Presentation on theme: "History of Post-traumatic Stress Disorder in Combat"— Presentation transcript:
1History of Post-traumatic Stress Disorder in Combat Presented byMylea Charvat, MS
2PTSD in Ancient Literature Though referred to by a number of different names, PTSD has been with us for as long as wars have been fought.Herodotus, writing of the battle of Marathon in 490 BC, mentions an Athenian warrior who went blind when the soldier standing next to him was killed, although the blinded soldier “was wounded in no part of his body.”Steven Bentley, “A Short History of PTSD: From Thermopylae to Hue, Soldiers Have Always Had A Disturbing Reaction To War The VVA Veteran, March/April 2005
3PTSD in Ancient Literature Herodotus also wrote of the Spartan commander Leonidas, who, at the battle of Thermopylae in 480 BC, dismissed his men from combat because he recognized they were mentally exhausted from previous battles.
4PTSD in Ancient Literature The Iliad makes a reference to what appears to be PTSD -- Ajax loses a duel, comes under a "spell" from Athena, slaughters a herd of sheep thinking they are the enemy, and then kills himself.
5Evolution of PTSD1678 Swiss physician Johannes Hofer coins the term “nostalgia.” to describe symptoms seen in Swiss Troops.Symptoms of “Nostalgia”melancholyincessant thinking of homedisturbed sleep or insomnialoss of appetiteanxietycardiac palpitations
6Napoleonic EraFrench physicians recognized numerous factors important in producing nostalgia:Cultural (rural vs urban conscripts)Social (boredom vs rigorous activity)Environmental (clement vs inclement weather)Battle (victorious armies suffering fewer cases)
7Napoleonic EraNapoleon’s Chief Surgeon, prescribed a treatment for Nostalgia which consisted of:Regular exerciseListening to music“Useful instruction”
8The U.S. Civil War The Union Army 2,600 cases of insanity5,200 cases of nostalgia.In addition many “insane” soldiers were simply discharged and left to find their own way home.In 1864 the War Department ordered that such soldiers be transferred to the Government Hospital until their families could retrieve them.Franklin D. Jones, M.D., F.A.P.A, “Psychiatric Lessons of War in War Psychiatry, The Textbooks of Military Medicine, ed. Brigadier General Russ Zajtchuk, M.C., (Washington, DC: Office of The Surgeon General, Department of the Army, 1995),
9The U.S. Civil War: Soldier’s Heart 1871 Jacob Mendez Da Costa (internist) noted the following symptoms in soldiers:Chest-thumping (tachycardia)AnxietyBreathlessness (hyper-arousal)These symptoms were referred to first as Soldier’s Heart and later as Da Costa Syndrome.
10Railway Spine1867 – following a series of deadly train accidents in Great Britain:Railway spine was characterized by:“…the manifestation of a variety of physical disorders in otherwise healthy and apparently uninjured railway accident victims.”Ralph Harrington, The Railway Accident: Trains, Trauma and Technological Crisis In Nineteenth Century Britain, in Traumatic Pasts: History and Trauma in the Modern Age ed. Mark S. Micale and Paul Lerner, Cambridge: Cambridge University Press.
11World War I: “Shell Shock” Symptoms of Shell ShockStaring eyesViolent tremorsBlue, cold extremities.Unexplained deafness, blindness, or paralysisF. C. Hitchcock. Stand To: A Diary of the Trenches 1915–1918. London: Hurst & Blackett, 1937; report, Heath field, England: The Naval & Military Press, Ltd., 2001.
12World War I: Treating Shell Shock 1917: U.S. Army Surgeon General’s office creates comprehensive treatment program for shell shockPlacing psychiatrists in combat unitsTreatment is Centered on:Proximity (treating the soldier as close to the battle as possible)Immediacy (treating the soldier as soon as possible)Simplicity (providing simple treatment such as rest, a warm shower and food)Expectancy (the expectation that the solider will return to fight after he has been treated)
13World War IIWyeth Pharmaceuticals placed this ad in Life Magazine on September 17, 1945, touting the benefits of their product in curing "battle reaction & mental trauma" caused by WWII...and colic
14WWII: Combat Fatigue Forward Treatment Employed. Unit cohesion recognized as a factor in “resilience” to combat fatigue.Understanding that intensity and duration of combat exposure increased risk for combat fatigueConcurrently it was noted that “replacement” troops were more susceptible than “seasoned” Veterans – see unit cohesion.
15DSM: 1952DSM-Iwhat we now know as PTSD was called "stress response syndrome" and was caused by "gross stress reaction".
17Vietnam War 1968: Veteran’s Treated for “Stress Response Syndrome” Informed that if their symptoms lasted more than 6 months after their return from Vietnam they had a "pre-existing" condition, making it a "transient situational disorder", and the problem was not considered service connected.
18Vietnam War: DSM-II: 1968Trauma-related disorders were lumped together in a category titled "situational disorders".the jungles of Guadalcanal.
191980 DSM-III: PTSDPost-traumatic Stress disorder first introduced as a diagnosisPlaced under a sub-category of anxiety disorders
20DSM-III PTSD CriteriaEssential feature: Characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience. The original stressor is usually experienced with intense fear, terror, and/or helplessness.The precipitating stressor must not be one which is usually well tolerated by most other members of the cultural group (e.g., death of a loved one, ordinary traffic accident).
21Evolution of PTSD: DSM-III-R Changes in DSM-III-R:Specification of generic characteristics of traumatic stressorsClearer organization of symptoms around three dimensions of stress response (re-experiencing, avoidance and numbing, and physiological arousal)inclusion of symptoms specific to children, and specification of onset and duration of the disorder.
22DSM-IV Criteria Re-experiencing >1 Intrusive thoughts or memories Person Experiences Traumatic EventPerson Experiences Fear, Helplessness or HorrorThe person experiences a combination of the following Sx which are still present > 4 weeks following the TE, last more than one month and cause significant distressRe-experiencing >1Intrusive thoughts or memoriesTrauma related dreamsActing/feeling as though the trauma were reoccurringEmotional distress in response to triggersPhysical Sx in response to triggersAvoidance >3Efforts to avoid trauma related thoughts or feelingsAvoidance of people, places or activities that trigger reminders of traumaMemory loss for all or parts of the traumaLoss of interest in activitiesFeelings of estrangement from othersExpectation of foreshortened futureHyperarousal >2Difficulty with sleepIrritability and angerAttention and Concentration problemsHypervigilenceExaggerated startle reaction