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Evolution of an illness: how shell shock in the Great War has changed over the past century, and is now treated as post-traumatic stress disorder.

THROUGHOUT HUMAN HISTORY, society's awareness of the psychological impacts of surviving conflict or witnessing troubling or catastrophic events has proven remarkably robust.

Literature from as far back as ancient Mesopotamia and Ancient Greece gives us clear descriptions of individuals' combat-induced post-traumatic symptoms and, by the dawn of the Industrial Revolution, modern psychiatry began documenting examples of man-made disasters resulting in what we would now call post-traumatic stress disorder (PTSD).

Survivors of enormous railway disasters, for instance, were struck by symptoms recognizable to many veterans of modern combat.

In the 18th century, a debate emerged over the causes of "hysteria." One school of thought believed that microscopic lesions of the spine or brain caused mental symptoms, while others embraced the idea that emotional shock was the fundamental cause. This controversy lasted until WWI.

Mental health injuries became apparent very early in the First World War in amounts that had not been anticipated. In 1917, a respected German psychiatrist named Robert Gaupp said that the "big artillery battles of December 1914 ... filled our hospitals with a large number of unscathed soldiers and officers presenting with mental disturbances. The main causes are the fright and anxiety brought about by the explosion of enemy shells and mines, and seeing maimed or dead comrades ... The resulting symptoms are states of sudden muteness, deafness, general tremor, inability to stand or walk, episodes of loss of consciousness, and convulsions."

It was not uncommon for soldiers suffering from shell shock to be viewed as nothing more than cowards, and many suffered punitive 'treatments' for their ailments, including electroshock therapy and solitary confinement.

During the interwar years, the term shell shock was replaced with combat fatigue or battle exhaustion, but erroneous beliefs with regards to the nature of the affliction were still readily held.

It was, for example, commonly believed that combat-related trauma was a short-term illness, and some soldiers were, because of their inherent psychological weakness, more 'predisposed' to suffer trauma than others.

This, inevitably, added to the shame of those who suffered.

In a military context, the Vietnam War was the catalyst for the most significant turning point in the history of psychological war trauma. Psychiatrists could not ignore the numbers of men returning home with symptoms initially labelled as "post-Vietnam syndrome."

Veterans of the conflict waged a long and ultimately successful campaign for greater recognition of their suffering; in 1980, PTSD was included in the American Psychiatry Association's Diagnostic and Statistical Manual of Mental Disorders.

Today, the Canadian Mental Health Association defines PTSD as a mental illness involving "exposure to trauma involving death or threat of death, serious injury or sexual violence" and treatable through psychotherapy, counselling, medication and support groups.

PTSD and other war-related ailments are a significant problem in the Canadian military community.

Psychiatric conditions are the second-most common disability claim of the 40,000 Canadian soldiers who served in Afghanistan. Troops who served in the Afghan War made nearly 3,500 disability claims for psychiatric conditions such as PTSD, depression and substance abuse, according to Veterans Affairs.
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Title Annotation:SIDEBAR
Author:Moir, Matt
Publication:Esprit de Corps
Date:Apr 1, 2015
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