Section I. GENERAL

01-01. General. Since you are reading this manual one of the followings things is probably taking place:

a. You think you may have Post Traumatic Stress Disorder (PTSD).
b. You are being treated for PTSD.
c. You know someone who has PTSD.

Before you begin this journey you need to know what Post Traumatic Stress Disorder (PTSD) is.

Less than a year ago I did not know what PTSD was and I believed that Veterans who claimed to have PTSD were using their claims to shield them from the consequences of their own stupidity or alcohol/drug abuse. Boy was I wrong.
In this chapter I will present a brief history of PTSD and define PTSD in language you can understand so that;

a. You can determine whether or not you may be afflicted with PTSD.
b. When the time comes you will be better equipped to express your symptoms to your doctor, and explain your condition to your interviewer.

Section II. HISTORY

01-02. General. Prior to the studies done on Vietnam veterans, there were very few scientific studies of what we today call Post Traumatic Stress Disorder (PTSD).

01-03. The 1800’s. During the early 1800’s military doctors began diagnosing soldiers with “exhaustion” following the stress of battle. This “exhaustion” was characterized by mental shutdown due to individual or group trauma. Like today, soldiers during the 1800’s were not supposed to be afraid or show any fear in the heat of battle. The only treatment for this “exhaustion” was to bring the afflicted soldiers to the rear for a while then send them back into battle. Through extreme and often repeated stress, the soldiers became fatigued as a part of their body’s natural shock reaction.
During that time, in England, there was a syndrome know as “railway spine” or “railway hysteria” that bore a remarkable resemblance to what we call PTSD today, exhibited by people who had been in the catastrophic railway accidents of the period. In 1876 DR. Mendez DaCosta published a paper diagnosing Civil War combat veterans with “Soldiers Heart”: The symptoms included startle responses, hyper-vigilance, and heart arrhythmia’s.

01-04. The 1900’s. During WWI overwhelming mental fatigue was diagnosed as “soldier’s heart” and “the effort syndrome”. An article published on a now restricted Internet web site maintained by Med. Access entitled “Chronic Fatigue Syndrome” states that “...some 60,000 of the British forces were diagnosed with the problem and 44,000 of these were retired from the military because they could no longer function in combat”.
The term “shell shock” emerged during WWI followed in WWII by the term “combat fatigue.” These terms were used to describe those veterans who exhibited stress and anxiety as the result of combat trauma. The official designation of “Post Traumatic Stress Disorder” did not come about until 1980 when the Third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published.

01-05. The Diagnostic and Statistical Manual of Mental Disorders (DSM). This “bible”, published by the American Psychiatric Association (APA), provides the “official” definition of all mental illnesses. When first published in 1952 what we now know as PTSD was called “stress response syndrome” and was caused by “gross stress reaction”.
In the second edition (DSM-II), 1968, trauma-related disorders were lumped together in an area called “situational disorders”. Mrs. Patience Mason, author of Recovering From The War: A woman’s Guide to Helping Your Vietnam Veteran, Your Family, And Yourself, and After The War, points out that those Vietnam Veterans treated for the disorder during that period were informed that if their symptoms lasted more than 6 months after their return from Vietnam they had a “pre-existing” condition, making it a “transient situational disorder”, and the problem was deemed not service connected. This resulted in a lot of “walking wounded” and I am certain attributed to the high suicide rate suffered by Vietnam Veterans of that time. More Vietnam Veterans have committed suicide than were killed in the war.
In the third edition, 1980, DSM-III the title “Post-traumatic Stress disorder” was used and placed under a sub-category of “anxiety disorders”. In the edition printed in 1994, DSM-IV, “Post-traumatic Stress Disorder” is again used but has been placed under a new “stress response” category and remains in the “anxiety disorder” category.
You may have noticed above that what started out as a “syndrome” turned into a “disorder”. According to Taber’s Cyclopedic Medical Dictionary a “syndrome” is “a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition” and a “disorder” is an illness. PTSD changed from being part of a collective indicator to a singular illness, a significant medical distinction.
With few exceptions, up until DSM-IV, most combat veterans were diagnosed with “shell shock”, which didn’t warrant long term treatment. Other combat veterans were merely diagnosed with “bad nerves” which not only didn’t warrant long term treatment, but also induced a “get over it” attitude from the military and medical communities. This type attitude was personified in the movie “Patton” when General Patton, played by George C. Scott, threatened apparently uninjured military hospital patients with malingering.
The initial definition of PTSD described a psychological condition experienced by a person who had faced a traumatic event which caused a catastrophic stressor outside the range of usual human experience (an event such as war, torture, rape, or natural disaster). This definition separated PTSD stressors from the “ordinary stressors” that were characterized in DSM-III as “Adjustment Disorders”, such as divorce, failure, rejection and financial problems.

Section III. DEFINITIONS

01-06. American Psychiatric Definition. The following is a quote, references to children excluded, from The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Washington, DC, American Psychiatric Association, 1994, section 309.81, beginning on page 427.

This disorder is described as occurring when:
“A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened.