Post Traumatic Stress Post Traumatic Stress DisorderDisorder
Dr. Craig JacksonDr. Craig JacksonSenior Lecturer in Health PsychologySenior Lecturer in Health Psychology
School of Health and Policy StudiesSchool of Health and Policy StudiesFaculty of Health & Community Care Faculty of Health & Community Care
University of Central EnglandUniversity of Central England
[email protected]@uce.ac.uk
Futility of stress researchFutility of stress research
“One evening we had an almost inaudible talk from…..the BBC staff doctor
who told us how to recognise stress in our staff: the body sits slumped, with
the head shrunk between the shoulders. At least I think that is what he said.
He was difficult to hear as we were all sitting slumped with our heads shrunk
between our shoulders”
Frank Muir in A Kentish Lad
StressStress
Golden Age of StressGolden Age of Stress
Everyone is StressedEveryone is Stressed
BBCi - “Stress” = 16,000 findsBBCi - “Stress” = 16,000 finds
More people experiencing more stressMore people experiencing more stressGreater demands from employersGreater demands from employersPeople working longer hoursPeople working longer hours24 / 7 society24 / 7 society
World Wars I and IIWorld Wars I and IIWhere was stress?Where was stress?Possible evidence from dud shellsPossible evidence from dud shells
Some Stress is goodSome Stress is good
Keeps one alertKeeps one alert
Keeps one aliveKeeps one alive
Evolutionary perspective:Evolutionary perspective:
Too little stress = extinctionToo little stress = extinctionToo much stress = extinctionToo much stress = extinctionBalance stress = evolutionBalance stress = evolution
Pressure is good - - Stress is badPressure is good - - Stress is bad
perf
orm
ance
perf
orm
ance
stressstress
Common ExperienceCommon Experience
Minor trauma is a part of everyday lifeMinor trauma is a part of everyday life
For most people these injuries are only transient For most people these injuries are only transient
Some haveSome have psychiatric and social complicationspsychiatric and social complications
Most people experience majorMost people experience major trauma at some time in their livestrauma at some time in their lives
Psychological Behavioural, and Social factorsPsychological Behavioural, and Social factorsall relevant toall relevant to
Subjective intensity of physical symptomsSubjective intensity of physical symptomsandand
Consequences for work, leisure, and family lifeConsequences for work, leisure, and family life
Disability may become greater than might be expected from the severity of Disability may become greater than might be expected from the severity of physical injuries alone physical injuries alone
What kids think of stressWhat kids think of stress
STRESSSTRESS
Looks like a flaming deamon (sic) Looks like a flaming deamon (sic)
Sounds like an eagle squaking (sic) Sounds like an eagle squaking (sic)
Tastes like a burnt sausage Tastes like a burnt sausage
Smells like sour milk Smells like sour milk
Feels like stroking a hedgchog (sic) Feels like stroking a hedgchog (sic)
Stress is when mum says NO!!!!! Stress is when mum says NO!!!!!
