Battle Fatigue, Shell Shock, PTSD - Evolving Ways of Treating the Traumatized Psyche.
Posted: Monday, May 30, 2011
by Christofer French
Rain Dancer Associates, LLC
It was June of 1984, and President Reagan and a great body of veterans and media made the trip to honor the 40th. It was probably the most notable anniversary to date of D-Day which was the most hellish collection of violence ever purposefully engineered. Thousands of officials, relatives and veterans were honorably and formally gathered on the very well-adorned and beautified Normandy Peninsula in France.
“Every night.” He answered with a bit of a broken voice. “For the last 40 years I have suffered short dreams, long dreams, dreams that make you wake up screaming, and dreams that won’t let you wake up.”
The Interviewer asked whether he had been wounded. “I got a light wound actually. But the wounding that your psyche gets can’t be measured in blood lost or bones broken. Your head records everything. Your heart feels everything. That is the long lasting suffering of battle. And you don’t share it ever. Except - perhaps on days like this.”
Times have changed in the last 70 years, and perhaps the wholesale “forgetting” about the mentally suffering in battle has changed. The thousands of veterans sent home to live the rest of their lives in quiet terror, like our “hero”, would in this day be greeted by a more enlightened corps of professionals. That story is herein outlined.
From Rome to Afghanistan
Even in Roman times, writers would chronicle the emotional taxation on the fighting soldier. Leaping forward to modern day, we can note that the Civil War classified this emotional and psychological state as “Battle Fatigue”. In the First World War, it was called “Shell Shock”. In World War II, it got the appellation of “Combat Neurosis”, perhaps because of certain Generals who wanted a stigma on the condition. Korea should not be let out of the discussion either. Sufferings of POWs is a whole dimension here. The political fray that affected the Vietnam soldier also affected the development of the professional treating of trauma during that time.
First Classified a Disorder in 1980
Post Traumatic Stress Disorder (PTSD) was first classified as a disorder in 1980 in the DSM-III, although versions of it were found in the earliest edition of theDSM. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is developed and revised periodically by the American Psychiatric Association and is used by mental health professionals to diagnose patients.
“Transient Situational Disturbances”
The DSM-I came out around the time of the Korean War. It included a condition called “gross stress reaction.” The DSM-II described a “transient situational disturbance.” During this time, medical and mental health professionals learned more about the condition and the stigma applied to the condition during World War II began to lift. A cynic might at this time declare: “Yeah, but it doesn’t change the intensity or level of suffering that we went through. It just changes the way the establishment classified it.”
When scientists realized that the “disturbance” was a way of functioning with normal bodily processes, society could deal with PTSD in a more conscious and official way. The body and the mind were actually working on how to process the trauma. Rape victims and others suffering in much the same manner became the beneficiaries of a new more enlightened group of psychiatrists and counselors.
By the time DSM-III came to full development, it began to be understood that not just war veterans, but other trauma victims experienced the same set of symptoms.
The Varying Flashback
If you have a friend, relative, associate, co-worker, or you just know a returning veteran, be mindful that there are a variety of ways people can suffer Flashbacks. They vary from person to person but, according to Mind.org.uk, symptoms typically include:
- General Problems with Sleep
- Smell – The sense is often bizarre and out of context with the present;
- Affection is limited and awkward;
- Vague images drift in and out of waking consciousness;
- Irritability, agitation, and restlessness;
- Headaches, breathlessness, palpitations, chest pains and other panic indicators arise.
- Dreams of a difficult nature and/or nightmares occur; and
- Physical sensations that do not seem to make sense and constitute real distortions of reality. Feeling like you cannot reach the pedals of the car when driving.
“Intellectualizing” the Stress and the Trauma. This is a first effort, and often utilized in a facile way, in which the real intense pain has not actually set in, and the victim is of a mind that he can analyze his way out of the situation internally.
When the stress and trauma live in the night and in the dream state, there are still emotional states that arise in the every day. Temper gets short. Irritation arises and conversations can get snappy and unusually negative.
Phobias and Rage
The Victim can take note that when intellectualizing and losing the trauma in dreams, the manifestation of his or her stress can sprout in phobias and anger turns more into rage. The worsening, or changing of the symptoms should tell the sufferer that the body and mind are continuing to try to deal and are essentially “asking” for you to attend to yourself.
