is 'n geestesgesondheidstoestand wat ontstaan ​​wanneer iemand 'n ernstig traumatiese gebeurtenis aanskou of ervaar. Dit kan oorlog of gevegte insluit, ernstige ongelukke, natuurrampe, terrorisme of gewelddadige persoonlike aanrandings, soos verkragting.

Mense met die siekte kan PTSD -simptome ondervind, soos gereelde vrees, spanning en angs as gevolg van die traumatiese gebeurtenis. Hulle herleef die gebeurtenis moontlik deur terugflitse of nagmerries en het intense, ontstellende gedagtes en gevoelens wat verband hou met die gebeurtenis. Hulle vermy soms mense, plekke en situasies wat hulle aan die trauma herinner.

Hulle kan ook toenemende opwinding en reaktiewe simptome ervaar, soos om springerig te voel (maklik te skrik), probleme met konsentrasie of slaap te hê, maklik kwaad of geïrriteerd te raak en aan roekelose of selfvernietigende gedrag deel te neem.

Wat is PTSD?

Dit is nie heeltemal bekend wat veroorsaak dat PTSD ontwikkel nie, maar dit kan verband hou met die streshormone.

Dit wil sê, traumatiese gebeurtenisse plaas die liggaam in 'n oorlewings- "veg of vlug" -modus, waarin die liggaam streshormone (adrenalien en noradrenalin) vrystel om 'n uitbarsting van energie te verskaf terwyl sommige van die brein se ander take onderbreek word, soos om kort termyn te vul herinneringe.

Mense met PTSD produseer steeds groot hoeveelhede van hierdie hormone buite gevaarlike situasies en hul amygdala - die deel van die brein wat vrees en emosie hanteer - is meer aktief as mense sonder PTSD.

Met verloop van tyd verander PTSD die brein, onder meer deurdat die deel van die brein wat geheue hanteer (die hippocampus) laat krimp.

PTSD in Epics en Classics

Lank voor die aanbreek van die moderne psigiatrie, is mense en situasies wat PTSD uitbeeld moontlik in vroeë literatuurwerke aangeteken.

Byvoorbeeld, in die Epos van Gilgamesj, die vroegste oorlewende groot literatuurwerk (wat dateer uit 2100 v.C.), sien die hoofkarakter Gilgamesh die dood van sy naaste vriend, Enkidu. Gilgamesh word geteister deur die trauma van die dood van Enkidu, wat herhalende en indringende herinneringe en nagmerries beleef wat verband hou met die gebeurtenis.

Later, in 'n 440-v.C. As gevolg van die slag by Marathon, beskryf die Griekse historikus Herodotus hoe 'n Atheens met die naam Epizelus skielik blind was terwyl hy in die hitte van die geveg was toe hy sy kameraad in 'n geveg sien doodmaak het. Hierdie blindheid, wat deur angs veroorsaak is en nie deur 'n fisiese wond nie, het oor baie jare voortgeduur.

Ander antieke werke, soos dié van Hippokrates, beskryf soldate wat skrikwekkende gevegsdrome beleef het. En buite Grieks-Latynse klassieke verskyn soortgelyke herhalende nagmerries ook in Yslandse letterkunde, soos Gísli Súrsson Saga.

In die Indiese epiese gedig RamayanaWaarskynlik ongeveer 2500 jaar gelede, ervaar die demoon Marrich PTSD-agtige simptome, waaronder hiper-opwinding, herlewing van trauma en vermydingsgedrag, nadat hy amper deur 'n pyl gedood is. Marrich het ook sy natuurlike plig opgegee om monnike te teister en het 'n meditatiewe kluizenaar geword.

Nostalgie en Soldaat se hart

In die afgelope honderd jaar het mediese dokters 'n paar PTSD-agtige siektes beskryf, veral by soldate wat gevegte beleef het.

In die laat 1600's het die Switserse dokter dr. Johannes Hofer die term "nostalgie" bedink om Switserse soldate te beskryf wat aan wanhoop en heimwee ly, sowel as klassieke PTSD -simptome soos slapeloosheid en angs. Ongeveer dieselfde tyd beskryf Duitse, Franse en Spaanse dokters soortgelyke siektes by hul militêre pasiënte.

In 1761 skryf die Oostenrykse geneesheer Josef Leopold Auenbrugger in sy boek oor nostalgie by trauma-geteisterde soldate Inventum Novum. Volgens hom het die soldate onder meer lusteloos en eensaam geword, en pogings kon weinig doen om hulle uit hul pad te help.

PTSD in die burgeroorlog

Nostalgie was 'n verskynsel wat oral in Europa opgemerk is en die 'siekte' bereik Amerikaanse grond tydens die Amerikaanse burgeroorlog (1861-1865). Eintlik het nostalgie 'n algemene mediese diagnose geword wat oor die kampe versprei het. Maar sommige militêre dokters beskou die siekte as 'n teken van swakheid en 'n siekte wat slegs mans met 'n 'swak wil' beïnvloed het - en openbare bespotting was soms die aanbevole 'geneesmiddel' vir nostalgie.

Terwyl nostalgie veranderings by veterane vanuit 'n sielkundige perspektief beskryf het, het ander modelle 'n fisiologiese benadering gevolg.

Na die burgeroorlog het die Amerikaanse dokter Jacob Mendez Da Costa veterane bestudeer en gevind dat baie van hulle fisiese probleme het wat nie verband hou met wonde nie, soos hartkloppings, asemhaling en ander kardiovaskulêre simptome. Daar word vermoed dat hierdie simptome voortspruit uit 'n oorstimulasie van die senuweestelsel van die hart, en die toestand word bekend as 'soldaat se hart', 'prikkelbare hart' of 'Da Costa se sindroom'.

Interessant genoeg was PTSD-agtige simptome nie in die 1800's tot soldate beperk nie. Tydens die Industriële Revolusie het treinreise meer algemeen geword - net soos spoorwegongelukke.

Oorlewendes van hierdie ongelukke vertoon verskillende sielkundige simptome (byvoorbeeld angs en slapeloosheid), wat gesamentlik bekend staan ​​as 'spoorwegrug' en 'spoorwegbrein' omdat lykskouings suggereer dat spoorongelukke mikroskopiese letsels aan die sentrale senuweestelsel veroorsaak het.

Bomskok

Post-traumatiese stresversteuring was 'n groot militêre probleem tydens die Eerste Wêreldoorlog, hoewel dit destyds bekend was as 'dopskok'.

Die term self verskyn die eerste keer in die mediese tydskrif Die Lancet in Februarie 1915, ongeveer ses maande nadat die 'Groot Oorlog' begin het. Kapt Charles Myers van die Royal Army Medical Corps het soldate gedokumenteer wat 'n reeks ernstige simptome ondervind het - insluitend angs, nagmerries, bewing en gestremde sig en gehoor - nadat hulle blootgestel was aan ontploffende skulpe op die slagveld. Dit blyk dat die simptome die gevolg was van 'n soort ernstige harsingskudding in die senuweestelsel (vandaar die naam).

Teen die volgende jaar het mediese en militêre owerhede egter dopskok simptome gedokumenteer by soldate wat nie naby die ontploffing was nie. Die toestande van hierdie soldate word beskou as neurasthenie - 'n soort senuwee -ineenstorting van oorlog - maar word steeds omring deur 'dopskok' (of oorlogsneurose).

Teen die einde van die oorlog was daar slegs 80 000 gevalle van dopskok in die Britse weermag. Soldate keer dikwels na slegs 'n paar dae se rus na die oorlogsgebied terug, en diegene wat langer behandel is, het soms hidroterapie of elektroterapie ondergaan.

