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Monday, March 25, 2013

PTSD in History and Literature

Is PTSD a modern phenomenon advanced by our greater understanding of the psychology of the mind and how traumas affect people or can Post-Traumatic Stress Disorder be found elsewhere in man's history?  If so, where would a person begin to look for evidence of the truth of this emotional and psychological disorder?  This was my task this week as I wanted to learn if others throughout history might be able to report to us from their time whether men and women were experiencing similar reactions to traumatic events in their worlds.  It was an enormous task, one that I thought would take me weeks to compile and pull all the information together.  Fortunately though, others have already done the work for me, and with much gratitude and honor to them for putting in the time and effort to bring man's history of PTSD together, I use their materials as a reference and guide to educate those who have little understanding or awareness of the startling impact PTSD has had on the lives of millions of people in the course of man's history.

Again, I think it is important to refresh our memories on what PTSD is.  Post-Traumatic Stress Disorder, according to the American Psychiatric Association, is an anxiety (emotional) disorder which arises from a particular incident evoking significant stress.  This stress severely impacts and damages the 'Fight-or-Flight' response in a person who is experiencing the effects of trauma.  When in danger, it is natural to feel afraid.  The body makes many split-second changes to prepare to defend against or avoid the danger that is life-threatening.  This 'fight-or-flight' response is a healthy reaction meant to protect the person from harm.  In PTSD, this reaction is changed or damaged.  People who have PTSD may feel stressed, frightened, or anxious even when they are no longer in danger.  PTSD's common characteristics are: re-experiencing of the trauma in thought, feeling or in dreams, which is further evidenced by the individual taking steps to psychologically and emotionally numb themselves from the event (this can take many forms, for example, substance abuse).  Other symptoms to look for: feelings of strong guilt and depression; feeling emotionally numb; loss of interest in work or activities once enjoyable in the past; anger; feeling tense or on "edge"; having difficultly sleeping; cynicism and distrust of others; memory loss of past events; alienation and isolation from others.  There are other symptoms, but these are the big ones.

I also want to point out that anyone can get PTSD at any age.  This includes war veterans, survivors of physical and sexual assault, or abuse.  Children can get PTSD from dysfunctional parents or from bullies.  PTSD can occur from emotionally or physically abusive relationships, accidents, disasters, and many other traumatic events.  In fact, most people in our society are walking around with some form of PTSD and are not even aware of it.  Not everyone with PTSD has been through a dangerous event.  Some people get PTSD after a friend or family member experiences danger or harm (say, for instance, a son or daughter fighting in war, or being sent to prison).  Just thinking about what could be happening to someone we love who is in harms way can bring on a case of PTSD.  The mind doesn't know the difference if what you are experiencing is real or imaginary   Constantly thinking about it, changes the way our brains work and function.  That's why our thoughts are so important and learning how to interrupt those thoughts before they trigger the re-experiencing of the trauma is critical to recovery.  PTSD can be found among survivors of the Holocaust; of major natural disasters like earthquakes or tsunamis; of tragedies like 9/11; of car or train accidents; and, of course, combat.  Some people get PTSD after the sudden and unexpected death of a loved one.  Even some of the television shows and movies we watch can throw us into trauma because of their horrific and brutal level of violence.  Surprising isn't it?

Now, let's take a look at the historical evidence of PTSD (below I reference the articles where I found this bounty of information.  I encourage all of you to read it, especially Steve Bentley's article, of which I will tag a link to the Vietnam Veteran's of America's website):


  • Nearly 3000 years ago, a combat veteran from Egypt described his feelings before going into battle.  His name was Hori.  "You determine to go forward...Shuddering seizes you, the hair on your head stands on end, your soul lies in your hand." [1]
  • The Greek Historian Herodotus wrote a lot about PTSD experienced by the Greeks of that time.  In the Battle of Marathon in 490 B.C., he cites an Athenian soldier who went blind when the soldier next to him was killed, even though the blinded soldier "was wounded in no part of his body."  Herodotus also reports that Leonidas dismissed many of the troops before the battle of Thermopylae because he recognized they were psychologically worn down from too much fighting.  "They had no heart for the fight and were unable to take their share in the danger." [1]
  • Homer's epic poems 'The Iliad' and 'The Odyssey' deal with the effects of war both during the battle and the long journey home.  In 'The Iliad', Ajax goes mad, slaughters a bunch of sheep he thought were the enemy, and then commits suicide.  One could argue Ajax was under the influence of PTSD.  Achillies slaughters hundreds of Trojans after the death of his friend Patroclus in battle.  Clearly, the lines of morality and humanity have been blurred by the wrath and the desire for savage retribution experienced as a consequence of the horrors and pains of war.  In 'The Odyssey', Odysseus suffers from PTSD, takes a 10 year journey, fraught with challenges and trials, as he tries to return home and re-integrate himself back into a world that is both familiar and foreign to him.  Both these epic poems echo the same loss, anger, and guilt that have wounded soldiers for generations. 
  • The playwright Sophocles wrote two plays 2,500 years ago that began to explore the effects war was having on the minds of those who fought them.  The two plays: "Ajax" and "Philoctetes".  Amazingly, Sophocles was already talking about the thousand yard stare, and using words like 'shell-shocked.'
  • In 1003 A.D., The Anglo Saxon Chronicle reported that the English commander Alfred, during the battle between the English and the Danes, became so violently ill that he began to vomit and was not able to lead his men. [1]
  • Shakespeare described PTSD very accurately in his play 1 Henry IV.  In Act II, scene iii, Lady Persy questions her husband Henry Persy as to what is troubling him.  She tells him what she has observed: that he doesn't sleep; that his eyes are bent to the earth; that he is prone to melancholy; in his sleep, he murmurs "tales of iron wars" and she watches him in the throws of his nightmares.

