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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2089086/

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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* How were veterans affected by the new technologies and traumas from the war?
* How did initial shell shock transition into PTSD
* Has the government fulfilled its role in caring for those who fought for the country?

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elaborate son wartime trauma and the unwillingness of survivors to talk about it

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Considering trauma, censorship and social convention, Julian Walker asks why many soldiers were unwilling or unable to talk about their experience of World War One.

'He was in the war, but he never spoke about it'. An unwillingness to talk about the war, expressed in this familiar sentence, sums up its horror, stoicism, and inexplicability. As the culture of the war then and since has been so much a verbal culture, this notable absence of words needs to be considered. Was the silence engendered by the soldiers themselves, was there pressure on them to remain silent, or was there a drift into leaving it all behind?

Too painful for words

One theory proposes that the obvious way to deal with the experience of suffering, of inflicting pain on others, and of witnessing death and injury on such a scale, so new and different for many men and women serving, was by removing it from speech: just as speaking about it made it real, not speaking about it contained it. But other aspects of the management of language affected the business of speaking about the realities of conflict.

Control over written communication

A culture of control over written communication developed during the war, with the troops finding their letters censored, and the press knowing that information was being withheld. Numerous amendments to the Defence of the Realm Act (DORA) left people unsure of what they could legitimately say, while knowing that dissent was a punishable offence. The familiarity of the phrase 'Somewhere in France' on letters home indicates how much the troops complied with this. In this environment, with conscientious objectors and non-combatants publicly castigated, there was considerable pressure not to express negative attitudes towards the conflict. Troops meeting on the march often ironically gave the good-natured challenge 'Are we downhearted?'(the formula assumed the cheerful response, 'no!'); the fact that the actual soldiers' answer was usually 'Yes!' itself acknowledged that the default answer was the optimistic 'no'. As any talk that would cause people to doubt the worth of pursuing the war and leave them feeling that the costs were too high, involved risk, a pragmatic course was that of silence.

Swearing and slang

Tim Cook has suggested that swearing was such a strong part of soldiers' way of coping with war, and an expression both of belonging and of excluding others, that many would have had trouble talking about their experiences without swearing. This reinforces the view that to a large extent the war was mediated by language; it proposes that there was an essential link between the primary experience of conflict and a particular kind of language. In a domestic environment, where obscenity would cause a breakdown in communication, soldiers were not equipped to 'translate' - it was easier not to talk about the experience of the war at all.

To what extent did soldiers know how to talk about what they had experienced? The absence of slang terms for major injuries - the slicing away of parts of the body by shrapnel - implies that these could only be expressed in clinical or literary terms or not at all. Around 10 years after the armistice there was a spate of books which explored the 'pornography' of war, but during the conflict this was avoided; compare 'a Mills bomb would blow seven men to rags' from Charles Edmonds' A Subaltern's War (1929) with 'concerning their actual killing exploits the men were absurdly reticent' from Troddles in the Trenches by R Andom, printed for Newnes' Trench Library (1919). For those trying to write about the experience of the Front there were only words that described indescribability; it was 'beyond description', 'utterly undescribable'.

Belonging at the Front

A repeated motif is the idea of the Front as the place where the soldier belongs. For Robert Graves 'home was awful because you were with people who didn't understand what this was all about': in particular he noted that the level of noise at the Front was incommunicable. Corporal J Bemner writes in his diary, three days after his return from England: 'I am beginning to feel all right again after leave' (6 August 1915). A poem, On Leave, in the Depot Review No.5, begins:

'I wanter get back from the war news
I wanter get back to the Hun;
I wanter retreat from the chaps in the street
'Oo know how the war should be won ...'

Erich Maria Remarque wrote of home in All Quiet on the Western Front (1929): 'I do not belong here any more, it is a foreign world.' Those who had not been at the Front could not possibly understand what it was like.

An 'acceptable' reaction

Reticence was praised more highly then than now. Sangfroid was employed and no doubt felt at all levels - 'nothing makes you feel madder than being fired at when doing a job that has to be done slowly and carefully, such as insulating the wire after baring the cable and joining the ends. A man who has been fouled at footer has the same feeling', wrote C W Langley in Battery Flashes (1916). Not expressing despair was reflected back as bravery, increasing self-esteem and status. Rudyard Kipling, devastated in private by the death of his son at the Front, mentioned his name in passing in one sentence in his two-volume The Irish Guards in the Great War (1923). In the face of the inexpressible, silence was the expected and praiseworthy position.

The verbal expression of trauma

Those who declared themselves unable to cope, through shell or combat shock or devastating loss of comrades, were generally treated as malingerers rather than victims. Few doctors, with the notable exception of W H Rivers and Arthur Brock at Craiglockhart Hospital for victims of shell shock, explored the verbal expression of trauma. Up to 1917 treatment for shell shock involved being forbidden to talk about the war. One officer treated by Rivers at Craiglockhart, said 'that it was obvious to him that memories such as those he had brought with him from the war could never be forgotten. Nevertheless, since he had been told by everyone that it was his duty to forget them he had done his utmost in this direction.' It was felt that silence settled the mind, and that unpleasant memories could be replaced by means of pleasant activities such as walking and sports. An advertisement in the Pall Mall Gazette (8 May 1919) read: 'So bury all those unpleasant memories in Dora's waiting grave ... and get your Austin Reed straw hat to signalise the event' [DORA was the Defence of the Realm Act].