In die Tweede Wêreldoorlog beskryf Britte en Amerikaners traumatiese reaksies op bestryding as 'gevegsvermoeidheid', 'bestrydingsvermoeidheid' en 'bestrydingsstresreaksie' - terme wat die oortuiging weerspieël dat die toestande verband hou met lang ontplooiings. Volgens die National Center for PTSD het moontlik die helfte van militêre ontslag tydens die oorlog verband gehou met uitputting.

Moderne PTSD

In 1952 voeg die American Psychiatric Association (APA) 'growwe stresreaksie' by sy eerste Diagnostic and Statistical Manual of Mental Disorders, of DSM-I. Die diagnose hou verband met sielkundige kwessies wat voortspruit uit traumatiese gebeurtenisse (insluitend gevegte en rampe), alhoewel dit aangeneem het dat die geestesgesondheidskwessies van korte duur is-as die probleem langer as 6 maande duur, word gedink dat dit niks te doen het nie met oorlogstyddiens.

In die DSM-II, wat in 1968 gepubliseer is, het die APA die diagnose verwyder, maar 'aanpassingsreaksie op die volwasse lewe' ingesluit, wat PTSD-agtige simptome nie effektief opgevang het nie. Hierdie verwydering het beteken dat baie veterane wat aan sulke simptome ly, nie die nodige sielkundige hulp kon kry nie.

Die APA het post-traumatiese stresversteuring ingesluit in die DSM-III (1980), gebaseer op navorsing oor mense wat ernstige traumatiese gebeure oorleef het, insluitend oorlogsveterane, oorlewendes van die Holocaust en seksuele trauma. Die diagnose het 'n duidelike onderskeid getref tussen traumatiese gebeurtenisse en ander pynlike stressors, soos egskeiding, finansiële ontberings en ernstige siektes, wat die meeste mense kan hanteer en nie dieselfde simptome veroorsaak nie.

Die diagnostiese kriteria vir PTSD is hersien in die DSM-IV (1994) en DSM-IV-TR (2000) en DSM-5 (2013) om voortgesette navorsing te weerspieël. In die DSM-5 word PTSD nie meer as 'n angsversteuring beskou nie, omdat dit soms ander gemoedstoestande (depressie), sowel as kwaad of roekelose gedrag veroorsaak; dit is nou in 'n kategorie genaamd trauma- en stressorverwante afwykings.

Volgens die Anxiety and Depression Association of America het ongeveer 7,7 miljoen Amerikaanse volwassenes PTSS.

Bronne

Post-traumatiese stresversteuring (PTSV)-Oorsake; NHS.
Wat is PTSD ?; WebMD.
Wat is PTSD ?; Alledaagse Gesondheid.
Wat is Posttraumatiese Stresversteuring ?; Amerikaanse Psigiatriese Vereniging.
Sheth et al. (2010). "Angsversteurings in antieke Indiese literatuur." Indian Journal of Psychiatry.
Marc-Antoine Crocq en Louis Crocq (2000). "Van dopskok en oorlogsneurose tot posttraumatiese stresversteuring: 'n geskiedenis van psigotraumatologie." Dialoë in die kliniese neurowetenskap.
Geskiedenis van PTSD in veterane: burgeroorlog tot DSM-5; VA.
Toe nostalgie 'n siekte was; Die Atlantiese Oseaan.
Tydlyn: geestesongesteldheid en oorlog deur die geskiedenis; Minnesota Openbare Radio.
Het burgeroorlogsoldate PTSV gehad ?; Smithsonian.
Anderson, David (2010). "Sterf aan nostalgie: heimwee in die Unie -leër tydens die burgeroorlog." Burgeroorlog geskiedenis.
Die skok van oorlog; Smithsonian.
Geskiedenis van PTSD in veterane: burgeroorlog tot DSM-5; Nasionale Sentrum vir PTSV, VA.
Wanneer soldate snap; Die New York Times.
PTSD; Angs en Depressie Vereniging van Amerika.


Shell Shock, bestryding van moegheid, PTSD & Ons ken almal die algemene Patton -verhaal: 100 jaar ontwikkelende behandeling

'PTSD' of 'Post-traumatiese stresversteuring' is vandag so 'n algemene term dat 'n mens skaars die opskrifte kan lees of TV kan kyk en dit nie ten minste een keer per dag kan hoor nie. Alhoewel baie mense die term om verskillende redes gebruik, wat ver verwyderd is van militêre gebruik, is dit goed om dit na die simptome van veterane te verwys.

Hou in gedagte dat 'posttraumatiese stresversteuring' 'n algemeen gebruikte mediese/sielkundige term is, en dat die gebruik daarvan vandag so min stigma het dat gewone mense dit gereeld gebruik. Ons het nie 'n bynaam daarvoor nie, soos 'die skud', 'senuwees', ens.

Dit wys hoe ver ons gekom het in die behandeling van veterane wat ernstige trauma op die slagveld ondergaan het. Daar is natuurlik 'n lang pad om te gaan, veral as u die veelvuldige langtermyn-ontplooiings van vandag se soldate in ag neem.

Selfs so onlangs as die Viëtnam -oorlog, is veterane wat simptome van PTSS getoon het, soms 'lafaards' genoem wat probeer om buite aksie te kom. In die Eerste Wêreldoorlog is hulle 'skarrelaars' genoem. Hou my saam terwyl ek 'n oomblik afwyk …

Vir diegene van u wat geskiedenis, woorde en die geskiedenis van woorde het, kyk na Google Books. Google het al die boeke wat gedigitaliseer is op/in Google Books (miljoene) geneem, en 'n program daaraan gekoppel wat die gebruik van 'n woord oor tyd, of eerder gedurende sekere tye, meet.

Wil u byvoorbeeld weet wanneer die woord 'Shirker' die meeste gebruik word? Tydens en direk na die Amerikaanse burgeroorlog en die Eerste Wêreldoorlog. Geen toeval nie. Koppel die woord “geel” en#8230, die woordgebruik piek tydens …WWI. Tik 'moegheid', 'n algemene woord, maar met pieke op die grafiek by � en 1945.

“The 2000 Yard Stare ”, deur Thomas Lea, 1944, Tweede Wêreldoorlog.

'Bestryding van moegheid' was die term vir PTSD in die Tweede Wêreldoorlog. Vir baie was 'lafaard' die mees gekose vir die misverstaande toestand. Ons ken almal die General Patton -verhaal.

Die mees algemene term vir PTSV in die Eerste Wêreldoorlog was 'dopskok' (die gebruik van woorde in 1920 bereik 'n hoogtepunt). Alhoewel daar soms grense was wat die intensiteit van die mense in die Eerste Wêreldoorlog nader, het soldate in die eerste twintigste eeu 'n wêreldwye konflik artillerieblokke ondergaan wat soms dae duur, en miljoene skulpe het in relatief beperkte gebiede geland. Diegene wat oorleef het, was uiters gelukkig, of het die voordeel gehad van goed voorbereide loopgrawe/bunkers/uitgrawings.

Beeld uit die Groot Oorlog geneem in 'n Australiese Advanced Dressing Station naby Ieper in 1917. Die gewonde soldaat links onder op die foto het 'n verdwaasde duisend meter staar – 'n gereelde simptoom van “dop-skok ”.

Maar stel jou voor dat jy waarskynlik regtig kan, maar probeer. Jy is ses of tien voet ondergronds in 'n bunker met tien of twintig van jou kamerade. Stapels lê langs die mure, 'n paar houttafels in die middel. Gaslampe hang aan die mure of op tafels en gee 'n dowwe lig.

Miskien sing 'n kanarie in 'n hok, omdat hy nie weet dat sy dood 'n waarskuwing is vir 'n gasaanval nie. Dan begin uit die niet 'n aaklige gefluit, gevolg deur honderde, dan duisende massiewe ontploffings wat almal en alles om jou begin skud en al die gasligte uitskakel. 'N Deel van die uitgrawing stort in die donker in duie en mense begin skree. Dit duur agt-en-veertig uur sonder om te stop.