The spirit within thee hath been so at war, 
 And thus hath so bestirr'd thee in thy sleep, 
That beads of sweat have stood upon thy brow, 
Like bubbles in a late-disturbed stream, 
And in thy face strange motions have appear'd, 
Such as we see when men restrain their breath 
On some great sudden hest.

  • To show you that PTSD is not limited to the war experience, there is the account of Samuel Pepys who lived in London in the 1600's and survived the Great Fire of London in 1666.  In his diary of the event, he says he was unable to sleep for days after the fire.  "Both sleeping and waking, and such fear of fire in my heart, that I took little rest." [1]  He goes on to say a couple weeks later, "[M]uch terrified in the nights nowadays, with dreams of fire and falling down of houses."[1] 
  • The American Civil War heralded in the dawn of modern warfare.  Soldiers were exposed to repeating rifles and pistols, the Gatlin gun, and delayed artillery rounds that burst in the air.  The immediate consequence of the evolution of military warfare technology was the dramatic increase in the psychological injury done to the soldiers in the field.  Men were collapsing from emotional illness when they returned home, even though they had shown no symptoms when they were on the front lines.  Military physicians were at a loss on how to treat the ever increasing problems, and would simply send the most extreme cases back home on a train with no supervision, with only their name of their home town or state pinned to their tunics.  Richard A. Gabriel, a former consultant to the Senate and House Armed Services Committees and one of the foremost chroniclers of PTSD, reported "others were left to wander about the countryside until they died from exposure or starvation." [1]  By 1863, the number of insane soldiers simply wandering about the countryside was so great, there was a public outcry to do something about it.  In response, the military established its first hospital for the insane, the most common diagnosis was for 'nostalgia', 'soldier's heart', or 'exhausted heart', what we today refer to as PTSD. [1]
  • Charles Dickens was involved in a railway accident on June 9, 1865 where the front of the train plunged off a bridge under repair in which 10 people died and another 49 were injured.  Dickens wrote in letters to people after the accident describing the horrific scene and what he had witnessed and the lingering effects of the trauma that debilitated him.  He wrote that he was "unsteady," unable to concentrate on his writings, and had this constant fear of riding in trains because he kept imagining and feeling that the train was tipping over on its side.  Dickens was never as prolific a writer after this incident. [1] [2]
  • For WWI and WWII, the numbers of men who suffered from psychiatric casualties is staggering.  During WWI, almost 2 million men were sent to fight overseas.  116,516 died in the war, another 204,000 were wounded.  159,000 soldiers were kept out of action because of mental or emotional disturbance, and nearly half of these (70,000) were permanently discharged. [1]  Between the wars, psychiatrists continued to believe this emotional and psychological collapse was rooted in men who were weak in character.  So, they began to more thoroughly screen the people entering the military, thinking that if they weeded out the weak in character, this would solve the problem.  They were wrong.  "In World War II, the ratio of rear-area support troops to combat troops was twelve to one.  In the four years of the war, no more than 800,000 soldiers saw direct combat, and of these, 37.5 percent became such serious psychiatric cases, they were permanently discharged.  In the U.S. Army alone (not counting Army air crews) 504,000 men were lost to the fight for psychiatric reasons.  Another 1,393,000 suffered symptoms serious enough to debilitate them for some period." [1]  Clearly, as these numbers indicate, it was not just the "weak" who broke down in war.  The military finally started to realize that "every man has his breaking point".[3]
  • In Korea, 1,587,040 served.  33,629 were killed in combat and 103,284 were wounded.  Of the 198,380 who were actually in combat, 24.2 percent suffered from PTSD. [1]
  • In Vietnam, there were 2.8 million who served.  According to the Research Triangle Institute's Vietnam readjustment study, approximately 480,000 of those who served have full blown PTSD and another 350,000 have partial PTSD.[1]
  • The Iraq and Afghanistan Veterans of America, a nonprofit and nonpartisan organization for the veterans of our current wars, states 2.4 million people have served in these wars.  According to the National Veterans Foundation, when I spoke with them several months ago, they told me 20-35 percent of those who've served or are serving have some form of PTSD.    


