V&W... Is for Violence and War; Professor Jonathan Bisson Explains Why Post-Traumatic Stress Disorder Is a Real Condition Not the "Ubiquitous Phenomenon" It Is Sometimes Considered to Be

Article excerpt

Byline: Jonathan Bisson

SAMUEL Pepys and Charles Dickens are among the historical figures who have described symptoms suggestive of post-traumatic stress disorder (PTSD).

Medically unexplained physical symptoms, such as palpitations and shakes, have been a characteristic feature of many people's reactions to traumatic events over the centuries.

Such physical manifestations of stress and anxiety reactions have been given a number of labels suggestive of a physical cause - for example during the American Civil War there was irritable heart and in the 19th century, railway spine.

By the World War I, it was increasingly accepted that people did experience psychological reactions to traumatic events - hence those who suffered from shell shock were treated in military psychiatric hospitals.

The reactions tended to have a stronger physical feel in those days. For example, conversion disorders such as paralyses of limbs or muteness were commoner than now.

This was, perhaps, understandable given that a psychological reaction, which involved running away from the frontline, risked being labelled as cowardice with potentially fatal consequences.

World War II resulted in many more traumatised individuals but lessons learned during the wars appeared to be forgotten afterwards.

During the 1970s, a powerful lobby developed in the US concerned with the existence of psychological reactions to the Vietnam War. At the same time, similar symptoms were being reported by another group of traumatised individuals, predominantly women. This was called rape trauma syndrome.

These two groups have been credited by many with the first recognition of PTSD as a diagnosable psychiatric disorder in 1980. Officially, we weren't able to diagnose it this side of the Atlantic until 1992.

The lifetime risk of developing PTSD has been estimated at around 7% and once established, it becomes a chronic enduring psychiatric disorder in around a third of sufferers.

My first conscious memory of PTSDwas as a relatively new regimental medical officer in the Army in the late 1980s.

The medical centre staff were concerned about a soldier who had presented early that morning in a distressed state and was being calmed by the staff.

He was clearly unwell, agitated, tearful and barely able to get his words out. He told me his difficulties had been building up since witnessing an observation tower being attacked on a tour of Northern Ireland the year before.

He described recurrent distressing thoughts of what had happened, nightmares re-enacting the attack, which woke him from his sleep panic stricken, and attempts to avoid talking or thinking about what had happened.

To his great credit, he had soldiered on but his work performance had deteriorated.

For the first time, but definitely not the last, a soldier described how the smell of marzipan would trigger very distressing thoughts - sodium nitro benzene, an improvised explosive, has the same smell as marzipan.

The soldier had become withdrawn and detached from his family and friends, he described reduced interest in things around him and was very on edge. He spoke of being irritable and had got into trouble as a result.

He described reduced concentration, sleeping difficulties and marked hyper-vigilance. This is again characteristic of veterans I have treated with PTSD, especially those who have served in Northern Ireland and Iraq - they speak of it being very difficult not knowing who the "enemy" was.

I left the military in 1993 and came to Wales. My military background resulted in me receiving referrals to see veterans, particularly former Welsh Guards, the same age as me, who had served in the Falklands War and were on, or in the vicinity of the Galahad when it was bombed.

Many of these veterans were severely affected by their experiences - they certainly fulfilled the criteria for PTSD, but also for other conditions. …