Breinstreke wat verband hou met stres en posttraumatiese stresversteuring

Dat iemand dit met hul liggaam en hul verstand ongeskonde oorleef het, is 'n "wonderwerk". Baie mans het hul gedagtes in verskillende grade van hulle afgeruk. Na raming is baie van die minder geraak binne enkele dae na die lyn teruggekeer. Baie is agter die linies na hospitale verwys of in Engeland. Sommige van hulle keer terug na diens. Baie het nie. Byna almal was nooit dieselfde nie.

In minder ernstige gevalle het dopskok mans sensitief gemaak vir harde geluide. Miskien het hulle dinge of werk vermy wat dit veroorsaak het. Miskien later in die lewe, toe hulle kinders gehad het, het hulle totale stilte en miskien mishandeling van kinders geëis toe hulle skielik onverwags geraak het. Toe ek grootgeword het, het ek 'n Okinawa -veteraan en sy gesin geken wat so gely het.

In die erger gevalle kan slagoffers van skok 'n ruk ontwikkel, hetsy hard of gereeld. Miskien het hulle hande sigbaar geskud, of het hulle 'n gesigstert gehad, wat sosialisering in 'n minder verstaanbare ouderdom moeilik gemaak het. Soms het dopskok sy teenwoordigheid in die vorm van 'n hakkel bekend gemaak, wat die lewe weer op baie maniere bemoeilik het - sosiaal, professioneel, romanties …

Dienslede gebruik kuns om PTSV -simptome te verlig.

In sy ergste vorm, wat u sal sien as u op die onderstaande skakel klik, het mans van alle nasies, maar veral diegene wat aan die Westelike Front gedien het, gevangenes geword van hul eie verstand en liggaam. In hierdie gevalle kon mans nie meer as normale mense dink nie - in wese was dit wat hulle 'mens' gemaak het, van hulle ontneem, en hulle lewens en optrede was dié van verskrikte diere. Hulle kon eet en drink. Miskien het hulle beheer oor hul liggaamlike funksies gehad, maar in baie gevalle nie. Dit was omtrent dit.

Baie van hierdie mans het nooit herstel nie en het die res van hul lewens in instellings deurgebring - as hulle gelukkig was, en in die VSA, Groot -Brittanje of Frankryk. Sommige Duitse slagoffers het instellings tot hul beskikking, maar in die haglike na-oorlogse ekonomiese omstandighede van die land was sorg in die meeste gevalle afskuwelik.

Dit is nie bekend hoeveel mans gely het in gesinshuise, weggesteek nie. Dit laat die vraag ontstaan ​​- hoeveel van die meer en meer 8220 selfmoord pleeg selfmoord? Hoeveel is doodgemaak deur vriende en/of familie uit jammerte? As u dink dat die laaste vraag heeltemal buite lyn is, kyk dan na hierdie video:

In 'n 2011 -artikel vir die BBC Online het professor Joanna Burke van die Universiteit van Londen gepraat oor die behandeling wat een van die ernstiger gevalle in hospitale in Engeland kan verwag:

'As 'n breuk 'n verlamming van die senuwees was, word massering, rus, dieet en elektriese skokbehandeling toegepas. As 'n sielkundige bron aangedui word, sal die ‘ praatkuur, hipnose en rus die herstel versnel. In alle gevalle word beroepsopleiding en die inskerping van die#8216masculiniteit ’ sterk aanbeveel. Soos die mediese superintendent in 'n militêre hospitaal in York dit stel, hoewel die mediese beampte simpatie moet betoon, moet die pasiënt aangespoor word om sy siekte manlik te hanteer ’ ”.

Terwyl ek hierdie artikel skryf, is dit Mei 2018. Presies honderd jaar gelede is mans in die Eerste Wêreldoorlog getraumatiseer op 'n manier wat die meeste van ons feitlik onmoontlik is om te dink. Hulle en diegene wat in die volgende oorloë in die eeue gevolg het, het egter bygedra tot die begrip wat ons nou van PTSS het. As daar iets goeds oor die gevolge van WWI gesê kan word, is dit miskien dit.

Matthew Gaskill het 'n MA in Europese geskiedenis en skryf oor 'n verskeidenheid onderwerpe, van die Middeleeue tot die Tweede Wêreldoorlog tot genealogie en meer. Hy is 'n voormalige opvoeder en waardeer nuuskierigheid en ywerige navorsing. Hy is die skrywer van baie topverkopers van Kindle op Amazon en werk tans aan 'n nuwe boek.


"Traumatiese histerie"

Mediese historici het baie vroeë verslae oor wat nou as PTSD geklassifiseer sou word, gedokumenteer. Daar is Herodotus se beskrywing van 'n Atheense soldaat wat blind geword het nadat hy die Slag van Marathon in 490 v.C. gesien het, en 'n Shakespeare -monoloog in Henry IV, deel 1 waarin Lady Percy haar slapeloosheid en onvermoë om die lewe te geniet na 'n geveg beskryf, beskryf. Dan is daar meer moderne beskrywings, soos verslae van vegters van die burgeroorlog wat ontwikkel het wat hul dokters 'soldaat se hart' noem.

Maar hoewel vroeë dokters na 'n fisiese oorsaak gesoek het, het psigiaters eers in die 1880's die simptome met die brein verbind. Vroue wat sterk emosies uitgespreek het, is destyds bestempel as 'histerie', 'n toestand wat vermoedelik uit die baarmoeder ontstaan ​​het. Toe die Franse neuroloog Jean-Martin Charcot soortgelyke simptome by mans sien, kry hy dit tot traumatiese gebeurtenisse-eerder as biologiese lot-en word die term 'traumatiese histerie' gebore.

"Die konsep van trauma was van die begin af verstrengel met vroulike swakheid," sê MaryCatherine McDonald, 'n historikus van PTSV wat as assistent -professor in filosofie en godsdiensstudies aan die Old Dominion University werk. En toe die Eerste Wêreldoorlog op die toneel verskyn, betwis dit die algemene oortuiging dat sielkundige bestendigheid 'n kwessie van persoonlike karakter, manlikheid en morele krag is.


Van Shell-Shock tot PTSD: 'n Eeu van onsigbare oorlogstrauma

Viëtnam was nog 'n keerpunt vir gevegsverwante PTSS omdat veterane op 'n ongekende manier vir hulself begin pleit het. Begin met 'n klein optog in New York in die somer van 1967, het veterane self begin om aktiviste te word vir hul eie geestesgesondheidsorg. Hulle het gewerk om 'post-Viëtnam-sindroom' te herdefinieer, nie as 'n teken van swakheid nie, maar eerder as 'n normale reaksie op die ervaring van gruweldade. Die openbare begrip van die oorlog self het ook begin verander, aangesien die groot televisieverslae van die My Lai -slagting vir die eerste keer die verskrikking van oorlog in Amerikaanse woonkamers gebring het. Die veteraan se veldtog het gehelp om PTSD in die derde uitgawe van die Diagnostic and Statistical Manual for Mental Disorders (DSM-III), die belangrikste Amerikaanse diagnostiese hulpbron vir psigiaters en ander geestesgesondheidsklinici, op te neem.

Editor & aposs note: Hierdie artikel verskyn oorspronklik op The Conversation.

In die nasleep van die Eerste Wêreldoorlog het sommige veterane gewond teruggekeer, maar nie met ooglopende fisiese beserings nie. Hulle simptome was soortgelyk aan dié wat voorheen met histeriese vroue geassosieer is - meestal geheueverlies, of 'n soort verlamming of onvermoë om sonder duidelike fisiese oorsaak te kommunikeer.