Through combined efforts of professional assistance, organizational expertise, individual counselors, and doctors, the modern sufferer can benefit from an array of help.
Psychotherapy– Cognitive Behavioral Training must be taught, and thus learned, but it a training that once learned can be useful and practical to a victim. There are undoubtedly varying techniques being employed by a variety of professionals, but Cognitive Behavioral Training is one of the most active and consciously employed techniques around.
Trauma Support Groups– There can be hardly any other beneficial activity than simply being in the company of others who have experienced the same trauma. Sharing experiences and signs of post traumatic stress with others who have "been there" may reduce feelings of terror and helplessness. If you are involved closely with someone, try to help them in the process of finding a good trauma support group. Logically, honesty, health, and shared communication are the most important in dealing with symptoms of post-traumatic stress disorder.
Medication – Serotonin Reuptake Inhibitors seem to work very positively for those suffering on a regular basis. These tend to elevate mood and help the sufferer drive through the somber and stolid types of states that tend to dominate. In addition, other drugs such as Zoloft, Paxil, Depakote (if mania is involved), and also there are those who can benefit from sleep disturbance drugs.
On this Memorial Day, it is important to note that Vietnam Vets still live in a zone of lack of comfort. The professional world changed slowly after they got back, and there suffering in many ways was largely unattended for a long time. One Vet told me that he still cannot believe the difference in the way the returning Vets are greeted compared to the greetings they got in the 60’s and 70’s. Certainly there is no “going back” for them, but in your comings and goings, if you contact a Vietnam Vet, you might acknowledge the contribution of heart, and mind and soul; and give them the same thanks that you extend to the older, or the younger of their cohorts.
Suite 101 was a very helpful source for this article, and allows the seeker to discover a wide array of sources for help of self or loved ones. (http://www.suite101.com/content/signs-of-posttraumatic-stress).
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Top-level comments on this article: (4 total)This was enlightening. I learned things I did not know very much about--symptoms as an example. I have a young friend coming back from Afghanistan and also leaving the Marines in a few weeks. He saw much blood and guts. I understand they debrief him for a long time (maybe a month or more before discharge?) where they help them with these issues. It seems that with every war that we go through we get better at handling these issues. I guess that's good but less wars would be better. Nice text!Thanks very much, Steve. Yes. An article on the "debriefing" that they do now would probably be called for. Sounds like a good topic for a new article. Thanks much for talking about your obvious closeness to our returning veterans.
Hi Christofer. Thank you for this wonderfully informative, yet heartbreaking piece. I learned a lot and I do hope and pray that there continues to be more help for our military personnel and their families. These people are special in every way to do what they do and did so long ago. Blessings! TeresaThank you Teresa. These people should be helped all along the way by the best our country has to offer. Blessings to you.
I would add this Chris . . . http://psychcentral.com/news/2011/06/02/transcendental-meditation-helps-vets-with-ptsd/26627.htmlThanks very much, e.
Thank you Christofer, there is never enough that can be said about Post Traumatic Stress Disorder. As noted in your article PTSD has affected our soldiers for as long as we’ve had wars. It has recently been determined that one out of every three soldiers coming home from Afghanistan and/or Iraq will have a degree of PTSD which is very sad indeed.
I was surprised you did not mention how many individuals with PTSD use drugs and alcohol to self-medicate in an effort to eliminate their symptoms. This was especially true in those returning from Vietnam due to the fact no real treatment was available to them (as noted by the fact “Post Traumatic Stress Disorder" was not added to the Diagnostic and Statistical Manual of Mental Disorders until 1980).
The fact extreme care that must be used when dealing with individuals with severe PTSD if they are exhibiting anger and rage due to the real possibility the person could very easily disassociate is also worth noting.
The newest treatment available to victims of PTSD, Eye Movement Desensitization and Reprocessing (EMDR), has been proven effective in many instances, but just like everything else, the same treatment does not work on everyone, because people are as different as snowflakes.
Veterans Affairs is probably the best source of information on this particular subject because of the fact they deal with so many individuals suffering from the disease. The National Center for PTSD is an excellent source of information to Veterans and the general public and provides extensive lists on resources available to those suffering from this debilitating disease.
You might want to repair the link indicated for suite101 as the link indicated is not active.
Once again, thank you for writing about a major problem affecting so many hundreds of thousands of our veterans and others exposed to traumatic events.
Pat Johnson
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