Post-Traumatic Stress Disorder or PTSD is a mental disorder, which can occur after a traumatic event outside the range of normal human experience. Symptoms and manifestation of Post-Traumatic Stress Disorder vary based on each patient, but the most common symptoms include reliving of the event, hyper vigilance or alertness, insomnia, anger and aggression, reduced social interaction, night terrors and possible flashbacks.
There is a vast array of treatments and treatment plans but just as how the symptoms from patient to patient vary so do effective treatments. Currently PTSD is most commonly treated with routine traditional psychotherapy and mediated with medication. There has been significant research done supporting alternative medicine and the military has begun using combined treatments.
This paper will give an in-depth look at this mental disorder by first discussing what we do know about Post-Traumatic Stress Disorder, including the disorder’s history, what is currently understood and future outlook for the disorder. Next we will discuss the psychological symptoms that are associated with Post Traumatic Stress Disorder, including the clinical definition, manifestations, and effects to patient.
The third section of this paper will discuss many of the treatments used to treat PTSD, ranging from the traditional psychotherapy to the broad array of alternative treatments available. The final sections of this paper will include a short summary of the topics discussed and my final conclusions. What Do We Know About Post-Traumatic Stress Disorder? PTSD is not a new disorder it has existed since the very first major trauma. Even though PTSD can happen to anyone who has experienced a traumatic event this paper will focus on Combat Related PTSD.
I am blind to beauty for I have seen the ugliness of war, my heart discard my souls an open sore, my spirits broken and my body is not well, for I have seen the smoke and fire and passed through the gates of hell, I’ve held a dying man grasping for last breath and been surrounded by the taste of death and the smell of fear, I’ve buried both friend and foe in fields where no crops will ever grow, there is no honor in taking of a life, and I have done so with my rifle and my knife, and I do not sleep well at night, for in my dreams I still fight, and the enemy I see is a soldier… and its me. [ (Lyons, 2007) ]
History of Post-Traumatic Stress Disorder: Looking back throughout history there have been countless accounts of soldiers running from the battlefield, having emotional breakdowns and suffering from the myriad of symptoms of Post Traumatic Stress Disorder. The very first case of soldiers experiencing these symptoms was in 1678 documented by a group of Swiss military Physicians [ (Zagata, 2010) ]. During the bloodiest war in American history the Civil War physicians of the time documented more emotionally disabling behaviors to the stress and fear of battle.
Due to the lack in the field of psychology at the time the soldiers were sent home with no treatment or supervision and often looked at as weak and cowardice by their fellow soldiers [ (Zagata, 2010) ]. This is when the stigma of PTSD began. The Russian army was the first to realize the connection between the stress of war and the mental breakdown of a soldier. In 1905 during the Russian and Japanese war, the Russian soldiers also began to display the symptoms of PTSD and Russia took the first steps to legitimize these symptoms as an actual condition or disorder [ (Zagata, 2010) ].
Even after Russia had begun to recognize this as an actual disorder America continued to view PTSD and its symptoms as a stigma for the weak. During World War I soldiers were subject to such mass slaughter from the use of the first major artillery war that physicians assumed the change in mental status was from concussions sustained from the artillery blasts and coined the phrase or diagnosis or “Shell Shock” [ (Alexander, 2010) ].
With the new advances in the field of psychology during the time of World War II the military began to administer psychiatric screening tests to all soldiers prior to entry into the service and after admission into a field hospital from a combat injury. Even with these new revelations in the field of psychology more than 25% of all American casualties were still classified as being weak but now they were given the title of “Combat Exhaustion” [ (Ramsay, 2013) ]. After World War II many mental health professionals began to question what if any role did a soldiers biology play in this psychological distress.
The very first disease based model for this condition was “gross stress reaction” and can be found in the first diagnostic manual, the Diagnostic and Statistical Manual I (DSM-I) by the American Psychiatric Association [ (American Psychiatric Association, 1952) ] from1952. Even with a medical diagnosis for the condition the soldiers who suffered from “gross stress reaction” still had to deal with the stigmatization of being considered weak [ (Marlowe, 2013) ]. During the Vietnam War many preventative steps were taken to alleviate these symptoms, such as; specially trained medical personnel and increased training and education.
At first, these measures seemed hugely successful, as very few psychological casualties were reported in the war’s initial years. But as the war continued and lost the support of the American people these soldiers began to experience an even greater stigmatization from the public and the numbers of psychological injuries increased exponentially. It is estimated that nearly 31% of males and 27% of female Vietnam veterans have experienced PTSD at some point in their lifetime.
