The evolution of PTSD: from an excuse to a disorder

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Post Traumatic Stress Disorder (PTSD) is now recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-V) under the umbrella of Trauma and stress-related disorders. However, this wasn’t always the case. PTSD was only added to the DSM-III after several roadblocks and controversies in 1980 and we will talk more about that later.  First, let us understand the historical roots that led to the discovery of what we know now as PTSD. 


Nostos Algos and the Greek civilization

The phenomenon known as PTSD was omnipresent and prevalent even during ancient civilizations like the Greek civilization; documentation of the condition was found in “Iliad” by Homer, where soldiers who returned from war exhibited symptoms similar to PTSD. The Greeks termed this condition “nostos algos”, translated as “the pain of returning home”; this signified how wars took a psychological toll on warriors and the after-effects of such traumatic experiences. The ancient Greeks did not have a formal diagnosis for PTSD, though, their acknowledgment of the emotional aftermath of war foreshadowed the modern understanding of this condition. This also highlighted the universality of human experiences in the face of trauma. 


Shell shock and the world war-I

The illustrious debate over PTSD arose during World War I, while the world was in turmoil and the cases of “shell shock” were increasing by the minute. Soldiers who were exposed to high explosions were seen to have repercussions in the form of a neurological condition termed “shell shock,”  whose symptoms were unsurprisingly similar to PTSD. Due to the repeated exposure to bombardments, several soldiers were rendered sick and relieved of military duties at the same time. Also, they underwent treatment for this unusual disease that had no physical implications. The increasing number of patients led to a dual approach to the treatment of this condition: on one hand, the neurologists were looking for physical evidence that backed the recurring symptoms that accompanied shell shock, and on the other hand, psychiatrists turned to the writings of Freud and Jung to combat the same. We should also keep in mind that it was during the World War that a distinction arose between neurology and psychiatry, which was a result of the ongoing debate regarding the treatment of “shell shock.” As the war progressed and the number of soldiers affected by shell shock increased, the British government convened a commission to investigate the true nature of shell shock and its effects. The South borough committee decided to ban the use of the term “shell shock” as they feared that the soldiers would use it as an excuse to be exempted from their military duties. 


Combat fatigue and post-World War II 

The aftermath of World War II witnessed a rise in the cases of “combat fatigue” which we know by now had symptoms similar to PTSD. Authorities were beginning to recognize the importance of psychological support needed for returning veterans. However, their strategy to abate the chances of a soldier developing combat fatigue was by psychologically screening the inductees and rejecting the ones who were thought to have a “weak constitution.” Although they gradually understood that a serviceman’s ability to survive psychological combats could never be accurately predicted, they were still miles away from accurately analysing the symptoms of PTSD. 


PTSD and the Vietnam War

The Vietnam War—-which is lesser known amongst all those mentioned— played a pivotal role in the development of PTSD as we know it today. The brutal guerilla warfare, exposure to Agent Orange, and the challenges of reintegration into a society deeply divided over the war contributed to the high prevalence of PTSD among Vietnam veterans. However, it was the post-war climate that shaped our understanding of PTSD today. (The veterans were always neglected throughout history and their psychological struggles were often ignored, though, this time close attention was paid to their symptoms and the result was the recognition of PTSD as a psychological disorder and the establishment of the same in the DSM-III. )- (split it into two sentences.)


PTSD and military psychology

The intersection between military psychology and PTSD has a long history of turns and turmoil as we have witnessed. Yet, the role of military psychologists in mitigating the effects of PTSD has been pivotal; these psychologists work with veterans and service members to diagnose, understand, and treat them. The roots of PTSD were originally limited to battlefield situations; however, today our understanding of PTSD is holistic and recognizes traumatic incidents as a probable cause for the same. Additionally, advancements in military psychology emphasise the importance of preventive measures, resilience training, and early intervention to mitigate the long-term effects of trauma.


In conclusion, the evolution of PTSD from being recognized as an excuse to be exempted from military duties to being classified as a mental disorder has a long history that spans over an entire century. This also includes several names that were changed over the years to describe the same condition: from “Nostos Algos”, “shell shock,” and “combat fatigue” to “PTSD.” The climate of war has taken over our world yet again. What we need to understand is that PTSD is not limited to military personnel only but it also affects civilians who have lost their loved ones, or maybe just someone who has witnessed the war on screen. If you come across someone who is diagnosed with PTSD, a little empathy goes a long way!


References:

  • Shively, Sharon B. MD, PhD; Perl, Daniel P. MD. Traumatic Brain Injury, Shell Shock, and Posttraumatic Stress Disorder in the Military—Past, Present, and Future. Journal of Head Trauma Rehabilitation 27(3):p 234-239, May/June 2012. | DOI: 10.1097/HTR.0b013e318250e9dd 

  • Picture from- https://www.istockphoto.com/photo/psychologist-making-notes-during-therapy-session-with-sad-male-soldier-ptsd-gm1168238079-322491532?irclickid=zi1V-sTLjxyPTmMyFW0goTZdUkHzFwxhew-c1A0&irgwc=1&cid=IS&utm_medium=affiliate&utm_source=Elevated+Logic%2C+LLC&clickid=zi1V-sTLjxyPTmMyFW0goTZdUkHzFwxhew-c1A0&utm_term=stocksnap&utm_content=1852840&irpid=426523


About the author:

Parishi Shah

Subhead, Psycreative column

Psychology committee, SDSOS, NMIMS

Parishi Shah is a first-year student, currently pursuing her B.Sc in applied psychology from NMIMS. She is an aspiring psychologist who also aims to write a novel someday. She believes in the little moments that define your life and make it special. She loves reading, and writing poetry and holds a special place for Sylvia Plath in her heart. She is diligent, hardworking, and mostly altruistic. She believes in honest conversations and letters in the era of tech and texts. Her simple ideology is getting through one day at a time until she knows that she has made it. 


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