Post Traumatic Stress Syndrome

Post Traumatic Stress Syndrome Brain ScansCertainly since 1980 PTSD Post Traumatic Stress Syndrome has been considered a mental illness since it was added to the Diagnostic and Statical Manual volume III (DSM III). This was as opposed to “Viet Nam Syndrome” Derek Summerfield said “the newly minted diagnosis of PTSE” was meant to shift the focus of attention from the details of a soldier’s background and psychology to the fundamentally traumatic nature of war”.

In 1987 PTSD was expanded to include stressor could be second-hand such as be next to a fellow soldier shot in war. Things got dicey when PTSD was expanded yet again in 1994 in DSM IV to include “hearing about the unexpected death of a loved one or a loved one receiving a fatal diagnosis. The main example given was persons who developed PTSED from watching 911 unfold live. I

Now what constitutes the diagnosis of Post Traumatic Stress Syndrome itself? NAMI describes it a s a condition in response to military combat, assault, accident, natural disaster resulting in survival from the “fight of flight” response but that later may disappear from  one’s consciousness and lead to long lasting psychological effects.

15% of the U.S. adult population or nearly 8 million have experienced PTSD at some point in their lives. Surprising to me is that it occurs in women more than men. The average of onset is in the 20s.

The symptoms of PTSD Post Traumatic Stress Syndrome

Intrusive memories such as flashbacks, bad dreams, avoidance or staying away from certain places or reminders of the event, guilt or depressed when unable to remember the event (dissociation or derealization), hypervigilance, easily startlied, tense, insomnia and outbursts of anger.

Usually the Post Traumatic Stress Syndrome symptoms begin within three months of the event and must last more than a month. There is often co-existing major depression disorder, substance abuse or anxiety disorder.

The treatment includes medications such as antidepressants or mood stabilizers, antipsychotics, psychotherapy, group therapy and mindfulness techniques.

The NAMI piece states that PTSD is not curable. Other articles cited below make this a misstatement.

The National Institute of Mental Illness (NIMH) adds that PTSD interferes with relationships or work and that some recover with six months but many suffer for a lifetime. Their diagnostic criteria are the same but are placed in four divisions and to make the diagnosis the individual must have one from each of the four for at least one month.

1.      Re-experiencing symptom—flashbacks with physical symptoms like a racing heart or sweating bad dreams or frightening thoughts

2.      Avoidance symptoms—avoiding places, event or object that remind of the traumatic experience and avoiding thoughts or feeling related to the traumatic event

3.      Arousal symptoms—easily startled , on edge, insomnia, angry out bursts

4.      Cognition and mood symptoms—trouble remembering a key feature of the traumatic event, negative thoughts about oneself, distorted feelings like guilt or blame, loss of interest in enjoyable activities.

It is this fourth group that is summarized by the word “disassociation”. I have been at this mental advocacy since 2012 and heard this word many times but have not got into the word. The usual definition is an out of body experience. But what does that mean? Number four pretty much covers it. Daydreams, dreams, amnesia for events, guilt for things one cannot remember or “might have done”. As I was preparing to write for this article I was reading a book “The Couple Next Door” by Shari Lapena, 2016. The protagonist is a woman who has been diagnosed as having recurrent dissociative events in her life since a teenager and she aware of this. Something catastrophic happens in the book and she wonders if she could have been the cause and just does not remember it. Now I understand the meaning. As far as “derealizaton” I am not going to try to understand at this point!

The prevalence rate is put at 8%.

The Mental Illness Policy Organization (MIPO) article goes into the most depth and history. Related terms from the past are Shell Shock for WWI, “battle fatigue, combat exhaustion and war stress since then and PTSD since Viet Nam.

This piece alludes to an article in Science from 2006. An article from 1988 stated that Viet Nam veterans had a 50% recovery over time. The newer study of 2006 said 19% had suffered PTSD after returning but half had recovered.

In the Journal of Traumatic Stress from 2010 two dozen studies were reviewed concerning soldiers returning from Iraq and Afghanistan and a large range of 5% to 20% had PTSD.

The MIPO states “The story of Post Traumatic Stress Syndrome starts with the Vietnam War. In the late !960s, a band of self-described antiwar psychiatrists led by Chaim Shatan and Robert Jay Litton, who was well known for his work on the psychological damage wrought by Hiroshima—formulated a new diagnostic concept to describe the psychological wounds that the veterans sustained in the war. They calls it “Post Vietnam Syndrome”, a disorder marked by ‘growing apathy, cynicism, alienation, depression, mistrust, and expectation of betrayal as well as inability to concentrate, insomnia, nightmares, restlessness, uprootedness and impatience with almost any job or course of study.’”

This syndrome has been used in Hollywood for the basis of the “walking time bomb” movies, “Taxi Driver” and “Rambo”. The New York Times in 1972 stated that this Viet Nam Syndrome was a product of the anti-war slant of the authors and the lack of popularity of the war” and distinct from PTSD. Soldiers returning from WWII were received as heroes. Viet Nam vets had to return by back alleys.

Shell shock of WWII was considered purely a mental problem that is a weakness. Those soldiers were not able to cope. Coining the term PTSD for Post Traumatic Stress Syndrome and placing it in the DSM III clearly reversed the above order such that the trauma comes first and the syndrome is independent of the individual’s prior mental state.

The article states that those who work for the Veterans Administration Hospitals have to be careful and make all attempts to diagnose and treat soldiers with the diagnosis of PTSD before assigning a disability status. They also need to weed out malingerers.

Written by paul