by Andrew (aged 10)by Andrew (aged 10)Year 5Year 5Potley Hill Primary SchoolPotley Hill Primary School
Traumatic Events are CommonTraumatic Events are Common
Lifetime prevalence of specific traumatic events (n=2181) Lifetime prevalence of specific traumatic events (n=2181)
Type of traumaType of trauma Prevalence Prevalence
AssaultAssault 38%38%
Serious car or motor vehicle crashSerious car or motor vehicle crash 28%28%
Other serious accident or injuryOther serious accident or injury 14%14%
Natural disasterNatural disaster 17%17%
Other shocking experienceOther shocking experience 43%43%
Diagnosed with a life threatening illnessDiagnosed with a life threatening illness 5% 5%
Learning about traumas to othersLearning about traumas to others 62%62%
Sudden, unexpected death of close friend or relativeSudden, unexpected death of close friend or relative 60%60%
Any traumaAny trauma 90%90%
Immediate Effects of Frightening TraumaImmediate Effects of Frightening Trauma
Anxiety, numbness, dissociation and sometimes inappropriate calmness Anxiety, numbness, dissociation and sometimes inappropriate calmness
““Innocent victims” often angry and frustratedInnocent victims” often angry and frustrated
““Acute Stress Disorder" is now usedAcute Stress Disorder" is now used
Occurs in 20-50% of those who have suffered major traumaOccurs in 20-50% of those who have suffered major trauma
The severity of emotional symptoms is much more closely related to howThe severity of emotional symptoms is much more closely related to howfrighteningfrightening the trauma was than to the the trauma was than to the severity of the injuryseverity of the injury
Even uninjured victims may suffer considerable distress Even uninjured victims may suffer considerable distress
Severe distress is usually temporary but indicates a risk of long term postSevere distress is usually temporary but indicates a risk of long term posttraumatic symptomstraumatic symptoms
Acute Stress and Chronic StressAcute Stress and Chronic Stress
CommonCommon
After-effectsAfter-effects
Leave behindLeave behind
Life threateningLife threatening
One-offOne-off
Ever-presentEver-present
By proxyBy proxy
Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorder (PTSD)
Response to specific traumatic / extreme eventResponse to specific traumatic / extreme event
DSM IV Diagnostic condition DSM IV Diagnostic condition && ICD-10 Diagnostic condition ICD-10 Diagnostic condition
1. 1. Experience intense fearExperience intense fear
2. 2. Persistent re-experiencePersistent re-experience
3. 3. Avoidance of associationsAvoidance of associations
4. 4. Persistent increased arousal since eventPersistent increased arousal since event
5.5. FlashbacksFlashbacks
6.6. Hyper-arousal – sleep, irritability, concentration, hyper-vigilance, startleHyper-arousal – sleep, irritability, concentration, hyper-vigilance, startle
HistoryHistory
Associated most with Disasters and WarfareAssociated most with Disasters and Warfare
Not new - 6th Century BCNot new - 6th Century BC
Every conflict since American Civil War in 1863Every conflict since American Civil War in 1863
““Shell-Shock” Shell-Shock” “Battle Fatigue”“Battle Fatigue” “Combat Syndrome”“Combat Syndrome”
THIS IS NOT GULF WAR SYNDROMETHIS IS NOT GULF WAR SYNDROME
HistoryHistory
40 Conflicts in world at any one time40 Conflicts in world at any one time
1% of world pop are refugees1% of world pop are refugees
American Civil War – “Nostalgia”American Civil War – “Nostalgia”
More casualties than dysenteryMore casualties than dysentery
WWIWWI 13,000 cases of “shell shock” in Brits13,000 cases of “shell shock” in Brits
200,000 cases by 1918200,000 cases by 1918
Case History 1Case History 1
During active service in Northern IrelandDuring active service in Northern Ireland the patient was involved in a the patient was involved in a
helicopter crash. The patient washelicopter crash. The patient was strapped in but the blood and brains of his strapped in but the blood and brains of his
"best mate" spattered"best mate" spattered him. Four months of psychological help was deemed him. Four months of psychological help was deemed
successful.successful. Later, in the Gulf war, observation of troop transport helicoptersLater, in the Gulf war, observation of troop transport helicopters
awakened his memoriesawakened his memories of the incident. He carried on successfully of the incident. He carried on successfully until he until he
was demobilised in 1994, when the was demobilised in 1994, when the support of regimentalsupport of regimental camaraderie was camaraderie was
lost.lost. Helicopter transport of troops in a film, Helicopter transport of troops in a film, Bravo 2 ZeroBravo 2 Zero, , forced his mind forced his mind
back to the crash.back to the crash. Subsequently Subsequently any referenceany reference to helicopters led to to helicopters led to re-re-
experiencing the trauma.experiencing the trauma. The diagnosis of post-traumatic stress disorder was The diagnosis of post-traumatic stress disorder was
straightforwardstraightforward when his military history was taken as part of an assessment when his military history was taken as part of an assessment
ofof fatigue, impaired memory, nocturnal sweating, rashes, musculoskeletalfatigue, impaired memory, nocturnal sweating, rashes, musculoskeletal
aches, dyspnoea, andaches, dyspnoea, and dyspepsia.dyspepsia.
