Post Traumatic Stress

Discussion in 'Veteran Accounts' started by Trincomalee, Oct 3, 2007.

  1. Ron Goldstein

    Ron Goldstein WW2 Veteran WW2 Veteran Patron

    Formerjughead

    I have to admit that whenever I post anything on a thread as contentious as this one I am always acutely aware that anything I have to say will be examined at length by others and may be used in evidence against me :)

    PLEASE...... do not read too much into my comments.

    My use of the word "weakness" was not intended to be derogatory.

    At the time that I wrote the above I was probably in a hurry and chose unwisely.

    On consideration, there are plenty of other words I could have used to explain my thoughts, "weakness of character" is pretty naff and deserves to be booted out of court. I therefore apologise in advance to anyone who feels they have been offended by the above.

    As a matter of Forum courtesy I will not be editing my posting to pick another word, I hate it myself when people go back and remove substance from a posting so that subsequent comment no longer makes sense.

    Regards

    Ron
     
  2. Wills

    Wills Very Senior Member

  3. jacksun

    jacksun Senior Member

    Interesting discussion. PTSD is one of those psychiatric diagnosis that I think are used and often misunderstood. I don't mean we fail to grasp what it means, but that we apply a too restrictive definition to it and it causes. We also tend to dismiss or diminish such a disorder simply because it is a mental health problem.

    Traumatic Stress is something that is different for everyone, Police Officers, Medics, Fire Fighters, Nurses, and Doctors can easily be subject to suffering from this disorder simply because of the things they see every day, as can anyone else conditioned to seeing traumatic things or not. Everyone will respond differently to a given situation or stressor.
    Doctors are beginning to realize the impact these events have on people, and are expanding PTSD's definition as well diagnosis criteria.

    Ron's use of the word "weakness", when applied clinically is accurate. We all have biological weaknesses, yours may be a susceptibility to high cholesterol, another's may be an inability to deal with stress effectively, and someone else's may be an inability to deal with pollen. These "weaknesses" are not always visible or known, but can be brought out when the person is placed in an extreme situation, or in multiple situations over extended periods of time such as the case of medics.

    When it comes to PTSD, and other mental health issues for some reason we think of them differently. "You have depression? Buck up boy, quit your whinging and get over it" was a common response years ago. When in fact depression can be a very debilitating illness, not unlike many physical ailments. Having had the unfortunate experience of seeing someone who was healthy and happy suddenly completely destroyed by depression to the point of violent suicide because of a single event made me realize how serious these issues can be.

    Having a man's man attitude (not uncommon in the Military) and too proud to ask for help combined with PTSD can be a recipe for disaster. Families and loved ones can end up suffering in many ways.

    Even the Psychiatrists can't nail things down yet, and if we look at the DSM-IV versus the proposed DSM-V (DSM is the Psychiatrists Bible for diagnosis) we see the definition expanding.

    There is even PTSD criteria for preschool children recommended. This brings up many issues and questions surrounding PTSD, like where is the line?

    The DSM criteria is an interesting read to say the least.

    DSM IV criteria for Post Traumatic Stress Disorder
    DSM IV criteria for Post Traumatic Stress Disorder - DWP

    1. The person has been exposed to a traumatic event in which both of the following were present-:

    The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
    The person’s response involved intense fear, helplessness, or horror
    2. The traumatic event is persistently re-experienced in one (or more) of the following ways-:

    Recurrent and intrusive distressing recollections of the event, including images, thoughts, and perceptions
    Recurrent distressing dreams of the event
    Acting or feeling as if the traumatic event were recurring
    Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
    Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
    3. Avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following-:

    Efforts to avoid thoughts, feelings, or conversations associated with the trauma
    Efforts to avoid activities, places, or people that arouse recollections of the trauma
    Inability to recall an important aspect of the trauma
    Markedly diminished interest or participation in significant activities
    Feeling of detachment or estrangement from others
    Restricted range of affect (e.g., unable to have loving feelings)
    Sense of foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span)
    4. Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following-:

    Difficulty falling or staying asleep
    Irritability or outbursts of anger
    Difficulty concentrating
    Hypervigilance
    Exaggerated startle response
    5. Duration of the disturbance (symptoms in criteria 2, 3 and 4) is more than 1 month.

