Vancouver Sun

PTSD: Modern name, ancient affliction

Some First World War soldiers were executed for cowardice, as ‘ shell shock’ was thought to be widely faked


For a disorder that didn’t officially exist until 1980, posttrauma­tic stress has a long history.

Descriptio­ns of the psychologi­cal wounds of war can be traced back as far as the fifth century, when Herodotus, a Greek historian, wrote about the battles between the Greeks and Persians.

First World War

In the First World War, the term “shell shock” was used to describe soldiers with symptoms of fatigue, impaired vision, nightmares, confusion and seizure- like tendencies. A soldier was diagnosed as having shell shock when no obvious physical injury could be found and he was believed to be mentally unsound.

At the time, no medical personnel really understood the cause ( some tried to attribute it to the physical impact and sound of artillery shells), and as a result, the behaviour was often perceived as cowardice. Based on the idea that soldiers were faking their psychologi­cal problems to escape the front lines, many were put on trial, even executed. By the end of the war in 1918, more than 100,000 soldiers from the British, Canadian and American armies showed signs and symptoms related to shell shock.

Second World War

During the Second World War, psychologi­sts and experts began making a bigger effort to understand these psychologi­cal wounds, and the term “shell shock” was replaced by “combat fatigue” or “combat exhaustion.” Soldiers who showed signs of combat fatigue were taken off the front line and placed in makeshift mental wards; some were given barbiturat­e drugs to help ease stress. Psychiatri­sts were starting to understand the close link between psychologi­cal damage and warfare, but it would still be several decades until PTSD was establishe­d as a mental disorder.

DSM- I guide

In 1952, the first edition of a standard guide for the classifica­tion of mental disorders ( called the Diagnostic and Statistica­l Manual of Mental Disorders or DSM- I) included a section on gross stress reaction, but nothing specific on PTSD.

Then came the Vietnam War, with its legions of troubled American soldiers returning home with what was described as “Post Vietnam Syndrome.”

That war and the psychologi­cal problems it caused for participan­ts are commonly credited with the term posttrauma­tic stress disorder finally becoming official. The term was included in the diagnostic manual’s third version, known as DSM- III, published in 1980. That edition defined PTSD as a traumatic event that created a “catastroph­ic stressor” in an individual, different from a typical human experience. Such stressors included events such as war, torture, natural disasters and humanmade disasters.

PTSD recognized

“When PTSD became recognized as a legitimate condition to have, it happened because of the political movement of veterans coming back from the Vietnam War,” said Kalina Christoff, an associate professor of psychology at the University of B. C. “The veterans, those soldiers coming back, formed a political movement demanding the recognitio­n of veterans’ conditions.”

The veterans suffered from flashbacks, anxiety, anger, depression and alcohol and drug abuse. Public antagonism against the war combined with the psychologi­cal damage done to veterans put public pressure on experts and psychiatri­sts to address their psychologi­cal issues, which were much different than the typical mood and anxiety disorders of the time.

Revisions to disorder

The definition of PTSD was revised in 1987 to include witnessing or learning of a family member’s exposure to a lifethreat­ening event or death.

In 1994, it was revised again to include experienci­ng, witnessing or confrontin­g “an event or events that involved actual or threatened death or severe injury, or a threat to the physical integrity of self or others.”

The latest definition of PTSD, outlined in the diagnostic manual’s fifth version in 2013, officially included sexual assault as a traumatic event.

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