A Medical Dilemma: Psychiatric Timeline in Defining and Diagnosing Posttraumatic Stress Disorder Since 1914
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In defining and diagnosing posttraumatic stress disorder (PTSD), the roots of contemporary psychiatry have drawn heavily from lessons learned from four major conflicts in the twentieth century: the First World War (WWI), the Second World War (WWII), the Vietnam War, and the ongoing Iraq and Afghanistan Wars. In conjunction with the eternal politicization of war, the advent of mass-produced munitions and explosives in modern warfare resulted in injuries that have created Two U.S. military police officers mourning the death of an Iraqi girl in Balad, a mental health epidemic Iraq in June 2003. Iraq War Collection, Associated Press Archives. in militaries. Physicians and psychologists alike have continually battled to observe, diagnose, and treat the conditions associated with modern warfare. From WWI to Iraq and Afghanistan, the formalization of PTSD into a mental diagnosis evolved from political and societal pressure towards addressing the mental and physical trauma experienced by soldiers. In the First World War, the combination of revolutionized military technology and outdated military tactics proved disastrous as the estimated twenty million military casualties created a psychiatric nightmare. At the end of 1914, British military psychiatrists and psychologists began observing an abnormal mish mash of mental and physical symptoms never diagnosed in conjunction before—perceptual abnormalities such as loss of sight and hearing, tremors, fatigue, confusion, nightmares, and headaches. The initial cause of these symptoms was widely speculated to be attributed to cowardice, malingering, a lack of masculinity, moral strength, in their personal character, or as an externalized reaction towards physical injuries.1 In Britain, the term “shell shock” appeared extensively throughout 1915 and well into the 1930s thanks to the widespread publicity and attention it received due to the overwhelming casualties of war. Numerous British psychiatrists believed shell shock was a physical head injury “initially conceived as a neurological lesion, a form of commotio cerebri, [or] the result of powerful compressive forces” due to relentless artillery barrages, mortar attacks, devastating mine explosions, and red-hot shrapnel.2 These theories, however, puzzled psychiatrists as the 1916 Battle of the Somme had produced a significant spike in “numbers of soldiers who had been close to a detonation without receiving a head wound” whose symptoms could not be linked to physical injury.3 On the other hand, consulting psychologists such as Charles Myers in the British Expeditionary Force (BEF) observed “many shell-shocked soldiers [who] had been nowhere near an explosion had identical symptoms to those who had been in close proximity to an explosion.”4 This led psychologists to theorize that shell-shock was primarily a psychological condition.5
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