Case History 2Case History 2
A young nurse was woken by a missile explodingA young nurse was woken by a missile exploding to her left. Terrified and to her left. Terrified and
claustrophobic she vomited and evacuatedclaustrophobic she vomited and evacuated her bowel and bladder. Her her bowel and bladder. Her
protective kit could not be removedprotective kit could not be removed until tests allowed the all clear to be until tests allowed the all clear to be
sounded about five hourssounded about five hours later. She later. She became too frightened to showerbecame too frightened to shower because because
being nakedbeing naked would have prevented her running to awould have prevented her running to a shelter. She took shelter. She took
accelerated discharge from the air force. She could not keep jobs because of accelerated discharge from the air force. She could not keep jobs because of
poor time keeping, irascibility, andpoor time keeping, irascibility, and disproportionate emotional responses to disproportionate emotional responses to
minor adversity. Distressingminor adversity. Distressing recall of terrified anticipation of her death recall of terrified anticipation of her death
occurred by dayoccurred by day and night. She developed fatigue and anorexia and solitary and night. She developed fatigue and anorexia and solitary
alcoholalcohol bingeing. She bingeing. She became claustrophobicbecame claustrophobic when shopping or on public when shopping or on public
transport where she vomited and screamed. Civilian consultationstransport where she vomited and screamed. Civilian consultations proved proved
unhelpful because no one asked about her experiences duringunhelpful because no one asked about her experiences during the conflict to the conflict to
learn the origins of herlearn the origins of her dysfunction.dysfunction.
Case History 3Case History 3
A major aged 37 years directed some of theA major aged 37 years directed some of the clear up of battle field carnage. He clear up of battle field carnage. He saw and smelled many remainssaw and smelled many remains of Iraqi people but of Iraqi people but thought that he was not thought that he was not affected.affected. He became He became uncommunicative but irritable; his love of life and the uncommunicative but irritable; his love of life and the army diminished.army diminished. Two years after his early retirement he saw a television Two years after his early retirement he saw a television documentarydocumentary on the Gulf and on the Gulf and dramatically recalled the events of six yearsdramatically recalled the events of six years
previouslypreviously. The . The smell of off-fresh chicken meatsmell of off-fresh chicken meat focused memories focused memories of rotting of rotting flesh. Repeated recall of half-burnt Iraqi corpsesflesh. Repeated recall of half-burnt Iraqi corpses forced him to re-experience forced him to re-experience the initiating trauma. His nightmares,the initiating trauma. His nightmares, insomnia, poor memory, fatigue, and insomnia, poor memory, fatigue, and irascibility became worse,irascibility became worse, and he developed headaches, musculoskeletal and he developed headaches, musculoskeletal aches, and dyspepsia.aches, and dyspepsia. His decision making and attendance at work suffered. His decision making and attendance at work suffered. General medicalGeneral medical and rheumatological consultations were unhelpful. Post-and rheumatological consultations were unhelpful. Post-traumatictraumatic stress disorder was diagnosed stress disorder was diagnosed only after his battlefield and only after his battlefield and psychiatricpsychiatric histories were consideredhistories were considered. Many symptoms had not previously . Many symptoms had not previously beenbeen discussed. His wife felt "trapped in a tunnel with no lights"discussed. His wife felt "trapped in a tunnel with no lights" and and commented "I wish this Rupert could go to the Gulf and bringcommented "I wish this Rupert could go to the Gulf and bring my old Rupert my old Rupert back . . . I don't know how to helpback . . . I don't know how to help him."him."
World War 1 and DevelopmentsWorld War 1 and Developments
First special hospital First special hospital ““CraigLockhart” in EdinburghCraigLockhart” in Edinburgh
““Mausoleum filled with the morbid slumbers of men Mausoleum filled with the morbid slumbers of men haunted by self-haunted by self- lacerating failure to achieve the impossible”lacerating failure to achieve the impossible”
Siegfried SassonSiegfried Sasson
Repressed Trauma ?Repressed Trauma ?
