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.
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.
January 18, 2017 § 3 Comments
I read David Means’ novel, Hystopia, last week. It is an alternative history of the 1960s and 70s in the United States; a novel within a novel. Hystopia, according to the editor’s notes, was actually written by a Vietnam vet named Eugene Allen, shortly before he killed himself in 1973 or 1974. In Hystopia, JFK survived Lee Harvey Oswald’s bullet, and continued on as president and is now in his 3rd term (the scholar in me wonders how he got passed the 27th Amendment, mind you). He oversaw a massive increase in American involvement in Vietnam, much greater than that of his successor in real life, Lyndon Baines Johnson. And, of course, there was no Great Society policy initiatives. He was eventually assassinated in Springfield, IL, in 1970. But this is not the interesting part. The interesting part is what happens to Vietnam vets when they get home: they get enfolded.
A new branch of the government, Psych Corps, has attempted to use drugs to deal with the horrors that the soldiers in Vietnam saw, with a caveat: they only accept men who are not physically disabled by the war. At the Psych Corps HQ, the vets are fed an anti-psychotic drug and ‘enfolded.’ Psych Corps re-creates the source of the trauma and PTSD for soldiers, they are forced to relive it, and in so doing, their memories are essentially wiped. Thus, veterans who have been enfolded don’t remember their experience in the war, such as the ‘hero’ of the novel, a veteran named Singleton. Singleton, we eventually realise was an officer in Vietnam and commanded the unit that also included the other main characters of the book. But he has no recollection of this. The only thing that connects him to Vietnam is a horrible burn scar on his left side. Singleton’s scar comes from a friendly fire caused by a soldier calling in the wrong co-ordinates for a fire bombing, resulting in his own death.
Now employed by Psych Corps, Singleton falls in love (against regulation) with a fellow officer, Wendy, and sets off to Northern Michigan to track down Rake, a former member of his unit and a failed enfold. Rake, meanwhile, has kidnapped the beautiful but deeply troubled, Meg, whose boyfriend and first love was the soldier who got himself killed. Meg is also Eugene Allen’s sister.
Immediately after Hystopia, I picked up Bessel van der Kolk’s The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma, for a new researh project I am undertaking. It turns out that Hystopia and The Body Keeps The Score are directly related for my purposes. I am still only about 100 pages into the book, but van der Kolk is talking about his early experiences in the field of psychiatry in the early 1970s (the same period the fictive Eugene Allen was writing his novel, incidentally) and his first clients, including Vietnam vets at the VA in Boston.
He writes about what trauma does to the brain, using a vet as an illustration. This guy was a high functioning, and very successful criminal lawyer in Boston. But, he was completely empty inside. He went through the motions at home, with his family, at work. He felt violent impulses and thus recused himself from his family, spending weekends at a time drinking heavily in an attempt to get his war experiences out of his head. He had been a platoon leader, and watched helplessly as he lead his men into an ambush. They were all killed or wounded. He was not. The next day, he took his wrath out on a Vietnamese village, killed at least one child and raped a woman.
As I read this story, and others, I couldn’t help think of Hystopia, and the vets being drugged to forget stories such as this veteran’s. In the late 1980s, van der Kolk began experimenting with PET scans and, ultimately, fMRIs, by which the traumatising event is re-created, according to a script, in order to discover which parts of the brain are triggered. It turns out it is exactly the same parts of the brain that one would expect to be triggered during a traumatic event. More to the point, the participants in these experiments reported feeling exactly as they did during the original event. And thus, van der Kolk notes, his colleagues began to wonder about how to use drugs to treat PTSD patients, using the information from the PET and fMRI scans to learn which parts of the brain neeed to be treated. Or, in other words, exactly what happens in Hystopia when the soldiers are enfolded upon return from Vietnam. The difference, of course, is that enfolding works for the majority of patients. There is no cure-all for PTSD for us in the real world.
Nonetheless, van der Kolk notes that we tend to respond to deeply traumatising events, whether something as graphic and terrifying and terrible as his Vietnam vet, or other traumas such as sexual assault, rape, being beaten as a child, etc.. And I found myself wondering about how our brains work to incorporate these memories and recast them in terms of society, how our memories and our traumas are never ours alone, but also belong to our wider society. Our memories are formed, re-formed, and re-fined in light of our interaction with society, of course. And it is difficult to tell where our individual experiences end and our societal imports begin, or vice versa.
And as I embark on a this project, I am wondering where that dividing line is between our own personal traumas and where society intervenes in the reconstructions of the narratives we tell ourselves about our experience. What makes our traumas unique and what makes them like other victims of traumatising experiences?