How we learned about PTSD

When will society recognize PTSD among survivors of domestic violence?

Let’s look at how the world learned about PTSD and related disorders.

Post-traumatic stress disorder is one of a group of similar conditions, known variously through history as shell shock, soldier’s heart, combat stress reaction, and so forth. Trauma became much easier to spot and discuss in the 19th century, when technology made warfare much more dangerous and traumatic to soldiers. The American Civil War introduced the combat model of large numbers of soldiers armed with rifles, firing out in the open. As a result, there were staggering combat casualties. Once the troops began to see the incredible body counts in the battles, psychological trauma skyrocketed – in fact it was the second-most common diagnosis by battlefield doctors. Psychiatry was still barely in its infancy back then, and the doctors didn’t even have the vocabulary to describe psychological trauma, to say nothing of actually treating it.

Although the science wasn’t moving very forward quickly on the psychiatric front, it was positively galloping forward in the field of military technology. World War One introduced trench warfare, gas warfare, tanks, machine guns, aerial bombing and other horrors. Psychological trauma among soldiers increased again: as an incredible 56 percent of soldiers were physically wounded in the war, the numbers of psychologically damaged soldiers also shot up. In WWI, literally millions of soldiers went home from the war showing a whole gallimaufry of trauma symptoms. The problem became harder to ignore, but people still didn’t really know what trauma was, and diagnosis was still primitive. During WWI the British believed that the damage was actually caused by the shaking effect of artillery shelling, and only soldiers who showed trauma symptoms during an artillery attack got military pensions.

A key player is this drama was actually George Patton, one of America’s generals in World War Two. At one point in 1943, one of his officers told him that his 1st Infantry Division reportedly had a lot of lazy soldiers faking illness in order to avoid combat. Patton visited a hospital shortly thereafter; most of the soldiers of course jumped to attention when Patton arrived, but one guy, Charles Kuhl, was sitting on a stool, essentially in a catatonic daze. Patton asked him whether he was wounded, and he replied "I guess I can't take it.” Patton slapped Kuhl in the face with his gloves, dragged him by the collar to the tent entrance, and kicked his butt, calling him a son of a bitch and a gutless bastard. Patton visited other patients, and then left the tent to yell at Kuhl again. A week later, Patton did the exact same thing, slapping another soldier at a hospital.

Once word of these incidents got out, some Americans were outraged, but many supported Patton. Kuhl’s parents didn’t want Patton to get into trouble, and even Kuhl said Patton was a great general. Kuhl also said something odd -- "I think at the time it happened, he [Patton] was pretty well worn out himself.” Eisenhower, Patton’s army boss, insisted that Patton apologize to Kuhl but rejected demands that Patton be fired. It was discovered that Kuhl also had malaria; when Patton apologized, he said he hadn’t known how sick Kuhl was. Then Patton apologized to the other soldiers who had been there at the first incident also.

But in the meantime, more and more people began talking about the impact of combat on men like Kuhl during and after WWII. Like WWI, WWII sent millions of men home with terrible symptoms of trauma: during the war itself one-tenth of active-duty troops were hospitalized for psychological trauma, and men who served on the front lines for 35 or more straight days had an incredible 98 percent chance of psychological problems. Society at large, and the psychological community, were taking more notice.

In the 1970s two things gave forward impetus to the cause to learn more about trauma. First, psychiatry, long mired in a morass of shock therapy, over-medication and over-reliance on the myths of Freud, began to grow up, as a scientific discipline. And second, a generation of vets came back from Vietnam loaded with trauma symptoms. The linkages between PTSD, combat service, and homelessness became easier to see.

Over the next 40 years, psychiatry got better at diagnosing and treating trauma, although there are still plenty of growing pains. The DSM manual is still changing its definitions of disorders, doctors still give up on patients and resort to heavy medication, and there are still many doctors who are sadly under-trained in what PTSD actually is. A particular problem is that doctors, instead of making the effort to offer therapy sessions which allow PTSD patients to safely confront their traumatic past and manage their trauma better, will take the lazy way out and just mask the problem by stupefying their patients with antidepressants. “Here’s your prescription – who’s next?”

The vast stream of very weary soldiers returning from Iraq and Afghanistan is forcing the Veterans Administration to take a good look at how they help trauma victims today.

So what is the next battle? The psychiatric community has recognized and studied PTSD, and the military community has recognized the epidemic of PTSD within its ranks. So when is the world community going to recognize that, in America for example, there are a million abusers abusing a million women? Ten thousand injured every day, a thousand killed every year, an epidemic of destructive emotional abuse? Thousands and thousands of PTSD women who either haven’t been diagnosed at all, or have been improperly treated by doctors who don’t fully understand the syndrome? And numbers just as bad, or worse, all across the world? Why do these women need to go to people like the Veterans Administration to get working aids and research on PTSD, all larded with tough macho advice aimed at soldiers? The world has recognized soldiers with trauma – it’s time they recognized the survivors of domestic violence too.