Localised electric shock ?Localised electric shock ?
Hypnosis ?Hypnosis ?
ETHICAL DILEMMA:ETHICAL DILEMMA:GET TROOPS BETTER, TO SEND THEM BACK TO TRENCHESGET TROOPS BETTER, TO SEND THEM BACK TO TRENCHES
World War 1 and DevelopmentsWorld War 1 and Developments
Shell Shock recognised by War Office – 1916Shell Shock recognised by War Office – 1916(Charles Myers)(Charles Myers)
Acute incapacity NOT beyond their controlAcute incapacity NOT beyond their control
307 troops executed for cowardice307 troops executed for cowardice
80,000 cases80,000 cases
80% of cases never returned to active duty80% of cases never returned to active duty
1918 - 15,000 still hospitalised1918 - 15,000 still hospitalised
World War 1 and DevelopmentsWorld War 1 and Developments
Ernest Jones (president of British Psycho-Analytic Association)Ernest Jones (president of British Psycho-Analytic Association)
““An official abrogation of civilised standards' in which men were not only An official abrogation of civilised standards' in which men were not only allowed, but encouraged...to indulge in behaviour of a kind that is allowed, but encouraged...to indulge in behaviour of a kind that is throughout abhorrent to the civilised mind. All sorts of previously throughout abhorrent to the civilised mind. All sorts of previously forbidden and hidden impulses, cruel, sadistic, murderous and so on, are forbidden and hidden impulses, cruel, sadistic, murderous and so on, are stirred to greater activity, and the old intrapsychical conflicts which, stirred to greater activity, and the old intrapsychical conflicts which, according to Freud, are the essential cause of all neurotic disorders, and according to Freud, are the essential cause of all neurotic disorders, and which had been dealt with before by means of 'repression' of one side of which had been dealt with before by means of 'repression' of one side of the conflict are now reinforced, and the person is compelled to deal with the conflict are now reinforced, and the person is compelled to deal with them afresh under totally different circumstances.”them afresh under totally different circumstances.”
Return to normal civilian mentality could spark off delayed reaction in someReturn to normal civilian mentality could spark off delayed reaction in some
World War 2 and RegressionWorld War 2 and Regression
200 psychiatrists recruited after Dunkirk200 psychiatrists recruited after Dunkirk
Churchill didn’t like meddlingChurchill didn’t like meddling
RAF had diagnosis of LMFRAF had diagnosis of LMF
Good Training and Leadership seen as the keyGood Training and Leadership seen as the key
William Sergeant used drugs to open unconsciousnessWilliam Sergeant used drugs to open unconsciousness
North Africa – Battle Exhaustion highNorth Africa – Battle Exhaustion high
Call for right to shoot deserters to be re-instatedCall for right to shoot deserters to be re-instated
Stigmatisation Stigmatisation
Vietnam WarVietnam War
Seen at time to have low psychological casualtiesSeen at time to have low psychological casualties
Legacy of 480,000 vets with PTSD after 15 yearsLegacy of 480,000 vets with PTSD after 15 years
PTSD started in Vietnam WarPTSD started in Vietnam War
Anti-war psychiatristsAnti-war psychiatrists
Political DiagnosisPolitical Diagnosis
““Backfired”Backfired”
Modern Day ViewModern Day View
Victim Identity of modern warfare?Victim Identity of modern warfare?
