The history and treatment of posttraumatic stress disorder, PTSD

PTSD highlighted in pink in a book.There’s the crash. There’s the boom. There’s the shot. There’s the pain. There’s the voice of the doctor saying to wake up. Eyes open, but there is nothing. All of a sudden, the heart begins beating faster and faster and regular breathing turns into hyperventilation. The walls are closing in. The event keeps replaying in the mind over and over again. This is the type of experience reported by people with posttraumatic stress disorder (PTSD).

Definition of PTSD

Posttraumatic stress disorder (PTSD) is a psychological disorder that may develop after a traumatic event has occurred. Usually, the traumatic event has to have occurred at least one month before symptoms of PTSD show up, but symptoms can occur as late as one year or more after the event. Specific symptoms of PTSD include: nightmares, flashbacks, insomnia, irritability, anger, being suicidal or having suicidal thoughts, and having thoughts about harming oneself.

In 1980 PTSD was recognized by the American Psychiatric Association (APA) as a psychological and mental disability, and was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Friedman, 2014).

While the Americans with Disabilities Act does not include a list of specific conditions as ‘disabilities,’ a person with a disability is defined as:

  • A person with a physical or mental impairment that substantially limits one or more major life activities; or
  • A person with a record of such a  physical or mental impairment; or
  • A person who is regarded as having such an impairment. (42 USC §12102(2))

At first, the definition of PTSD was focused on soldiers returning from the traumas of war (Karekezi, 2011). But in 1994, the definition was edited to include anyone who has had a traumatic event in their life. (Karekezi, 2011). A traumatic event is an event that can cause distress and fear in one’s life. Often, if someone has PTSD, they tend to avoid things that remind them of that specific distressing event.

Though the term PTSD is new, the experience of extreme fear during combat has been with us as long as people have recorded history. It was first described by Greek historian, Herodotus, who talked about the first symptoms he witnessed at the Battle of Marathon in 490 B.C. He noted that the looks on the soldiers’ faces were reminiscent of “blindness, deafness, and paralysis” (Bentley, 2005). These three observations are closely related to the actual symptoms of PTSD.

There was also speculation that PTSD was related to homesickness, or heimweh, in German (Bentley, 2005). But it wasn’t until around 1915 during World War One (WWI) that Charles Myers came up with one of the first names for PTSD. That term was “shell shock” or “war neurosis” (Joseph, 2011). As seen in the video titled “WWI War Neuroses,” symptoms of shell shock included a “hysterical gait,” nervous tics, and loss of body function. It was thought that the sound of the shells caused a “concussion to the mind” (Bentley, 2005).

However, the famous English writer, Charles Dickens, was the first person to describe symptoms of PTSD without experiencing war. On June 9, 1865 Dickens experienced a tragic train accident. Afterwards, he noted he felt rather “unsteady.” When Dickens sued the railway company, the lawyers Dickens hired thought he had “compensation neurosis” [PDF] — a fictitious and exaggerated disorder where one doesn’t recover from an event that could possibly pay money (Bentley, 2015).

In current times, when people think of PTSD, they tend to think about people in the military or war veterans because of its long history and association to war. In fact, according to a study published in 2014, 90% of the times PTSD is mentioned in legislation at the federal level, the focus of the bills is on military veterans. (Ewing, 2014). In 1989, the National Center for PTSD was established, and it focused mainly on veterans. Several years later, in 2010, Congress declared June 27 to be National PTSD Awareness Day. This day is an opportunity for those who have PTSD to come together, and support one another. Still the focus remained almost exclusively on soldiers, with little acknowledgement of civilians who might develop PTSD outside of military service. Even in the bill that created PTSD Awareness Day, it describes PTSD as a “wound of war” experienced by those in combat. (Ewing, 2014).

