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History of Post-traumatic Stress Disorder in Combat

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History of Post-traumatic Stress Disorder in Combat. Presented by. Mylea Charvat, MS. mcharvat_at_stanford.edu – PowerPoint PPT presentation

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Title: History of Post-traumatic Stress Disorder in Combat


1
History of Post-traumatic Stress Disorder in
Combat
  • Presented by
  • Mylea Charvat, MS
  • mcharvat_at_stanford.edu

2
PTSD in Ancient Literature
  • Though referred to by a number of different
    names, PTSD has been with us for as long as wars
    have been fought.
  • Herodotus, writing of the battle of Marathon in
    490 BC, mentions an Athenian warrior who went
    blind when the soldier standing next to him was
    killed, although the blinded soldier was wounded
    in no part of his body.
  • Steven Bentley, A Short History of PTSD From
    Thermopylae to Hue, Soldiers Have Always Had A
    Disturbing Reaction To War The VVA Veteran,
    March/April 2005

3
PTSD in Ancient Literature
  • Herodotus also wrote of the Spartan commander
    Leonidas, who, at the battle of Thermopylae in
    480 BC, dismissed his men from combat because he
    recognized they were mentally exhausted from
    previous battles.

4
PTSD in Ancient Literature
  • The Iliad makes a reference to what appears to be
    PTSD -- Ajax loses a duel, comes under a "spell"
    from Athena, slaughters a herd of sheep thinking
    they are the enemy, and then kills himself.

5
Evolution of PTSD
  • 1678 Swiss physician Johannes Hofer coins the
    term nostalgia. to describe symptoms seen in
    Swiss Troops.
  • Symptoms of Nostalgia
  • melancholy
  • incessant thinking of home
  • disturbed sleep or insomnia
  • loss of appetite
  • anxiety
  • cardiac palpitations

6
Napoleonic Era
  • French physicians recognized numerous factors
    important in producing nostalgia
  • Cultural (rural vs urban conscripts)
  • Social (boredom vs rigorous activity)
  • Environmental (clement vs inclement weather)
  • Battle (victorious armies suffering fewer cases)

7
Napoleonic Era
  • Napoleons Chief Surgeon, prescribed a treatment
    for Nostalgia which consisted of
  • Regular exercise
  • Listening to music
  • Useful instruction

8
The U.S. Civil War
  • The Union Army
  • 2,600 cases of insanity
  • 5,200 cases of nostalgia.
  • In addition many insane soldiers were simply
    discharged and left to find their own way home.
  • In 1864 the War Department ordered that such
    soldiers be transferred to the Government
    Hospital until their families could retrieve
    them.
  • Franklin D. Jones, M.D., F.A.P.A, Psychiatric
    Lessons of War in War Psychiatry, The Textbooks
    of Military Medicine, ed. Brigadier General Russ
    Zajtchuk, M.C., (Washington, DC Office of The
    Surgeon General, Department of the Army, 1995),

9
The U.S. Civil War Soldiers Heart
  • 1871 Jacob Mendez Da Costa (internist) noted the
    following symptoms in soldiers
  • Chest-thumping (tachycardia)
  • Anxiety
  • Breathlessness (hyper-arousal)
  • These symptoms were referred to first as
    Soldiers Heart and later as Da Costa Syndrome.

10
Railway Spine
  • 1867 following a series of deadly train
    accidents in Great Britain
  • Railway spine was characterized by
  • the manifestation of a variety of physical
    disorders in otherwise healthy and apparently
    uninjured railway accident victims.
  • Ralph Harrington, The Railway Accident Trains,
    Trauma and Technological Crisis In Nineteenth
    Century Britain, in Traumatic Pasts History and
    Trauma in the Modern Age ed. Mark S. Micale and
    Paul Lerner, Cambridge Cambridge University
    Press.

11
World War I Shell Shock
  • Symptoms of Shell Shock
  • Staring eyes
  • Violent tremors
  • Blue, cold extremities.
  • Unexplained deafness, blindness, or paralysis
  • F. C. Hitchcock. Stand To A Diary of the
    Trenches 19151918. London Hurst Blackett,
    1937 report, Heath field, England The Naval
    Military Press, Ltd., 2001.

12
World War I Treating Shell Shock
  • 1917 U.S. Army Surgeon Generals office creates
    comprehensive treatment program for shell shock
  • Placing psychiatrists in combat units
  • Treatment is Centered on
  • Proximity (treating the soldier as close to the
    battle as possible)
  • Immediacy (treating the soldier as soon as
    possible)
  • Simplicity (providing simple treatment such as
    rest, a warm shower and food)
  • Expectancy (the expectation that the solider will
    return to fight after he has been treated)

13
World War II
  • Wyeth Pharmaceuticals placed this ad in Life
    Magazine on September 17, 1945, touting the
    benefits of their product in curing "battle
    reaction mental trauma" caused by WWII...and
    colic

14
WWII Combat Fatigue
  • Forward Treatment Employed.
  • Unit cohesion recognized as a factor in
    resilience to combat fatigue.
  • Understanding that intensity and duration of
    combat exposure increased risk for combat fatigue
  • Concurrently it was noted that replacement
    troops were more susceptible than seasoned
    Veterans see unit cohesion.

15
DSM 1952
  • DSM-I
  • what we now know as PTSD was called "stress
    response syndrome" and was caused by "gross
    stress reaction".

16
Vietnam War
  • 1971 Marine Corps
  • Recruiting Poster

17
Vietnam War
  • 1968 Veterans Treated for Stress Response
    Syndrome
  • Informed that if their symptoms lasted more than
    6 months after their return from Vietnam they had
    a "pre-existing" condition, making it a
    "transient situational disorder", and the problem
    was not considered service connected.

18
Vietnam War DSM-II 1968
  • Trauma-related disorders were lumped together in
    a category titled "situational disorders".

the jungles of Guadalcanal.
19
1980 DSM-III PTSD
  • Post-traumatic Stress disorder first introduced
    as a diagnosis
  • Placed under a sub-category of anxiety disorders

20
DSM-III PTSD Criteria
  • Essential feature Characteristic symptoms
    following a psychologically distressing event
    that is outside the range of usual human
    experience. The original stressor is usually
    experienced with intense fear, terror, and/or
    helplessness.
  • The precipitating stressor must not be one which
    is usually well tolerated by most other members
    of the cultural group (e.g., death of a loved
    one, ordinary traffic accident).

21
Evolution of PTSD DSM-III-R
  • Changes in DSM-III-R
  • Specification of generic characteristics of
    traumatic stressors
  • Clearer organization of symptoms around three
    dimensions of stress response (re-experiencing,
    avoidance and numbing, and physiological arousal)
  • inclusion of symptoms specific to children, and
    specification of onset and duration of the
    disorder.

22
DSM-IV Criteria
  • Person Experiences Traumatic Event
  • Person Experiences Fear, Helplessness or Horror
  • The person experiences a combination of the
    following Sx which are still present gt 4 weeks
    following the TE, last more than one month and
    cause significant distress
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