When you look at this, truly look at how PTSD has affected the lives of millions of people throughout history,  including our own present day, it's no wonder this is all coming to a head to be examined, understood, and healed for humanity.  And this list doesn't take into account all the millions of people affected by accidents, disasters, emotional or physical abuse, family traumas, or secondary PTSD.  When looked at from this larger perspective, it's staggering how many unknown millions have been affected by it.  There are so many of us today who are walking around with it or have been influenced by it on some level.

Mankind is at a crossroads.  We will end war in our time, or war will end us.  It's that simple.  I don't know how war and peace can co-exist.  Our weapons are too sophisticated, our technology too advanced.  We have harnessed the power of the atom, and with just the push of a button, we can wipe out humanity for good.  Conflict doesn't necessarily mean violence, but that's what we have defined it as, and our history shows it.  There has to be a better way to deal with the conflicts in our lives than to resort to war and violence as the answer.  Whenever war or violence has been used, it is opposed to everything life is for, and diminishes our capacity to live our lives as they were meant to be lived.  We become trapped in the endless cycles of pain and trauma that plague the collective and individual consciousness of those that came before us and those with us today.  To truly break free and learn from the past, what all those souls before us are screaming at us to look at is not to go psychically numb to the truths of war and violence.  The truth may hurt, but it sure is a lot better than lying to ourselves that we were not affected by the traumatic events in our lives.  When we see the truth clearly, and have not numbed ourselves to our own pain and suffering, we open ourselves up to making better choices in the present and for the future, so as not to put others through the same experiences we went through.  But we can't get there unless we re-frame the nature of conflict.

Conflict is a rite of passage and helps you to grow tools.  As any good storyteller knows, you have to put your protagonist in a series of escalating conflicts which stretches him to his limits, tests him in ways he could never have imagined, reaching the climax where he is confronted with the ultimate challenge, and then, at the end of the story, the protagonist is redeemed.  The main character is better for having gone through the experience.  He has become better as a consequence of going through this journey.  He has earned what he has gained.  Whatever your story may be, the conflicts that have colored your life are the very experiences you needed to gain the tools to become better than you were before.  We all get to choose how we allow the traumas in our lives to influence us.  If we suppress them, they come back to us in another form asking for us to look at them.  Nothing goes away until we have learned everything we need to learn from it.  Wherever we have been wounded, no matter how deep, there is a gift behind it.  Conflict stresses us. Sometimes it constricts, confines, and squeezes us to the point where we think we can't take it anymore, where we feel we can't go on, and then, amazingly, comes the period of growth and expansion.  The conflict forced us to break out of our way of being, to re-evaluate who we are and who we'd like to become.  And this process occurs not only with individuals, but in our communities, societies, and nations as a whole.

Seeing conflict as a rite of passage neutralizes the negative connotations we have associated with it.  Ironically, without conflict, we do not grow, and we do not learn the tools that would get us to where we want to be, and who we want to become.

What does the history of PTSD show us?  It shows us that people have suffered enormously over the many centuries because of traumas, whether it be war, accidents, disasters, emotionally or physically abusive relationships, family traumas, etc.  It's time we stop turning our backs, look at it for what it is, and learn the lessons all these many millions want to teach us.  We must find a way to heal PTSD within ourselves, so that we stop the cycles of traumas that plague our lives and the lives of our loved ones, and stop it from being passed down to future generations.  We must learn to remove violence from our association with the nature of conflict, and see the value conflict brings into our lives for our growth and evolution.  And lastly, it shows us the insanity of war.  How sane men go insane because of what they see and experience.  The casualties of war go far beyond those left on the battlefield, and until we as a society, as a world community, decide we will finally eradicate the greatest cause of PTSD throughout all time, war, those casualties will continue to mount.
        

      
References
1.  Bentley, S. (2005).  Short History of PTSD: From Thermopylae to Hue soldiers have always had a disturbing reaction to war.  Vietnam Veterans of America: The Veteran.  Retrieved from http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm
2.  http://io9.com/5898560/from-irritable-heart-to-shellshock-how-post+traumatic-stress-became-a-disease
3.  http://historyofptsd.wordpress.com/
4.  https://www.ptsdforum.org/c/wiki/history-of-posttraumatic-stress-disorder/
5.  http://www.nbcnews.com/id/26203463/#.UU9m_RyG1ic
6.  www.iava.org