Halle P's List: History of PTSD

• Vietnam was partitioned, ostensibly temporarily, into a communist North and a non-Communist (and, some hoped, an eventually democratic) South. The former was to be ruled by Ho Chi Minh, while the latter would be under the control of Emperor Bao Dai.

• The Diem Regime
• A year after the Geneva Accords, Prime Minister Diem commenced a “Denounce the Communists” campaign in the south. Throughout the summer of 1955, communists and other oppositionists were jailed and executed.
•  

  

  President of South Vietnam Ngo Dinh Diem, left, is welcomed in ceremonies at Washington National Airport. With him is President Dwight D. Eisenhower.

  Photograph Courtesy of the National Archives & Records Administration

    

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  The Diem Regime

    

  A year after the Geneva Accords, Prime Minister Diem commenced a “Denounce the Communists” campaign in the south. Throughout the summer of 1955, communists and other oppositionists were jailed and executed.
• ssaulted Buddhist sects and organized crime, which further alienated the largely Buddhist Vietnamese people and eroded his support.
• Diem rigged a referendum on the future of the country and declared the formation of the Republic of Vietnam,
• Despite this, the US actively supported the Diem regime as a buttress against Ho Chi Minh’s communist forces in the north.
• In 1957, a low-level guerrilla movement began to emerge in the south, conducted by Viet Minh units that had not returned north after the accords. Two years later, these groups successfully pressured Ho’s government into issuing a secret resolution calling for an armed struggle in the south.
• the National Front for the Liberation of South Vietnam (Viet Cong) was formed to carry out the fight.

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• PTSD is a new name for an old story

• It’s been with us now for thousands of years, as incidents   in history prove beyond a doubt.

   
• thousand   years ago, an Egyptian combat veteran named Hori wrote about the   feelings he experienced before going into battle: “You determine   to go forward. . . . Shuddering seizes you, the hair on your head   stands on end, your soul lies in your hand.”
• Three
• an Athenian warrior who went   permanently blind when the soldier standing next to him was   killed, although the blinded soldier “was wounded in no part of   his body.” So, too,
• blindness, deafness, and paralysis, among   other conditions, are common forms of “conversion reactions”   experienced and well-documented among soldiers today.
• Herodotus   tells of another Spartan named Aristodemus who was so shaken by   battle he was nicknamed “the Trembler”—he later hanged him- self   in shame.)
• he English commander Alfred   reportedly became so violently ill that he began to vomit and was   not able to lead his men.
• same symptoms maladie du pays
• and the Spanish, confronted with the same reactions among their   soldiers, called it estar roto (literally, “to be broken”).
• French doctors termed the
• During the   siege of Gibraltar in 1727, a soldier who was part of the defense   of the city kept a diary. In it, there is mention of incidents in   which soldiers killed or wounded themselves. He also describes a   state of extreme physical fatigue which had caused soldiers to   lose their ability to understand or process even the simplest   instructions. In this state, the soldiers would refuse to eat,   drink, work, or fight in defense of the city, even though they   would be repeatedly whipped for not doing so.
• as   having three dif ferent stages. The first is heightened excitement   and imagination; the second is a period of fever and prominent   gastrointestinal symptoms; the final stage is one of frustration   and depression.

  • gastrointestinal- affecting stomach and intestines (probably vomiting etc.)
  Add Sticky Note
• including   paralysis, tremors, self-inflicted wounds, nostalgia, and severe   palpitations—also called “soldier’s heart” and “exhausted heart.”
• soldiers on normal leave often collapsed with emotional illness at   home, even when they had shown no symptoms of mental debilitation   before they had left the fighting.
• the Civil War the first step on the road to modern warfare
• The immediate   result was that psychological symptoms became so common, field   commanders as well as medical doctors pleaded with the War   Department to provide some type of screening to eliminate recruits   susceptible to psychiatric breakdown.
• “They were put on trains   with no supervision, the name of their home town or state pinned   to their tunics, others were left to wander about the countryside   until they died from exposure or starvation
• Richard A.   Gabriel, a consultant to the Senate and House Armed Services   Committees and one of the foremost chroniclers of PTSD.
• in 1863 the number of insane soldiers   simply wandering around was so great, there was a public outcry.
• the first military   hospital for the insane was established in 1863. The most common   diagnosis was nostalgia
• . The government made no effort to deal   with the psychiatrically wounded after the war
• “It is by   lack of discipline, confidence, and respect that many a young   soldier has become discouraged and made to feel the bitter pangs   of homesickness, which is usually the precursor of more serious   ailments,” commented the assistant surgeon general in 1864,   reflecting the sentiment that most who suffered signs and symptoms   of war trauma were, in fact, malingering.

