Post-Traumatic Stress Disorder in the Military Essay Example for Free

Post-Traumatic Stress Disorder in the Military Es verbaliseI. AbstractStoked by an adversarial media and the run-up to Presidential elections next year, the trauma afflicting our body politic often seems to a neater extent important than the deaths, somatic dis ablement and post-trauma sieve inconvenience unmatchednessself that afflict assistancemen on the frontlines.In this paper, I review the historical origins and roll the preponderance of what was whimsic wholey called passs look in the Civil contend and disordered accomplish of the heart (DAH) or neurasthenia at the turn of the centimeury and has now gained cognizance as field of honor weariness or PSTD. The etiology is vast, since trash melody seems to provoke a great numerous an(prenominal) tangible, physiological and anxiety- associate disorders. Lastly, I investigate the treatment options. struggle is ever a violent business. If the North-South Civil fightf ar assaulted Ameri digests with unkn birth hazard counts and the violence of troths waged at the dawn of the industrial age, World war I traumatized the semipublic with the everlasting violence brought to bear in swears of breaking the stalemate that was the Western front. Poison gas, the machine gun, barbed wire, and massed weapon system bombardment sent casualty counts sky high. Besides the United States, 17 other(a) countries on both sides of the war to end all wars suffered no little than 5.7 million soldiers killed and a nonher 12.8 million wounded.Soldiers at the frontline were brutalized by the sheer violence of artillery bombardments, the random deaths these caused and the experience of seeing an unceasing number of their fellow soldiers slaughtered by gas or machine gun fire. It was then that the nervous condition runner barriered war neuroticism or neurasthenia manifested in great numbers. Eventually, the equivalent term sheath jounce came into wider use. contend stress receptions first came to the attention of the aesculapian establishment (psychiatry was in an embryonic stage then) in the second half of the baseball clubteenth century and early in the 20th when physicians came to recognize adverse reactions that had more to do with uphold pic to battle conditions than any physical injury. In retrospect, the Civil contend condition then termed soldiers heart was really a form of rubbish stress reaction.During the Boer state of war waged by the British in South Africa (1899-1902), due notice had already been given to either disordered action of the heart (DAH) or neurasthenia/shellshock. Retrospective analysis of British soldiers who had been pensioned off for these conditions (Jones, Vermaas, Beech, Palmer, et al. 2003) found no especially signifi whoremongert fight in mortality comp ared to comrades who filed for dis magnate owe to bullet or shrapnel wounds.The Russia-Japanese state of war of 1904 and 1905 gave Russian physicians their first describe pain ting to, and the opportunity to try and treat, nervous breakdowns owing to the stress of warfare, compounded by the demoralization of losing to the Japanese. by and by in the 20th century, the evolving nature of the battlefield and the competitor World War II, the Vietnam War, the Iraq and Afghan occupations existence the more prominent examples created unexpected new sources of stress that complicated the armed combat drudge syndrome and led to the broader post-traumatic stress disorder coming into wide use. So whereas combat bear referred to a intellectual disorder caused by the stress of active warfare, posttraumatic stress disorder revolved on post-combat fatigue, shock or neuroticism.V. Statement of the caperIn this research paper, we review the available authoritative sources to assessThe continuing prevalence of PSTD in the vary conditions of modern warfare.Short- and long-term therapy employed to resolve the disorder.The extent to which familial and community supp ort ameliorates PSTD and improves patient outlook.For a world that has experienced unremitting infringe since World War II, whether orthodox warfare, low-intensity conflict or insurgency, chances are that anticipating and providing therapy for stress disorders pass on be a continuing concern.VI. Literature ReviewA. The Character of Modern infringeIn the subsequentlymath of the Great War many people believed that they had seen the most terrible war the world testament ever see. History would prove them wrong. In the century that followed, war became fifty-fifty more traumatic and horrifying in its brutality. From the Russian civil war to the present conflict in Iraq, war took an ever-heavier price on the human psyche. Technology improved the methods by which death might be