Modern soldier seen as more Modern soldier seen as more psychologicalpsychological than predecessors than predecessors
PoliticalPolitical CulturalCultural MedicalMedicalcontextcontext contextcontext contextcontext
Has bred a population of vets with investment in being chronic casesHas bred a population of vets with investment in being chronic cases
Culture of trauma and compensation links military and civilian worldsCulture of trauma and compensation links military and civilian worlds
DeniedDenied
ExaggeratedExaggerated
UnderstoodUnderstood
ForgottenForgotten
Modern Day ViewModern Day View
Psychiatric diagnosis is not a diseasePsychiatric diagnosis is not a disease
Distress and suffering is not psychopathologyDistress and suffering is not psychopathology
PTSD constructed from political ideasPTSD constructed from political ideas
PTSD linked to changes in society and individual “personhood” of modern lifePTSD linked to changes in society and individual “personhood” of modern life
Diagnoses must be objectiveDiagnoses must be objective
PTSD lacks precisionPTSD lacks precision
What is subjective distress or objective disorderWhat is subjective distress or objective disorder
Psuedocondition – transforms social ills into medical onesPsuedocondition – transforms social ills into medical ones
Modern Day Reasons for Uses of Victim SupportModern Day Reasons for Uses of Victim Support
Mayou & Farmer 2002Mayou & Farmer 2002
Psychological Consequences of TraumaPsychological Consequences of Trauma
Acute anxiety, numbing, arousal (acute stress disorder)Acute anxiety, numbing, arousal (acute stress disorder)
Pain and apparently disproportionate disabilityPain and apparently disproportionate disability
Anxiety disorderAnxiety disorder
Unexplained physical symptomsUnexplained physical symptoms
Major depressive disorderMajor depressive disorder
Impact on family (such as family arguments, depression in family members)Impact on family (such as family arguments, depression in family members)
Post-traumatic symptoms and disorderPost-traumatic symptoms and disorder
Avoidance and phobic anxietyAvoidance and phobic anxiety
Types of Modern TraumaTypes of Modern Trauma
Occupational Occupational
Return to work often slower than in other types of injuryReturn to work often slower than in other types of injury
Liaison with employer essentialLiaison with employer essential
Compensation issues may impede return to work Compensation issues may impede return to work
SportingSporting
May be associated with physical unfitness or with inappropriate activity for May be associated with physical unfitness or with inappropriate activity for
age age
DomesticDomestic
Assess role of alcohol, consider possible family and other problems, assess Assess role of alcohol, consider possible family and other problems, assess
risk of further incidents risk of further incidents
DisastersDisastersFear of unpredictability and lack of controlFear of unpredictability and lack of control
Types of Modern TraumaTypes of Modern Trauma
Assault (including sexual) Assault (including sexual)
Assess role of alcohol, keep detailed records, suggest availability of help for Assess role of alcohol, keep detailed records, suggest availability of help for
major, and especially for sexual, assault major, and especially for sexual, assault
Road traffic crash Road traffic crash
Psychological complications may occur even if no significant physical injury.Psychological complications may occur even if no significant physical injury.
Whiplash injuries should be treated by well planned mobilisation andWhiplash injuries should be treated by well planned mobilisation and
encouragement, together with alertness to possible psychologicalencouragement, together with alertness to possible psychological
complicationscomplications
TerrorismTerrorism
Fear of being killed / injured / capturedFear of being killed / injured / captured
Fearful for loved onesFearful for loved ones
Recent PTSD Cases in UKRecent PTSD Cases in UK
HurleyHurley vsvs Gwent ConstabularyGwent ConstabularyPolice officerPolice officer
FearonFearon vsvs Martin Martin Injured burglarInjured burglar
ArmstrongArmstrong vsvs Home OfficeHome OfficePrison officer in Rosemary West trialPrison officer in Rosemary West trial
Expansions:Expansions: Witnesses and Bystanders ?Witnesses and Bystanders ?
Good Samaritans ?Good Samaritans ?
Compensation NeurosisCompensation Neurosis
Pending litigationPending litigation
Treatment results often poorTreatment results often poor
Some overt malingeringSome overt malingering
Exaggerated illness due to:Exaggerated illness due to:suggestionsuggestion ++ somatizationsomatizationrationalizationrationalization ++ distorted sense of justicedistorted sense of justicevictim statusvictim status ++ entitlemententitlement
Adverse legal / admin. systemsAdverse legal / admin. systems
Harden patient’s convictionsHarden patient’s convictions
With time, care-eliciting behaviour may remain permanentWith time, care-eliciting behaviour may remain permanent
Bellamy, 1997Bellamy, 1997
Compensation NeurosisCompensation Neurosis
Improvement in health.....Improvement in health.....
