My interest in Post Traumatic Stress Disorder started whilst researching my family history. My Grt Grandmother had three brothers who fought in WW1. Two were killed on the bloody battlefields in France and one, Uncle Jimmy, was “lucky” enough to return home. When I asked family members about Jimmy, the reply I most often received was “Oh Jimmy, he was just an old “alcho” (sic). So easily could Jimmy have been written into history as the family drunk. Luckily for Jimmy though, one old aunt quietly said to me “ You know Jimmy was never the same after the war, it did something to his head.” So, with my curiosity now aroused, I sent to Canberra for Jimmy's war records.
What had happened to Jimmy in those years, to drive him to the bottle? What had happened that made him sit on his sister's veranda, head in hands, crying and rocking back and forth saying repeatedly “JEEZZUS, JEEZZUS” I could well imagine how hard it would have been losing his brothers, but never could I have imagined what else these records held. Jimmy, the old drunk now became "Corporal James Morley Robertson. M.M" .The M.M at the end of his name stands for Military Medal. A medal received for bravery in the field. The citation for this award reads,
“ On the morning of 26th August 1918, at Suzanne Ridge, this NCO displayed great gallantry and judgement in bringing fire to bear upon the enemy in his trench line of resistance. By crawling he succeeded in pushing his Lewis Gun forward until he had forced the enemy's gunners back to their trench. Then he swept the parapet with Lewis Gun fire, thus enabling the party on the flank to rush the trenches and enfilade the enemy. He continued fire and pursued the enemy with it when they were routed; tough in few positions was he afforded any cover from fire. He performed his role in the attack with great dash and sheer disregard for his own life. At Bray on the morning of the 24th August 1918, this NCO commanded his team very well, and by careful manoeuvre silenced an enemy gun which was causing casualties on the 40th Battalion - all the while being in an exposed position.”
Reading through his records I found that Jimmy had been shot in the hip during the battle of Messines, (the allies loss of life in this battle was 26,000 soldiers, including 6800 Australians), he spent two months in hospital with this injury, then he was gassed twice, and treated for Shellshock (which now would be called PTSD). The treatment for Shellshock was one week away from front line, but Jimmy was still within hearing of the guns. Not long after this Jimmy's record shows one blemish on it, he went AWOL (absent without leave). This was the day his brother William died of wounds. Had Jimmy had gone to be with his dying brother?
So the war finished and Jimmy and his cobbers were packed up and sent home,
Life went on, for some…………………………
For others, like Jimmy, the mental wounds of war would last forever.
HISTORY OF POST TRAUMATIC STRESS DISORDER
During the history it has been named as "soldier's heart", “Da Costa's syndrome”, "shell shock”,” combat neurosis", "combat fatigue", "traumatic neurosis". Nowadays due to the raising awareness of prevalence of the disorder and its harmful effects to quality of life it has been named as Posttraumatic Stress Disorder (PTSD). In 1980, American Psychiatric Association included PTSD in the third edition of Diagnostic Statistic Manual of Mental Disorders - DSM-III, as nosological entity.
CIVIL WAR - DA COSTAS SYNDROME
Beginning with the American Civil War, military physicians seeing soldiers under the stress of combat have described a syndrome characterized by breathlessness, light-headedness or dizziness, pronounced fatigue and exercise intolerance, numbness and paresthesia's and chest pain. Rarely have organic diseases been found to account for the symptoms in such cases, yet despite reassurance, symptoms commonly persist for prolonged periods despite removal from the apparent stress setting. This syndrome has been given many names including irritable heart, soldier's heart, Da Costa's syndrome, effort syndrome, neurocirculatory asthenia and, more recently, hyperventilation syndrome.
WW1 - SHELLSHOCK
Shellshock as the name implies, was first thought to be caused by exposure to exploding shells. Doctors believed that the hysteria observed among men and officers could be traced to an organic cause. However, it was soon concluded that this was not the case.
At first there was little sympathy for Shellshock victims. Shellshock was so obviously a retreat from the war that many military authorities refused to treat victims as disabled. Some even went so far as to say that they should be shot for malingering and cowardice. Others blamed it on a hereditary taint and careless recruiting procedures. The symptoms displayed under the term 'Shellshock' were extraordinarily numerous and different. Among regular soldiers hysteria - paralysis, blindness, deafness, contracture of limbs, mutism and limping were the most common, while officers mainly experienced nightmares, insomnia, heart palpitations, dizziness, depression and disorientation
The treatments of Shellshock were many and varied. Disciplinary treatment was the most common at the time. The doctors involved with this form of treatment had harsh moral views of hysteria and stressed quick cures, as the goal of wartime psychiatry was to keep men fighting. Shaming, physical re-education and the infliction of pain were the main methods used. Electric Shock Treatment was very popular. This involved an electric current being applied to various body parts to cure the symptoms of Shellshock. For example, an electric current would be applied to the pharynx of a soldier suffering from mutism or to the spine of a man who had problems walking.
In the years following the First World War, many war memoirs or novels were written. However, very few were by the men. The male veterans were struggling to repress their war memories, to banish the most painful of them from their minds. For some the memories would never go away. As Dr. Jay Winter has pointed out; "Those who couldn't turn off their feelings, internalise them, brought them home with them, dreamt about them and went mad because of them".
