The history of treatment for post traumatic stress disorder has evolved from the fallacy of blaming the symptoms on cowardice to the present day practice of recognizing the symptoms and treating it accordingly. It was once called battle fatigue, combat fatigue, shell shock, and soldier’s heart.
Post Traumatic Stress Disorder
The history of treatment for post traumatic stress disorder has prgressed from the symptoms being associated with cowardice to the present day approach, whereby symptoms are recognized by mental health professionals and treated through therapy. Individuals suffering with PTSD have unrelenting thoughts and memories about the traumatic ordeal they endured. They will typically become emotionally numb, especially towards those they were once very close to, have difficulty sleeping, and are easily startled. The individual re-experiences the trauma through nightmares and/or flashbacks, is often angry, has increased arousal because of a heightened state of awareness, and avoids any stimuli that can be associated with the trauma. The individual will often avoid crowded areas and tend to isolate. Prior to the recognition of PTSD it was called battle fatigue, combat fatigue, shell shock, and soldier’s heart.
Previous Treatment Meant Sending Soldiers Back to the Front Line
1678 through the Civil War (1861-1865)
The symptoms of post traumatic stress disorder were labeled as “nostalgia" by Johannes Hofer, a Swiss physician. The symptoms consisting of insomnia, weakness, anxiety, loss of appetite, and heart palpitations were being noticed in soldiers in Europe and thought to be brought on due to the soldiers persistently thinking of home. Therefore, they were thought to be experiencing nostalgia. The term nostalgia and home sickness, was carried through to the Civil War in the United States. During the Civil War, it was though the symptoms were brought on by soldiers with unrealistic expectations of war and poor motivation. Treatment, therefore, was to encourage the soldiers to tough it out and become more realistic about the war around them.
Following the U.S. Civil War, doctors began to notice an increase in heart problems among troops. The symptoms were attributed to fatigue from war conditions. Treatment for the fatigue, anxiety, high blood pressure, and irritable heart conditions, consisted of rest. In 1871, Dr. Jacob Mendez Da Costa, converted the term nostalgia to soldiers heart after he began to notice an increase in heart problems with soldiers, as well as with civilians. He attributed the symptoms to fatigue caused by excessive marching, difficult service in the field, and missing loved ones. The recommended treatment for soldiers heart also consisted of rest.
The Russo-Japanese War (1904-1906)
Military psychiatry began to discover that in order for a soldier to return to battle, the treatment for symptoms were dependant upon the amount of time between the battle site and the treatment site. They termed the method, "forward treatment" and concluded that the quicker a soldier was treated for wounds and soldiers heart, and returned to battle, the quicker the symptoms would subside.
World Wars I (1914-1918) and II (1939-1945)
The symptoms of PTSD during World War I and World War II were termed “shell shock" and were considered to be the result of mortar rounds and artillery shells that were continuously bombarding the troops. There were two different labels assigned to those suffering with shell shock. Shell shock W (wounded) was considered to be the result of enemy rounds and the soldier received and wore a wound stripe fo it. However, if the man had a breakdown that was not the result of a shell explosion, he was labeled shell shock S (sickness) and would not receive a pension or a wound stripe. A vast majority of French and British troops were being treated for shell shock and not being sent back to active duty. The United States military attempted to avoid the possibility of having their troops not be sent back after treatment by sending Major Thomas Salmon to observe the health practices of the British and French. Maj. Salmon designed a set of “forward treatment" procedures known as the PIE principles for treatment of the shell shock S men. The PIE principle consisted of:
- Proximity (treat casualties close to the front lines and within sound of the fighting).
- Immediacy ( treat without delay and not wait until the wounded were dealt with).
- Expectancy (ensure everyone had the expectation of their return to the front line after rest and replenishment).
Those with “shell shock" were treated with the PIE principle for three to ten days and returned to active duty. In World War II attempts were made to avoid the many casualties seen in World War I, by administering psychological screening tests as a way to eleminate those who could not tolerate battle. The tests were concluded as a failure and there were very few rejected recruits. In World War II t the “forward treatment" continued to be implemented as a method for those suffering with shell shock.
Korean War (1950-1955)
Forward treatment as a practice was being dismissed and those suffering psychological despair were being removed from the front lines. Implemented as treatment at this time was, rest and relaxation (R & R) and a more frequent rotation of troops. Colonel Albert J. Glass fought to have the principles of “forward treatment" reimplemented which resulted in approximately 90% of the troops suffering psychological distress after being returned to the front lines. During the Korean war, the first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published. Military psychiatrists from World War II were responsible for defining “combat stress" characteristics. Defined as “gross stress reactions" the reactions portion being what sparked the future road for proper treatment, to both veterans and civilians.
Vietnam War (1961-1975)
The DSM-II was released in 1968 and did not contain the symptoms, signs or definition for “combat stress," making it difficult to treat those returning home. Veterans began showing post battle signs but, were not being treated as the doctors had no comparable evidence to base the symptoms on, therefore, no way to determine the best treatment. Without proper treatment, the Vietnam war veterans began self-medicating with drugs and alcohol.
Present Day (1975-Present)
Finally, the history of treatment for post traumatic stress disorder began to take a turn for the better. Psychologists, veterans and anti-war activists banded together to have PTSD put in the DSM-III. In the 1980’s the symptoms were defined and recognized as post traumatic stress disorder. The diagnoses was determined to be caused by traumatic and unusual events, such as war and rape. Presently, the standard treatment for PTSD is exposure therapy, a form of psychotherapy and/or medications. During therapy, the patients are encouraged to face the trauma through verbal discussions and/or writing about their experience.
Soldiers that Exhibit No Signs of PTSD Until Long After Their Combat Service
It is also very important to note that throughout the history of this condition many soldiers exhibited no signs of PTSD until after their combat tours were over. They performed their duties admirably in combat suppressing the terrible things they saw and experienced in war to get the job done. Only after the wars, upon reintegrating into society, the symptoms materialized and disrupted their lives. The "Post Traumatic" label is an important key to this, that means after the experience of war. Until recently, in the wake of Viet Nam, these veterans were largely forgotten and not treated by the VA mental health professionals who have a firmer grasp about how to teach vets to cope with PTSD. Even today, more than half a century after their service, World War II veterans visit VA hospitals across the country to finally get help and relief fom the psychological impairments they suffered from all these years. There should be no stigma attached to PTSD, the average person couldn't possibly fathom the stress, demoralization, and anger that being exposed to combat conditions can cause in an individual. War changes virtually every soldier permanently; there is no escaping that reality. Throughout the history of war, in all lands and all languages, it has been said about many veterans that they were never the same after coming home. That is the mark of PTSD. Mental health professionals today have finally recognized that it is their duty to help and treat veterans who sacrificed so much to perform their roll and service in combat, and are deserving of the best medical help available.