delivered but it has through nothing to strengthen the minds of those who had to bear it.The Russian civil war that succeeded until after World War I was a horror to behold. Thousands died in the fighting bet ween the White Russians and Red Russians. Thousands more froze in the spend for lack of appropriate gear. Worse, many civilians were murdered by both sides on mere suspicion of macrocosm col getators.World War II was a litany of affrights. Whole societies were brainwashed into supporting the war from an ideological standpoint. Millions of Jews were gassed and ruin in the holocaust simply being Jews. The SS, the KGB and the Kempetai would murder anyone at whim. Thousands of women were kidnapped and raped as comfort women by the Imperial Japanese Army.More than the individual or large-scale slaughter of men, the true horror of WWII was the paroxysm it inflicted on societies. Entire cities were razed to the ground in terror bombing. Cities became prison cells where starving denizens were forced to labor endlessly. Men went off to war leaving women to tend the factories and leaving no one to care for the children. and then at that place was the Atomic Bomb. A scant few pull ahead of thousands died. Both cities were leveled to the ground. The radioactive damaged would suffer for age. Even those who tried to help the victims were themselves victimized by the radiation.In Korea and Vietnam, millions were fielded in grueling civil wars. Korean fought against Korean backed by Communist and Imperialist masters. The same would be true for Vietnam but with the cellular inclusion of terrible chemical weapons that defoliated forests and would cause harm for generations to come. In turn, the Viet Cong and Khmer Rouge executed savage campaigns against their own people.The Arab-Israeli and Iraq-Iran wars would institutionalize child-soldiery. Israel had a scant 4 million citizens to oppose over 200 million Arabs. When attacked by the Arabs, Israel would be forced to deploy all its manpower, along with women, to help fight off the invaders. Chemical weapons were in addition used. The Israelites were left to defend their small nation against all their neighbors.Iraq an d Iran would field child soldiers in countless thousands. They would be given rifles then thrown into battle against hardened veterans in the hope of at least slow down down the enemy. Muslim killed each other over essentially religious disputes.But perhaps the polish off war of the 20th century would be the War on Terror. In the past the enemy was a particular country or group of countries. If they bomb our territory we can bomb theirs. But today, the enemy is not a nation. Today, servicemen in Iraq or Afghanistan do not know where or when the enemy will strike. All they know is that the enemy is out on that point lurking amongst a hostile population.The war on terror also has another unsavory aspect. The enemy resort to bombing civilian targets back home. Worse, the soldiers know that their victories will exactly make the enemy more desperate and make them retaliate more against innocent civilians.As if the violence of outright warfare and low-intensity conflict were not enou gh, American and British forces of occupation as strong as the soldiers of every nation that serve in U.N. peacekeeping forces confront at least personify prospects of PTSD. Whether in the Korean DMZ, the former Yugoslavia, Iraq, Afghanistan, Somalia, Lebanon, Ireland, or Timor, every soldier on such assignments faces a mountain of perils.In many cases, peacekeeping forces are in a low-intensity-conflict situation but hampered by rules of date that deny them the right to shoot first and shrug it off as a mistake. The potential for battlefield fatigue climbs higher with alien cultures and religions, a seemingly ungrateful, resentful and even hostile native population, self-annihilation attacks, well-armed guerillas, booby traps, mortar and improvised missile attacks. Such occupying forces are also apt to lose the public relations war for being unable to stop factions from slaughtering each other such as happened in Iraq, Afghanistan, Israel, Lebanon, East Timor and Rwanda. And perhaps the unkindest cut of all is when their own countrys media deliberately distort the casualty count from fratricidal or genocidal conflict as having been caused by the occupying or peacekeeping forcesB. Incidence of Shell misfortune, PTSD and Precipitating EventsWhen shell shock came to be widely recognized in World War I, the initial hypothesis was that it was induced by an inordinate number of fatal casualties. In fact, about 10% of all military forces then engaged succumbed on the battlefield, double the rate in World War II (less than 5%, in great part because the wide availability