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Tuesday, May 29, 2007

What Is It About Combat PTSD?

More discussion going on here on this post.

When I did my research last year for Moving a Nation to Care, one day it occurred to me that, depending upon the volume I had in my hands, what we call post-traumatic stress disorder never seemed to settle on one name. It's had at least 80 at last count, in fact (all are in Moving's Chapter Notes, p. 161-162).

But never one that sticks. What is it about PTSD?

I've been opening my book events by listing a few of these 80 out loud, asking what people think about having so many confusing names for the same thing (the second installment of Gen. Wes Clark Community Network's Troops & Vets series on 'Society and the Soldier' begins in the same way):

Traumatic neurasthenia. Railway spine. War syndrome. Gross stress reaction. Old sergeant syndrome. Neurocirculatory asthenia. Vietnam disease. Cerebro-medullary shock. Simple continued fever. Disordered action of the heart. Buck fever. Swiss disease...

When we speak of post-traumatic stress disorder, or PTSD, most of us are familiar with a handful of the labels given the after-effects of war. We’ve probably heard that it used to be called ‘nostalgia’ or ‘irritable heart’ during the Civil War. During World War I it became ‘shell shock’ in reaction to the arrival of powerful industrial weapons of war like the quick firing artillery piece, the machine gun and the magazine rifle. By World War II it became ‘combat fatigue’ or ‘battle fatigue.’ The second-to-last stop before arriving at the definition we use today was ‘post-Vietnam syndrome.’

While these are the more well-known of labels given to modern post-traumatic stress disorder, by merely repeating these more familiar terms, we lose sight of an important aspect of the history of PTSD: the human resistance to acceptance of the condition – no matter what it’s called. The fact that one generation after another has to ‘rediscover’ PTSD and give it its own name offers a glimpse into society’s desire not to have to own up to it, not to have to dig too deeply into the dark recesses of it, not to expand on our understanding of it, perhaps not even to believe it exists.

By this I mean to ask, why is that we have so many (80, and easily many more if we actually made it a point to look) different labels used througout the centuries for the same general malady? Do we have as many altering labels for other conditions, too? If not, why does nostalgia, or irritable heart, or battle fatigue, or PVS or now again PTSD never seem to 'stick'?

Continuing in the Troops & Vets piece:

Indeed, even today there is a rejection bubbling under the surface surrounding the use of post-traumatic stress disorder. Many doctors and counselors and soldiers believe the term falls short of the mark, saying that ‘psychological injury’ or ‘deployment-related stress’ or ‘combat-related stressors’ more accurately describe what’s going on here; others don’t like the term because it’s become ‘too political.’ Of course, whatever you call the aftereffects of war, it’s always been political, with a fixation on labels instead of the issue.

No surprise, then, that House VA Affairs Chairman Bob Filner made these comments at the open of last week's symposium on PTSD:


The House Veterans' Affairs Committee held a PTSD Health Care Symposium to discuss improved ways to provide mental health care services to veterans. Mental health care providers, medical doctors and researchers discussed how families, school systems, business owners, law enforcement and the community are affected and what every American should know about PTSD. Chairman Bob Filner gives opening remarks.

So, it's obvious we are still not at peace with the latest label for war trauma, PTSD. What is it about PTSD?

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