WW2& KOREA - COMBAT NEUROSIS
During WW2 the syndrome became known as Operational Fatigue, Combat Neurosis and Concentration Camp Syndrome. In response to the belief of universal vulnerability, the U.S. Army adopted the official slogan "Every Man Has His Breaking Point," with respect to the problem of combat stress or, as it became popularly known, "combat fatigue" or "battle fatigue." It was established that even the bravest and strongest people exposed to combat for a long enough period would break down. Psychological and behavioural symptoms became predominant. Physical symptoms remained, but they tended to be less-dramatic, chronic discomforts rather than disabling ones
VIETNAM / GULF WAR
The mass incidence of psychiatric disorders among Vietnam veterans resulted in the "discovery" of PTSD, a condition that we now know traditionally occurred as a result of warfare, but never in such quantity. Returning Vietnam veterans were attacked and condemned in an unprecedented manner. The traditional horrors of combat were magnified by modern conditioning techniques, and this combined with societies condemnation created a circumstance that resulted in up to 1.5 million cases of Post-Traumatic Stress Disorder (PTSD) in Vietnam veterans. About 30 percent of Vietnam veterans developed PTSD at some point after the war. The disorder also has been detected among veterans of the Persian Gulf War, with some estimates running as high as 8 percent
WHAT IS POST TRAUMATIC STRESS DISORDER
Post -Traumatic Stress Disorder, or PTSD is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, abuse (sexual, physical, emotional, ritual), and violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the persons daily life.
PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting. Traumatic events are more likely to lead to PTSD if they are the result of human malice, as opposed to an accident or a natural disaster. It has been argued that this is because natural disaster survivors are less likely to lose their trust in other humans and society. Most men who have the disorder have experienced combat and most women have been the victim of a physical assault or rape.
SYMPTOMS OF POST TRAUMATIC STRESS DISORDER
PTSD usually appears within 3 months of the trauma, but sometimes the disorder appears years later. PTSD can become a chronic psychiatric disorder that can persist for decades and sometimes for a lifetime. There is a delayed variant of PTSD in which individuals exposed to a traumatic event do not exhibit the PTSD syndrome until months or years afterwards. Usually, the immediate precipitant is a situation that resembles the original trauma in a significant way (for example, a war veteran whose child is deployed to a war zone or a rape survivor who is sexually harassed or assaulted years later)
In people with PTSD, memories of the trauma reoccur unexpectedly, and episodes called "flashbacks" intrude into their current lives. This happens in sudden, vivid memories that are accompanied by painful emotions that take over the victim's attention. This reexperience, or "flashback," of the trauma is a recollection. It may be so strong that individuals almost feel like they are actually experiencing the trauma again or seeing it unfold before their eyes and in nightmares.
Avoidance symptoms affect relationships with others: The person often avoids close emotional ties with family, colleagues, and friends. At first, the person feels numb, has diminished emotions, and can complete only routine, mechanical activities. Later, when reexperiencing the event, the individual may alternate between the flood of emotions caused by reexperiencing and the inability to feel or express emotions at all. The person with PTSD avoids situations or activities that are reminders of the original traumatic event because such exposure may cause symptoms to worsen.
The inability of people with PTSD to work out grief and anger over injury or loss during the traumatic event means the trauma can continue to affect their behaviour without their being aware of it. Depression is a common product of this inability to resolve painful feelings. Some people also feel guilty because they survived a disaster while others-particularly friends or family-did not.
PTSD can cause those who have it to act as if they are constantly threatened by the trauma that caused their illness. They can become suddenly irritable or explosive, even when they are not provoked. They may have trouble concentrating or remembering current information, and, because of their terrifying nightmares, they may develop insomnia. This constant feeling that danger is near causes exaggerated startle reactions.
Finally, many people with PTSD also attempt to rid themselves of their painful re-experiences, loneliness, and panic attacks by abusing alcohol or other drugs as a "self medication" that helps them to blunt their pain and forget the trauma temporarily. A person with PTSD may show poor control over his or her impulses and may be at risk for suicide.
Untreated, PTSD can become a chronic disabling disorder, so it is important that effective diagnosis and treatment is obtained at the earliest opportunity. Help should be sought where the individual:
 Experiences problems which are severe or last for more than a few months Is constantly on edge or irritable Has difficulty responding emotionally to others Increasingly uses alcohol or other drugs Becomes unusually busy to avoid dealing with issues Has a strong need to share experiences, but no-one is available or able to listenRef - (http://www.ncptsd.unimelb.edu.au/resources/brochures/brochure2.html)
TREATMENT FOR POST-TRAUMATIC STRESS DISORDER
Treatment - Today, psychiatrists and other mental health professionals have good success in treating the very real and painful effects of PTSD. These professionals use a variety of treatment methods to help people with PTSD to work through their trauma and pain.
Behaviour therapy - focuses on correcting the painful and intrusive patterns of behaviour and thought by teaching people with PTSD relaxation techniques and examining (and challenging) the mental processes that are causing the problem.
Psychodynamic psychotherapy - focuses on helping the individual examine personal values and how behaviour and experience during the traumatic event affected them.
Family therapy - may also be recommended because the behaviour of spouse and children may result from and affect the individual with PTSD.
Discussion groups or peer-counselling groups - encourage survivors of similar traumatic events to share their experiences and reactions to them. Group members help one another realize that many people would have done the same thing and felt the same emotions.
Medication - can help to control the symptoms of PTSD. The symptom relief that medication provides allows most patients to participate more effectively in psychotherapy when their condition may otherwise prohibit it. Antidepressant medications may be particularly helpful in treating the core symptoms of PTSD-especially intrusive symptoms.
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