The evolution of PTSD

18 Sep

Some psychiatric casualties have always been associated with war, but it was only in the twentieth century that our physical and capability to sustain combat outstripped our psychological capacity to endure it. – Lt. Col. David GrossmanPTSD

The media frenzy around post-traumatic stress disorder (PTSD) may make us think that it is a new disorder, but PTSD reaches back to the early part of the last century where it began to manifest during the first major European war of the 20th century.

PTSD reared its ugly head during World War 1 when it was known as “shell shock”, a disorder of psychological origin. Soldiers on both sides of this conflict suffered immeasurably from new types of weapons in trench warfare: tanks, heavy machine guns, mortars, and poison gas including mustard, nerve, and chlorine gasses which caused horrific damage to the human body. Casualties were immense but for those who survived, a curious condition began to emerge. Shell shock was the first mental health disorder associated with war and the military wasn’t sure what to make of it.

BBC’s excellent documentary on shell shock explains the confusion around the sometimes bizarre behaviour found in military troops at the time: “Soldier’s unconscious minds, so distressed by war, crippled their bodies and took them out of fighting. The military found it hard to accept such a radical theory; it undermined the theory that men could and should control their fears and emotions.”

Soldiers stricken by war trauma displayed strange behaviours never seen before. Men in the ranks suffered from body tremors, paralysis, temporary blindness or loss of speech, and the inability to walk. As a misunderstood condition, shell shock was considered contagious and the men who suffered from it were thought to threaten to their platoons. Six months into the war, 15 percent of the British army suffered from the condition. Dr. Charles Myers, a consulting neurologist to the army with an interest in the growing condition, coined the term “shell shock” in 1915, and decided that the roots of the problem were psychological. By 1916, the British War Office officially recognized shell shock as a genuine war wound.

When officers began to display their own shell shock symptoms — stammering, irritability, and loss of memory — the military realized that this psychological response to warfare was taking an enormous toll. Something had to be done.

Military hospitals were set up and experiments with various treatments began; from Freudian dream analysis to hypnotism to electric shock, some shell shock therapies were successful, others not. The biggest obstacle to dealing with shell shock was the stigma attached to it; men affected by the condition were thought of as “incurable lunatics” or cowards, and a shame was carried with the condition, a shame divided up like a class system.

The condition did not discriminate, but the military did. Men in the ranks were shell-shocked but for an affected officer, to have shell shock in his medical records was an embarrassment so instead, officers suffered from “neurasthemia”, prolonged and exhaustive exposure to war. Officers, you see, were not meant to break down; they were strong, masculine leaders who could, or were expected to control their emotions and behaviour.

Shell shock was an uncontrollable external event that affected the military men internally, but it wasn’t interpreted that way. Sadly, many men who suffered from shell shock or neurasthemia were court martialed, shot, or committed suicide.

Battle exhaustion of World War IIWW2 military man

When World War II began, the military did not learn any lessons from the First World War, and shell shock took on a new identity: “battle exhaustion” or “battle fatigue”. Soldiers in this war suffered paralysis, amnesia, trembling, sleep disorders, memory loss, fear, isolation, and hopelessness. For a sense of the vastness of psychiatric casualties during this war, 20 percent of U.S. war casualties were neuropsychiatric-based, and 25 percent of all British D-Day casualties were psychiatric.

With numbers this high, the military was forced to look for more effective treatments, and young doctors wanted more dynamic cures for their battle fatigued patients. A number of new therapies emerged: talking therapy, individual and group psychoanalysis, electric shock therapy, hypnosis, sports therapy, and art therapy.

Battle exhaustion was considered a temporary condition and military psychiatrists believed that if the soldiers simply rested, they could recover and carry on fighting. An unconventional “sleeping therapy” or “narco-analysis” consisted of psychologically affected soldiers given sodium amytal (also known as “truth serum”), a sedative that induced sleep for weeks at a time to settle anxiety and exhaustion. Drugs administered during the sleep brought soldiers around so they could briefly recall and describe their battle experiences; this was considered a “cleansing” experience without any anxiety upon waking and completing the therapy.

