Evolution of Post Traumatic Stress Disorder (PTSD)

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The Evolution of Post-Traumatic Stress Disorder!

It was not until World War I that specific clinical syndromes came to be associated with combat duty. In prior wars, it was assumed that such casualties were merely manifestations of poor discipline and cowardice. However, with the protracted artillery barrages commonplace during "The Great War," the concept evolved that the high air pressure of the exploding shells caused actual physiological damage, precipitating the numerous symptoms that were subsequently labeled "shell shock." By the end of the war, further evolution accounted for the syndrome being labeled a "war neurosis"

During the early years of World War II, psychiatric casualties had increased some 300 percent when compared with World War I, even though the pre-induction psychiatric rejection rate was three to four times higher than World War I. At one point in the war, the number of men being discharged from the service for psychiatric reasons exceeded the total number of men being newly drafted.

During the Korean War, the approach to combat stress became even more pragmatic. Due to the work of Albert Glass (1954), individual breakdowns in combat effectiveness were dealt with in a very situational manner. Clinicians provided immediate on-site treatment to affected individuals, always with the expectation that the combatant would return to duty as soon as possible. The results were gratifying. During World War II, 23 percent of the evacuations were for psychiatric reason. But in Korea, psychiatric evacuations dropped to only six percent. It finally became clear that the situational stresses of the combatant were the primary factors leading to a psychological casualty.

Surprisingly, with American involvement in the Vietnam War, psychological battlefield casualties evolved in a new direction. What was expected from past war experiences--and what was prepared for-- did not materialize. Battlefield psychological breakdown was at an all-time low, 12 per one thousand. It was decided that use of preventative measures learned in Korea and some added situational manipulation, which will be discussed later, had solved the age-old problem of psychological breakdown in combat.

As the war continued for a number of years, some interesting additional trends were noted. Although the behavior of some combatants in Vietnam undermined fighting efficiency, the symptoms presented rarely resembled the previous classical picture of combat fatigue. As the war progressed, a previously obscure but very well documented phenomenon of World War II began to be re-observed. After the end of World War II, some men suffering from acute combat reaction, as well as some of their peers with no such symptoms at war's end, began to complain of common symptoms. These included intense anxiety, battle dreams, depression, explosive aggressive behavior and problems with interpersonal relationships, to name a few. These ere found in a five-year follow-up and in a 20-year follow-up.

A similar trend was once more observed in Vietnam veterans as the war wore on. Both those who experienced acute combat reaction and many who did not, began to complain of the above symptoms long after their combatant role had ceased. What was so unusual was the large numbers of veterans being affected after Vietnam. The pattern of neuropsychiatric disorder for combatants of World War II and Korea was quite different than for Vietnam. For both World War II and the Korean War, the incidence of neuropsychiatric disorder among combatants increased as the intensity of the wars increased. As these wars wore down, there was a corresponding decrease in these disorders until the incidence closely resembled the particular prewar periods. The prolonged or delayed symptoms noticed during the postwar periods were noted to be somewhat obscure and few in numbers therefore, no great significance was attached to them. However, the Vietnam experience proved different. As the war in Vietnam progressed in intensity, there was no corresponding increase in neuropsychiatric casualties among combatants. It was not until the early 1970's, when the war was winding down, that neuropsychiatric disorders began to increase. With the end of direct American Troop involvement in Vietnam in 1973, the number of veterans presenting neuropsychiatric disorders began to increase tremendously.

During the same period in the 1970's many other people were experiencing varying traumatic episodes other than combat. There were large numbers of plane crashes, natural disasters, fires, acts of terrorism on civilian populations and other catastrophic events. The picture presented to many mental health professionals working with victims of these events, helping them adjust after traumatic experiences, was quite similar to the phenomenon of the troubled Vietnam veteran. The symptoms were almost identical. Finally, after much research by various veterans' task forces and recommendations by those involved in treatment of civilian post-trauma clients, the DSM III was published with a new category: post-traumatic stress disorder, acute, chronic and/or delayed.

Besides viewing war "Up close and personal," the Vietnam Veteran had to contend with another factor during their tour in Nam. This was the rotation date for leaving Vietnam and returning to the United States. This KNOWN departure date was called the date of expected return from oversees or the DEROS system. Head over to the DEROS Page to learn more.

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