Die Engelse geneesheer Charles Myers, wat in 1915 die eerste artikel oor 'dop-skok' geskryf het, het teoretiseer dat hierdie simptome eintlik as gevolg van 'n fisiese besering spruit. Hy beweer dat herhaaldelike blootstelling aan harsingskudding veroorsaak word deur breintrauma wat tot hierdie vreemde groepering van simptome gelei het. Maar sodra hy op die proef gestel is, het sy hipotese nie volgehou nie. Daar was baie veterane wat byvoorbeeld nie blootgestel was aan die harsingskudding van slootoorlogvoering nie, wat nog steeds die simptome van dopskok ondervind het. (En beslis nie alle veterane wat hierdie soort geveg gesien het nie, het met simptome teruggekeer.)

Ons weet nou dat dit wat hierdie gevegsveterane in die gesig gestaar het, waarskynlik was wat ons vandag post-traumatiese stresversteuring, of PTSD, noem. Ons kan dit nou beter herken, en behandelings het beslis gevorder, maar ons het nog steeds nie 'n volledige begrip van wat PTSD is nie.

Die mediese gemeenskap en die samelewing in die algemeen is gewoond daaraan om die eenvoudigste oorsaak en genesing vir enige kwaal te soek. Dit lei tot 'n stelsel waar simptome ontdek en gekatalogiseer word en dan gekombineer word met terapieë wat dit sal verlig. Alhoewel hierdie metode in baie gevalle werk, het PTSD die afgelope 100 jaar weerstaan.

Ons is drie geleerdes in die geesteswetenskappe wat PTSD individueel bestudeer het - die raamwerk waardeur mense dit konseptualiseer, die manier waarop navorsers dit ondersoek, die terapieë wat die mediese gemeenskap daarvoor bedink. Deur ons navorsing het elkeen van ons gesien hoe die mediese model alleen nie voldoende rekenskap gee van die steeds veranderende aard van PTSS nie.

Wat ontbreek, is 'n samehangende verduideliking van trauma wat ons in staat stel om die verskillende maniere waarop die simptome daarvan mettertyd manifesteer, te verduidelik en by verskillende mense kan verskil.

Nie -fisiese gevolge van die Groot Oorlog

Sodra dit duidelik geword het dat nie almal wat breinskok opgedoen het in die nasleep van die Eerste Wêreldoorlog breinbeserings opgedoen het nie, het die British Medical Journal alternatiewe nie-fisiese verklarings gegee vir die voorkoms daarvan:

'N Swak moreel en 'n gebrekkige opleiding is een van die belangrikste, indien nie die belangrikste etiologiese faktore nie: ook dat dopskok 'n' vangende 'klagte was. - (The British Medical Journal, 1922)

Skulpskok het oorgegaan van 'n wettige fisiese besering tot 'n teken van swakheid, van beide die bataljon en die soldate daarin. Een historikus skat dat ten minste 20 persent van die mans dopskok opgedoen het, hoewel die syfers troebel is weens die destydse onwilligheid van dokters om veterane met 'n sielkundige diagnose te merk wat 'n ongeskiktheidsvergoeding kan beïnvloed.

Soldate was argetipies heldhaftig en sterk. Toe hulle huistoe kom sonder om te praat, te loop of te onthou, sonder fisiese redes vir die tekortkominge, was die enigste moontlike verklaring 'n persoonlike swakheid. Die behandelingsmetodes was gebaseer op die idee dat die soldaat wat as 'n held die oorlog aangegaan het, hom nou as 'n lafaard gedra en daaruit moet ruk.

Elektriese behandelings is voorgeskryf in psigoneurotiese gevalle na WWI.Foto via Otis Historical Archives

Lewis Yealland, 'n Britse klinikus, beskryf in sy 1918 "Hysterical Disorders of Warfare" die soort brutale behandeling wat voortspruit uit die denke oor dopskok as 'n persoonlike mislukking. Na nege maande sonder suksesvolle behandeling van pasiënt A1, insluitend elektriese skok in die nek, sigarette op sy tong en kookplate agter in sy keel, roem Yealland daarop dat hy aan die pasiënt gesê het: 'U sal hierdie kamer nie verlaat voordat u net so goed praat as wat jy ooit gedoen het, nie voorheen nie ... jy moet jou gedra as die held wat ek van jou verwag. ”

Yealland het toe 'n elektriese skok op die keel toegedien wat so sterk was dat die pasiënt agteruit gespoel het en die battery uit die masjien gehaak het. Yealland het die pasiënt ongeduldig vasgemaak om die probleem met die battery te vermy en het 'n uur lank skok toegedien, waarna pasiënt A1 uiteindelik 'Ah' fluister. Na nog 'n uur begin die pasiënt huil en fluister: 'Ek wil 'n bietjie water drink.'

Yealland het hierdie ontmoeting triomfantlik gerapporteer - die deurbraak beteken dat sy teorie korrek was en sy metode werk. Skulpskok was 'n siekte van manlikheid eerder as 'n siekte wat voortspruit uit getuienis, onderwerping aan en deelname aan ongelooflike geweld.

Evolusie weg van dopskok

Die volgende golf van die studie van trauma het gekom toe die Tweede Wêreldoorlog weer 'n toestroming van soldate ondervind het wat soortgelyke simptome het.

Dit was Abram Kardiner, 'n klinikus wat in die psigiatriese kliniek van die Amerikaanse veterane -buro werk, wat bestrydingstrauma in 'n baie meer empatiese lig heroorweeg het. In sy invloedryke boek, "The Traumatic Neuroses of War", het Kardiner bespiegel dat hierdie simptome spruit uit sielkundige beserings, eerder as 'n gebrekkige karakter van 'n soldaat.

Werk van ander dokters na die Tweede Wêreldoorlog en die Koreaanse Oorlog het gesuggereer dat naoorlogse simptome blywend kan wees. Longitudinale studies het getoon dat die simptome van ses tot 20 jaar kan voortduur as dit glad verdwyn. Hierdie studies het 'n mate van legitimiteit gebring aan die konsep van bestrydingstrauma wat na die Eerste Wêreldoorlog verwyder is.

Namate veterane van die oorlog in Viëtnam teruggekeer het, word bestrydingstrauma minder gestigmatiseer. Foto via DoD/Creative Commons

Die skrywers van die DSM-III het doelbewus vermy om oor die oorsake van geestesversteurings te praat. Hulle doel was om 'n handleiding te ontwikkel wat gelyktydig gebruik kan word deur psigiaters wat radikaal verskillende teorieë volg, insluitend Freudiaanse benaderings en wat nou bekend staan ​​as 'biologiese psigiatrie'. Hierdie groepe psigiaters sou nie saamstem oor hoe om siektes te verduidelik nie, maar hulle kon - en wel - kom ooreen oor watter pasiënte soortgelyke simptome het. Dus het die DSM-III afwykings, insluitend PTSD, gedefinieer slegs op grond van groepe simptome, 'n benadering wat sedertdien behoue ​​bly.

Hierdie neiging tot agnostisisme oor die fisiologie van PTSS word ook weerspieël in die hedendaagse bewysgebaseerde benaderings tot medisyne. Moderne medisyne fokus op die gebruik van kliniese toetse om aan te toon dat 'n terapie werk, maar is skepties oor pogings om die effektiwiteit van die behandeling te koppel aan die biologie wat aan 'n siekte onderliggend is.

Vandag se mediese PTSD

Mense kan PTSD ontwikkel om verskillende redes, nie net in gevegte nie. Seksuele aanranding, 'n traumatiese verlies, 'n vreeslike ongeluk - elkeen kan tot PTSD lei. Die Amerikaanse Departement van Veterane Sake beraam ongeveer 13,8 persent van die veterane wat terugkeer uit die oorloë in Irak en Afghanistan, het tans PTSD. Ter vergelyking, 'n manlike veteraan uit die oorloë is vier keer meer geneig om PTSV te ontwikkel as wat 'n man in die burgerlike bevolking het. PTSD is waarskynlik ten minste gedeeltelik die basis van 'n nog meer kommerwekkende statistiek: meer as 22 veterane pleeg elke dag selfmoord.

