A good account of CSR can be found in Stephen Crane's Red Badge of Courage, which describes the acute reaction of a new Union Army recruit when faced with the first barrage of Confederate artillery. Patton, did not believe "battle fatigue" was real. Some American military leaders, such as Lieutenant Gen. In World War II, the shell shock diagnosis was replaced by Combat Stress Reaction (CSR), also known as "battle fatigue." With long surges common in World War II, soldiers became battle weary and exhausted. Battle Fatigue or Combat Stress Reaction (CSR) In European hospitals, "hydrotherapy" (water) or "electrotherapy" (shock) were used along with hypnosis. For those with severe or chronic symptoms, treatments focused on daily activity to increase functioning, in hopes of returning them to productive civilian lives. Soldiers often received only a few days' rest before returning to the war zone. "War neuroses" was also a name given to the condition during this time.ĭuring World War I, treatment was varied. Thinking changed when more soldiers who had not been near explosions had similar symptoms. Shell shock was first thought to be the result of hidden damage to the brain caused by the impact of the big guns. Symptoms included panic and sleep problems, among others. At that time, some symptoms of present-day PTSD were known as "shell shock" because they were seen as a reaction to the explosion of artillery shells. In 1919, President Wilson proclaimed November 11th as the first observance of Armistice Day, the day World War I ended. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma. Injured passengers who died had autopsies that suggested injury to the central nervous system. The thought that physical injury led to PTSD-like symptoms was supported by European reports of "railway spine." As rail travel became more common, so did railway accidents. doctor Jacob Mendez Da Costa studied Civil War soldiers with these "cardiac" symptoms and described it as overstimulation of the heart's nervous system, or "Da Costa's Syndrome." Soldiers were often returned to battle after receiving drugs to control symptoms. "Soldier's heart" or "irritable heart" was marked by a rapid pulse, anxiety, and trouble breathing. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.Ī second model of this condition suggested a physical injury as the cause of symptoms. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. military efforts, Austrian physician Josef Leopold (1761) wrote about "nostalgia" among soldiers. Nostalgia, Soldier's Heart, and Railway Spine European descriptions of the psychological impact of railroad accidents also added to early understanding of trauma-related conditions. The American Civil War (1861-1865) and the Franco-Prussian War (1870-1871) mark the start of formal medical attempts to address the problems of military Veterans exposed to combat. Early attempts at a medical diagnosisĪccounts of psychological symptoms following military trauma date back to ancient times. So, the history of what is now known as PTSD often references combat history. War takes a physical and emotional toll on Servicemembers, families, and their communities. Research about Veterans returning from combat was a critical piece to the creation of the diagnosis. PTSD became a diagnosis with influence from a number of social movements, such as Veteran, feminist, and Holocaust survivor advocacy groups. The PTSD diagnosis has filled an important gap in psychiatry in that its cause was the result of an event the individual suffered, rather than a personal weakness. For example, authors including Homer ( The Iliad), William Shakespeare ( Henry IV), and Charles Dickens ( A Tale of Two Cities) wrote about traumatic experiences and the symptoms that followed such events. Literary accounts offer the first descriptions of what we now call posttraumatic stress disorder (PTSD). Attacks by saber tooth tigers or twenty-first century terrorists have likely led to similar psychological responses in survivors of such violence. Exposure to traumatic experiences has always been a part of the human condition.
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