    6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


    Criteria changes being considered for DSM V
    Proposed Revision | APA DSM-5

    Updated May-11-2012

    Note: The following criteria apply to adults, adolescents, and children older than six. There is a Pre-school Subtype for children age six and younger (see below).

    A. Exposure to actual or threatened a) death, b) serious injury, or c) sexual violation, in one or more of the following ways:

    1. directly experiencing the traumatic event(s)

    2. witnessing, in person, the traumatic event(s) as they occurred to others

    3. learning that the traumatic event(s) occurred to a close family member or close friend; cases of actual or threatened death must have been violent or accidental

    4. experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse); this does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.

    B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

    1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.)

    2. recurrent distressing dreams in which the content or affect of the dream is related to the event(s) (Note: In children, there may be frightening dreams without recognizable content. )

    3. dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) are recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. (Note: In children, trauma-specific reenactment may occur in play.)

    4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

    5. marked physiological reactions to reminders of the traumatic event(s)

    C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by avoidance or efforts to avoid one or more of the following:

    1. distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

    2. external reminders (i.e., people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about, or that are closely associated with, the traumatic event(s)

    D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred), as evidenced by two or more of the following:

    1. inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia that is not due to head injury, alcohol, or drugs)

    2. persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” "The world is completely dangerous"). (Alternatively, this might be expressed as, e.g., “I’ve lost my soul forever,” or “My whole nervous system is permanently ruined”).

    3. persistent, distorted blame of self or others about the cause or consequences of the traumatic event(s)

    4. persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)

    5. markedly diminished interest or participation in significant activities

    6. feelings of detachment or estrangement from others

    7. persistent inability to experience positive emotions (e.g., unable to have loving feelings, psychic numbing)

    E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:

    1. irritable or aggressive behavior

    2. reckless or self-destructive behavior

    3. hypervigilance

    4. exaggerated startle response

    5. problems with concentration

    6. sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

    F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

    G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    H. The disturbance is not attributed to the direct physiological effects of a substance (e.g., medication, drugs, or alcohol) or another medical condition (e.g. traumatic brain injury).



    Specify if:

    With Delayed Expression: if the diagnostic threshold is not exceeded until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).



    Subtype: Posttraumatic Stress Disorder in Preschool Children

    A. In children (less than age 6 years), exposure to one or more of the following events: death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:

    1. directly experiencing the event(s)

    2. witnessing, in person, the event(s) as they occurred to others, especially primary caregivers (Note: Witnessing does not include events that are witnessed only in electronic media, television, movies or pictures.)

    3. learning that the traumatic event(s) occurred to a parent or caregiving figure;

    B. Presence of one or more intrusion symptoms associated with the traumatic event(s) , beginning after the traumatic event(s) occurred:

    1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note: spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.)

    2. recurrent distressing dreams in which the content and/or affect of the dream is related to the traumatic event(s) (Note: it may not be possible to ascertain that the frightening content is related to the traumatic event.)

    3. dissociative reactions in which the child feels or acts as if the traumatic event(s) were recurring, (such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings). Such trauma-specific re-enactment may occur in play.

    4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

    5. marked physiological reactions to reminders of the traumatic event(s)

    One item from criterion C or D below:

    C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by avoidance or efforts to avoid:

    1. activities, places, or physical reminders that arouse recollections of the traumatic event

    2. people, conversations, or interpersonal situations that arouse recollections of the traumatic event.

    D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by one or more of the following:

    1. markedly diminished interest or participation in significant activities, including constriction of play

    2. socially withdrawn behavior

    3. persistent reduction in expression of positive emotions

    E. Alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

    1. irritable, angry, or aggressive behavior, including extreme temper tantrums

    2. hypervigilance

    3. exaggerated startle response

    4. problems with concentration

    5. sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

    F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

    G. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.

    H. The disturbance is not attributable to another medical condition.

    Note: An individual can be diagnosed with both the Preschool and Dissociative Subtypes if criteria for both are met.



    Subtype: Posttraumatic Stress Disorder – With Prominent Dissociative (Depersonalization/Derealization) Symptoms


    The individual meets the diagnostic criteria for PTSD and in addition experiences persistent or recurrent symptoms of A1, A2, or both:

    A1. Depersonalization: Experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling as though one is in a dream, sense of unreality of self or body, or time moving slowly.