of sulfanilamide averted more deaths from battlefield infection). ulterior came the realization that it was total casualty count that really mattered. Historical research shows that around 56% of soldiers on the Western Front were either killed or wounded. When every other fellow in ones platoon gets hit, fatally or not, it is no wonder that stress casualties were as numerous as battle casual ties.The term itself, shell shock reveals the ingrained belief that psychiatric casualties from the horrors of the battles of the Somme, Marne, Ypres, etc. had suffered concussion (physical trauma to the head or brain) from a close call with an exploding artillery shell. Nearly a decade elapsed before a British War Office Committee realized (Military History retainer, 2004) that battle exhaustion and other varieties of war neuroses accounted for a far greater proportion of cases than concussion did.Great Britain having entered the fray early, the numbers of servicemen struck with shell shock and assorted neuroses were significant.By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions about 15% of all pensioned disabilities and another 44,000 or so were acquire pensions for soldiers heart or Effort Syndrome. (Shephard, 2000)In the post-World War II era, the Vietnam war can be counted the most trauma tic for the U.S. military, not least because of the failure to achieve a clear-cut supremacy and the dissatisfaction of the American public with a war that dragged on so long. Since the fall of Saigon in 1975, estimates of the long-term relative incidence of post-Vietnam syndrome (now recognized as PTSD) among veterans varied from a high of 30% in 1989 and a slightly dishonor 21% in 1996 (Allis, 2005).The most authoritative review in recent years, by researchers from Columbia University and other institutions, suggested that the lower end of the range was the more realistic figure nearly 19 percent of Vietnam War veterans succumbed to PTSD as a direct result of military combat. In addition, The more strong the exposure to war zone stresses, the greater the likelihood of developing post-traumatic stress disorder and having it persist for many years, say Bruce P. Dohrenwend, an epidemiologist at Columbia University. (McKenna, 2006).Fast forward to the current occupation of Iraq. The Defense send offe section reports, based on a sample survey of over 1,600 Army soldiers and Marines, that around one-third (30 percent) of those who had been in intense combat were diagnosed with such mental wellness problems as PTSD and effect. Incidence appeared higher among soldiers deployed to Iraq at least double and for more than six months at a succession (Bookman, 2007). So harming is the occupation, according to an Army study, that one in six of close 1 million soldiers surged to Afghanistan and Iraq will very liable(predicate) be afflicted with PTSD (Allis, op. cit.).The reality turned out to be worsened. Even more appalling estimates of incidence were inform by what has to be the most thorough accounting of the prevalence of post-traumatic stress disorder (PTSD) and conditions resembling chronic fatigue syndrome (CFS), a survey by Kang, Natelson, Mahan, Lee, Murphy (2003) on the entire population of 15,000 gulf War and 15,000 non-Gulf-War veterans. nurture w as gathered in 1995-97.Gulf War veterans reported significantly higher incidence of PTSD (adjusted betting odds ratio = 3.1, 95% confidence detachment 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval 3.9, 5.9). Furthermore, the prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend p 0.01).Back home, the Department of Veterans Affairs reported on an investigation of principally Persian Gulf War veterans (79%) who had availed of the National Referral plan (NRP) and visited war-related nausea and injury study centers meant for combat veterans with unexplained illnesses . Over the consequence from January 2002 to March 2004The more vernacular diagnoses were chronic fatigue syndrome (n = 23, 43%), neurotic depression (n = 21, 40%), and post-traumatic stress disorder (n = 20, 38%). Self-reported exposures related to weaponry environmental hazards, stressA small increase in mean SF-36V mental subdiv ision scores (2.8 points, p = 0.009) and use of rehabilitation therapies (1.6 additional visits, p = 0.018) followed the NRP referral (Lincoln, Helmer, Schneiderman, Li, et al. 2006).The political furor over U.S. deployment in the in-between East has led to permutations, including what Baker (2001) refers to as Gulf War Illness. The more combat exposure they had had, the greater the likelihood that veterans manifest depression, PTSD, fibromyalgia, anxiety, and strike ecumenically ridiculouser health-related quality of life.For the British, a more sanguine view about involvement in Iraq may explain a conclusion that deployment to that strife-torn scene of action does not necessarily lead to increased risk of PTSD. Simon Wessely of the Kings Centre for Military Health Research at Kings College London reports that there is no evidence of anything like an Iraq war syndrome and that British troops returning from deployment were no more likely than U.K.