Dear Readers,

Welcome to April! This month, we will focus on Post Traumatic Stress Disorder. There is quite a bit to learn, so let’s start at the beginning. Two years ago all our lives were considerably upended. I live in NYC, and still have  very vivid memories waking up to reports, of another 800-900 souls who lost battle with COVID-19 the day before. The virus raged through the city. With more than 9 million of us packed into in small spaces, it was a recipe for the disaster it was.

The NYC Health Commission has been relentless. Every day, there is a television ad imploring residents to be mindful of our mental health. Free counseling and advice is avaialble to those who are struggling. It’s not a stretch to say many are suffering from pandemic related PTSD.  Many people associate post-traumatic stress disorder (PTSD) with combat soldiers. But many were never in the military. Any traumatic event can result in PTSD.

Post-Traumatic Stress Disorder (PTSD), a trauma or stressor related disorder, is debilitating, and affects roughly 7-8% of the population, according to the U.S. Department of Veteran Affairs. Sufferers experience  symptoms brought on by a traumatic event or series of events. Though PTSD is most commonly associated with people who served in the military, anyone who goes through a traumatic experience is at risk for developing it. 

The American Psychiatric Association defines PTSD this way; a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

Populations commonly exposed to traumatic events have a higher average of PTSD than the average citizen. Soldiers who served in Operation Iraqi Freedom (OIF) and Enduring Freedom (OEF) returned with a 10-20% rate of PTSD. Of those who served in the Vietnam War, around 15% were diagnosed with PTSD.  

                                                             HISTORY OF PTSD
Although PTSD has been around for centuries, it wasn’t added to the Diagnostic and Statistical Manual of Mental Disorders until 1980. The term became much more familiar to the common American after the Vietnam War. In other times in American history, PTSD was referred to as other things. Physicians noted changes in people, usually soldiers, that couldn’t be wholly explained by wounds or injuries.

A FEW NAMES USED TO DESCRIBE PTSD BEFORE 1980

• Nostalgia. Coined by Swiss physician Dr. Johannes Hofer in the late 1600s to describe soldiers experiencing deep despair, homesickness, sleeplessness and anxiety. 
• Soldier’s/irritable heart. Used by Dr. Jacob Mendez Da Costa, to describe physical issues soldiers in the Civil War, not related to combat wounds; constricted breathing, heart palpitations, and other cardiovascular ailments
• Railway spine or railway brain. PTSD terms not related to soldiers. During the 1800s, railroad travel became very common. It also saw a stark rise in railroad related accidents. People who survived these accidents sometimes suffered from anxiety and sleeplessness, referred to as railway brain.
• Shell shock. Term used after World War I. A particularly brutal war, with many soldiers coming home experiencing things like anxiety, nightmares, impaired sight and vision, tremors, and fatigue. They were directly exposed to exploding shells on the battlefield, giving the name “shell shock” it’s origin.
• Gross stress reaction. Used in the DSM-I in 1952 to diagnose psychological issues connected to traumatic events. It was believed symptoms would only last a short period of time. If they persisted longer than 6 months, it was no longer thought to be related to a specific traumatic event.
• Adjustment reaction to adult life. In 1968, PTSD-related terms were removed and replaced with the words “adjustment reaction to adult life.” Many experts believe this change failed to truly encompass the disorder and related complications and was a step in the wrong direction.
• Post-traumatic stress disorder. Officially added to the DSM-III in 1980. Writers of the DSM-III used symptoms from people who had survived traumatic events such as war veterans, Holocaust survivors, and sexual victims to help develop the diagnosis description.

PRE 1980’S DEFINITIONS

The 1980s term PTSD was a major shift in the way people began to view reaction to trauma. During World War I, many perceived soldiers with PTSD symptoms as being weak or feeble. It was thought that the things they were feeling were due to a poor constitution. 

The change during the 1980s put PTSD in an entirely new light. According to the U.S. Department of Veterans Affairs. “From an historical perspective, the significant change ushered in by the PTSD concept was the stipulation that the etiological agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis)” In other words, anyone can be susceptible to a physical and mental reaction to a highly traumatic life event. 

                                                 PTSD IN THE DSM-5 (IN 2013)
In 2013, the Diagnostic and Statistical Manual was updated. PTSD was changed from being categorized as an anxiety disorder, to a “trauma or stressor-related disorder.” One of the reasons for this change is that PTSD is not only exhibited as anxiety. 

Psychiatrist Dr. Tracey Marks explains: “with the Diagnostic and statistical manual that came out in 2013, it was moved to the category of trauma and stress-related disorders. The significance of this is that PTSD is more than anxiety. People have very complex emotions afterward that include guilt, shame, and anger and those are just examples…but lots of things more than just anxiety”.

Did any of this surprise you? Now that the history has been summarised, The next will look at the symptoms, in a two-part post. There is a lot to unpack, and I think it’s best to deliver some of the information in bite sized pieces. See you soon!

To Your Success,
Juan