    A2. Derealization: Experiences of unreality of one’s surroundings (e.g., world around the person is experienced as unreal, dreamlike, distant, or distorted)

    B. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts, or behavior during alcohol intoxication), or another medical condition (e.g., complex partial seizures).

    Note: The Dissociative and Preschool Subtypes are not mutually exclusive.
     
  4. Formerjughead

    Formerjughead Senior Member

    .....PLEASE...... do not read too much into my comments.
    My use of the word "weakness" was not intended to be derogatory.

    .........Regards

    Ron

    I have absolutely no problems with the wording; because that is exactly what exposure to traumatic events does. Some are affected immediately by it while others carry on only to have it affect them later: Hours, Days, Weeks, Months, Years, Decades.
    I have said before that PTSD manifests itself in different ways; depending on the coping skills of the person.
     
  5. Jim Lankford

    Jim Lankford Member

    I have absolutely no problems with the wording; because that is exactly what exposure to traumatic events does. Some are affected immediately by it while others carry on only to have it affect them later: Hours, Days, Weeks, Months, Years, Decades.
    I have said before that PTSD manifests itself in different ways; depending on the coping skills of the person.

    "Coping skills" is almost certainly an oversimplification and misrepresentation of the vast, complex mental and physical interactions that result in PTSD. Somewhere I have a copy of a book on the subject written by a friend of mine as a introductory medical text. It is very readable. If I can lay my hands on it I will add the title in case you are interested in reading it.
     
  6. A-58

    A-58 Not so senior Member

    Brad beat me to it Mr. Goldstein, we know what you meant in your post and took it at face value. Someone of your experience and knowledge will not degrade another's misfortune and predicaments due to PTSD.

    And I agree with you position on not going back and editing your posts to please others, or as it is known here in the US and "being PC". Remember, "once you compromise your thoughts and works, you become a candidate to mediocrity". Author unknown, I wish it was me.

    Either that or fodder for the opposition. (I made that part up myself).
     
  7. Formerjughead

    Formerjughead Senior Member

    "Coping skills" is almost certainly an oversimplification and misrepresentation of the vast, complex mental and physical interactions that result in PTSD. Somewhere I have a copy of a book on the subject written by a friend of mine as a introductory medical text. It is very readable. If I can lay my hands on it I will add the title in case you are interested in reading it.

    It would be if it wasn't what it's called:
    coping skills - Google Search

    *****SPOILER ALERT*********
    There are 6 Million hits when you use the term "Coping Skills" 585,000 are PTSD specific.
     
  8. Jim Lankford

    Jim Lankford Member

    It would be if it wasn't what it's called:
    coping skills - Google Search

    *****SPOILER ALERT*********
    There are 6 Million hits when you use the term "Coping Skills" 585,000 are PTSD specific.

    I found the found the book. It’s “Post-Traumatic Stress Disorder: Additional Perspectives,” by Merrill I. Lipton, MD.

    Merrill is an expert on PTSD, and as a practicing psychiatrist took part in efforts to develop effective diagnosis and treatment protocols for the problem. After being severely wounded multiple times in a very short period of time, and spending two years in Army hospitals Merrill suffered from PTSD, although formal recognition of the disorder would not come into existence or be codified for many years.

    A catch all phrase like “coping skills” is a useful, but oversimplification of a very complex problem as indicated by the book’s lengthy discussion of the etiology, diagnoses and treatment of PTSD. Think about the intricacies and complexities of the human mind, and you will see that there are numerous processes at work and interacting with each other at any given moment in time. Taken in toto we might easily call the mind’s efforts deal with horrific injuries, etc. “coping skills” although in reality the mind and body, conscious and subconscious, are attempting to make sense of and process a veritable host of causal agents associated with PTSD. These same intricacies can mitigate or exacerbate the effects of PTSD for decades, if not for the remainder of the sufferer’s life. So “coping skills” functions as a convenient shorthand for alluding to a vastly complex disorder. This is all I was pointing out in my previous post. Put another way, it just ain’t that simple. (I was not, and am not now, “heckling” you.)

    Returning to the book for a moment, it is an introductory text, and is written in a manner that is accessible to non-professionals. Although copies are difficult to find, I highly recommend the book to anyone who is interested in catching a glimpse of this devastating, even deadly disorder, and how it might be treated.

