The Political Economy of Shell Shock

January 30, 2017 § 2 Comments

Post-Traumatic Stress Disorder (PTSD) was not officially recognized until DSM-III, published in 1980.  But that, of course, does not mean it does not have a long history.  In the First World War, symptoms that look a lot like PTSD were called ‘shell shock.’  We have all heard of shell shock.  When I played hockey, I was a goalie.  It was not uncommon for me to come out of the net after a game where I was peppered by shots to have my teammates joke about me experiencing shell shock (I played for a string of really bad teams).  In other words, shell shock has become part of our lexicon.

One of the jobs of historians is to complicate matters and what we think we know about the past (my other job as an historian is to explore what we know about the past and why and to what uses such knowledge gets used).  I joke with my students that historians can ruin anything in this manner.  And so, shell shock.

The British were the first to diagnose and name shell shock, in the fall of 1914, right after the war started.  The name itself actually came from the soldiers themselves.  There was not, however, much in the way of agreement over what shell shock actually was; it became a catch-all phrase. It could be physical.  It could be psychological.  It could even be a lack of moral fortitude.

But shell shock was also complicating for the British Expeditionary Force (as the British Army in Europe was called in the First World War) and its attached colonial expeditionary forces (most notably Canada, Australia, New Zealand, and South Africa, the Dominions).  In particular, it was demoralizing.  So, the British High Command did what you would expect: it banned shell shock.  In June 1917, the order came down: the term was no longer to be used in any reports, any diagnoses, in any conversation.  It simply no longer existed.

This echoed the German response to shell shock, which the Germany Army dismissed simply as a lack of moral fortitude.  So it punished shell shocked soldiers.

By 1922, the British government was adamant that shell shock would never exist ever again.  The Southborough Report of that year recommended that the symptoms of shell shock should be regarded as nothing greater or lesser than any other battlefield injury.  The government and the army came to the conclusion that troops who were well-trained and properly led would not suffer the fate of the malingerers of World War I.

The reasons for denying the existence of shell shock differed between 1917 and 1922.  In 1917, it was a question of morale and defeating the Germans.  In 1922, it was a question of finances, as the United Kingdom was nearly broke.  Shell shock diagnoses from World War I cost money, in the form of compensation to affected veterans.  The government simply didn’t want to pay anymore casualties in any future wars.

 

Diagnoses and Stigmatization in Mental Health

January 25, 2017 § 2 Comments

Today is Bell Let’s Talk Day in Canada.   For every Tweet and Instagram post with the hashtag, #BellLetsTalk Bell (a major telecommunications corporation in Canada) will donate $0.05 to to Canadian mental health programs. For every txt and long distance call made on Bell’s cell and land line networks, it will donate $0.05.  And for every view of a video about the initiative on Bell’s Facebook page, and every use of the Bell Let’s Talk geofilter on SnapChat, Bell will donate $0.05.  See the theme here?

We can debate the fact that this is a corporate-sponsored thing.  Personally, I don’t care. I am more interested in the donations to mental health programs and ending the stigma about mental health. I find it shocking and depressing that in 2017, there still exists a stigma surrounding mental health.

As I noted in a previous post, I am reading Bessel van der Kolk’s The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma for a new research project on childhood, memory, and trauma.  Van der Kolk is a psychiatrist and, it would appear, a pretty good one.  One thing that has really captured my attention in reading this book is his argument about the power of diagnosis.  In particular, he is concerned with Post-Traumatic Stress Disorder (PTSD), which arose out of his work with Vietnam veterans at the VA in Boston in the late 1970s.  Since then, he has worked with probably thousands of children and adults suffering from PTSD and other ramifications of trauma.

I have long been sceptical of diagnoses in mental health, as they can also lead to a stigmatization of the individual in question.  This is certainly an issue, and van der Kolk notes it.  But he also argues that diagnosis is very important because it allows for a systematic plan to deal with mental health issues.  It allows practitioners and patient/clients to draw on a great deal of expertise from researchers, clinicians, and patients/clients and a variety of treatment models that have been theorized and tested.  And, he also notes, there’s the question of research and funding.  For example, he notes, between 2007 and 2010, the US Department of Defence spent over $2.7 billion USD on treatment and research of PTSD in combat veterans.

In other words, there is something very valuable in the diagnosis of mental health problems.  I still have serious problems with the stigmatization of diagnoses.  And I still have a serious problem with the ‘disorder’ terminology used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatry Association (APA).  The term ‘disorder’ is a dangerous one in mental health precisely because of the stigmatization that comes with it.

Van der Kolk, to be fair, is aware of this and is also leery of what he dismisses as pseudo-scientific diagnoses.  In fact, he goes on the attack of DSM-V, which was published in 2013. He recalls how before the likes of Louis Pasteur and Robert Koch, doctors were limited to treating physical symptoms, that which could be seen.  Koch and Pasteur, however, pointed out that bacteria, unseen by the naked eye, caused many diseases.  Thus, physicians changed their tactics to treating underlying causes, rather than the symptoms of illness.  The problem with DSM-V, he argues is that with over 300 diagnoses in 945 pages, it offers ‘a veritable smorgasbord of possible labels for the problems associated with’ severe early-life trauma.  He dismisses many of these labels, such as Oppositional Defiant Disorder, Intermittent Explore Disorder, and Disruptive Mood Regulation Disorder, as ‘pseudo-scientific.’

Fundamentally, he argues that the problem with all of these labels is that they are symptoms, not the actual problem.

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