-based soldiers to succumb to PTSD, anxiety or depression (New Scientist, 2006). Wessely seemed heartened by the fact that PTSD casualties this time around were significantly lower than during the former, even less controversial Persian Gulf War of 1991.He also explained the advantage vis--vis incidence of around 20% for U.S. troops on three facts. First of all, British troops are more battle-hardened. Two-thirds of British troops have been in deployments elsewhere, compared with only 10 per cent of US troops. Secondly the US also uses more reservists (in the form of National Guard units) and has responsibility for the batter of the hostile combat zones. To an outside observer, the adversarial stance of the U.S. press and the softness of the American public to withstand sustained conflicts not amenable to success over a visible enemy also count as contributing factors.It would take an Englishman to look into the topic but tongue-in-cheek analysis by Ismail et al. (2000) of U.K. Gulf War veterans revealed tha t the chances of falling prey to PTSD are greater with lower rank (and, presumably, lower social status) and if one leaves the service.Some research has shown that, far from being a steady state or amenable to ageless remission, PTSD has a way of recurring with the re-occurrence of the original precipitating factors or other less specific pressures, such as with serious illness or the sudden lifestyle change of retirement. In Israel, reactivation is a constant possibility owing to the fact the nation is always in a state of war with recalcitrant enemies so this potential trigger has come under scrutiny (Nachshoni Singer, 2006). Case studies suggested that PTSD can recur even when the call to duty is for a family member.C. SymptomatologyIn World War I, shell shock was observed principally as nervous fatigue. The famous photograph (see Figure 1, above) of a patient manifesting the thousand-yard scan became the enduring image of intolerable combat stress glassy-eyed fatigue, slow re actions, indecisiveness, being detached from ones immediate surroundings, and a certain vagueness about that needed doing first.So great were the numbers afflicted and so vividly did the novel phenomenon manifest itself that even the popular press in the U.K. could accurately report the symptoms of battle traumaSomething was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the new-fashioned men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them.They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost nurse of themselves, many were bitter in their speech, violent in opinion, frightening. (Shephard, op. cit.)The unfortunate circumstance of decades of unending small-scale conflict and insurgency campaigns post-World War II have enab led military psychiatrists to more fully define three mark facets of combat neurosis and PTSD fatigue, psychosomatic manifestations and neurotic symptoms.Fatigue is the common denominator behind indecision and inability to concentrate, memory loss, constant waffling about priorities, little initiative, significantly slowed reaction time, seriously downgraded alertness and thought processes, pickings refuge in obsessing and nitpicking unimportant details, and, most telling of all, difficulty with even routine tasks.The element of neurosis crops up as fearfulness, anxiety, irritability, depression, confusion, paranoiac tendencies, fear of loss of swear, and self-destructive behavior such as depicted object abuse or suicide.Consequently, PTSD patients manifest the entire spectrum of somatically-induced disorders headaches, backaches, (see also Mayor, 2000) being constantly high-strung, shaking and tremors, sweating, sickness and vomiting, loss of appetite, abdominal distress, frequ ency of urination, urinary incontinence, palpitations, hyperventilation, dizziness, muscle and joint pain (see also Ricks, 1997), insomnia and other balance disorders. Barrett et al. (2002) found this psychosomatic explanation incomplete. In a telephone survey of 3,682 Gulf War veterans and mesh subjects of the same era, the authors revealed that Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life.D. Long-term EffectsNo doubt, psychosomatic disorders are of a chip with another syndrome physicians like to point to chronic multisymptom illness (CMI). Building on earlier studies that