To Hell and Back: Evolution of Combat-Related Post Traumatic Stress Disorder
Nidiffer, F. Don, Leach, Spencer, Developments in Mental Health Law
Post Traumatic Stress Disorder (PTSD) is the psychiatric diagnosis now given to a set of reactive symptoms that result from experiencing a traumatic event or a series of such events. This Article will focus on the history of combat-related PTSD and the emotional and behavioral responses to being in a war zone. The history of this diagnosis will be reviewed in conjunction with related contemporary political, legal, and social developments to better understand the unique aspects of this diagnosis. The behaviors of military service members (i.e., Soldiers, Marines, Airmen, Sailors, and members of the Coast Guard) in combat and their integration back into society will also be addressed. Finally, the challenge of making reliable and accurate related diagnoses and determining the appropriate dispositions for Veterans with this disorder, including those who have run afoul of the criminal justice system, will also be briefly discussed.
"It's my nerves. I can hear the shells come over but I can't hear them burst." (1)
The quotation that begins this Article is arguably the most famous sentence uttered in the history of the military--and perhaps in general--regarding PTSD. Although reports vary, on August 3, 1943, Lt. Gen. George S. Patton, commander of the Seventh U.S. Army, was visiting a military hospital in Sicily. In one account (Finding Dulcinea, 2009), as Patton walked past the beds of wounded soldiers, he would ask them about their injuries. When he came to the bed of 18-year-old Pvt. Charles H. Kuhl, he noted no visible signs of injury. Patton inquired about Kuhl's health and was told he had been tentatively diagnosed as having a case of psychoneurosis.
Turning to Pvt. Kuhl, when Kuhl told Gen. Patton that he could not handle psychologically the battle lines, Patton reportedly became enraged, called Kuhl a coward, and slapped him across the face. As Patton began to leave the tent, he heard Kuhl crying. Turning back, he struck Kuhl again and ordered him to leave the infirmary tent. It later emerged that Kuhl had malaria and a high fever. In a less publicized event a week later, Patton slapped Pvt. Paul G. Bennet, who had been hospitalized for his "nerves." News of both incidents ultimately reached Gen. Dwight D. Eisenhower, who sent a letter of reprimand to Patton and wrote "I am well aware of the necessity for hardness and toughness on the battle field.... But this does not excuse ... abuse of the 'sick'."
Months later a radio broadcaster revealed to his American listening audience that Patton had slapped Kuhl, which resulted in many members of Congress and the press calling for Patton's removal from command. Notwithstanding that Patton at the time was one of the most famous and successful generals of World War II, the Senate delayed Patton's confirmation as major general because of this incident and he was relieved of his command of the Seventh Army by Eisenhower. Later he would be given command of the Third Army, which he led to victory in the Battle of the Bulge and other encounters. The repercussions Patton incurred for his response to these soldiers marked a significant shift in society's (and the military's) recognition of and response to PTSD.
PTSD has formally existed as a behavioral health issue since its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III)in 1980. However, the symptoms associated with PTSD have no doubt always been part of human psychology. Emotional and behavioral reactions to traumatic life-threatening events have likely occurred since humans first hunted animals for food and competed with other humans for the resources needed for survival. On a more collective scale, warfare--which has been prominent throughout human history--has had a similar impact. Trauma has generally been an inherent component of this warfare, notwithstanding efforts by commanders of armies to sometimes ignore and, at other times, suppress what are relatively typical psychological and behavioral responses to life-threatening combat in their soldiers. …