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Q: The discovery of PTSD ( Answered,   1 Comment )
Subject: The discovery of PTSD
Category: Health > Conditions and Diseases
Asked by: bubz121-ga
List Price: $50.00
Posted: 03 May 2006 10:46 PDT
Expires: 02 Jun 2006 10:46 PDT
Question ID: 725135
I need to know the major cause of the discovery of PTSD. I know it was
discovered shortly after the vietnam war but why at that time? and also what
individual dicovered it and when did the scientific comunity add PTSD
to their libary? Also what social/economic/political factors led to
the discovery? please answer ASAP
Subject: Re: The discovery of PTSD
Answered By: boquinha-ga on 03 May 2006 22:24 PDT
Hello bubz121-ga!

Post-traumatic Stress Disorder is not so much an entity that was
?discovered? but one that was ?defined? after the Vietnam War. It
existed in various forms for centuries and only later was categorized
and described in modern medical literature. I have found what I think
will be useful resources and sets of information to you, and will
expound on some of what I?ve said.

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Post-traumatic Stress Disorder (PTSD) was first defined as a distinct
diagnosis in the 3rd edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM-III), published in 1980. It has been known by
many other names for thousands of years, however. The ancient
Egyptians as early as around 2000 B.C. described adverse psychological
effects after wars, and Greek philosophers described emotional trauma
during the Battle of Marathon in 490 B.C. There are a number of other
similar accounts described through history.

Terminology has changed through the years, as well. An overview is
given in the PTSD Manual. After the Civil War, soldiers began
experiencing ?soldier?s heart,? with symptoms of startle responses,
hyper-vigilance, and arrhythmias. During World War I ?the effort
syndrome? was added. This gave way to the familiar terms ?shell shock?
and ?combat fatigue? during World War II.

The terminology in the DSM has undergone quite a bit of change, as
well. In the original 1952 DSM, what we now call PTSD was referred to
as ?stress response syndrome? caused by a ?gross stress reaction.? The
second edition of the DSM (DSM-II), published in 1968, introduced the
term ?situational disorders,? including all trauma-related disorders.
At that time, however, any symptoms lasting longer than 6 months was
considered pre-existing, so the U.S. Government was under no
obligation to treat Vietnam vets with this disorder as a ?service
connected? problem. As I mentioned above, the DSM-III defined PTSD as
a distinct disorder.

The current DSM-IV criteria for diagnosing PTSD can be found here:

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Some of the earliest 20th-century research was done by Abram Kardiner,
M.D. He involved himself with traumas of war and began to emphasize
the importance of studying ?traumatic neuroses.? He defined PTSD and
revised the diagnostic criteria for the DSM-III and DSM-IV. His
initial research was applied by other psychiatrists during World War
II, and laid the groundwork for other researchers around the time of
the Vietnam War.

When Vietnam War veterans began returning from the conflict, they
started experiencing intense symptoms of ?shell shock.? Psychiatrists
Chaim Shatan and Robert J. Lifton were antiwar activists who became
involved in ?rap groups? with returning veterans in the New York City
area. Vietnam Veterans Against the War, a large organization of
antiwar veterans, was headquartered there and received lobbying
assistance from Shatan and Lifton. They argued that psychiatric
symptoms that the Vietnam veterans were experiencing differed
significantly from those of past wars. They felt that a distinct and
new diagnosis was necessary to bring these issues to light so the
veterans could be adequately treated.

Bessel A. van der Kolk, M.D. in a chapter from ?Traumatic Stress? has
this to say about the ?development? of PTSD:

?PTSD as a diagnosis was constructed in response to a social demand to
delineate a syndrome that captured the psychological suffering
experienced by many Vietnam combat veterans at a time that the U.S.
was coping with millions of soldiers that had just returned from the
war. . . . The DSM III definition of PTSD, guided by Kardiner?s
description of the ?traumatic war neuroses? . . . highlighted the
physiological alterations that follow traumatization, and the
co-existing traumatic intrusions and emotional numbing and avoidance.?

Mardi J. Horowitz was another researcher that played a major role in
the formal definition of PTSD in the 1970s. In his major work, ?Stress
Response Syndromes,? he outlined a predictable sequence of symptoms
following stressful life events. These symptoms are now recognized as
the primary symptoms of PTSD as defined in the DSM-III. Other
important works include ?Psychological Aspects of Stress,? edited by
Harry S. Abram in 1969; and John Henry Krystal?s ?Massive Psychic
Trauma,? investigating trauma psychology in World War II concentration
camp survivors.