demonstrated CMI being more common among veterans who deployed to Saudi Arabia and Kuwait in contrast with those who had never participated in that campaign, Blanchard, Eisen, Alper n, Karlinsky, Toomey, Reda, Murphy, Jackson and Kang (2006) prune out to assess the situation ten years after deployment and found that veterans were twice as likely to develop CMICross-sectional data collected from 1,061 deployed veterans and 1,128 nondeployed veterans examined between 1999 and 2001 were analyzed. CMI prevalence was 28.9% among deployed veterans and 15.8% among nondeployed veterans (odds ratio = 2.16, 95% confidence interval 1.61, 2.90).Blanchard et al. noted that those who did suffer from CMI had already been diagnosed for anxiety and depression unrelated to PTSD prior to 1991. Common CMI manifestations comprised bluff medical symptoms, metabolic and psychiatric disorders. And those afflicted were more likely to smoke, besides reporting distinctly middle-level quality of life.M Hotopf, Anthony S David, Lisa remove, Vasilis Nikalaou, et al. (2003) carried out one of the more comprehensive and authoritative studies of long-term effects, a two-stage cohort study on British soldiers who had deployed during the 1991 Persian Gulf War or on peacekeeping duties in Bosnia.The study relied on four instruments self reported fatigue measured on the Chalder fatigue scale psychological distress measured on the general health questionnaire, physical functioning and health perception on the SF-36 and a count of physical symptoms. Military personnel who had been deployed elsewhere served as control group.Table 1 Prevalence of Categorical Outcomes (value are percentages .95 CL unless otherwise indicated)GulfBosniaEra decimal point 1 peak 2Ratio* (new cases/ cured cases)Stage 1Stage 2Ratio* (new cases/recovered cases)Stage 1Stage 2Ratio* (new cases/recovered cases)Fatigue cases48.8 (45.4 to 52.2)43.4 (39.9 to 46.8)0.65 (0.45 to 0.85)29.0 (25.6 to 32.4)32.7 (28.6 to 36.8)1.21 (0.83 to 1.59)22.8 (20.0 to 25.6)22.0 (18.6 to 25.4)0.91 (0.56-1.26)Post-traumatic stress reaction cases12.4 (10.7 to 14.2)10.8 (9.1 to 12.5)0.73 (0.47 to 0.99)5.7 (4.0 to 7.4)6.0 (4. 2 to 7.8)1.07 (0.49 to 1.65)4.0 (2.6 to 5.3)6.6 (4.8 to 8.4)2.45 (0.88-4.02) command health questionnaire cases40.0 (36.8 to 43.2)37.1 (33.8 to 40.4)0.79 (0.59 to 1.00)29.2 (25.5 to 32.9)31.5 (27.4 to 35.6)1.25 (0.84 to 1.67)25.3 (21.7 to 28.9)23.8 (20.1 to 27.6)0.88 (0.56-1.20)Self reported Gulf war syndrome18.6 (16.2 to 21.1)15.8 (13.3 to 18.2)0.58 (0.25 to 0.90)All prevalence estimates are weighted for sampling.* Values of 1 indicate declining prevalence. Ratios are weighted for sampling.Gulf veterans evinced a higher prevalence of fatigue, post-traumatic stress reaction, self-reported Gulf War syndrome and general health compared to the other two cohorts. The difference is consistent throughout stages 1 and 2. However, the veterans in question did show some improvement on all four measures over time.Table 2 Scores (.95 CL) for Continuous Measures, by Cohort and StageGulfBosniaEraStage 1Stage 2DifferenceStage 1Stage 2DifferenceStage 1Stage 2DifferenceSF-36* physical function90.3 (88.3 to 91.3)88.7 (87.6 to 89.9)-1.6 (-2.5 to -0.7)95.4 (94.4 to 96.4)92.9 (91.6 to 94.1)-2.6 (-3.8 to -1.3)92.1 (90.6 to 93.6)90.8 (89.2 to 92.3)-1.3 (-2.7 to 0.1)SF-36* health perception65.8 (64.1 to 67.5)65.9 (64.2 to 67.6)0.1 (-1.2 to 1.4)76.2 (74.4 to 77.9)72.9 (71.0 to 74.8)-3.3 (-5.1 to -1.6)76.8 (75.0 to 78.6)74.4 (72.4 to 76.4)-2.4 (-4.2 to -0.6)General health questionnaire14.5 (14.1 to 14.9)14.2 (13.8 to 14.5)-0.3 (0.1, -0.6)13.1 (12.7 to 13.6)13.2 (12.7 to 13.7)0.1 (-0.4 to 0.6)12.4 (12.0 to 12.8)12.9 (12.5 to 13.3)0.5 (0.05 to 1.0)Fatigue17.8 (17.4 to 18.1)16.9 (16.5 to 17.2)-0.9 (-1.2 to -0.6)15.6 (15.2 to 16.0)15.3 (14.9 to 15.7)-0.3 (-0.7 to 0.2)14.7 (14.3 to 15.0)14.9 (14.5 to 15.3)0.2 (-0.2 to 0.6) complete symptoms11.0 (10.4 to 11.6)10.7 (10.1 to 11.3)-0.3 (-0.8 to 0.1)6.2 (5.6 to 6.8)7.9 (7.3 to 8.5)1.7 (1.2 to 2.3)5.3 (4.8 to 5.8)6.4 (5.8 to 7.0)1.1 (0.6 to 1.6)All scores are weighted for sampling.For SF-36 scores, negative differences in mean indicate a deter ioration in health. For other scales, negative scores indicate an improvement in health.