    Jim
     
  9. canuck

    canuck Token Colonial Patron

    An interesting perspective by Copp and some statistics and observations on the German handling of battle exhaustion cases.


    Broken In Battle: The Invisible Casualties: Army, Part 101

    August 11, 2012, by Terry Copp

    Every soldier is affected by the strain and violence of combat. Most learn to cope or even adapt, some become stronger and tougher, but others develop immediate or delayed reactions that can be psychologically disabling. Historically these have been labelled shell shock, combat fatigue, battle exhaustion, combat stress reaction, post-traumatic stress disorder and most recently operational stress injury. Psychological problems related to experiences in war and other stressful situations are universal, but doctors, patients, governments and the military are constantly changing their ideas about causation, prevention and treatment.

    During the Second World War the Canadian Army initially refused to employ so-called intelligence tests or other methods of personnel selection, preferring to leave it to medical officers to cull “obvious misfits” defined as those “with a history of nervous breakdown, residence in a mental institution, drug addiction, etc.” A specialized hospital combining neurosurgery with neuropsychiatry was created and established at Basingstoke in southern England.
    The neurosurgeons found steady work because the army allowed large numbers of young Canadians to ride motorcycles on the “wrong side of narrow English roads.” The resulting head injuries led German propaganda broadcasts to suggest that every Canadian soldier be given a motorcycle.
    Gradually patients with nervous disorders flooded the hospital which soldiers began to call “No I Nuts.” The neuropsychiatrists at Basingstoke paid close attention to each patient while trying to decide on the best treatment. One particularly difficult case, a major from the Seaforth Highlanders of Canada, responded well to a frank discussion of his problems, but after several months back in his unit he was forced to return to hospital. Normally this would mean an immediate discharge and return to Canada, but something about this young, intelligent officer led the psychiatrists to offer him another chance. The major, Bert Hoffmeister, returned to the Seaforths, and commanded them in action until he was promoted to brigadier and then major-general commanding 5th Armoured Division.
    The Hoffmeister case and other similar examples helped Canadian doctors avoid rigid ideas about the range of neurotic disorders they treated at Basingstoke and the army’s senior psychiatrists, Colonel F.H. Van Nostrand and Lieutenant-Colonel J.C. Richardson, advocated a pragmatic treatment system for use in combat. Third Canadian Div., training with I British Corps for D-Day, got its own psychiatrist, a dynamic young New Brunswick doctor, Maj. Bob Gregory, who won the confidence of medical and military commanders. When large numbers of combat stress cases occurred during the fighting in Normandy for Carpiquet and Caen, Gregory and the field dressing stations were well prepared to provide treatment based on the principles of proximity (to the battlefield), immediacy and expectation (of relief of symptoms and return to unit). When it became apparent that many patients could not be returned to combat, jobs were found in the rear areas.
    [​IMG] PHOTO: FRANK ROYAL, LIBRARY AND ARCHIVES CANADA—PA163670
    Princess Patricia’s Canadian Light Infantry in action, Sicily, July 1943.

