Shell Shock

Post-traumatic stress disorder (PTSD), formerly and colloquially called shell shock (this is a World War One term), battle fatigue (World War II), and operational exhaustion (Korean War) during war, is a term for the psychological consequences of exposure to stressful, life-threatening and traumatic experiences. Symptoms include nightmares and flashbacks, sleep abnormalities, extreme distress resulting from personal "triggers", and emotional detachment with the possibility of simultaneous suffering of other psychiatric disorders. Experiences likely to induce the condition include rape, combat exposure, and childhood physical abuse. Unlike brief reactive psychosis, PTSD is a chronic condition.

PTSD is distinguished from normal grief and adjustment with traumatic events in that the normal emotional effects of traumatic events will tend to subside after several months or years, while in PTSD the emotional effects are ongoing. Most people who experience traumatic events will not have PTSD.

In earlier times and even today, "shell shock" among veterans has been regarded as simple cowardice, an unwillingness to put one's welfare at risk when danger is at hand. The modern psychological evaluation disagrees strongly. Shell shock is a mental condition in which the individual involved is perilously close to a break from reality, usually by succumbing to any of several neuroses or psychoses.

PTSD was first recognized in combat veterans following many historical conflicts; the term "shell shock" dates to World War I. At first, the medical community believed that shell shock resulted directly from the stress caused by the noise of repeated shell explosions. The modern understanding of the condition dates to shortly after the Vietnam War. PTSD may be experienced following any traumatic experience or series of experiences that do not allow the victim to readily recuperate from the detrimental effects of stress. It is believed that of those exposed to traumatic conditions, around 9% will experience some symptoms. In peacetime, 30% of those that suffer will go on to develop a chronic condition; in wartime, the levels of disorder are believed to be somewhat higher.

Symptoms

Symptoms can include general restlessness, insomnia, aggressiveness, depression, dissociation with reality, emotional detachment, or nightmares. Amplification of other underlying psychological conditions may also occur. Young children suffering from PTSD will often enact aspects of the trauma through their play, and may often have nightmares that lack any recognizable content.

Treatment of trauma

PTSD is treated by psychotherapy (cognitive-behavioral therapy, group therapy, and exposure therapy are popular) and drug therapy (Prozac, Effexor, Seroquel, and Zoloft). Talk therapy may prove useful, but only insofar as the individual victim is enabled to come to terms with the trauma suffered and successfully integrate the experiences in a way that does not further damage the psyche. The US FDA recently approved a clinical protocol that combines the drug MDMA ("Ecstasy") with talk therapy sessions.

PTSD may co-occur with depression.

Two controversial techniques for the treatment of trauma are EMDR and TIR:

EMDR(Eye Movement Desensitization and Reprogramming) is a technique developed by Dr. Francine Shapiro, in which the client supposedly uses the movement of his or her eyes to access the traumatic event and allow the integration of emotions and sensations that occurred during the traumatic event. For more information on EMDR:

TIR (Traumatic Incident Reduction) is a less well known technique for reducing and eliminating the effects of a traumatic event. TIR is more of a graduated exposure technique that is controlled by the client. In TIR the client retells the trauma and releases the emotions held in check. In addition the client remembers the event and allows the conscious mind to process any decisions, intentions and cognitive distortions that might have occurred during or after the trauma. Practitioners who have been trained in both EMDR and TIR report that TIR is safer because it is focused on a single event and EMDR can occasionally trigger several events and multiple emotions. Interviews with these practitioners have suggested that, while they continue to use both techniques, TIR is the preferred intervention for known traumatic events where the client wants insight and understanding about the event and the aftereffects of the trauma. For more information on TIR

Another aspect of PTSD often overlooked is that the persistence of depressive symptoms in PTSD may be caused by an underlying biochemical disorder associated with insulin resistance (hypoglycemia) that can be treated without recourse to drugs with a change in diet, namely with the Hypoglycemic Diet. see: http://www.hypoglycemia.asn.au/articles/PTStress.html

In animal research, a part of the brain call the amygdala has been shown to be needed to form fear memories. From brain imaging studies, the amygdala has also been shown to be active in human fear. Disfunction of the amygdala may be involved in PTSD. Futher animal and clinical research into the amygdala and fear conditioning may provide additional treatments for the condition.

Fiction

• Pat Barker: Regeneration
• William Somerset Maugham: The Razor's Edge
• Philip Roth: The Human Stain
• Rebecca West: The Return of the Soldier

Non-Fiction

• Spike Milligan: Mussolini: His Part in My Downfall. In this war diary Milligan, one of Britain's greatest post-war comedians, details his descent into madness during the Italian campaign of World War II. The sequel, Where Have All the Bullets Gone? describes the appallingly unsympathetic treatment he received at the hands of military doctors.