Sunday , January 17 2021

From shell shocks to PTSD, centuries of invisible war trauma

In the light of the First World War, some veterans returned to wounded, but not obvious bodily injuries. Instead, their symptoms were similar to those previously associated with hysterical women – most commonly with amnesia or some paralysis or incompatibility of communication without clear physical causes.

An English physician, Charles Myers, who wrote the first article on "barking shock" in 1915, theorized that these symptoms were actually caused by bodily injury. He postponed this repeated exposure to concurrent explosions due to brain trauma that resulted in this strange group of symptoms. But once put on a test, his hypothesis did not support it. There were a lot of defenders who were not exposed to the controversial explosion of a warship, for example, who still had symptoms of shocks. (And surely not all veterans who saw this type of battle returned with symptoms.)

Now we know that what these combat veterans are facing is probably what we now call posttraumatic stress disorder or PTSD. We have now recognized it better, and the treatments are certainly advanced, but we still do not have much understanding of what PTSD is.

The medical community and society as a whole are used to seeking the simplest cause and remedy for any illness. This results in a system where the symptoms are revealed and cataloged, and then aligned with the therapies that will alleviate them. Although this method works in many cases, PTSD has resisted over the past 100 years.

We are three scientists in the humanities who have independently studied the PTSD – the framework through which people conceptualize, the way researchers explore, the therapies that the medical community goes for it. Throughout our research, each of us saw that the medical model failed to adequately take into account all the changing nature of PTSD.

What is missing is a coherent explanation of the trauma that allows us to explain the various ways in which its symptoms manifest over time and may differ in different people.

Nephiotic consequences of the Great War

After it became clear that not all those who suffered from shock after the First World War experienced brain injury, the British Medical Journal provided alternative, illogical explanations for its prevalence:

Bad morale and incorrect training are one of the most important, if not the most important, etiologic factors: such a shell shock was a "catchy" objection. – (The British Medical Journal, 1922)

Shell shock has gone from being considered legitimate bodily injuries as a sign of weakness, and the battalion and the soldier in it. One historian estimates that at least 20 percent of men developed scaly shocks, although the numbers are dark due to reluctance of physicians at the time of a veteran brand with a psychological diagnosis that could affect disability compensation.

The soldiers were archetypal heroic and strong. When they came home I can not speak, walk or remember, without any physical reason for these disadvantages, the only possible explanation was personal weakness. Treatment procedures are based on the idea that a soldier who entered the war as a hero now behaved like a coward and should have been thrown out of it.

Electric treatments are prescribed in psioneurotic cases after the First World War. Photo by Otis's Historical Archives National Museum of Health and Medicine

Lewis Yealland, British Clinician, described in 1918 "Hysterical War Disorders" the kind of brutal treatment that comes from thinking of shell shocks as a personal failure. After nine months of unsuccessful treatment of patient A1, including electric shock on the neck, tongue and hot plates on the back of the throat, Yealland boasted, saying to the patient: "You will not leave this room until you speak as you ever, no, not before … you have to behave like a hero I expect you to be. "

And then he applied an electric shock to his throat so strongly that the patient was sent back, unplugging the battery from the machine. Undeterred, Yealland lowered the patient down to avoid the battery problem and continued to apply shock for one hour, so patient A1 whispered "Ah." After another hour the patient began to cry and whispered: "I want to drink water."

That encounter won the match – the breakthrough meant that his theory was right and that his method worked. Shell-shock was a disease of mankind rather than a disease that came from testimony, subjecting and participating in incredible violence.

Evolution away from shocks

The next wave of trauma studies came when the Second World War saw another influx of soldiers dealing with similar symptoms.

He was Abram Kardiner, a clinician at a psychiatric clinic in the US Veterans' Office, who was investigating the trauma in much more empathic light. In his influential book "Traumatic neuroscience of the war," Cardinal speculated that these symptoms were a result of psychological injury, not the soldier's defective character.

The work of other clinicians after the Second World War and the Korean War suggested that post-war symptoms could last. Long-term studies have shown that the symptoms may last from six to twenty years, if they have disappeared altogether. These studies have brought legitimacy to the concept of combat trauma that was seized after the First World War.