...may result in loss of status...may result in loss of status
Patient compelled to guard against getting betterPatient compelled to guard against getting better
Financial reward for illness is a powerful noceboFinancial reward for illness is a powerful nocebo
Exacerbates illnessExacerbates illness
In a litigious society, will compensation neurosis become more widespread?In a litigious society, will compensation neurosis become more widespread?
Accident NeurosisAccident Neurosis
• Failure to improve with treatment until compensation issue settledFailure to improve with treatment until compensation issue settled
• Accident must occur in circumstances with potential for compensation Accident must occur in circumstances with potential for compensation
paymentpayment
• Inverse relationship to severity of injury - Accident neurosis rare in cases of Inverse relationship to severity of injury - Accident neurosis rare in cases of
severe injurysevere injury
• Low socio-economic status favors accident neurosisLow socio-economic status favors accident neurosis
• Complete recovery common following settlement of compensation issueComplete recovery common following settlement of compensation issue
? ? ?? ? ?
Miller, 1961Miller, 1961
Abnormal Illness Behaviour after Compensable InjuryAbnormal Illness Behaviour after Compensable Injury
Accident neurosisAccident neurosis Accident victim syndromeAccident victim syndromeAftermath neurosisAftermath neurosis American diseaseAmerican diseaseAttitudinal pathosisAttitudinal pathosis Barristogenic illnessBarristogenic illnessCompensatory hysteriaCompensatory hysteria CompensationitisCompensationitisCompensation neurosisCompensation neurosis Fright neurosisFright neurosisFunctional overlayFunctional overlay Greek diseaseGreek diseaseGreenback neurosisGreenback neurosis Invalid syndromeInvalid syndromeJustice neurosisJustice neurosis Perceptual augmenterPerceptual augmenterPost accident anxiety syndromePost accident anxiety syndrome PensionitisPensionitisPostaccident fibromyalgia Postaccident fibromyalgia Post-traumatic syndromePost-traumatic syndromeProfit neurosisProfit neurosis Psychogenic invalidismPsychogenic invalidismRailway spineRailway spine Secondary gain neurosisSecondary gain neurosisTraumatic hysteria Traumatic hysteria Symptom magnification syndromeSymptom magnification syndromeTraumatic neurastheniaTraumatic neurasthenia Traumatic neurosisTraumatic neurosisTriggered neurosisTriggered neurosis Unconscious malingeringUnconscious malingeringVertebral neurosisVertebral neurosis Wharfie’s backWharfie’s backWhiplash neurosisWhiplash neurosis Mendelson, 1984Mendelson, 1984
Secondary Gain Pre-dispositionSecondary Gain Pre-disposition
MotivationMotivation
• Desire for attentionDesire for attention
• Punish spouse / othersPunish spouse / others
• Solve life’s problemsSolve life’s problems
• Cry for helpCry for help
• Diversion from workDiversion from work
• Socially approved task avoidanceSocially approved task avoidancesex with spousesex with spouseworkworkmilitary dutymilitary duty
Secondary Gain Pre-dispositionSecondary Gain Pre-disposition
Potential ClaimantsPotential Claimants
• Military patients nearing severanceMilitary patients nearing severance
• Workers under retirement age Workers under retirement age
• Low job satisfactionLow job satisfaction
• Workers soon to be made redundantWorkers soon to be made redundant
• Members of support groupsMembers of support groups
Secondary Gain Pre-dispositionSecondary Gain Pre-disposition
Non-economic motivationNon-economic motivation
• LonelinessLoneliness
• Difficulty expressing emotional painDifficulty expressing emotional pain
• Previous history of attention seeking when illPrevious history of attention seeking when ill
• DepressionDepression
• AnxietyAnxiety
Chronic Illness Behaviour (Care Eliciting Behaviour)Chronic Illness Behaviour (Care Eliciting Behaviour)
• Disability disproportionate to detectable illnessDisability disproportionate to detectable illness
• Constant search for disease validation Constant search for disease validation
• Relentless pursuit of “enlightened doctors”Relentless pursuit of “enlightened doctors”
