May 27, 2015 Tony Burke

Some Background on Post-Traumatic Stress Disorder (PTSD)

Woman looking in a mirror seeing herself as a soldier

The experience was unendurable to his conscious mind, which rejected it along with his entire past.

Let There Be Light, Documentary film by John Huston, 1946

The American Psychiatric Association officially added Post-Traumatic Stress Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders in 1980 (the third edition of the publication abbreviated as DSM). After this adoption as an official diagnosis, reliable methods of assessing PTSD were developed working primarily with Vietnam war-zone veterans. Approximately 3.6% of American men, and 9.7% of American women suffer from PTSD, which is about 5.2 million people.

PTSD History & Symptoms

Adoption of the concept of PTSD ushered in a fundamental change in thinking about mental disorders. Traumatic stressors were considered to be occurrences outside the realm of usual human experience. Trauma is considered to originate outside of the body, and is thus separate from more common stressors including failure, rejection, relationship issues, etc., which healthy humans are considered able to cope with naturally. As such, stressors became categorized as either ordinary or traumatic, with “traumatic” being something expected to overwhelm a healthy person’s coping mechanisms.

Similar to pain, PTSD is difficult to objectify. People have proven to have wide ranging capacities for dealing with traumatic events. Many people who suffer a trauma do not develop PTSD, yet a significant percentage do go on to develop the full syndrome.

Traumatic events are generally considered to fall into the following categories: threat of death or injury, sexual violence, and direct exposure to a catastrophic event. The symptoms of PTSD are now well-defined.

The primary PTSD symptom clusters include:

  • Intrusive Recollections –  An individual involuntarily relives the emotions of his/her trauma.
  • Avoidance – An individual fears confronting any reminder of his/her trauma, espicially in front of others.
  • Negative Cognitions and Mood – An individual experiences persistent negative emotions or dramatic changes in his/her attitude and/or beliefs.
  • Alterations in Arousal or Reactivity – An individual exhibits hypervigilance resembling paranoia, irritability, and is easily startled. Individuals are also more likely to engage in unsafe sex and other dangerous or reckless behavior.

In order to obtain a PTSD diagnosis, individuals must experience symptoms from each cluster listed above and these symptoms must persist for at least one month. Additionally, the symptoms must cause demonstrable distress in some facet of the individual’s life, be it social, occupational, or other. The symptoms must be present and unrelated to any medication, substance abuse, or illness. PTSD has been known to persist in patients for several decades, meaning recovery can be a long road with great potential for relapse. However, the more we learn and recognize PTSD, the greater hope victims have of sustained recovery.

Likely the earliest breakthrough in understanding what is now known as PTSD, was the documentary Let There Be Light, by filmmaker John Huston in 1946. Let There Be Light was the third in a series of three post-World War II documentaries made by Huston. While the coining of the term “post-traumatic stress disorder” was still a long way off (quaintly referred to here as “battle neurosis,” among other things), the documentary was a glimpse into the lives of soldiers suffering from ailments we now know to be symptomatic of PTSD.

The documentary focused on WWII veterans suffering from anxiety, crying spells, trouble sleeping, and combat dreams among other symptoms. The film followed veterans participating in a counseling and rehabilitation program designed to alleviate the symptoms that closely match what would later become known as PTSD.

This is an excerpt from the documentary’s opening message:

The special treatments shown in this film, such as hypnosis and narco-synthesis, have been particularly successful in acute cases, such as battle neurosis. Equal success is not to be expected when dealing with peacetime neuroses which are usually of a chronic nature.

Huston, writer and director of such classic films as The Maltese Falcon (1941) and The African Queen (1951) helped to bring the ravages of traumatic stress to the public eye, and the subject continues to gain awareness today. In addition to its treatment by Huston, PTSD and the personal carnage it wreaks have received solemn treatment in many modern Hollywood films as well, notably including The Deer Hunter (1978), The Hurt Locker (2009), and American Sniper (2014). In 2010, Huston’s Let There Be Light was selected for preservation by the National Film Registry.

In 1952, six years after Let There Be Light, DSM-I included “gross stress reaction” as an official diagnosis. The definition and understanding in this first edition resembles that of modern day PTSD. This was an early breakthrough in the concept of mental illnesses being attributable to a source external to the individual.

In 1980, DSM-III was published, marking the first publication listing “posttraumatic stress disorder” as an official diagnosis (the hyphen was absent in this initial publication). This diagnosis was included based on the strength of data compiled in the 1970s from working with Vietnam veterans.

PTSD came to be associated with dated war terminology including nostalgia, shell shock, combat stress reaction, and traumatic war neurosis. Some of these terms date back to the nineteenth century, suggesting a deeply substantiated human history of such afflictions. Today, the public continues to gain awareness of the disease. While awareness will continue to improve, PTSD is still a misunderstood ailment as a scourge of not only our Armed Forces, but civilians who have never seen wartime combat.

Sources:

U.S. Department of Veterans Affairs: PTSD History and Overview

Let There Be Light, John Huston, 1946 (YouTube)  (full film)

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