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From a purely financial standpoint, it was difficult for veterans
suffering from PTSD to receive government benefits for treatment
because there was no diagnostic code for ?combat stress? in the
DSM-II. And, under the DSM-I, symptoms persisting beyond 2 years after
discharge was not considered ?service-related? by the U.S. government,
excluding veterans from receiving benefits. PTSD was often
misdiagnosed as depression, paranoid schizophrenia, or character or
behavior disorders.

During the time that Shatan and Lifton were conducting their ?rap
groups,? Shatan learned that he was under surveillance. FBI agents
even masqueraded as veterans and would attend these groups in an
attempt to get closer to Shatan and entrap him. He remained vocal in
advocating for veterans and against the war, despite friends and
colleagues warning him about potential danger. When he and Lifton
estimated the prevalence of PTSD among Vietnam veterans to be about
20% (much higher than the government figure of 5%), the Veterans
Affairs central office highly criticized them in the press, and they
were described as being too ?hung up? on the war, and accused of
dishonoring brave men.

Senator Alan Cranston, a World War II veteran and member of the
Senate?s Committee on Veterans Affairs, felt that the psychological
problems that faced Vietnam veterans were different from the older
veterans. He introduced a number of bills to improve counseling and
funding for the treatment of these psychological problems. His bill
passed the Senate in 1973 and 1975, but never passed the House. The
House was dominated by World War II veterans who refused to believe
that there were different problems produced by the Vietnam War from
those of other past conflicts. This obstacle to the formal definition
of PTSD as a distinct diagnosis was overcome slowly as a result.

For a completely fascinating account of controversy surrounding PTSD
and war-related trauma read this article in its entirety.

Eventually, through Cranston?s efforts, specialized counseling centers
sponsored by the Veterans Affairs office appeared, providing a place
for veterans suffering from PTSD and other emotional disorders to
receive the counseling and other services they so desperately needed.
The official entry of PTSD into the DSM-III also made is such that
veterans could receive treatment for this newly defined
service-connected diagnosis

Research continued beyond the formal inclusion of PTSD in the DSM-III
in 1980. A study commissioned in 1983 by Congress was the National
Vietnam Veterans' Readjustment Study (NVVRS). Its primary goal was to
investigate PTSD and other postwar psychological problems among
Vietnam veterans. It sought accurate data regarding its prevalence in
order to better provide for the needs of veterans. For a complete
description of the study, as well as a summary of its findings see:

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Here are some additional resources regarding PTSD that I thought you
would find interesting.

This is from the National Center for PTSD, of the U.S. Department of
Veterans Affairs. It includes information about the Vietnam veterans
as well as effects of recent conflicts, such as the conflict in Iraq.
Here is their fact sheet on PTSD:

Here is the homepage for the PTSD Alliance, an organization dedicated
to educating the public about the effects of PTSD, as well as
advocating for better treatment and research.

Here is information about PTSD from the National Institutes of Health.

Here is the fact sheet on PTSD from the American Psychiatric Association.

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I hope that you?ve found this information both helpful and
interesting. Despite a degree in the mental health field, I didn?t
know a lot of the history behind this before researching your
question, so I find this very interesting. If you have need of any
clarification please let me know how I can help.


Search terms:

PTSD origin
Kardiner PTSD
Shatan Chaim Robert J. Lifton
History PTSD
PTSD DSM criteria
Subject: Re: The discovery of PTSD
From: frde-ga on 04 May 2006 05:59 PDT
'Shell Shock' was quite well known in the 1914-18 war

- mostly, pour encourager les autres, it was dealt with, with a firing squad.
(a gross generalization - but deliberately so)

At the end of WWII they were pretty careful (in the UK) about de-mob,
they also (according to people who were there) tended to cover up
anti-social episodes.

I've met a fair few people who have live(d) on a hair spring trigger
from WWII, Korea, Vietnam and other places.

As for the socio-economic stuff, it is unwise to bring back veterans
to a 'Land /un/-fit for Heroes' - which is why the Romans either
settled their veterans where they de-mobbed (ideal) or gave them
profitable farms in Italy.

It would be interesting to compare this with the 'residue' of the
British Navy when they were discharged after major threats.

Returning armies are very dangerous, they have been taught to think differently.

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