* SF-36 scales range from 0-100, with higher scores indicating better health.Table 3- Incidence and Persistence of Outcomes. (Values presented with 0.95 CLs)IncidencePersistenceCohortRiskCrude odds ratioCorrected odds ratio*RiskCrude odds ratioCorrected odds ratio*General health questionnaire casesGulf20.2 (16.4 to 24.0)1.01.061.8 (57.3 to 66.3)1.01.0Bosnia21.2 (16.7 to 25.8)1.1 (0.7 to 1.5)0.9 (0.6 to 1.4)58.9 (51.9 to 65.8)0.9 (0.6 to 1.1)1.1 (0.7 to 1.6)Era15.4 (11.4 to 19.4)0.7 (0.5 to 1.1)0.7 (0.5 to 1.1)48.4 (41.0 to 55.9)0.8 (0.6 to 1.1)0.6 (0.4 to 0.8)Fatigue casesGulf18.8 (14.4 to 23.1)1.01.069.7 (66.4 to 73.0)1.01.0Bosnia19.8 (15.1 to 24.4)1.1 (0.7 to 1.6)0.9 (0.6 to 1.5)59.9 (54.2 to 65.6)0.6 (0.5 to 0.9)0.7 (0.5 to 1.0)Era11.2 (7.5 to 15.0)0.6 (0.3 to 0.9)0.5 (0.3 to 0.9)58.2 (53.1 to 63.4)0.6 (0.5 to 0.8)0.7 (0.5 to 0.9)Post-traumatic stress reaction casesGulf5.0 (3.6 to 6.4)1.01.051 .8 (44.8 to 58.9)1.01.0Bosnia4.0 (2.5 to 5.5)0.8 (0.5 to 1.3)0.8 (0.4 to 1.5)38.9 (24.3 to 53.3)0.6 (0.3 to 1.2)0.8 (0.4 to 1.8)Era4.6 (3.0 to 6.2)0.9 (0.6 to 1.5)0.9 (0.5 to 1.5)54.8 (37.8 to 71.9)1.1 (0.5 to 2.4)1.2 (0.6 to 2.7)* Controlled for demographic variables (age, sex, rank, marital status).Comparing scores for continuous measures, one sees that Gulf War veterans were less healthy at both stages of the longitudinal study, though they were stable as far as health perceptions were concerned and reported a statistically-significant, if slight, reduction in fatigue. One concedes that physical functioning declined for all three cohorts.Additionally, Gulf veterans were more likely to experience persistent fatigue compared with the Era and Bosnia cohorts, a finding that remained significant after controlling for potential confounders (P = 0.009).Overall, despite being less likely to manifest less fatigue (48.8% at stage 1, 43.4% at stage 2) and a lower prevalence of psychological distress (40.0% stage 1, 37.1% stage 2) over time, veterans of the Gulf War reported a decline in physical function on the SF-36 (90.3 stage 1, 88.7 stage 2). By all measures used, this group also attested to worse health indicators a higher incidence of illness and more persistent symptoms.Twelve years after helping smash the Iraqi incursion into Kuwait, the authors concluded, Gulf war veterans continue to experience symptoms that are substantially worse than would be expected in an equivalent cohort of military personnel. However, Gulf war veterans are not deteriorating and do not have a higher incidence of new illnesses (Hotopf et al., op. cit.)E. Treatment Recommendations and shell Practice1. World War ISince little is known about the methods Russians used to treat their shock casualties during the Russo-Japanese War, the noted English psychologist Charles Myers first University Lecturer in Cambridge (for the course Experimental Psychology) and appointed Consulting Psycholog ist to the Army in 1916 is generally credited with the first systematic effort to treat PTSD (Bartlett, 1937).While espousing the benefits of a agreeable environment, psychotherapeutic regimens and even hypnosis, Myers was very emphatic about the value of providing succor as promptly as possible. Key to his proposals, therefore, was the establishment of special centers and rest homes close to the frontlines.By Christmas 1916, two developments led to modifications of Myers preferred regimen. First, the British Adjutant General resisted physicians opinions that a soldier was a shock casualty and insisted on obtaining a hallmark from the victims commanding officer to the effect that the trauma was due to physical causes. This attitude was share by the eminent British neurologist Sir Gordon Morgan Holmes, CMG CBE FRS, who was put in charge of the very active northerly part of the front in December. Physicians reacted to the delays in committing victims to neurological centers by sen ding the men back to their units and goad their superiors to both monitor and engage with them.By 1917, therefore, treatment for not yet diagnosed nervous (NYDN) had evolved to embrace the so-called PIE principlesProximity treatment close to the front and within earshot of the fighting to convince the soldier there was nothing wrong with himImmediacy treat without delay and give equal priority with wounded casualties and, foresight assure all victims of their return to the front after due rest and recovery.Reviewing the CSR toll after the war, the British War Office saw fit to recommend treatment programs that includedPhysical therapy baths, application of buggy electric current (recall that medicine has advanced greatly in the eight decades since then), massage rest and general recuperationPsychotherapy emphasizing explanation, persuasion and suggestion and,Crafts and hobbiesHypnotherapy in selected cases for inducing deep sleep and evoking repressed memories.As a rule, the British view of the time was weighted toward returning the afflicted soldier to serviceable employment in civilian life. For the military establishment was gravely concerned about the battlefield dangers of patients who manifested severe anxiety neuroses, other neuroses that required confinement in a mental institution or well(p) treatment back in the U.K itself.Exhaustive research on combat stress reactions