Causes of PTSD

This categorization of those who can or cannot have PTSD causes conflict between the two groups. There are two problems with the assumption; first, that veterans returning from war automatically have PTSD, and second, that people who are not in the military can’t have it. It is thought that those who say they have PTSD and aren’t members of the military actually have posttraumatic stress (PTS). PTS does have very similar symptoms to PTSD, such as rapid heartbeat, anxiety, and bad dreams. The main difference is that symptoms of PTS are temporary, and usually last less than a month, whereas symptoms of PTSD last longer (Bender, 2015).

However, the common assumption that PTSD is only caused by war has to end. Also, not everyone should be defined by PTSD or be limited by the official definition of PTSD described in medical books. This causes people to label and categorize people having these symptoms, and stigmatizing and excluding them from society, as illustrated in this USA Today story.

In an article that shares personal thoughts from people who have PTSD, Julianne Parker Jeppesen elaborates on how everyday people can suffer from this disorder, and not only veterans of war (McGlensy, 2015).

“It isn’t just war veterans who suffer from it. It’s caused by being in any traumatic situation, such as mental, physical or sexual abuse. Car accidents or watching a traumatic incident can also cause it.”
Julianne Parker Jeppesen

Even surgeries can be as traumatizing as going to war. The problem is that surgeons don’t tend to see it, as it occurs after the surgery, nor do they refer patients to see a therapist because mental health diagnosis and treatment is not in their field of study (Levenson, 2007). Because surgeons don’t see it, patients can be misdiagnosed or not even diagnosed at all.

Treatment options for people with PTSD

In addition to psychiatric medications, there are several other treatment options for people with PTSD.

Service dogs can be very effective in assisting people with PTSD. Not only can service dogs assist people who are blind, they can also help relieve anxiety or panic attacks that often come with having PTSD. Essentially, whenever one gets flashbacks or is triggered by an event or object that reminds them of the traumatic event, the service dog helps bring the person back to the present. And, with all of their hugs and kisses, they are a good way to calm someone down. After all, they are man’s best friend and provide unconditional love. A news story by Fox 4 News illustrates the role of a service dog for an Iraq war veteran in Kansas.

In addition to service animals, there are multiple types of treatment for PTSD. The most common form of treatment is called Cognitive Behavioral Therapy (CBT), where the person talks about the traumatic experience and works through the negative feelings associated with the event.

Then there is exposure therapy (ET) or prolonged exposure therapy (PE), during which the person with PTSD re-experiences the traumatic event physically, for example watching videos of war, if fighting in war was the specific traumatizing event.

Also, a new and upcoming technique called Eye Movement Desensitization and Reprocessing (EMDR) is being used to help patients cope with PTSD. It was developed in 1987 by psychologist, Dr. Francine Shapiro. This technique guides the patient in eight steps to slowly desensitize the mind of negative thoughts (After Silence, 2007). Eventually these negative thoughts will be replaced with positive ones and one will be able to think about the event without having such strong negative feelings toward it. During the therapy process, the rapid eye movement of sleep is mimiced. The stimulation occurs as the person is thinking back on the traumatizing event or on negative thoughts. Eventually, the person learns to “clear the mind” of negative thoughts.These therapies are guided by a therapist, counselor or psychologists.

In addition, there are other forms of ‘self-therapy,’ such as biofeedback. Biofeedback therapy is a way to learn to control the intense physiological responses that come with PTSD. As shown in this WCVB-TV story, the technique is performed first in a therapist’s office, where the patient is connected via sensors to a computer that monitors the breathing rate, heart rate, blood pressure, muscle tension and skin temperature. The patient learns how to observe their own reactions, and how to calm down [PDF] if they begin to experience negative effects of the traumatic event.

Changing attitudes toward people living with PTSD

Awareness of PTSD is growing, and people are learning best ways to approach and understand people who are experiencing it. In interacting with a person living with PTSD, it often helps to be less sympathetic and more empathetic, as described in a Make the Connection video, titled “The path to recovering from PTSD.”  Rather than expressing pity, what that person may need is someone who will listen, and be open and supportive. In addition, there is a constant fixation on the need to “cure” PTSD or telling someone to “just get over it.” PTSD is not something that can just be cured overnight, but rather it takes time to slowly get better. And the fact is that for some people, it may never be fully cured.