UN DATOTEKA PHOTO – The US Navy on combat missionary missions during the Vietnam War crashed as marines moved through low leaves in demilitarized zone Photo by Reuters

Vietnam was the second time to fight PTSD because the veterans began to strive for themselves without precedent. Starting with the small March in New York in the summer of 1967, veterans began to become activists for their own psychological care. They worked to redefine the "post-Vietnam syndrome", not as a sign of weakness, but to a normal response to the experience of the crime. Public understanding of the war has also begun to change, as widely reported reports of My Lai had brought horror in the American living room for the first time. The veteran campaign has helped PTSP into the third edition of the Diagnostic and Statistical Handbook for Mental Disorders (DSM-III), the major US diagnostic resource for psychiatrists and other mental health clinics.

The authors of DSM-III deliberately avoided talking about the causes of mental disorders. Their goal was to develop a handbook that could simultaneously be used by psychiatrists who have radically different theories, including freudian approaches and what is now known as "biological psychiatry". Those psychiatric groups would not agree on how to explain the disorder, but they could – and are – agreed on which patients have similar symptoms. Thus, DSM-III defined disorders including PTSD, solely based on a cluster of symptoms, an approach that has been retained since then.

This tendency of agnosticism on PTSD physiology is also reflected in the contemporary approaches of medicine based on evidence. Contemporary medicine focuses on the use of clinical trials to prove that therapy works but is skeptical about attempts to link drug efficacy to disease-based biology.

Today's medical PTSD

People can develop PTSDs for a variety of reasons, not just in the fight. Sexual assault, traumatic loss, horrible misfortune – each could lead to PTSD. The US Department of Defense estimates that around 13.8 percent of veterans returning from the wars in Iraq and Afghanistan currently have PTSDs. For comparison, a male veteran of these wars is four times more likely to develop PTSD than a man in a civilian population. PTSD is probably at least partially rooted in even more alarming statistical data: Over 22 veterans begin suicide every day.

PTSD therapies today tend to be a mixed bag. Practically speaking, when veterans seek PTSP treatment in the VA system, the policy requires that they be offered either exposure or cognitive therapy. Exposure therapies are based on the idea that the reaction to fear causes many traumatic symptoms can be softened by re-exposing to a traumatic event. Cognitive Therapies work on the development of personal methods of coping and slowly changing ineffective or destructive patterns of thought that contribute to the symptoms (for example, a shame that can be felt unsuccessful by completing a mission or saving another). The most common veterinary treatment likely to be received will contain psycho-pharmacy – especially the class of medicines called SSRIs.

Iraqi veteran Troy Yocum walks across New Jersey's George Washington Bridge in New York accompanied by the New York City Harbor Guard and New Jersey Guard Paint on June 15, 2011.Yokum is hiking over 7,000 miles across America to raise awareness of the tough problems of an American military family faced with soldiers returning home from overseas exchange with posttraumatic stress disorder (PTSD) and to raise funds to help the military families in need. Photo by Mike Segar / Reuters

Another possibility is that awareness-based therapies, based on the state of consciousness of mental states, thoughts and feelings, and accepting them instead of trying to fight or push them, are another possibility. There are also several alternative methods to be studied, such as eye degeneration and reprocessing or EMDR therapy, controlled dose MDMA (ecstasy) therapy, virtual reality exposure therapies, hypnosis and creative therapies. The Army finances the wealth of research into new technologies to address PTSD; This includes neurotrophic innovations such as transcranial stimulation and neural chips as well as new drugs.

Several studies have shown that patients improve most when choosing their own therapy. But even if it slammes its choices with those who support the weight of the National Center for PTSD using centrally online treatment aid, patients will still find five to five options, each of which is evidence-based, but implies a different psychomedical pattern of trauma and healing.

This Swedish treatment option allows us to separate our lack of understanding of why people experience trauma and respond to different ways of intervention. It also mitigates pressure for psychomedicine to develop a complete PTSD model. We refrained the problem as a consumer problem instead of a scientific one.

So while the First World War was about soldiers and punished them for their weakness, in modern times, the ideal veteran PTSD patient is a healthcare consumer who has an active role in finding and optimizing his / her own therapy.

Since we stand here with a strange retrospective approach that comes with 100 years of trauma-related trauma, we must be careful in marking our progress. What is still missing is an explanation of why people have different trauma responses and why different responses occur in different historical periods. For example, paraylsis and amnesia which are epitomized shock-shock cases in the First World War are now so rare that they do not even appear as symptoms of DSM intake for PTSD. We still do not know enough about how the military's own experiences and understanding of PTSDs shape wider social and cultural views of trauma, war and gender. Although we have made amazing steps in the century since the First World War, PTSD remains a chameleon and requires our further study.

This article was originally published on the topic Talk. Read the original story here.

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