Friday , January 28 2022

A century of invisible war trauma from shell shock to PTSD


After World War I, some veterans were wounded, but no injuries were experienced. Instead, their symptoms were similar to those previously associated with the symptoms of hysterical women – most commonly amnesia, or some kind of paralysis or no apparent physical cause.

British physician Charles Myers, who wrote his first thesis on "shell-shock" in 1915, theorized that these symptoms actually originated from physical injury. He repeatedly stated that repeated exposure to a seizure triggered brain trauma and caused these abnormal symptoms. But once he entered the test, his hypothesis was not supported. For example, there were many veterans who were not exposed to the violent explosion of the trench war, experiencing the symptoms of shell shock. (Of course, all the veterans who saw this kind of battle did not return to the symptoms.)

We now know what these combat veterans face today, what they call post-traumatic stress disorder (PTSD). We are now better able to recognize it, and the treatment has certainly improved, but we have not fully understood what PTSD is.

The medical community and society as a whole are accustomed to finding and treating the simplest causes of a given disease. The result is a system in which symptoms are discovered, cataloged, and coordinated with treatments that alleviate symptoms. While this method works well for many, PTSD has resisted over the past 100 years.

We are three human scientists who have studied PTSD individually. It is a framework that people conceptualize, how researchers investigate, and therapies designed by the medical community. Through our research, each of us has seen that the medical model alone can not adequately explain the ever-changing PTSD personality.

What is missing is a consistent description of the trauma, which can explain how the symptoms appear over time and can vary from person to person.

Non-physical ripple of World War II

The British Medical Journal replaced the non-physical description of fashion as it became clear that the British Medical Journal had not experienced brain damage from everyone suffering from a shell shock after World War I.

Poor fraud and defective training is one of the most important unless it is the most important etiologic factor. Shellshock was also a complaint of "catching". – (The British Medical Journal, 1922)

Shell shock is regarded as a legitimate personal injury and both the battalion and the soldier show weakness. A historian estimates that when giving a psychological diagnosis to a veteran who may affect a person with a disability compensation, the doctor's discomfort is low, but at least 20% of men develop a shell shock.

Soldiers were typically heroic and strong. The only explanation possible was a personal weakness when they could not come home to speak, walk or remember, and there was no physical reason for such a disadvantage. The treatment was based on the idea that a soldier who was a hero in the war was now acting like a coward and needs to inherit from it.

Electrotherapy was prescribed psychologically after World War I. Photo via Otis National Museum of Health and Medicine

British clinician Lewis Yealland explained the brutal remedy from his 1918 "Hysterical Disorders of Warfare" when he considered Shell Shock a personal failure. After nine months of inability to successfully treat patient A1, including electric shock to his throat, he spread a cigarette on his tongue and placed a hot plate behind his throat, and Yealland boasted to the patient: I said it like you did. No, not before … You have to act as the hero you expect. "

Then, Yealland applies an electrical shock to his throat, causing the patient to tilt back and remove the battery from the device. Yeonand tied up the patient to avoid battery problems and continued to shock for an hour. Patient A1 finally whispered "ah." One hour later, the patient began to cry and whispered. water."

Yealland reported this encounter as a victory. The breakthrough meant that his theory was accurate and his method worked. The bark shock was a disease of men, not witnessing, experiencing tremendous violence and disease.

Evolution from shell-shock

The next wave of trauma research arose when World War II saw another influx of soldiers dealing with similar symptoms.

Abram Kardiner, a psychiatrist at the American Veterans' Bureau, reconsidered the combat trauma with a much more sympathetic light. Kardiner argued in his influential book "Traumatic Neuroticism," that it was caused by a mental injury rather than a flawed character of a soldier.

Studies from other clinicians since World War II and the Korean War suggest that post – war symptoms may persist. Longitudinal studies have shown that if symptoms disappear altogether, it can last six to 20 years. These studies justified the concept of combat trauma removed after World War I.

US Navy moved from demilitarized zone to lowland, and the United States Marine Corps, who carried out a combat reconnaissance mission during the Vietnam War, took a photo through Reuters.