Deesdae is terapieë vir PTSD gewoonlik 'n gemengde sak. Prakties gesproke, wanneer veterane PTSD -behandeling in die VA -stelsel soek, vereis beleid dat hulle blootstelling of kognitiewe terapie aangebied word. Blootstellingsterapieë is gebaseer op die idee dat die vreesreaksie wat aanleiding gee tot baie van die traumatiese simptome, gedemp kan word deur herhaaldelike blootstelling aan die traumatiese gebeurtenis. Kognitiewe terapieë werk aan die ontwikkeling van persoonlike hanteringsmetodes en stadig veranderende onbehulpsame of vernietigende denkpatrone wat bydra tot simptome (byvoorbeeld die skande wat 'n mens kan voel as jy nie 'n missie suksesvol voltooi nie of 'n kameraad red). Die mees algemene behandeling wat 'n veteraan waarskynlik sal ontvang, sluit in psigofarmaseutika - veral die klas medisyne wat SSRI's genoem word.

Die weermag werk daaraan om virtuele realiteit op te neem met blootstellingsterapie vir PTSS -lyers. Foto via DoD

Mindfulness -terapieë, gebaseer op die bewustheid van geestelike toestande, gedagtes en gevoelens en dit aanvaar eerder as om dit te probeer beveg of weg te stoot, is 'n ander opsie. Daar word ook meer alternatiewe metodes bestudeer, soos desensibilisering van oogbewegings en herverwerking of EMDR-terapie, terapieë met behulp van beheerde dosisse MDMA (Ecstasy), blootstellingsterapie met 'n virtuele realiteit, hipnose en kreatiewe terapieë. Die weermag befonds 'n magdom navorsing oor nuwe tegnologieë om PTSD aan te spreek, insluitend neurotegnologiese innovasies soos transkraniale stimulasie en neurale skyfies, sowel as nuwe middels.

Verskeie studies het getoon dat pasiënte die meeste verbeter as hulle hul eie terapie gekies het. Maar selfs al sou hulle hul keuses beperk tot dié wat deur die gewig van die National Center for PTSD ondersteun word deur die sentrum se aanlyn-besluitnemingshulpmiddel te gebruik, weeg pasiënte steeds vyf opsies, wat elk bewysgebaseer is, maar 'n ander psigomediese metode behels. model van trauma en genesing.

Hierdie buffet van behandelingsopsies laat ons ons gebrekkige begrip van waarom mense trauma ervaar en so anders reageer op intervensies opsy sit. Dit verlig ook die druk van psigomedisyne om 'n volledige model van PTSV te ontwikkel. Ons hernoem die probleem as 'n verbruikerskwessie in plaas van 'n wetenskaplike probleem. Terwyl die Eerste Wêreldoorlog dus oor soldate gegaan het en hulle weens hul swakhede gestraf het, is die ideale veteraan -PTSD -pasiënt in die hedendaagse era 'n verbruiker in die gesondheidsorg wat 'n plig het om 'n aktiewe rol te speel in die uitvinding en optimalisering van sy eie terapie.

Terwyl ons hier staan ​​met die vreemde voordeel van die agteruitkyk wat 100 jaar bestudeer het wat gevegsverwante trauma bestudeer, moet ons versigtig wees om ons vordering te vier. Wat nog ontbreek, is 'n verduideliking waarom mense verskillende reaksies op trauma het en waarom verskillende reaksies in verskillende historiese periodes voorkom. Byvoorbeeld, die paraylsis en geheueverlies wat die WWI-dopskokgevalle toon, is nou so skaars dat dit nie eers as simptome in die DSM-inskrywing vir PTSD verskyn nie. Ons weet nog steeds nie genoeg oor hoe soldate se eie ervarings en begrip van PTSD gevorm word deur die breër sosiale en kulturele sienings van trauma, oorlog en geslag nie. Alhoewel ons sedert die Eerste Wêreldoorlog ongelooflike vordering gemaak het in die eeu, bly PTSD 'n verkleurmannetjie en vereis ons voortgesette studie.

MaryCatherine McDonald, assistent -professor in filosofie en godsdiensstudies, Old Dominion University Marisa Brandt, assistent -professor in die praktyk, Michigan State University, en Robyn Bluhm, medeprofessor in filosofie, Michigan State University

Hierdie artikel is oorspronklik gepubliseer op The Conversation. Lees die oorspronklike artikel.


Van dopskok tot PTSD, 'n eeu van onsigbare oorlogstrauma

In die nasleep van die Eerste Wêreldoorlog het sommige veterane gewond teruggekeer, maar nie met ooglopende fisiese beserings nie. Hulle simptome was soortgelyk aan dié wat voorheen met histeriese vroue geassosieer is - meestal geheueverlies, of 'n soort verlamming of onvermoë om sonder duidelike fisiese oorsaak te kommunikeer.

English physician Charles Myers, who wrote the first paper on “shell-shock” in 1915, theorized that these symptoms actually did stem from a physical injury. He posited that repetitive exposure to concussive blasts caused brain trauma that resulted in this strange grouping of symptoms. But once put to the test, his hypothesis didn’t hold up. There were plenty of veterans who had not been exposed to the concussive blasts of trench warfare, for example, who were still experiencing the symptoms of shell-shock. (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 likely what today we call post-traumatic stress disorder, or PTSD. We are now better able to recognize it, and treatments have certainly advanced, but we still don’t have a full understanding of just what PTSD is.

The medical community and society at large are accustomed to looking for the most simple cause and cure for any given ailment. This results in a system where symptoms are discovered and cataloged and then matched with therapies that will alleviate them. Though this method works in many cases, for the past 100 years, PTSD has been resisting.

We are three scholars in the humanities who have individually studied PTSD – the framework through which people conceptualize it, the ways researchers investigate it, the therapies the medical community devises for it. Through our research, each of us has seen how the medical model alone fails to adequately account for the ever-changing nature of PTSD.

What’s been missing is a cohesive explanation of trauma that allows us to explain the various ways its symptoms have manifested over time and can differ in different people.

Nonphysical repercussions of the Great War

Once it became clear that not everyone who suffered from shell-shock in the wake of WWI had experienced brain injuries, the British Medical Journal provided alternate nonphysical explanations for its prevalence:

A poor morale and a defective training are one of the most important, if not the most important etiological factors: also that shell-shock was a “catching” complaint. – (The British Medical Journal, 1922)

Shell-shock went from being considered a legitimate physical injury to being a sign of weakness, of both the battalion and the soldiers within it. One historian estimates at least 20 percent of men developed shell-shock, though the figures are murky due to physician reluctance at the time to brand veterans with a psychological diagnosis that could affect disability compensation.

Soldiers were archetypically heroic and strong. When they came home unable to speak, walk or remember, with no physical reason for those shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier who had entered into war as a hero was now behaving as a coward and needed to be snapped out of it.

Electric treatments were prescribed in psychoneurotic cases post-WWI. Photo via Otis Historical Archives National Museum of Health and Medicine

Lewis Yealland, a British clinician, described in his 1918 “Hysterical Disorders of Warfare” the kind of brutal treatment that follows from thinking about shell-shock as a personal failure. After nine months of unsuccessfully treating patient A1, including electric shocks to the neck, cigarettes put out on his tongue and hot plates placed at the back of his throat, Yealland boasted of telling the patient, “You will not leave this room until you are talking as well as you ever did no, not before… you must behave as the hero I expect you to be.”