  • malingering- avoiding work by faking sick
• Unfortunately,   the attitude that combat veterans with psychological problems are   really malingerers trying to gain economically is still with us   today. That attitude, combined with veterans’ pride and distrust,   accounts for the fact that, while a Research Triangle Institute   study concludes 830,000 Vietnam veterans have full-blown or   partial PTSD, only 55,119 have filed claims, and the adjudication   boards have only believed 28,411 (July 1990) of those claimants.

  • This is one side of the argument! The other is the idea of malingering! use this statement to further research!
  Add Sticky Note
• The   major’s Indian scout, Yellow Knife, was struck square in the face   by a bullet, which sent his blood, flesh, and brains spattering   all over Reno, who immediately went into shock. He began foaming   at the mouth, and his eyes rolled wildly in his head.
• Some of Reno’s   men were so paralyzed with fear, they couldn’t defend themselves.   They were so terrified, in fact, the Indians thought them cowards   and refused to kill them. Maj. Myles Moylan was found later by the   cavalry rescue force, “blubbering like a whipped urchin, tears   coursing down his cheeks.”
• About the   only thing that didn’t happen to Reno’s men during the battle was   desertion
• The first army   in history to determine that mental collapse was a direct   consequence of the stress of war and to regard it as a legitimate   medical condition was the Russian Army of 1905 in their war with   the Japanese.
• their recognition of the   principle of proximity, or forward treatment.
• the birth of military psychiatry.
• treating psychiatric casualties close to the front
• In   actuality, less than 20 percent were able to return to the front.
• the method was not very successful.
• WWI produced large numbers of the psychologically   wounded. Unfortunately, what little had been learned up to then   was forgotten.
• This time,   they began by attributing the high psychiatric casualties to the   new weapons of war; specifically, the large-caliber artillery.

• It was   believed the impact of the shells produced a concussion that   disrupted the physiology of the brain; thus the term “shell shock”   came into fashion.

   
• Although WWI   generated stress theories based on models of the mind, such as   Freud’s “war neurosis,” these theories never gained wide   acceptance.
• Quite simply, Freud postulated “war neurosis” was   brought about by the inner conflict between a soldier’s “war ego”   and his “peace ego.”
• • neuroasthenia= Psychiatry. (not in technical use) nervous debility and exhaustion occurring in the absence of objective causes or lesions; nervous exhaustion.
    Lesions= an injury
  Add Sticky Note
• Another diagnosis at the time which gained little currency was   neurasthenia
• By the end of   World War I, the United States had hundreds of psychiatrists   overseas who were beginning to realize that psychiatric casualties   were not suffering from “shell shock.” These psychiatrists came to   comprehend it was emotions and not physiological brain damage that   was most often causing soldiers to collapse under a wide range of   symptoms.
• they continued to believe
• weak in character.
• During WWI
• During the   same period, 159,000 soldiers were out of action for psychiatric   problems, with nearly half of these (70,000) permanently   discharged.
• psychiatrists concluded   that the answer to psychological casualties was to more thoroughly   screen those entering the military
• weed out those predisposed to break   down in combat.
• rejected no fewer than five million men for military   service
• World War   II,
• e. In the four years of war, no more than 800,000   soldiers saw direct combat, and of these, 37.5 percent became such   serious psychiatric cases, they were permanently discharged.
• It became   clear it was not just the “weak” in character who were breaking   down.
• “combat neurosis”   began to give way to the term “combat exhaustion.”
• Author Paul   Fussell says that term as well as the term “battle fatigue”   suggest “a little rest would be enough to restore to useful duty a   soldier who would be more honestly designated as insane.” While   the name change showed movement away from psychopathology, it   didn’t keep the military model of “predisposition plus stress   equals collapse” from working its way back into military medicine.
• Fussell was a   20-year-old Army lieutenant and the leader of a rifle platoon in   France.
• his highly acclaimed book,  Wartime,
• He points out that the   populace is naive to their pain and suffering
• Fussell quotes   Bruce Catton:
• “A singular fact about modern war is that it takes   charge. Once begun it has to be carried to its conclusion and   carrying it there sets in motion events that may be beyond men’s   control.
• Doing what has to be done to win, men perform acts that   alter the very soil in which society’s roots are nourished.”
• something that   can be said about any war when we fully realize that before   society’s roots can be altered, soldiers’ very souls are seared by   the acts they witness and perform.
• The denial and   naivete of the populace as to what war really is becomes a dynamic   underlying the trauma of soldiers: “
• S]evere trauma was often the   result of the initial optimistic imagination encountering   actuality.”
• “Now if we go back we will be weary, broken,   burnt out, rootless, and without hope. We will not be able to find   our way anymore. And men will not understand us. . . . We will be   superfluous even to ourselves; we will grow older, a few will   adapt themselves, some others will merely submit, and most will be   bewildered.”
  
