Shell Shock and the History of PTSD
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Humans have experienced traumatic stress since the time of our earliest written texts. Our concepts of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) reflect new ways of looking at natural biological reactions. However, many gaps between research studies and wording changes have contributed to misunderstandings. 

Western civilization has come a long way from studying the effects of trauma only as they relate to combat exposure. Now we strive for trauma-informed human services and even work environments. This article will touch on the history of terms, theories and studies that have shaped what we know about traumatic stress and how to heal from it.

Where does the term “shell shock” come from? 

Up to the time of the American Civil War, soldiers and military physicians talked about wartime ailments known as “nostalgia” and “soldier’s heart.” Soldiers in the field who missed their homes experienced anxiety, sleep problems and racing heartbeats. The term “shell shock” came about when soldiers in World War I started using heavier artillery and trench warfare. Dr. Charles S. Myers first studied the psychological effects of war or “war neurosis” in members of the British army. He believed that their repressed traumatic memories were causing the symptoms.

These early terms reflected some popular attitudes of their times. People thought there was something deficient or wrong with those who showed symptoms of traumatic stress. Some thought that damage to the heart, spine, brain or central nervous system caused these symptoms. They reasoned that being so close to explosions caused microscopic lesions. They noticed symptoms like tremors, headache, fatigue, heightened emotion, melancholy and withdrawal. 

PTSD’s fragmented military history

Many of the United States’ studies on PTSD have come from Veterans Affairs (VA). In Europe, doctors studied train wreck survivors because they showed peculiar psychological symptoms. By World War II, the term had changed to “battle fatigue.” Around this time, the first Diagnostic and Statistical Manual of Mental Disorders (DSM) listed it as “gross stress reaction.” It wasn’t updated to look more like our current concept of PTSD until 1980. This was the first time people noticed a connection between combat trauma and civilian life. Studies on Vietnam veterans, Holocaust survivors and sexual trauma victims provided new insight. 

“Combat fatigue” and stress reactions were absent from the second DSM, which came out during the Vietnam War in 1968. This was the first time battlefield conditions received major news coverage in the U.S. Graphic imagery caused civilians to experience “vicarious trauma.” Thousands of soldiers returned after the war with new traumatic stress symptoms. The VA was able to conduct one of the first large-scale studies on veterans with PTSD. Finally, an act of Congress established the VA’s National Center for PTSD as a site for education and research in 1989.

Breaks in PTSD research like this had real consequences. After World War I, the medical community abandoned the insights we gained on physiological treatments. Things shifted toward psychodynamic and behavioral approaches, only to resume later on. We missed other opportunities to study long-term prisoners of war after World War II. Placebo-controlled clinical trials of pharmacological PTSD treatments were delayed. Awareness waned after each renewed conflict. Each time, the public soon forgot the psychological tolls of war.

Evolution of PTSD treatments

Today several effective treatments are available for treating PTSD. These came along during the widespread studies conducted in the 1980s. Most types of trauma therapy involve exposure. Exposures are experiences where individuals gradually approach their “triggers” in a safe environment. They will imagine stressful situations, write about them, look at images and listen to recordings as forms of exposure. SSRIs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac) are all approved for PTSD. The SNRI venlafaxine (Effexor) can also be effective.

Here’s a summary of some of the most effective treatments available for PTSD today:

  • Exposure and response prevention (ERP) and prolonged exposure (PE) are both flexible modalities. They can be adapted to include different exposure methods. 
  • Eye movement desensitization and reprocessing (EMDR) made a huge leap forward in trauma treatments. Therapists use bilateral stimulation (e.g., alternating lights, pulses, or sounds) to engage both hemispheres of the brain. This facilitates faster and more efficient reprocessing. 
  • Cognitive processing therapy (CPT) helps trauma survivors rewrite their negative beliefs and their stories. They track “stuck points” or negative beliefs they formed during traumatic experiences. Then they challenge those negative beliefs and consider more helpful alternatives. 
  • Narrative exposure therapy and written exposure therapy both empower trauma survivors through retelling a personal story.

How Lightfully helps people with PTSD and CPTSD

We’ve created treatment environments that feel safe for people with PTSD. Our programs combine trauma therapies with other evidence-based modalities. We provide yoga therapy to heal the effects of trauma on the brain, the body and the self. We also hold powerful support groups where clients agree to keep each other’s stories confidential. This creates a safe space for deep, productive conversations about things most other people don’t understand.

Our process-based therapy (PBT) model focuses on treating people, not symptoms. Clients collaborate with their therapist to create a personalized care plan. Each one includes a mix of treatment modalities. They’ll work at a pace that’s comfortable yet challenging enough to stretch their window of tolerance. 

Have any questions about treatment for PTSD? Get in touch to chat with us today.

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