Psychiatrists acknowledged by 1945 that every man had his breaking point and that shock and breakdowns were inevitable, yet the stigma of psychological damage from war remained. Battle fatigue was still considered contagious and men touched by the condition were treated like criminals at army hospitals. Being afraid and showing it was something of a military suicide because the consequence was the humiliation of being labelled “LMF” — lacking in moral fibre, or otherwise cowardly, and having your rank stripped from you. The only saving grace to battle fatigue this time around was that a frightened and battle exhausted man would not be shot.

It should come as no surprise that military men were psychologically impaired because of their wartime experiences. As one World War II solider put it, “I can’t stand seeing people killed.”

 Modern warmodern soldier

Technologies and the methods of modern war have changed enormously since wars after World War II, but the psychological effects of war have not. What was once known as shell shock, battle exhaustion, and post-Vietnam syndrome has become post-traumatic stress disorder, and it is just as devastating as it has always been.

PTSD seems to be an accepted part of military life in the modern era; the tragedy of the loss of human life and the psychological effects of death and destruction is part and parcel of serving one’s country. Indeed, one in three American service people suffer or will suffer from PTSD according to an Al Jazeera report, The War Within. The news agency describes PTSD as “a ticking time bomb with a decades-long fuse — a problem whose true magnitude is difficult to determine.”

Press TV documentary, Invisible Wounds-Break Down, investigates the effects of PTSD on Afghan war vets and reports that more than 30 percent of U.S. Afghanistan veterans are psychologically damaged.  Suicide is one of PTSD’s effects and according the U.S. Department of Veteran Affairs, about 18 veterans take their own lives every day.

The true tragedy of modern war is that the response for service people who reach out for help is ridicule, bullying, humiliation, and hazing; affected personnel are expected to “suck up” their psychological trauma. It’s some kind of unwritten code of valour and it reaps a heavy toll. Cynthia Thomas, a U.S. army wife interviewed by Al Jazeera said that her husband was punished for asking for help and in the end, did not receive any. His suffering continues.

“Unless these officers are held accountable,” she says, “nothing is going to change.”

Conclusion

War as an industry, an industry we’ve been conditioned to accept as a part of our modern life. But war isn’t natural. In fact, according to U.S. military psychologist, Lt. Col. David Grossman, humans very much go against the grain of nature when they kill their own, affirming the idea that war is an act of political will.

In a TVO interview about his book, On Killing, Grossman explains that the first time someone kills another person, it at first feels exhilarating because the target has been hit and the job done, but most people will feel empathy and profound remorse and nausea when they realize what they’ve done; killing is repulsive to us.

There is a lifelong process of rationalization and acceptance [to killing], and if an individual fails at this process, the result is post-traumatic stress disorder, or some type of trauma that will stay with them for the rest of their lives.

Grossman says that through conditioning and desensitization, we now associate violence with pleasure and by doing this we are overcoming a powerful resistance to killing in our minds and in society. He says that combat is more about posturing more than it is about killing, and maintains that combat troops during WWII actually fired their weapons at their enemy only 15 percent of the time (he says that the vast majority of death during that war came from the fighter planes that dropped bombs), to 55 percent in Korea, to a stunning 95 percent in Vietnam. Aiming a weapon at another human being and pulling the trigger became a conditioned reaction.

By now, war, violence, and killing as seen through TV, film, and video games, takes away the horror of human suffering and turns it into entertainment. This completely counter-intuitive perception has enormous implications, and people don’t really know what is at stake.

History has seen leaders use political means to carry out their aggressive and violent motives, leaving the agents of their intentions dead, maimed, or psychologically injured. Assuming a false presumption that men, at least according to the patriarchal construct of men, could ignore their natural emotional state and freely kill other human beings without psychological consequence has proven throughout modern history to be profoundly flawed and deeply tragic. Men are emotional human beings no matter what our patriarchal-based society imposes and expects. One cannot just walk away from taking the life of another human being and remain unaffected. It isn’t natural.

PTSD is an enormous and multi-faceted topic that I will continue to discuss in posts to follow. Thank you for reading.

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