To make matter worse the American public did not support these soldiers instead many were treated poorly and hostile and often looked at as less than a normal citizen. This unsupporting system lead to a rise in veteran unemployment and substance abuse that we are still trying to deal with today [ (Marlowe, 2013) ]. All was not lost during the Vietnam War because through the trials and tribulations of these soldiers who suffered and are still suffering from this disorder gave rise to our current conceptualization of PTSD.
Chaim Shatan, a psychiatrist and advocate for Vietnam War veterans, began to raise awareness about the absence of a combat-related stress diagnosis in the DSM-II. In 1972, Chaim Shatan wrote an article for the New York Times regarding what he termed, “post-Vietnam syndrome,” an affliction which occurred nine to 30 months after Vietnam combat [ (Scott, 1990) ]. Shatan “described the syndrome as ‘delayed massive trauma’ and identified its themes as: guilt, rage, the feeling of being scapegoated, psychic numbing, and alienation” [ (Scott, 1990) ].
Shatan also added to Freud’s concept of grief by saying: “Freud elucidated the role grief plays in helping the mourner let go of a missing part of life and acknowledging that it exists only in the memory. The so-called Post-Vietnam Syndrome confronts us with the unconsummated grief of soldiers—impacted grief, in which an encapsulated, never-ending past deprives the present of meaning. Their sorrow is unspent, the grief of their wounds is untold, their guilt unexpiated. Much of what passes for cynicism is really the veterans’ numbed pathy from a surfeit of bereavement and death” (Scott, 1990) The New York Times article inspired an incredible amount of public support and soon after the Committee on Reactive Disorders began to research the hundreds of cases of what they termed, “catastrophic stress disorder. ” This task force came to the agreement that catastrophic stress disorder did not only affect combat veterans but could also result from non-combat traumas, and symptoms could develop immediately after exposure or much later.
In 1980 the American Psychiatric Association accepted the committee’s findings, but changed the term from “catastrophic stress disorder” to “posttraumatic stress disorder” and was published in the DSM-III. This diagnosis has remained throughout all new revisions of the DSM but the criteria have changed through the years [ (Scott, 1990) ]. Post-Traumatic Stress Disorder in the Present: The world has changed and advanced vastly over the last half a century since the Vietnam War. These advances and changes have changed everything from how we shop, do research, listen to music and even what and how we go to battle.
With these changes in war it is only logical that PTSD would change with it. In order to grasp how these changes have affected PTSD we must first recognize how our current war on terrorism differs from previous battles or wars. During World War I we fought in trenches, World War II after we stormed the beaches of Normandy was almost exclusively fought in two person foxholes, much of the Korean War was fought the same but a major difference between these wars and half of the Vietnam War was the idea of knowing who your enemy was.
Our current war on Terrorism and due largely to the fact that we are greatly more technologically advanced and better equipped than our current enemy leaves us with a new obstacle, who is the enemy. Our current battle was in Iraq and still is in Afghanistan but our fight is not with the military from these countries it is instead with non-uniformed combatants that use guerilla warfare to their advantage. These enemies do not fall under a certain flag and could be anyone a soldier or military member encounters to include woman and even children.
It is crucial to realize that with the improvements in weapons and warfare technology the “enemy” had to evolve too in order to keep up while being at a disadvantage. The terroristic attacks are the most haunting seen in modern warfare. This enemy not only targets military member but civilians as well. It is not uncommon for a soldier in today’s army to witness a vehicle bourne improvised explosive device explode in a crowded market place or school injuring and killing countless innocent victims.
These changes in the strategy of war lead to how soldiers experienced combat and this caused a change in PTSD and the way it influences soldiers [ (Liner, 2013) ]. Fortunately the soldiers of our current conflict have the public support even though many do not support the war. To most military members PTSD is still looked at as a stigma for the weak, but modern military directives and changes to regulations are trying to change that stigmatism. But these changes came only after a dramatic increase in active duty and veteran suicides [ (Liner, 2013) ].
It is currently estimated that more than 25% of all military members who served in Iraq and Afghanistan have already been diagnosed with PTSD. But it is also important to note that in past wars the symptoms of PTSD would not be caught until several years later. The military and field of psychology has made many advances and believes they have devised a model a certain criteria that can spot these symptoms with in the first year or two. Even with all our technological advances we still have not found a way to eliminate PTSD, but there is considerably more support and treatments available to patients [ (Liner, 2013) ].