1. From Shellshock to PTSD (Post-Traumatic Stress Disorder)

2. Hysterical Muscular Paralysis
from War Neuroses
1918 film

3. “Trauma” From the Greek meaning “wound” Used in surgical contexts
Beginning in 1860s and 1870s, was adopted in neurological and psychiatric settings
In 1894, William James wrote “Certain reminiscences of the shock fall into the subliminal consciousness, where they can only be discovered in ‘hypnoid’ states. If left there, they act as permanent ‘psychic traumata’, thorns in the spirit, so to speak.” (Psych. Review, 1,99)

4. 19th Century: Trauma Diagnoses
Traumatic neurosis (Oppenheim)—physical trauma causes neuroses; was compensated by the German state in Sometimes called a “pension neurosis.”
Railway Spine (in US and Britain)—similar to traumatic neurosis
War hysteria (Bonhoeffer and Charcot) neurosis is due to weakness of the constitution

5. A Case of Traumatic Male Hysteria

6. British Bomb Throwers, 1915
The Sphere,
1915

7. Patient with word deafness; could only hear
word “Bombs”
from War Neuroses, 1918 film

8. Early 20th C. War Neuroses
Shellshock (Charles S. Myers) or bomb concussion, initially thought to be due to shell explosion, which produced tiny brain lesions
NYDN—(not yet diagnosed, nervous?) term to replace shellshock in 1917 in Britain

9. Hysterical solider
and after cure
from War Neuroses
(1918)

10. Treatments for Shell Shock
Bedrest, relaxation, baths, massage
Occupational therapies, e.g. farm-work
Hypnosis and Suggestion (Max Nonne)
Electrical Shock Treatments (Lewis Yealland, Kaufmann)
Treatment by isolation, fake injections
Psychoanalysis (Sandor Ferenczi, W.H.R. Rivers)
Return home or to hospital

11. Electroshock Therapy Maudsley Hospital, 1918

12. The Kaufmann Cure

13. Transporting the Wounded

14. Sandor Ferenczi and Sigmund Freud

15. W. H. R. Rivers (1864-1922) Instinct and the Unconscious (1920)

16. Craiglockhart Hospital

17. Siegfried Sassoon ( )
Wilfred Owen ( )

18. "They"
The Bishop tells us: "When the boys come back
They will not be the same; for they'll have fought
In a just cause: they lead the last attack
On Anti-Christ; their comrades' blood has bought
New right to breed an honorable race,
They have challenged Death and stared him in the face."

19. "Were none of us the same!" the boys reply.
"For George lost both legs; and Bill's stone blind;
Poor Jim's shot through the lungs and like to die;
And Bert's gone syphilitic: you'll not find
A chap who's served that hasn't found some change.“
And the Bishop said: "The ways of God are strange!"
(Siegfried Sassoon, 31 October 1916)

20. Freud’s Death Instinct (Thanatos)
“The fateful question for the human species seems to me to be whether and to what extent their cultural development will succeed in mastering the disturbance to their communal life by the human instinct of aggression and self-destruction.”
Freud, Civilization and its Discontents, 1930

21. War Neuroses Abraham Kardiner: The Traumatic Neurosis of War (1941)
Spoke of “environmental, or reactive” responses to trauma rather than “defensive”—change in ego
Roy Grinker and John Spiegel: War Neurosis (1945)
descriptions of symptoms; personality
. dealing with overwhelming anxiety

22. American Medical Association, War Medicine 5 (1944)

23. Letting off Steam to shrink Resentment War Medicine (1944)

25. From the Cartoon Booklet, “The Story of Mack and Mike”

26. Post-Traumatic Stress Disorder (PTSD) entered DSM 1980, revised 1987
Individual experiences “recognizable stressor” –outside range of usual human experience
Re-experiencing of traumatic event (thoughts, memories, dreams)
Avoidance of stimuli associated with trauma, or numbing of general responsiveness
Increased autonomic arousal not present before trauma

27. History of Trauma Diagnoses
Traumatic neurosis (19th c)
Railway Spine (19th c)
War hysteria (WWI)
Shell Shock (WWI)
Battle Fatigue or Combat Fatigue (WWII) or Operational Exhaustion (Air Force)
PTSD (Vietnam)
PTSD (Iraq and Afghanistan)

28. Reports of soldiers
returning from
combat duty in Iraq
with PTSD range from
12.9 % (panel at
Institute of Medicine,
2007); 19-21% (chief
of psychiatry, Walter
Reed Army Institute
of Research,
Psychiatric Times, 2006); to as high as
30% (Army Surgeon General,
Veteran’s Today, 2006).

29. pregnant fiance´, who was killed. He could not get her out of the car;
Traumatic narratives: (a) he was almost killed in a motor vehicle accident with
pregnant fiance´, who was killed. He could not get her out of the car;
b) she was sexually abused from ages 12 to19 by both older brothers, it was
non-consensual; (c) he found son’s blood all over the basement after the son had
cut his wrist in a drunken suicide attempt.
Non-traumatic narratives: (a) he worries about his looks. It is a big problem;
(b) She has worried about what might happen to her children since their birth.
When a child, she worried about her mother the same way. The problem is much
worse in the past 5 years since the kids have not been nearby; and (c)
she worries about losing her siblings. She is the youngest. People of her age are
dying and she worries about being alone.
Equivocal narratives: (a) he was diagnosed with atrial flutter, which
proceeded to fibrillation 1 year ago during a routine physical exam. He became
obsessed with mortality after this benign cardiac abnormality; (b) she was locked
in a room at a party with four men who started to approach her sexually, but she
escaped; and (c) when 7 years old he was persuaded to fondle an old man.
No force was used and he felt curious at the time, not upset.
J. A.Bodkin et al. “Is PTSD caused by traumatic stress? Journal of Anxiety Disorders 21 (2007) 176–182