An Cosantóir

An Cosantóir May / June 2023 www.military.ie/magazine 26 | THE ORIGIN, CONCEPT AND TREATMENTS OF POST-TRAUMATIC STRESS DISORDER BY MELISSA PIA MORRIS - BSC ANATOMY (NUI GALWAY), MSC WAR & PSYCHIATRY (KING'S COLLEGE LONDON), ASSOCIATE OF KING'S COLLEGE LONDON (AKC) PHOTOS PROVIDED BY MELISSA PIA MORRIS W hy do some soldiers return from war in relatively good health, while others return woken at night by the sound of artillery or air raids? People react in different ways to traumatic events in life, and war is no different. What is Post-Traumatic Stress Disorder? When we hear the term Post-Traumatic Stress Disorder (PTSD) most of us will immediately think of war veterans and all they have done and witnessed while in combat. But what about those who have been the victims of sexual violence, severe neglect, a terrorist attack, a natural disaster or even a traumatic birth? Could they not experience PTSD? Of course, they could. PTSD is a term which was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the 1980's and can be described as a type of anxiety disorder triggered by a traumatic event, with symptoms lasting longer than a few months. However, PTSD existed well before the 1980's. The first description of something similar to PTSD was in 1915 when Charles Myers coined the term Shell Shock. Origin of PTSD PTSD first came into the public domain as something described as Shell Shock. Shell Shock was the primary injury of the "opening war of the modern age". The first to identify and group behaviours of PTSD, however, were the Swiss military physicians in 1678. During the American Civil War (1861-65) many soldiers were dismissed unsupervised, with their psychological stress breakdown attributed to a lack of discipline and cowardice. In 1905 following their war against the Japanese, the Russians were the first to accept that psychological stress during war time was a legitimate condition. The Korean War in the 1950's saw combat as a primary factor of psychological breakdown, particularly with the emergence of symptoms in veterans after the war. In September 1914 during the Battle of Marne, many men were described as being in 'military stance at their posts but not being alive'. The first cases of shell shock were recorded in The Lancet Journal in February 1915 by Charles Myers of the Royal Army Medical Corp. In these three cases the main symptoms present were reduced visual fields, loss of memory, smell and taste. The first record was made just six months after the beginning of the war! By 1917 medical personnel were discouraged from using the term 'Shell Shock' and instead were to use 'Not Yet Diagnosed (Nervous)'. Soldiers deemed to be 'Nervous' were then referred to a psychiatrist who would further diagnose under the term 'Shell Shock (Wound)', for those who were close to an explosion, and 'Shell Shock (Sick)' for those who had not been close to an explosion. Before being returned to the war or discharged, soldiers were given a chance to recuperate in privately funded treatment centres, such as the Lennel Auxiliary Hospital. The Lennel Auxiliary Hospital was a privately-owned country estate in Scotland owned by Major Walter Waring and his wife Lady Clementine. What is interesting about this particular treatment centre is, unlike the personal medical files which were destroyed during The Blitz of World War Two and the National Personal Records Office, the records of the Lennel Auxiliary House were kept safe in a metal box in the basement of the house. Are Shell Shock and PTSD the same? After the emergence of the term PTSD in the 1980's this was quite a common question – are shell shock and PTSD the same? In my opinion, the answer is two- fold. On the one hand, yes, they are the same in that when experiencing either of these disorders one has a "desire for mental escape". While on the other hand, shell shock is strictly a combat related disorder whereas PTSD is much broader in its causes, for this reason they are quite different. However, when reading DSM IV in the diagnosis of PTSD one will see that there are varying types of PTSD, with varying symptoms. Some of which resemble symptoms of Shell Shock. For example, some types of PTSD may be more fear conditioning while others may be more depressive. Coping Mechanisms and Treatments Military personnel risk unimaginable stressors during deployment, such as combat, injury, suffering and "To live is to suffer, to survive is to find meaning in suffering." — Friendich Nietzche " " The American Civil War Lennel House during World War One Soldier suffering from trauma

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