    The situation was very different in II Canadian Corps where medical and military officers rejected the advice of the psychiatrists, insisting that exhaustion casualties would not be a significant problem. Following the British model, they relied on a single corps exhaustion unit with an establishment of two psychiatrists and eight other ranks. No I Canadian Exhaustion Unit (CEU) was to be attached to whichever field dressing station had room for them. No. 1 CEU was commanded by an exceptionally able physician, Maj. Burdett McNeel, who tried to educate rather than challenge his fellow officers. No one, including McNeel, anticipated the scale of the challenge. During the six-day period before 2nd Div. began its first battle, 160 cases of acute stress reactions—with tremours, weeping, startle reactions and withdrawal as the main symptoms—arrived at McNeel’s unit. Treatment plans; immediate sedation for 24 hours, followed by two days of rest and “psychotherapeutic talks,” soon had to be abandoned as numbers grew and supplies of sodium amatyl—the sedative—ran out.
    McNeel’s war diary entry for July 18 notes that “We were awakened by a terrific roar of gunfire…rumour is that ‘This is it’ and that the show should soon be over…” So much for rumours, Operation Atlantic, the Canadian part of Operation Goodwood, cost 2nd Div. 249 fatal casualties and 900 men with physical wounds. More than 300 battle exhaustion cases were evacuated to the CEU. The entry for July 22 reads: “One hundred and one cases of exhaustion admitted…our ward and the “morgues” are filled. Those in the morgues have had to sleep on blankets spread on the ground. The rain has been pouring down and the majority of men are wet and muddy.” Fortunately, 2,000 capsules of sodium amatyl arrived and full sedation was possible.
    As McNeel and his small staff tried to cope, the corps’s senior medical officer who had opposed all preparations for psychiatric casualties arrived to apologize and find out what was needed. He warned McNeel that a new and potentially difficult night operation was planned for July 25 with the code name Operation Spring. “The Unit,” he warned, “should expect another increase in admissions.”
    On July 25, one of the blackest days in the history of the Canadian Army, a disaster of near-Dieppe proportions struck 2nd Div. By nightfall, 450 men were dead and more than 1,000 wounded, missing or taken prisoner. Battle exhaustion, during and immediately after this trauma, added several hundred more casualties. The division, after only 12 days in battle, had produced almost as many serious exhaustion cases as the 3rd Div. had suffered in six weeks. Between July 21, when Operation Goodwood ended, and Aug. 30, the Canadians suffered 3,000 killed and 7,000 wounded. More than 1,500 exhaustion cases were evacuated beyond the regimental aid posts. Operation Spring was a costly defeat, seen as having destroyed the self-confidence of much of the 2nd Div. Asked to examine the circumstances which had led to the apparent vulnerability of the division, McNeel conducted an investigation that included visits to the divisional field ambulances and dressing stations, as well as conversations with medical officers, battalion commanders, and the men at the sharp end.
    He soon began to grasp the complexity of the problem, and his report included this important statement: “The sources of error in the compilation of statistics and in the use of such a figure as an Exhaustion ratio are so numerous as to make any conclusion based on statistics alone of very doubtful value. The incidence of Exhaustion in any unit is only a part of the picture of that unit’s efficiency and may be outweighed in a positive direction by a generally high standard of performance and in a negative direction by large numbers of AWL, PoW, and trivial illnesses… The Exhaustion ratio will also be altered by the wholesale evacuation of trivial sick or wounded… For these reasons the thoughtful appraisal of the unit’s overall performance by responsible officers who know all the factors is of more value than any set of statistics or ratio can hope to be…”
    On the other side of the battlefield, the German army was attempting to cope with its own exhaustion crisis by tightening the disciplinary screws. German military psychiatrists had long insisted that stress breakdowns were a leadership problem, not a medical one. In the early years of the war, with the Germans everywhere victorious, such casualties were few. It was satisfying to attribute this to the army’s emphasis on group cohesion and the responsibility of junior officers and especially NCOs for the welfare of their men. But even in the days of triumph, the new Nazi-inspired code of military law was dealing out death sentences and long terms of penal servitude for disciplinary infractions, profoundly influencing military behaviour.
    Battle exhaustion became a significant problem after the German army was forced to the defensive. Some psychiatrists tried to intervene, urging recognition of the nature of stress reactions in battle. A film script about treating such casualties was completed and a statement advocating early forward treatment issued. No doubt many German army units were already using short rest periods and “comradely comfort” for stress casualties. The alternative was to allow soldiers to be caught up in a legal system that was “underpinned by compliance with Nazi war aims and ideology.” With new crimes added almost monthly in 1944-45, “death sentences rained down faster and faster each year.”
    By March 31, 1943, more than 1,500 death sentences had been carried out in the German army, most of them for crimes of desertion and “subverting the will of the people to fight.” (Only 48 German soldiers were executed in the First World War). By mid-1944, 107,000 German soldiers had been tried for absence without leave, 49,000 for disobedience, and 46,000 for contraventions against guard duty. The most serious crimes of desertion and subversion had led to between 13,000 and 15,000 cases each. More than 7,000 German soldiers had been executed for these crimes by June 1944.
    [​IMG] PHOTO: LT. MICHAEL M. DEAN, LIBRARY AND ARCHIVES CANADA—PA131437
    Canadian soldiers wounded on the Normandy beachhead are carried off a Landing Ship Tank in Southampton, England, June 1944.

