History of PTSD

Reports of battle-associated stress appear as early as the 6th century BC. Although PTSD-like symptoms have also been recognized in combat veterans of many military conflicts since, the modern understanding of PTSD dates from the 1970s, largely as a result of the problems that were still being experienced by Vietnam veterans.

The term post-traumatic stress disorder or PTSD was coined in the mid 1970s. Early in 1978, the term was used in a working group finding presented to the Committee of Reactive Disorders. The term was formally recognized in 1980. (In the DSM-IV, which is considered authoritative, the spelling "posttraumatic stress disorder" is used. Elsewhere, "posttraumatic" is often rendered as two words "post-traumatic stress disorder" or "post traumatic stress disorder" especially in less formal writing on the subject.)

Veterans and politics

The diagnosis was removed from the DSM-II, which resulted in the inability of Vietnam veterans to receive benefits for this condition. In part through the efforts of anti Vietnam war activists and the anti war group Vietnam Veterans Against the War and Chaim F. Shatan, who worked with them and coined the term post-Vietnam Syndrome, the condition was added to the DSM-III as posttraumatic stress disorder.

In the United States, the provision of compensation to veterans for PTSD is under review by the Department of Veterans Affairs (VA). The review was begun in 2005 after the VA had noted a 30% increase in PTSD claims in recent years. The VA undertook the review because of budget concerns and apparent inconsistencies in the awarding of compensation by different rating offices.

This led to a backlash from veterans'-rights groups, and to some highly-publicized suicides by veterans who feared losing their benefits, which in some cases constituted their only income. In response, on November 10, 2005, the Secretary of Veterans Affairs announced that "the Department of Veterans Affairs (VA) will not review the files of 72,000 veterans currently receiving disability compensation for post-traumatic stress disorder..."

The diagnosis of PTSD has been a subject of some controversy due to uncertainties in objectively diagnosing PTSD in those who may have been exposed to trauma, and due to this diagnosis' association with some incidence of compensation-seeking behavior.

The social stigma of PTSD may result in under-representation of the disorder in military personnel, emergency service workers and in societies where the specific trauma-causing event is stigmatized (i.e. sexual assault).

Because of the United States soldiers in combat in the wars in Iraq and Afghanistan, soldiers returning home have faced significant physical, emotional and relational disruptions, the United States Marine Corps has instituted programs to assist Marines in re-adjusting to life, and in particular marriage, outside of the Marine Corps. Similarly, Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist service members avoid or ameliorate PTSD and related problems.

Canadian veterans

Veterans Affairs Canada is a new program including rehabilitation, financial benefits, job placement, health benefits program, disability awards and family support.

Cultural references

Jonathan Shay, a psychiatrist for the Boston Department of Veterans' Affairs Outpatient Clinic was treating soldiers who suffered from PTSD. He was struck by the similarity of their war experiences to Homer's account of Achilles in the Iliad. He also believes Hotspur in William Shakespeares Henry IV, Part 1 is portrayed as a person suffering from PTSD J. R. R. Tolkien served in World War I. It is believed that he portrayed Frodo Baggins in The Lord of the Rings as a person suffering from PTSD. In recent decades, with the concept of trauma, and PTSD in particular, becoming just as much a cultural phenomenon as a medical or legal one, artists have engage the issue in their work. Many movies, such as Birdy, Coming Home, The Deer Hunter, Born on the Fourth of July and Heaven & Earth deal with PTSD. It is an especially popular subject amongst "war veteran" films, often portraying Vietnam war veterans suffering from extreme PTSD and having difficulties adjusting to civilian life.

In more recent work, an example is that of Krzysztof Wodiczko who teaches at MIT and who is known for interviewing people and then projecting these interviews onto large public buildings. Wodiczko aims to bring trauma not merely into public discourse but to have it contest the presumed stability of cherished urban monuments. His work has brought to life issues such as homelessness, rape, and violence. Other artists who engage the issue of trauma are Everlyn Nicodemus of Tanzania and Milica Tomic of Serbia.

George Carlin comments on the various incarnations of PTSD terminology on his 1990 album Parental Advisory: Explicit Lyrics. He traces the progression of what he views as euphemisms, which followed "shell shock" in World War I: "battle fatigue" in World War II, "operational exhaustion" in the Korean War, and finally PTSD, a clinical, hyphenated term, in the Vietnam War. "The pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd have still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time."