• Fussell points out all wars are boyish and are fought by boys who   are useful material for the sharp edge of war, but only for a   short time: “[A]fter a few months they’ll be dried up and as   soldiers virtually useless—scared, cynical, debilitated,   unwilling. . . .”
  
• While the average age in the military during WWII was 26, it was   the 18-year-olds who were up front.
• Replacements got hit before   anyone knew their names,
• Fussell notes   the detachment may be heartless but it makes it possible for   sensitive people to survive the war relatively undamaged.
• While   it’s true that we detach ourselves from war in order to survive,   it’s also clear that the act of detachment is itself a kind of   willed destruction. It’s the price paid; it’s why we never learn.   The psychic numbing necessary to survive combat is not something   you step into and out of easily. You can’t do it halfway.
• This attitude is about as tangible a   thing as you can find. It is all consuming and pervades the soul.   You carry it with you when you leave the battlefield. You carry it   home, where you live with it. You share it with your family and   your friends and your kids, and ultimately with your society. And   it is poisonous, exceedingly poisonous—and it alters “the very   soil in which society’s roots are nourished.”
• Edmund Wilson looked out over London and   said, “No one pretends to give a damn anymore—unless they are   one’s close friends or relatives—whether people are killed or not.   . . . The long-continued concentration on killing people whom we   rarely confront, the suppression of the natural bonds between   ourselves and these unseen human creatures, is paid by   repercussions. The spitefulness and fear and stifled guilt, in our   immediate personal relations. . . . Our whole world is poisoned   now.”
  
• Fussell 50 years to say, “Now there has been much   talk about ‘The Good War,’ the justified war, the necessary war,   and the like, that the young and innocent could get the impression   that it really was not such a bad thing after all. It’s thus   necessary to observe it was a war and nothing else, and thus   stupid and sadistic, a war, as Cyril Connally said, ‘of which we   are ashamed, a war…which lowers the standard of thinking and   feeling…which is as obsolete as drawing and quartering; further, a   war opposed to every reasonable conception of what life is for,   every ambition of the mind or delight of the senses.’”
• the Korean War.
• In other words, the chances of being   a psychiatric casualty in Korea was 143 percent better than the   chances of being killed.
• The British   psychiatrist R.D. Lang has written that an insane response to an   insane situation is sane behavior.
• “Thou shalt not kill,”   until he is drafted and the message becomes, “Kill, kill, kill!”
• Gabriel writes in No More Heroes, a study of madness and   psychiatry in war, that contrary to what is in the movies,   television, and the military, it is not only the weak and cowardly   who break down in battle. In reality, everyone is subject to   breaking down in combat, “perhaps most telling, not only are there   no personalities or demographic factors which are associated with   psychiatric collapse; neither are there any factors associated   with heroism
• When all is said and done, all normal   men are at risk in war.
• Gabriel   believes there is enough evidence from studies done after WWII to   suggest it is only those who are already mentally ill, about two   percent of the population, who don’t break down in battle. In   other words, only the sane can go insane; the already insane   remain that way.
• This idea,   that all normal men have a breaking point and all combat veterans   will fall off a continuum at recovering, from mild to severely   pathological, has been called the endurance model. It looks at war   madness as a form of adaptation. The task for therapists and   psychiatrists is to unravel the sense behind the symptomatology,   acute or chronic, that is observed in veterans today:
• Robert J. Lifton is a psychiatrist based at Yale University, and   he is renowned for his work with trauma patients, including   Vietnam veterans. His response to the illness model (soldiers in   their conflictive “neurotic” state become afraid to die and afraid   to kill) is he doesn’t see not wanting to die or kill as being   very “neurotic” and that, in fact, perhaps mankind can use a   little more of this attitude

  • neurotic = a relatively mild personality disorder typified by excessive anxiety or indecision and a degree of social or interpersonal maladjustment.
• The dynamics were different in Vietnam, where conditions of the   war were such that moral revulsion combined with psychological   conflict lead to both acute and delayed reactions
• questions of meaning—concerning life, and   ultimately, all other areas of living.”
• Lifton argues that in the search to understand the soldiers’   traumatic stress reaction, doctors should focus on the death and   destruction that actually took place and its related questions of   meaning, rather than invoke the idea of “neurosis.”
• There is a close relationship between psychic numbing . .   . and death-linked images of denial (‘If I feel nothing, then   death is not taking place’), or ‘I see you dying but I am not   related to you as your death.’”
  