    The Allied armies took more than 200,000 prisoners of war in Normandy. Many of them had surrendered in a condition suggesting complete physical exhaustion and serious nervous fatigue. McNeel, who saw many such prisoners in late July and August, was convinced many German soldiers were battle exhaustion cases by the end of the battle of the Falaise Gap. In the Allied armies, desertion and other crimes against discipline and good order were dealt with by prison sentences. There were no executions of soldiers or punishment of any kind for acute stress reactions.
    The Canadians, because of their relatively small numbers and their insistence on a completely Canadian medical system, were able to analyze medical events closely. By the fall of 1944, in both Italy and Northwest Europe, Canadian neuropsychiatrists had persuaded senior commanders that battle exhaustion was inevitable and reasonably predictable. Rapid treatment as far forward as possible was the best way of preserving manpower for battle, but it did not always work. A high return to unit rate was probably worth pursuing in military terms, but many individuals would break down again.
    No one was confident that the ones who did not turn up again at exhaustion centres were still effective with their units. Col. Van Nostrand, the senior Canadian psychiatrist overseas, offered his view of the problem: “I am not convinced that psychiatry will ever solve the vast problem of the psychiatric breakdown of soldiers during war. It is my opinion that the methods now employed in the British, American and Canadian armies will not materially lower the incidence of psychiatric casualties in a fighting force. There are various reasons for these opinions, but two of them are fundamental. First, there is direct conflict between the needs of the service and the needs of the individual soldier as assessed by his physician. Secondly, the attitudes and behavior of the successful soldier are contrary to most of his previous teaching. He must not allow death or mutilation of his comrades to prevent him from reaching his objective, and finally, he must pretend that he is glad to risk or lose his life for that cause.”
    He went on to note that “the basic conflicts will always exist in armies such as ours which are composed largely of civilians who become soldiers, either voluntarily or by compulsion for a short period. It is right that this should be so.
    “This is not a plea for sympathy for the inadequate soldier who is unable to stand the stresses of prolonged combat, nor is there any wish that discipline be relaxed or that any of the defections which fall under the heading of cowardice in the face of the enemy should be condoned. It is a plea for the adoption of realistic attitudes toward the reactions of normal men and women to the stresses of war.
    “We who formulate the medical policy should keep constantly before us certain premises which we believe to be true, but which we have ignored in practice: 1) An army’s killing power is not necessarily proportionate to its numerical strength. 2) We fight our wars with human material we have and not with what we think we would like. 3) Although there are wide variations in the capacities of normal soldiers to withstand stress, every soldier has his breaking point, and if this is reached, he becomes a liability to his unit.”
    His summary of the Allied experience with personnel selection and forward psychiatry in the war offers a comprehensive statement of what was known by 1945. Unfortunately, the lessons were soon forgotten.

    legionmagazine.com
     
  10. MikeyG

    MikeyG Junior Member

    I've just learned of my grandfather's PTSD. Unfortunately, like so many other veterans who have come to pass, he suffered in silence. I've been talking to family members about his experiences. My grandmother remembers him suffering from horrific nightmares and waking up in cold sweats. My father recalls his crying spells alone and he was often 'detached' when talking/playing with his children. I'm not too sure if this would be a symptom, but he did develop a kind of kleptomania after the war.
    He became a bricklayer after the war and worked on scaffolding, where a lot of accidents would occur. Every time someone had been in a serious accident, the other men on site would panic and flee for help. My grandfather had no problem approaching those injured. No matter how bad it was he always remained perfectly calm and was often the first to administer first aid. Perhaps his war experience shaped him this way?
     
  11. bob90

    bob90 WW2 Veteran WW2 Veteran

    After reading through the numerous comments on PTSB, I agree, a lot of honest points were put forward. But I tend to side with "Sappers" practicalities. Witnessing, first hand battlefield scrapes or intentions so many we termed as "bomb-happy" bloeks having a go. As Churchill Tank support we watched to respond, knowing any moment we could be "clouted" with something a thousand times as hard. Name of the game I believe. cheers , bob90
     
  12. DoreenC

    DoreenC Member

    I came to this forum 40 years after my father's death with a need to find out where he had been and what he had done the war. I knew something was wrong with him and found out that, at age 19 and with the Black Watch Regiment, his very first engagement with the enemy was in the battle of the Scheldt and he was there for "Black Friday".

    From everything I've read, I feel this battle would have been extremely mentally trying for mature and seasoned career soldiers, never mind a naive boy from Nova Scotia. I'm not a mental health specialist but I am now convinced that he suffered for the rest of his short life from PTSD, known then as "shell shock". Like a great many veterns he never spoke of the horrific sights he saw and the prolonged trauma endured by all who were there.