• Appeals to doctor’s responsibilityAppeals to doctor’s responsibility
• Attitude of personal vulnerability and entitlement to care by othersAttitude of personal vulnerability and entitlement to care by others
• Avoidance of health roles due to lack of skills and fear of failure Avoidance of health roles due to lack of skills and fear of failure
• Adoption of sick role due to rewards from family, friends, physicians Adoption of sick role due to rewards from family, friends, physicians
• Behaviours which sustain the sick role - complaints, demands, threatsBehaviours which sustain the sick role - complaints, demands, threats
Blackwell, 1987Blackwell, 1987
Cognitive Behavioural Strategies for PTSD
Talking it through Talking it through Encourage victim to discuss and relive feelings about the incident Encourage victim to discuss and relive feelings about the incident
Tackling avoidance Tackling avoidance Discuss graded increase in activities, such as return to travel after a road crash Discuss graded increase in activities, such as return to travel after a road crash
Coping with anxiety Coping with anxiety Anxiety management techniques (relaxation, distraction) Anxiety management techniques (relaxation, distraction)
Dealing with anger Dealing with anger Encourage discussion of incident and of feelings Encourage discussion of incident and of feelings
Overcoming sleep problems Overcoming sleep problems Emphasise importance of regular sleep habits and avoidance of excessive Emphasise importance of regular sleep habits and avoidance of excessive alcohol and caffeine alcohol and caffeine
Treat associated depression Treat associated depression Antidepressant drugs, limited role for hypnotics immediately after traumaAntidepressant drugs, limited role for hypnotics immediately after trauma
SummarySummary
““Acute Stress Disorder” more accurateAcute Stress Disorder” more accurate
Traumatic events can occur any time or placeTraumatic events can occur any time or place
Incapacity in face of fear and terror is naturalIncapacity in face of fear and terror is natural
Reactions can be immediate or delayed or bothReactions can be immediate or delayed or both
Delayed reactions triggered by any associationsDelayed reactions triggered by any associations
PTSD was a political diagnosis PTSD was a political diagnosis
Resulted in over-reporting of effects in Vietnam vet populationResulted in over-reporting of effects in Vietnam vet population
PTSD Diagnoses not objectivePTSD Diagnoses not objective
PTSD lacks precisionPTSD lacks precision
ReferencesReferences
Shell Shock: A History of the Changing Attitudes to War NeurosesShell Shock: A History of the Changing Attitudes to War Neuroses by Anthony by Anthony Babington (Leo Cooper, 1997)Babington (Leo Cooper, 1997)
From Shell Shock to Combat StressFrom Shell Shock to Combat Stress by JMW Binneveld (Amsterdam University by JMW Binneveld (Amsterdam University Press, 1997)Press, 1997)
War Neurosis and Cultural Change in England, 1914-22War Neurosis and Cultural Change in England, 1914-22 by Ted Bogacz by Ted Bogacz (Journal of Contemporary History, volume 24, 1989)(Journal of Contemporary History, volume 24, 1989)
Dismembering the Male: Men's Bodies, Britain and the Great WarDismembering the Male: Men's Bodies, Britain and the Great War by Joanna by Joanna Bourke (Reaktion Books, 1996)Bourke (Reaktion Books, 1996)
No Man's Land: Combat and Identity in World War OneNo Man's Land: Combat and Identity in World War One by Eric J Leed by Eric J Leed (Cambridge University Press, 1979)(Cambridge University Press, 1979)
Problems Returning Home: The British Psychological Casualties of the Great Problems Returning Home: The British Psychological Casualties of the Great WarWar by Peter Leese (The Historical Journal, volume 40, 1997) by Peter Leese (The Historical Journal, volume 40, 1997)
Female Malady: Women, Madness and English Culture 1830-1980Female Malady: Women, Madness and English Culture 1830-1980 by Elaine by Elaine Showalter (Virago, 1987)Showalter (Virago, 1987)
The Regeneration TrilogyThe Regeneration Trilogy by Pat Barker (Viking, 1996 ) by Pat Barker (Viking, 1996 )