Here are some other things to be sensitive about when interacting with a person who has PTSD. Don’t tell people that their fears are fake. Fears are different for everyone, and what one might fear someone else might not. Also, the term PTSD is sometimes used as slang and has become “trivialized” (McGlensy, 2015). It has been used to describe common phobias or fears, to make fun of that person with those fears. These misuses of the term are hurtful because people who experience flashbacks of traumatic events can have a great amount of anxiety, which may or may not affect their daily life. It all depends on the individual person.

At some point in time, everyone has experienced some type of stressful event in their life, whether it be a car accident, a major surgery, a death in the family or even going to war. Everyone has their fears. Same with people who have PTSD, just that their response to danger and fear is a bit greater than most. That does not mean people with posttraumatic stress disorder are any different than anyone else. The most important takeaway is always listen when talking to someone with PTSD. They may want advice, or they may not want advice. Though by listening, one is showing that they care, love, and support that person. And each day with time will begin to get better.

Primary Sources:

NW ADA Center, Definition of Disability. Web.

McGlensey, Melissa. “41 Truths People With PTSD Wish Others Understood.” The Mighty. The Mighty, 26 June 2015. Web.

Fox 4 News. “Service Dog Helps Veteran with PTSD.” Online video clip. YouTube. YouTube, 21 Nov. 2011. Web.

Make the Connection. “The path to recovering from PTSD.” Online video clip. YouTube. YouTube, 12 Dec. 2011. Web.

Brown, Dr. Allen. “Shell Shock in WWI.” Online Video Clip. YouTube. YouTube. 13 Nov. 2013. Web.

War Archives. “WWI War Neuroses.” Online Video Clip. YouTube. YouTube. 27 Sep. 2012. Web.

USA Today. “Watch service dog calm war vet’s PTSD reaction.” Online video clip. YouTube. YouTube, 16 Nov. 2014.

Secondary Sources:

Bentley, Steve. “A Short History of PTSD: From Thermopylae to Hue Soldiers Have Always Had A Disturbing Reaction to War.” The VVA Veteran–A Short History of PTSD. The Vietnam Veterans of America – The VVA, 1 Apr. 2005. Web.

Friedman, Dr. Matthew J. “PTSD: National Center for PTSD.” PTSD History and Overview. U.S. Department of Veterans Affairs, 25 Mar. 2014. Web.

Can I Get Disability For PTSD (Post Traumatic Stress Disorder)?” HG Legal Resources., 2015. Web.

“National PTSD Awareness Day (June 27, 2015).” National Child Traumatic Stress Network (NCTSN). NCTSN, 1 June 2015. Web.

Make The Connection.” What Is Posttraumatic Stress Disorder (PTSD)? Make the Connection, 2015. Web.

KNGFGeleidehonden. “The Royal Dutch Guide Dog Foundation (KNGF).” Online video clip. YouTube. YouTube, 10 Jan. 2014. Web.

Bender, Dr. James. “What Are the Differences Between PTS and PTSD?” Brainlinemilitary., 2015. Web.

Ewing, Rachel. “Federal Legislation Ignores PTSD Toll on Civilians.” DrexelNow., 11 Nov. 2014. Web.

Levenson, James L. “Psychiatric Issues in Surgical Patients Part I: General Issues.” Primary Psychiatry. Primary Psychiatry, 1 May 2007. Web.

Hall, Ryan, and Richard Hall. “Compensation Neurosis: A Too Quickly Forgotten Concept?” The Journal of the American Academy of Psychiatry and the Law 40 (2012): 390-98. Web. [PDF]

Kaneshiro, Neil K. “Traumatic Events: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. Ed. David Zieve. U.S. National Library of Medicine, 1 July 2015. Web.

Joseph, Stephen. “Is Shell Shock the Same as PTSD?: Shell Shock and PTSD.” Psychology Today., 20 Nov. 2011. Web.