Yealland then applied an electric shock to the throat so strong that it sent the patient reeling backwards, unhooking the battery from the machine. Undeterred, Yealland strapped the patient down to avoid the battery problem and continued to apply shock for an hour, at which point patient A1 finally whispered “Ah.” After another hour, the patient began to cry and whispered, “I want a drink of water.”

Yealland reported this encounter triumphantly – the breakthrough meant his theory was correct and his method worked. Shell-shock was a disease of manhood rather than an illness that came from witnessing, being subjected to and partaking in incredible violence.

Evolution away from shell-shock

The next wave of the study of trauma came when the Second World War saw another influx of soldiers dealing with similar symptoms.

It was Abram Kardiner, a clinician working in the psychiatric clinic of the United States Veterans’ Bureau, who rethought combat trauma in a much more empathetic light. In his influential book, “The Traumatic Neuroses of War,” Kardiner speculated that these symptoms stemmed from psychological injury, rather than a soldier’s flawed character.

Work from other clinicians after WWII and the Korean War suggested that post-war symptoms could be lasting. Longitudinal 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 stripped away after the First World War.

UNDATED FILE PHOTO – A US Marine on a combat-reconnaissance mission during the Vietnam war crouches down as the Marines moved through low foliage in the Demilitarized Zone Photo via Reuters

Vietnam was another watershed moment for combat-related 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 began to become activists for their own mental health care. They worked to redefine “post-Vietnam syndrome” not as a sign of weakness, but rather a normal response to the experience of atrocity. Public understanding of war itself had begun to shift, too, as the widely televised accounts of the My Lai massacre brought the horror of war into American living rooms for the first time. The veterans’ campaign helped get PTSD included in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), the major American diagnostic resource for psychiatrists and other mental health clinicians.

The authors of the DSM-III deliberately avoided talking about the causes of mental disorders. Their aim was to develop a manual that could simultaneously be used by psychiatrists adhering to 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 disorders, but they could – and did – come to agree on which patients had similar symptoms. So the DSM-III defined disorders, including PTSD, solely on the basis of clusters of symptoms, an approach that has been retained ever since.

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

Today’s medicalized PTSD

People can develop PTSD for a number of different reasons, not just in combat. Sexual assault, a traumatic loss, a terrible accident – each might lead to PTSD. The U.S. Department of Veterans Affairs estimates about 13.8 percent of the veterans returning from the wars in Iraq and Afghanistan currently have PTSD. For comparison, a male veteran of those wars is four times more likely to develop PTSD than a man in the civilian population is. PTSD is probably at least partially at the root of an even more alarming statistic: Upwards of 22 veterans commit suicide every day.

Therapies for PTSD today tend to be a mixed bag. Practically speaking, when veterans seek PTSD treatment in the VA system, policy requires they be offered either exposure or cognitive therapy. Exposure therapies are based on the idea that the fear response that gives rise to many of the traumatic symptoms can be dampened through repeated exposures to the traumatic event. Cognitive therapies work on developing personal coping methods and slowly changing unhelpful or destructive thought patterns that are contributing to symptoms (for example, the shame one might feel at not successfully completing a mission or saving a comrade). The most common treatment a veteran will likely receive will include psychopharmaceuticals – especially the class of drugs called SSRIs.

Iraq war veteran Troy Yocum walks across the George Washington Bridge from New Jersey to New York accompanied by a Port Authority of New York and New Jersey color guard June 15, 2011.Yokum is hiking over 7,000 miles across America to raise awareness about the severe problems U.S. military families face due to soldiers returning home from overseas deployment with Post Traumatic Stress Disorder (PTSD), and to raise funds to help military families in need. Photo By Mike Segar/Reuters

Mindfulness therapies, based on becoming aware of mental states, thoughts and feelings and accepting them rather than trying to fight them or push them away, are another option. There are also more alternative methods being studied such as eye movement desensitization and reprocessing or EMDR therapy, therapies using controlled doses of MDMA (Ecstasy), virtual reality-graded exposure therapy, hypnosis and creative therapies. The military funds a wealth of research on new technologies to address PTSD these include neurotechnological innovations like transcranial stimulation and neural chips as well as novel drugs.

Several studies have shown that patients improve most when they’ve chosen their own therapy. But even if they narrow their choices to the ones backed by the weight of the National Center for PTSD by using the center’s online Treatment Decision Aid, patients would still find themselves weighing five options, each of which is evidence-based but entails a different psychomedical model of trauma and healing.

This buffet of treatment options lets us set aside our lack of understanding of why people experience trauma and respond to interventions so differently. It also relieves the pressure for psychomedicine to develop a complete model of PTSD. We reframe the problem as a consumer issue instead of a scientific one.

Thus, while WWI was about soldiers and punishing them for their weakness, in the contemporary era, the ideal veteran PTSD patient is a health care consumer who has an obligation to play an active role in figuring out and optimizing his own therapy.

As we stand here with the strange benefit of the hindsight that comes with 100 years of studying combat-related trauma, we must be careful in celebrating our progress. What is still missing is an explanation of why people have different responses to trauma, and why different responses occur in different historical periods. For instance, the paraylsis and amnesia that epitomized WWI shell-shock cases are now so rare that they don’t even appear as symptoms in the DSM entry for PTSD. We still don’t know enough about how soldiers’ own experiences and understandings of PTSD are shaped by the broader social and cultural views of trauma, war and gender. Though we have made incredible strides in the century since World War I, PTSD remains a chameleon, and demands our continued study.

Hierdie artikel is oorspronklik gepubliseer op The Conversation. Read the original story here.


What Did We Call PTSD the Past?

Hildt’s case was called “acute mania,” which is most likely a blanket term to describe patients who were sent to an asylum because they were deemed “insane.” The soldiers of the time — not unlike members of the military today — were instilled with the pressure to be tough and “manly.” Mental illness was frowned upon because it gave the impression that those who suffered from it were weak.

There are records from Civil War times recounting soldiers who suffered from shortness of breath and tightness in their chest, symptoms that sound a lot like acute panic attacks and manifestations of PTSD in today’s terms. Rather than look at these as symptoms of psychological disorders, however, the clinicians of old called the condition “soldier’s heart” or “irritable heart,” pinning the causes on “tight knapsack straps.”

Shell Shock

Once World War I began, military technology had advanced to some degree. Explosives and artillery were more common, and examples of PTSD were called “shell shock.” In this conflict and World War II, “gas hysteria” was used to describe soldiers who had been driven mad by the fear of poison gas attacks. Later, it would be called “soldier’s fatigue” and “Combat Stress Reaction” (CSR).

These aren’t the only depictions of PTSD as it relates to war history. One review of texts on the subject found clinical mentions of neuroses that seemed to have been prompted by the battlefield as far back as the French Revolution in the late 1700s. Personal anecdotes from a soldier in the Hundred Years War in the 14th century described how he would sleep in a separate room from his wife and children because of hallucinations he would have in the night.

Historical Mentions of PTSD Off the Battlefield

Early instances of PTSD were not solely limited to combat, however. The 1952 DSM-1 includes some conception of PTSD as a “gross stress reaction.” In 1979, relief workers charged with cleaning up the aftermath at Jonestown — the death of 909 cult members as a mass suicide organized by leader Jim Jones — in Guyana observed PTSD-like symptoms. Clinical reports from the time described them as “dysphoria.”


PTSD and Post Trauma Growth History… WWI “Shell Shock” Explored by Ernest Hemingway in A Farewell to Arms.

“A Farewell to Arms is a novel by Ernest Hemingway set during the Italian campaign of World War I. The book, published in 1929, is a first-person account of American Frederic Henry, serving as a Lieutenant (“Tenente”) in the ambulance corps of the Italian Army. The title is taken from a poem by 16th-century English dramatist George Peele.”