Vietnam was another watershed for combat-related PTSD, as veterans began advocating for themselves in unprecedented ways. Starting with a small march in New York in the summer of 1967, veterans began to become activists for mental health care. They worked not to be signs of weakness, but rather to redefine "post-retirement syndrome" as a normal response to the experience of atrocities. The public perception of the war itself has also begun to change as news coverage of the My Lai massacre brings the fear of war to the US living room for the first time. The Veterans Campaign helped PTSD be included in the third edition of the DSM-III Mental Disorders Diagnostic and Statistical Manual (DSM-III), a major US diagnostic tool for psychiatrists and other mental health practitioners.

The authors of DSM-III deliberately avoided talking about the causes of mental illness. Their goal was to develop a manual that can be used by a psychiatrist who basically adheres to different theories, including the Freudian approach and what is now known as "biological psychiatry." The psychiatrist group did not agree on how to describe the disability but agreed to which patients had similar symptoms. Therefore, DSM-III has defined disability, including PTSD, based on symptom clusters and has remained thereafter.

This trend toward agnosticism of PTSD's physiology is reflected in modern evidence-based approaches to medicine. Modern medicine focuses on using clinical trials to demonstrate the effectiveness of therapies, but is skeptical of attempts to link therapeutic effects to biology, the root cause of the disease.

Today's Medical PTSD

People can develop PTSD for various reasons as well as combat. Sexual abuse, traumatic loss, terrible accidents – each can lead to PTSD. The Department of Veterans Affairs estimates that 13.8% of veterans returning from the war in Iraq and Afghanistan now have PTSD. For comparison, the male veterans of the war are four times more likely to develop PTSD than men in the civilian population. The PTSD will be at least partially at the source of more astonishing statistics. The top of 22 veterans commit suicide every day.

Today, therapies for PTSD tend to be mixed. In fact, if a veteran finds a PTSD treatment in a VA system, the policy should provide either exposure or cognitive treatment. Exposure therapy is based on the idea that fear responses that cause many traumatic symptoms can be buffered by repeated exposure to trauma events. Cognitive therapy develops personal coping strategies and slowly changes the pattern of unhelpful or destructive thinking that contributes to symptoms (for example, the number you feel when you do not successfully complete a mission or find a comrade). The most common treatments for veterans include psychoactive drugs, especially drugs called SSRIs.

Troy Yocum, an Iraqi war veteran, walks the George Washington Bridge from New York to New York accompanied by his New York and New Jersey color guard on June 15, 2011. Yokum The US military family is hiking over 7,000 miles across the US Facing Post-Traumatic Stress Disorder (PTSD) to raise money to help soldiers deployed overseas and troubled military families. Photo: Mike Segar / Reuters

A mind-set therapy based on recognizing mind states, thoughts and senses, and fighting or pushing them away rather than accepting them is another option. More alternatives are being investigated, such as eye movement desensitization and reprocessing or EMDR treatment, controlled dose MDMA (Ecstasy) use, virtual reality exposure therapy, hypnosis and creative therapy. The military supports a wealth of research funding for new technologies to address PTSD. This includes neuroscience innovations such as neural stimulation and nerve chips and new drugs.

Several studies have shown patients to be the best when they choose their treatment. However, even if the center uses the Online Treatment Decision Aid to reduce the choice to the patient backed by the weight of the PTSD National Center, the patient still weighs five options. Each option is evidence based, but different aesthetic trauma and healing models.

This treatment option can prevent people from understanding why they are suffering trauma and reacting so arbitrarily. It also relieves pressure on psychotic treatment to develop a complete model of PTSD. We reconstruct the problem into a consumer problem, not a scientific one.

Thus, while WWI was about soldiers and punishing them with weaknesses, ideal veteran PTSD patients are health care consumers who are obliged to play an active role in identifying and optimizing their treatment.

We must celebrate the progress because we stand here with a delayed wisdom that we need 100 years to study combat-related trauma. What is still missing is an explanation of why people react differently to trauma and why different reactions occur at different historical times. For example, paraylsis and amnesia, which summarize the WWI shell impact case, are currently very rare and do not appear to be symptomatic of DSM items in PTSD. We do not yet know enough about how the soldier's own experience and understanding of PTSD are formed by the broad socio-cultural view of trauma, war, and sex. Though we have made remarkable progress since the end of the First World War in the first century, PTSD remains a chameleon and our constant research is required.

This article was originally posted on The Conversation. Read the original story.

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