• One example is Canadian   bomber-pilot J.D. Harvey on his return from rebuilding Berlin in   1960: “I could not visualize the horrible death my bombs . . . had   caused here. I had no feeling of guilt. I had no feeling of   accomplishment.”
• Lifton tells us this happens in order for the soldier to avoid   losing his sense completely and permanently
• Having closed off and numbed themselves in order to survive,   soldiers are then faced with the task of working their way back   toward humanity. The struggle is to “re-experience himself as a   vital human being.” However, it is not all that easy, for “one’s   human web has been all too readily shattered, and in rearranging   one’s self-image and feelings, one is on guard against false   promises of protection, vitality, or even modest assistance. One   fends off not only new threats of annihilation but gestures of   love or help.
• But ever after, in peacetime,   the reconstruction of “the human web” becomes more and more   implausible: if societies are sane—if, in fact, they are   civilized—why are there wars?
• There are “cures” offered in the   best of societies for PTSD, programs that are established to   reintegrate sane men and women into the established order. But   always the absolute cure to the eradication of symptoms of PTSD is   to eradicate their causes. We are disturbed by war, and justly so.
• Today, PTSD is characterized by depression, loss of   interest in work or activities, psychic and emotional numbing,   anger, anxiety, cynicism and distrust, memory loss and alienation,   and other symptoms. And why not?
• The   point is that throughout history, men and women have acted to   suppress the horrors that they’ve seen. It’s time we recognize   that for what it is—as not only the outward manifestation of PTSD,   but the clearest evidence we have that wars are destructive in   other ways than in body counts. It takes many years for even the   most sane among us to arrive at what we have seen and wanted to   forget.
• Psychiatrist   Victor Frankel survived internment in four Nazi concentration   camps during WWII.
• he wrote   his book, Man’s Search for Meaning. In the book, he states   clearly that “an abnormal response to an abnormal situation is   normal behavior.”

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• While PTSD has likely been around for centuries, only as recently as 1980 has the American Psychiatric Association (APA) officially added PTSD to its Diagnostic Manual of Mental Disorders (DSM).
• • battle fatigue or gross stress reaction for soldiers who came down with PTSD after World War II  
  • combat fatigue or shell shock for soldiers who experienced PTSD symptoms after World War I  
  • soldier's heart for soldiers who developed the symptoms of PTSD after the Civil War.
• most leaders and doctors thought it was simply nothing more than cowardice or personal weakness.
• Although PTSD was largely disregarded for decades, the Vietnam War brought significant public attention to this emotional disorder when doctors began to diagnose it as post-Vietnam syndrome.
• oday, about 7 percent to 8 percent of the general population will develop PTSD. These numbers go up significantly for veterans and rape victims, among whom PTSD has anywhere from a 10 percent to 30 percent chance of developing.

   
• Films about the Vietnam War, such as Apocalyse Now, The Deer Hunter and Born on the Fourth of July, have all featured Vietnam veterans who end up having to deal with the issues that come with PTSD. These films have been well-received by audiences, which tells us that, as a culture, humans are very interested in how other people deal with traumatic events in their lives.
• • one in six soldiers returning from Iraq suffer from it.
     
  •  
    Enlisted men are twice as likely than military officers to report PTSD.
• American women serving in Iraq tend to suffer from more severe and debilitating forms of PTSD.

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• During World War I hundreds of men were shot for cowardice; it wasn't until 1980 that the mental illness they likely had was recognized with a formal diagnosis.
• a combination of extreme excitement and gut-wrenching terror.
• the emotions that can leave permanent mental health damage.
• In the past, it has been known as battle fatigue, shell shock, and, during the American Civil War in the 1860s, it was called soldier’s heart.
• with Vietnam veterans it was called post-Vietnam syndrome.
• During World War I, the standard therapy for shell shock among ordinary soldiers was execution.
• The only diagnosis allowed was “cowardice in the face of the enemy” and the treatment was a firing squad.
• “officers were prescribed rest and encouragement, usually accompanied by withdrawal from the war zone for a longer period of rest and rehabilitation.”
• By World War II, psychiatrists were attached to many military units at the division level.
• supportive counselling with the aim of getting them back to their fighting comrades within three days to a week
• General George Patton’s soldiers
• Old Blood and Guts
• Charles H. Kuhl, in a military hospital and he asked what the matter was. Kuhl said his nerves were shot - he couldn’t take the shelling any more. Patton flew into a profanity-filled rage, slapped the soldier, and called him a coward.

• Sufferers are taught about the nature of the condition; that it is caused by extreme stress and is not a sign of personal weakness.

   
• anti-depressants such as Zoloft and Paxil.

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• Shell shock, as combat stress used to be called during World War I, was often viewed as a coward’s reaction to fighting
• The few men who were diagnosed with combat fatigue were evacuated home often when it was too late for recovery.
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  With the deployment of US military troops to areas of conflict across the globe, effective ways to deal with combat stress has become a high priority. Combat stress casualties are not a new problem, but the way combat stress is dealt with has changed profoundly in the last century.
• In the US there was more pre-recruitment screening.

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