“Throughout 'N Afskeid van die wapen, Hemingway made it clear that Henry and his comrades were suffering mentally and physically from the hardships of war. He did so even before knowledge of Post-Traumatic-Stress-Disorder was common. “During World War I, the shell shock theory expressed the notion of predisposition, weakened reactive capacities, and a stunned nervous system and mind. Soldiers exhibited stupor, irritability, trembling, traumatic dreams, exaggerated startle response with agitation and conversion reactions.” [21] Church notes that “Psychological studies were still in their infancy before World War I.”

“Author Ernest Hemingway embraced local nature and nightspots with a vigor matched only by his fictional and largely autobiographical character Nick Adams. As Adams lived in Michigan’s wilderness, Hemingway meandered the meadows of Sun Valley and the Big Wood River. Hemingway’s time in Sun Valley began in 1939 when he came to the area after Union Pacific Railroad chairman Averell Harriman invited Hemingway and other celebrities to Sun Valley. In the fall of 1939, he finished his novel For Whom the Bell Tolls. He worked on it while staying in suite 206 at the Sun Valley Lodge.”

My inspiration for writing often comes while exploring the scenic and spiritual mountain regions of the west, and in living on the stunning coast of Oregon near Depoe Bay. We picked Sun Valley for a week of adventure and relaxation this spring. May is a transition month in Sun Valley. The changing weather has provided days of some sun, rain, and snow flurries with temperatures ranging from the lower 30’s at night to the mid 70’s during the day. On this day, we found a hike that was well suited for getting great exercise, while recognizing some limitations that come with bodies that do not perform the same way as in our younger years.

The hike we selected was a couple of miles outside of Ketchum, Idaho on the Corral Creek Trail, a 5 mile round trip. At the beginning of our hike we came upon a memorial to Ernest Hemingway, where we stopped and reflected a moment and took a couple of pictures. Hemingway’s story and spirit is very much alive in Sun Valley, and inspired me to dig deeper into his life in Ketchum. Ernest Hemingway took his own life in this beautiful valley during the summer of 1961 at the early age of 61, two weeks before his 62nd birthday. His young adult life included significant exposure to combat as an ambulance driver in WWI Italian campaign and civilian journalist in WWII. Hemingway observed and wrote about the horrific human suffering and carnage of war, including the apparent psychological and physical wounds. WWI was the beginning of the post-traumatic stress symptoms conversation and long before research connected the dots with post-traumatic stress disorder (PTSD) diagnosis of the post Vietnam era.

My own research and writing since 2010 shows post-traumatic stress symptoms in the mix way back to the Civil War when the term Soldiers Heart (click here for PTSD history) was used to describe the emotional behaviors of combat veterans and families of that time. Shell Shock was used to describe the psychological and troublesome emotional behaviors during WWI. In World War II and thereafter, diagnosis of ‘shell shock’ was replaced by that of combat stress reaction, and battle fatigue, a similar but not identical response to the trauma of warfare and bombardment. The U.S. Navy used ‘battle fatigue’ as an official way to diagnose my father during and after his severe exposure to combat during WWII in the Pacific Theater. There are even indications of the trauma of war and the challenges of warriors coming home from the horrors of battle during the time of Odyssey…Coming Home… click here for more…

There you have it PTSD is not new. History shows that mankind struggled for centuries since the time of Troy from post-traumatic stress. Tragically, mankind assimilated post-trauma conditions into society as an invisible wound and misunderstood infliction that was buried from one generation to the next. We have been stuck with the stigma of mental health challenges for so long that eradicating the generational curse might take several generations. My view supports vigilance and consistent awareness, especially during early childhood. We can save lives right now by taking steps in our own communities to end mental health stigma. Do not hesitate, start the conversation today!

Steve Sparks, Author, Reconciliation: A Son’s Story and My Journey of Healing in Life After Trauma, Part 1&2… Click the highlighted text for my author page to order books and other stuff…


Shell Shock - The Tragic History of PTSD

The world was rejoicing at the end of the gloomy four years of the First World War, (unaware of the fact that the second one was yet to come), and the peacemakers at the Paris Peace Conference were busy making the peace treaties. While new border lines began to form and life came back to normal, few of the people were still stuck in the borders of their own brain, in the hell of its own games.

Around 80,000 cases of Shell Shock were registered right after the end of the First World War. These people were all soldiers who had fought in the frontline. Nobody had seen this before, nobody knew the cure for it, it was like an epidemic of a mental disorder. Many at first related shell shock to exploding shells, which might have caused carbon monoxide to affect the brain but soon it was found out that it was a mental health issue, today more commonly known as PTSD (Post Traumatic Stress Disorder).

A victim of Shell Shock, also known as soldier’s hearts, would show symptoms of helplessness, anxiety, insomnia, nightmares , and paralysis. Many of those who survived never returned to the battlefield , but many didn’t survive at all. Sometimes, as people were new to this, the treatments were often hazardous. It took a lot of time to actually understand the problem and find a suitable cure.

However, a shocking part about the shell shock was that the victims were treated as cowards. Cowards because of a mental health issue? Cowards because they risked their life and now are facing the consequences? What is not so shocking about this is that we haven't changed. Showing compassion and understanding it is one thing, but not even knowing that it exists is completely mind-boggling.

Hundreds of soldiers still return home with the symptoms of PTSD, and to not forget, PTSD could happen to everyone. It could be after sexual harassment, a tragic accident, and even childhood negligence. In India alone, there are more than 10 million cases per year!

My point is that we are equally ignorant to it, as we were during the beginning of the 20th century. We have not progressed.

The question is hoekom. Why are we so ignorant? Why are we not aware of it? Die antwoord is eenvoudig. We haven’t been taught about it. Neither at school nor at home. But now that you know about it, here are a few tips on how to help people dealing with PTSD.

The first would be to always show compassion. It's one of those things that can make any situation better. Secondly, show understanding. Show that you understand their problem. Thirdly, always take to them a specialist as soon as possible. Therapy can really help too.

And last but not the least, educate people around you because it is important for people to know that “you cannot heal in the same environment where you got sick.”


Medical symptoms

Aerial shot of a battlefield on the Western Front © Arthur Hubbard was one of millions of men who suffered psychological trauma as a result of their war experiences. Symptoms ranged from uncontrollable diarrhoea to unrelenting anxiety. Soldiers who had bayoneted men in the face developed hysterical tics of their own facial muscles. Stomach cramps seized men who knifed their foes in the abdomen. Snipers lost their sight. Terrifying nightmares of being unable to withdraw bayonets from the enemies' bodies persisted long after the slaughter.

The dreams might occur 'right in the middle of an ordinary conversation' when 'the face of a Boche that I have bayoneted, with its horrible gurgle and grimace, comes sharply into view', an infantry captain complained. An inability to eat or sleep after the slaughter was common. Nightmares did not always occur during the war. World War One soldiers like Rowland Luther did not suffer until after the armistice when (he admitted) he 'cracked up' and found himself unable to eat, deliriously re-living his experiences of combat.

. everyone had a 'breaking point': weak or strong, courageous or cowardly - war frightened everyone witless.

These were not exceptional cases. It was clear to everyone that large numbers of combatants could not cope with the strain of warfare. By the end of World War One, the army had dealt with 80,000 cases of 'shell shock'. As early as 1917, it was recognised that war neuroses accounted for one-seventh of all personnel discharged for disabilities from the British Army. Once wounds were excluded, emotional disorders were responsible for one-third of all discharges. Even more worrying was the fact that a higher proportion of officers were suffering in this way. According to one survey published in 1917, while the ratio of officers to men at the front was 1:30, among patients in hospitals specialising in war neuroses, the ratio of officers to men was 1:6. What medical officers quickly realised was that everyone had a 'breaking point': weak or strong, courageous or cowardly - war frightened everyone witless.


