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During the U.S. Civil War, soldier's heart was the name given to a syndrome similar to today's Post Traumatic Stress Disorder (Jacob DaCosta's paper in 1871 on Irritable Heart). In fact clinicians have long noted that traumatic events can lead to psychological disturbance. At the end of the Nineteenth and the beginning of the Twentieth centuries, railway disasters, the World Wars, the Holocaust, atom bombs on Hiroshima & Nagasaki prompted systematic descriptions of the symptoms associated with traumatic stress reactions. These included:
  • Spontaneous re-experiencing of aspects of the traumatic events
  • Startle responses
  • Irritability
  • Impairment in concentration and memory
  • Disturbed sleep, distressing dreams
  • Depression, guilt, phobias
  • Psychic numbing
  • Multiple somatic complaints

The stress reactions were christened varyingly, depending on the traumatic events preceding the cluster of symptoms. Many different labels were in vogue.

  • Fright Neurosis
  • Combat / War Neurosis
  • Shell-shock
  • Survivor Syndrome
  • Nuclearisim
  • Operational Fatigue
  • Compensation Neurosis

The first half of the last century witnessed intense debate on the actual cause of these syndromes and post trauma states.

Charcot, Janet, Freud and Breurer suggested that psychological trauma caused hysterical symptoms, but their views were not widely accepted. Most opined that a traumatic event in itself was not sufficient cause of post trauma symptoms. The search went on, mainly for organic causes.

  • Damage to the spinal cord was suggested as the cause of the 'Railway Spine Syndrome'.
  • Microsections of exploded bombs entering the brain as the cause of the 'Shell-Shock' of World War I
  • Brain damage resulting from starvation as the cause of 'Survivor Syndrome' in the Post Holocaust era
  • Many doubted the validity of the symptoms and suggested malingering for compensation and coined the term 'Compensation Neurosis'
  • Finally the symptoms were attributed to psychological dysfunction. It was hypothesized that those with unstable personalities, pre-existing neurotic conflicts were prone to develop chronic post trauma states.

This view was held till the Vietnam War. But it changed with the recognition of long standing psychological problems in many war veterans. This convinced clinicians and researchers that even people with sound personalities can develop clinically significant psychological symptoms if they are exposed to horrific stressors. This prompted the introduction of Post Traumatic Stress Disorder (PTSD) as a diagnostic category into DSM III. 

And thus finally the fact that traumatic events such as combat, rape, man made or natural disaster give rise to a characteristic pattern of psychological symptoms was given due credence.

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