    There's no way to know what his life, and our lives, would have been like without WWII, but I'm pretty sure he wouldn't have died at age 46.

    I absolutely believe that PTSD is a very real condition.
     
    muggins likes this.
  13. Wills

    Wills Very Senior Member

    Sadly we had the 'if it ain't bleeding you are bluffing' attitude. Then we get the 'my war was worse than yours', which to the individual soldier is nonsense. taking point on patrol day after day where IEDs or other killing devices are used - makes no difference to that individual if the whole world is at war, his war is immediate too him. Denial - and first to admit we did not like these problems the fear was it would spread - so we took it out on the individual rather than help -many MOs had the get on with it attitude. The statistics for world war two are horrendous - yet many will shrug it off and pretend it was not a problem. The Quartermaster General thought it was a problem as it reduced manning levels. Of course we are applying modern thinking to a different era as indeed today thankfully is more enlightened to my era. 19 or more hours a day for week after week on one tour for six months - and other places ( many myself included were pained by boils one made sitting a problem) whilst trying to stay alert and keep the lads with you alert. We would look for signs in the lads and each other. Takes just one to put the rest of his unit at risk.
     
    urqh and A-58 like this.
  14. Formerjughead

    Formerjughead Senior Member

  15. von Poop

    von Poop Adaministrator Admin

  16. MI9

    MI9 Member

    Good thread and many people suffer with alsorts of military and none militay personnel such as emergency workers etc. Those who have love ones who experince the effects of PTSD would understand. Those who knocked it only helping creat a the stigma around a real medical condition. Those who smell, see and feel all it everyday understand a family member has it and relives tramua everyday. Well done all those who support Charities , Medical institiutions, Counsilor, and families well done.
     
  17. dbf

    dbf Moderatrix MOD

  18. Wills

    Wills Very Senior Member

    Looking back to what many thought at the time was a bloody pain - 'public duties' in London. Back from overseas, we would have leave and then back for tunic fittings with the tailors and the round of drill to get us back into shape. Hated it! Yet looking back it was a great way of making the lads switch on to something that occupied their minds - the worry was am I going to avoid getting bagged for kit or idleness at drill - sound unlikely? Many go from active service where they rely on each other all of the time,to a different pace, we had to keep the pace up still relying on the team in a different form of pressure. Just an observation from my own viewpoint. Today of course it would appear that time spent between tours is reducing to cope with reductions in manpower. My own instincts tell me that the next tour played on soldiers minds, not so much the last. Family life is disrupted more and I believe the security of contracts is not so clear cut. From what a pal tells me the moral is rock bottom - in itself a recipe for problems. However, my views are from my era, there are others here with current or more recent experience.
     
  19. DPas

    DPas Member

    I have only noticed this thread now and I have noticed that everyone is talking about the person. Now I am inclined to agree with the Vets - your generation are made of tougher stuff - just my opinion based on myself and other young pups - and no offence to anyone else meant.

    However, no one has really mentioned the home front. During WW2 everyone was involved in the war effort in some way and on return vets were surrounded by other vets. In conflicts since then there has arguably been less involvement from society as a whole and vets from these latter conflicts may feel more isolated and less able to "share the good times as well as the bad". This is arguably compounded by little **** who write articles such as "why I will not wear a poppy" and "remembrance glorifies war", and many similar minded individuals who vocally disagree with a given nation's involvement in modern conflicts.

    So my question for WW2 vets - do you think this makes a difference (genuine question, it is not meant as a leading one)?
     
  20. Wills

    Wills Very Senior Member

    Odd argument that the country fought a war for freedom of speech and then wish to label those who disagree with us. When I was young there were many living around us who had served, including my father - just as today many of those old soldiers would not turn out on armistice day, some would indeed argue that it glorified war. Some were still close to it and remembered quietly and as this subject covers did not wish to relive it. 'Similar minded individuals' who disagree with some of nations involvements in modern conflicts - well here is one! Anyone linking glory with war needs to think again. A good soldier will obey orders - he will also offer advice. This is our fourth expedition to Afghanistan - they turfed us out on three (one casualties of 12000 British, Indian troops and followers). There was not going to be a military solution this time either that observation is not peculiar to the soldier.
     

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