Post-Traumatic Stress Disorder and Older Men: If Only Time Healed All Wounds
Karner, Tracy Xavia, Generations
Trauma has been noted as the "hidden variable" in the lives of older adults that affects psychological, social, physiological, and behavioral functioning. Understandings of trauma have evolved considerably in the more than two decades of research since the initial entry of post-traumatic stress disorder (PTSD) in the 1980 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Originally a diagnostic category for war trauma primarily studied in Vietnam veterans, PTSD has been applied to individuals of all ages who have suffered a wide variety of both combat- and noncombat-related traumas. Thus the effects of trauma in older populations have been acknowledged, but thorough research remains to be done.
Currently FTSD is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR, 2000) as occurring after one experiences, witnesses, or confronts a traumatic event including actual or threatened death, serious injury, or a threat to the bodily integrity of self or others that evokes fear, helplessness, or horror. Traumatic events include physical assault, natural or man-made disasters, combat, and captivity (Cook and O'Donnell, 2005). Symptoms of PTSD include re-experiencing (flashbacks or visceral responses), avoidance activities (such as drinking or drug use), and arousal or hypervigilance. FTSD is considered acute if the symptoms last less than three months, and chronic if the symptoms continue for more than three months.
A BRIEF HISTORY OF PTSD
The definition of PTSD has broadened since 1980, though the diagnostic category is the direct result of the efforts of veterans of the Vietnam War and the psychologists to label and treat their experience (Scott, 1993). Combat-related FTSD was thought to be the contemporary version of "battle fatigue" or "shell shock," a psychological disintegration found to occur under the stresses of combat. As carry as the Civil War, some combatants were reported to have had difficulty adjusting to the stress of battle (Scott, 1993). The Surgeon General of the Union Army described the condition as "nostalgia" and recommended that such individuals should be retained in the combat zone but reassigned to less stressful duties. However, "nostalgia" was not treated by psychiatric specialists until the Russo-Japanese War (1904-1905), and it was not until World War I that the military began planning for psychiatric casualties as an integral part of their support operations (Bourne, 1970).
During World War I, soldiers' breakdowns were thought to be related to the proximity of exploding shells and thus labeled shell shock. Mental impairment was linked to an organic cause-shell explosions causing a concussion of the brain.
This organic model was called into question, though, by cases of "shock" among men who had not been near explosions (Showalter, 1985). Such cases were summarily written offas "outright cowardice" or "lack of moral fiber" and considered "emotional shock" (Bourne, 1970, p. II). During this war, treatments for shell shock and emotional shock differed dramatically. Those deemed emotionally shocked "were kept near the forward medical units and treated with painful electric shocks, threats of imprisonment and even execution" while the shell-shocked soldiers "were evacuated to medical facilities further to the rear" (Bourne, 1970, p. 12). Treatment for emotional shock was perceived to be highly effective, with a majority of patients returning to combat, while shell-shocked patients had a lower rate of recovery, which was thought to be the result of the organic nature of their problems.
Later systematic clinical tests concluded that there was not an organic component to shell shock (Showalter, 1985). Gradually, the psychiatric community came to the conclusion that "the emotional stress of prolonged exposure to violent death was sufficient to produce a neurotic syndrome resembling hysteria in men" (Herman, 1992, p. …