From Shell-Shock to PTSD, a Century of Invisible War Trauma

(THE CONVERSATION via the AP) In the wake of World War I, some veterans returned wounded, but not with obvious physical injuries. Instead, their symptoms were similar to those that had previously been associated with hysterical women – most commonly amnesia, or some kind of paralysis or inability to communicate with no clear physical cause.

English physician Charles Myers, who wrote the first paper on "shell-shock" in 1915, theorized that these symptoms actually did stem from a physical injury. He posited that repetitive exposure to concussive blasts caused brain trauma that resulted in this strange grouping of symptoms. But once put to the test, his hypothesis didn't hold up. There were plenty of veterans who had not been exposed to the concussive blasts of trench warfare, for example, who were still experiencing the symptoms of shell-shock. (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 likely what today we call post-traumatic stress disorder, or PTSD. We are now better able to recognize it, and treatments have certainly advanced, but we still don't have a full understanding of just what PTSD is.

The medical community and society at large are accustomed to looking for the most simple cause and cure for any given ailment. This results in a system where symptoms are discovered and cataloged and then matched with therapies that will alleviate them. Though this method works in many cases, for the past 100 years, PTSD has been resisting.

We are three scholars in the humanities who have inpidually studied PTSD – the framework through which people conceptualize it, the ways researchers investigate it, the therapies the medical community devises for it. Through our research, each of us has seen how the medical model alone fails to adequately account for the ever-changing nature of PTSD.

What's been missing is a cohesive explanation of trauma that allows us to explain the various ways its symptoms have manifested over time and can differ in different people.

Nonphysical repercussions of the Great War

Once it became clear that not everyone who suffered from shell-shock in the wake of WWI had experienced brain injuries, the British Medical Journal provided alternate nonphysical explanations for its prevalence.

"A poor morale and a defective training are one of the most important, if not the most important etiological factors: also that shell-shock was a 'catching' complaint. – (The British Medical Journal, 1922)"

Shell-shock went from being considered a legitimate physical injury to being a sign of weakness, of both the battalion and the soldiers within it. One historian estimates at least 20 percent of men developed shell-shock, though the figures are murky due to physician reluctance at the time to brand veterans with a psychological diagnosis that could affect disability compensation.

Soldiers were archetypically heroic and strong. When they came home unable to speak, walk or remember, with no physical reason for those shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier who had entered into war as a hero was now behaving as a coward and needed 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 follows from thinking about shell-shock as a personal failure. After nine months of unsuccessfully treating patient A1, including electric shocks to the neck, cigarettes put out on his tongue and hot plates placed at the back of his throat, Yealland boasted of telling the patient, "You will not leave this room until you are talking as well as you ever did no, not before… you must behave as the hero I expect you to be."

Yealland then applied an electric shock to the throat so strong that it sent the patient reeling backwards, unhooking the battery from the machine. Undeterred, Yealland strapped the patient down to avoid the battery problem and continued to apply shock for an hour, at which point patient A1 finally whispered “Ah.” After another hour, the patient began to cry and whispered, "I want a drink of water."

Yealland reported this encounter triumphantly – the breakthrough meant his theory was correct and his method worked. Shell-shock was a disease of manhood rather than an illness that came from witnessing, being subjected to and partaking in incredible violence.

Evolution away from shell-shock

The next wave of the study of trauma came when the Second World War saw another influx of soldiers dealing with similar symptoms.

It was Abram Kardiner, a clinician working in the psychiatric clinic of the United States Veterans' Bureau, who rethought combat trauma in a much more empathetic light. In his influential book, "The Traumatic Neuroses of War," Kardiner speculated that these symptoms stemmed from psychological injury, rather than a soldier's flawed character.

Work from other clinicians after WWII and the Korean War suggested that post-war symptoms could be lasting. Longitudinal 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 stripped away after the First World War.

Vietnam was another watershed moment for combat-related 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 began to become activists for their own mental health care. They worked to redefine "post-Vietnam syndrome" not as a sign of weakness, but rather a normal response to the experience of atrocity. Public understanding of war itself had begun to shift, too, as the widely televised accounts of the My Lai massacre brought the horror of war into American living rooms for the first time. The veterans' campaign helped get PTSD included in the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-III), the major American diagnostic resource for psychiatrists and other mental health clinicians.

The authors of the DSM-III deliberately avoided talking about the causes of mental disorders. Their aim was to develop a manual that could simultaneously be used by psychiatrists adhering to 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 disorders, but they could – and did – come to agree on which patients had similar symptoms. So the DSM-III defined disorders, including PTSD, solely on the basis of clusters of symptoms, an approach that has been retained ever since.

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

Today's medicalized PTSDPeople can develop PTSD for a number of different reasons, not just in combat. Sexual assault, a traumatic loss, a terrible accident – each might lead to PTSD. The U.S. Department of Veterans Affairs estimates about 13.8 percent of the veterans returning from the wars in Iraq and Afghanistan currently have PTSD. For comparison, a male veteran of those wars is four times more likely to develop PTSD than a man in the civilian population is. PTSD is probably at least partially at the root of an even more alarming statistic: Upwards of 22 veterans commit suicide every day.

Therapies for PTSD today tend to be a mixed bag. Practically speaking, when veterans seek PTSD treatment in the VA system, policy requires they be offered either exposure or cognitive therapy. Exposure therapies are based on the idea that the fear response that gives rise to many of the traumatic symptoms can be dampened through repeated exposures to the traumatic event. Cognitive therapies work on developing personal coping methods and slowly changing unhelpful or destructive thought patterns that are contributing to symptoms (for example, the shame one might feel at not successfully completing a mission or saving a comrade). The most common treatment a veteran will likely receive will include psychopharmaceuticals – especially the class of drugs called SSRIs.

Mindfulness therapies, based on becoming aware of mental states, thoughts and feelings and accepting them rather than trying to fight them or push them away, are another option. There are also more alternative methods being studied such as eye movement desensitization and reprocessing or EMDR therapy, therapies using controlled doses of MDMA (Ecstasy), virtual reality-graded exposure therapy, hypnosis and creative therapies. The military funds a wealth of research on new technologies to address PTSD these include neurotechnological innovations like transcranial stimulation and neural chips as well as novel drugs.

Several studies have shown that patients improve most when they've chosen their own therapy. But even if they narrow their choices to the ones backed by the weight of the National Center for PTSD by using the center's online Treatment Decision Aid, patients would still find themselves weighing five options, each of which is evidence-based but entails a different psycho-medical model of trauma and healing.

This buffet of treatment options lets us set aside our lack of understanding of why people experience trauma and respond to interventions so differently. It also relieves the pressure for psycho-medicine to develop a complete model of PTSD. We re-frame the problem as a consumer issue instead of a scientific one.

Thus, while WWI was about soldiers and punishing them for their weakness, in the contemporary era, the ideal veteran PTSD patient is a health care consumer who has an obligation to play an active role in figuring out and optimizing his own therapy.

As we stand here with the strange benefit of the hindsight that comes with 100 years of studying combat-related trauma, we must be careful in celebrating our progress. What is still missing is an explanation of why people have different responses to trauma, and why different responses occur in different historical periods. For instance, the paraylsis and amnesia that epitomized WWI shell-shock cases are now so rare that they don't even appear as symptoms in the DSM entry for PTSD. We still don't know enough about how soldiers' own experiences and understandings of PTSD are shaped by the broader social and cultural views of trauma, war and gender. Though we have made incredible strides in the century since World War I, PTSD remains a chameleon, and demands our continued study.

Hierdie artikel is oorspronklik gepubliseer op The Conversation. Read the original article here.



Kommentaar:

  1. Trevan

    Ja presies.

  2. Emerson

    Between us speaking, try to look for the answer to your question in google.com

  3. Hiamovi

    Merkwaardige idee en dit is behoorlik



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