in the intervene years failed to prove conclusively that PIE-based programs were effective in forestalling PTSD (U.S. Dept of Veterans Affairs, n.d.). Hence, American Armed Forces are now more likely to be administered some variation of the BICEPS modelBrevityImmediacyCentrality or ContactExpectancyProximitySimplicity2. World War IIThe catastrophic experiences of World War I did not seem to adequately inform or pervasively improve Allied preparations as war clouds loomed in Europe. A generation had passed and British army doctors had generally served in France in the earlier conflict. Still, Shephard notes (op. cit.), they initially floundered about and it was not until 1942 that the first psychiatric hospital was even set up (for the then-beleaguered Middle East Force). When the time came to invade Normandy in June 1944, British army physicians quickly forsook the expectancy principle and routinely returned battle trauma patients home over the Channel.For their part, the Americans initially imposed rigid screening pressures for mental ability in the rush of patriotic fervor that followed Pearl Harbor. Soon enough, this was abandoned for having no validity. Too many who tested well succumbed to battlefield exhaustion. In late 1943, the U.S. military approved a plan to add a psychiatrist to the T.O. E. of every Army division shipping overseas but it was not implemented until March 1944, when the drive up the Italian boot was well underway.This late in the war, nonetheless, the consort made an important discovery camaraderie and unit cohesion were effec tive shields against exhaustion. This finding course enough placed a premium on strong, effective leadership.The Germans were more unequivocal in placing great reliance on the quality of the officer corps. In their view, the war neuroses that sapped the will of their fighting men was tantamount(predicate) to cowardice and deserved to be treated as such. Beginning in 1942, however, when the Allies started the counterattack and the Afrika Korps was stymied, hospitalizations owing to battlefield trauma became too numerous to ignore (Belenky, 1987).3. New approaches in the Post-War PeriodAmong other developments, the Israelis modify PIE procedures by heightening the degree of support administered but keeping therapeutic confinement short. That this works at all is testimony to a nation of citizen-soldiers who must keep the economy working while eternally staying on a war footing.F. Treatment Success RatesThere is some evidence that proximal treatment is successful Despite the dual st ress of fighting another occupying force, the Syrian Army, and Palestinian refugees, nine in ten CSR were reported fit to return to their units within three days but only 40% for those evacuated to a hospital ship cruising the eastern Mediterranean or back home (Gabriel, 1986). In turn, the U.S. Army claims in its manual Combat Stress Control in a Theater of trading operations a similar success rate for proximate treatment (85%) in the Korean War (U.S. Army, Combat Stress Control in a Theater of Operations, n.d.). However, neither source tracked the long-term mental health of these soldiers, precisely the context in which one would expect PTSD to manifest.A ray of hope is, however, cast by an authoritative Columbia University study (McKenna, op. cit.) suggesting that the majority of Vietnam war veterans spontaneously recovered from PTSD over time, frequently without having recourse to treatment from mental health professionals.VII. ConclusionsThis review of the literature affirms t hat the advent of combat stress went hand-in-hand with the advent of industrial-era weaponry (in the Civil War) and mechanized warfare in succeeding conflicts. PTSD has many manifestations, can recur without warning and is certainly debilitating.Even with the advent of psychotherapy, occupational therapy and tranquilizers, treatment centers still purvey variations on the BICEPS and PIE theoretical models, the latter developed by British physicians during World War I. There clay a great deal of uncertainty about the proximity component of the PIE model returning the soldier to combat after suffering CSR. It seems battlefront physicians take successful cure to mean being able to return warm bodies to the frontlines. Critics assert that re-exposure to combat is likely to aggravate matters in the future and perhaps even precipitate PTSD altogether. Though the longest available cohort study spanned just 10 years, there is no question now that PSTD has long-term effects.Future researc hers need to investigate more thoroughly the psychosocial, military, and environmental risk factors that stimulate onset or, on the other hand, recovery. 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