Literary accounts of the war

Henri Barbusse's graphic account of trench life, Under Fire (1916), was widely read on both sides of the Front, with a 1917 reviewer in The Manchester Guardian noting that generally 'the "horrors of war" are taken for granted but ... mercifully concealed.' But the majority of the novels and poems that verbally explored the body's destruction were not published until 10 years after the armistice: the translation of Remarque's All Quiet On The Western Front (1929), Robert Graves' Goodbye To All That (1929), Charles Edmonds' A Subaltern's War (1929), Helen Z Smith's Not So Quiet (1930), Frederic Manning's Her Privates We (1930), Siegfried Sassoon's Memoirs of an Infantry Officer (1930) are a few of over 60 books on the war that were published in these two years. For Graves, Goodbye To All That was, as the title states, an attempt at closure: 'once this has been settled in my mind and written down and published it need never be thought about again.' The interim silence seemed to be as much about 'holding on' as 'holding back'. But there appears to have been a consensus for a period of literary silence, broken after a decade with a tumult of descriptions of violent death.

Under fire: The story of a squad by Henri Barbusse

Translated from the French novel Le Feu first published in 1916, Under Fire: The Story of a Squad realistically covers the horrors of the war.

Absence and silence

Typical of those who 'did not speak about the war' were lapses into silence, the 'thousand-yard stare', or 'a vacant look', all of them characterised by absence of communication. This absence is seen also in the way the major war memorials communicated the experience of the war: the empty tomb of the Cenotaph, the absent name of the Unknown Warrior, the open space at the centre of the major architectural memorials in France and Belgium, at Vimy, Thiepval and the Menin Gate; and most of all in the annual two minutes' silence on Armistice Day. The 'empty space in the centre' became the defining motif of memorialising the war.

And ultimately, what did the people who were not there actually want to hear? While relatives needed details of time and place in order to make meaning out of their loss, did they want to know that the loved one's body had been blown apart or had lain rotting unburied for days? W H Rivers was clearly aware that there was the 'natural tendency to repress, being in my experience almost universally fostered by ... relatives and friends' John Brophy wrote in 1965: 'for the men who survived it, it became in retrospect an experience to be thrust out of memory most of the time, an experience impossible for the mind to digest, and, for many, tolerable only when some of the less distressing events were selected for recall and dressed up with sentimental emotions'.

Footnotes

[1] Tim Cook 'Fighting Words: Canadian Soldiers' Slang and Swearing in the Great War' in War in History, 2013 20: 323

[2] Personal diary of H H Cooper, Imperial War Museums

[3] David Fraser Jenkins, Paul Nash: the Elements (London: Scala, 2010)

[4] W H Rivers, Instinct and the Unconscious: A contribution to a biological theory of the psycho-neuroses (Cambridge: University Press, 1922), p.189

[5] W H Rivers, The Repression of War Experience, presented to the Royal School of Medicine, 4 December 1917.

[6] John Brophy and Eric Partridge (eds), The Long Trail: Soldiers' Songs and Slang, 1914-18 (New York: Books for Libraries Press, 1972).

Julian Walker is an artist, writer and educator, who works with the Learning Department at the British Library. His research-based art and writing practice explores language, social history, the nature of objects and engagement with the past. He is co-author of Trench Talk: Words of the First World War (Stroud: Spellmount, 2012).

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Considering trauma, censorship and social convention, Julian Walker asks why many soldiers were unwilling or unable to talk about their experience of World War One. 'He was in the war, but he never spoke about it'. An unwillingness to talk about the war, expressed in this familiar sentence, sums up its horror, stoicism, and inexplicability.

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Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

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* specifically subsection 6- shell shock

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PTSD, or post-traumatic stress disorder, leapt to the public's consciousness when the American Psychiatric Association added the health issue to its diagnostic manual of mental disorders in the 1980s. But PTSD-known to previous generations as shell shock, soldier's heart, combat fatigue or war neurosis-has roots stretching back centuries and was widely known during ancient times.

PTSD Symptoms

Post-traumatic stress disorder is a mental health condition that occurs when someone witnesses or experiences a severely traumatic event. This can include war or combat, serious accidents, natural disasters, terrorism, or violent personal assaults, such as rape.

People with the disorder may experience PTSD symptoms such as frequent fear, stress, and anxiety stemming from the traumatic event. They may relive the event through flashbacks or nightmares and have intense, disturbing thoughts and feelings related to the event. They sometimes avoid people, places and situations that remind them of the trauma.

They may also experience increased arousal and reactive symptoms, such as feeling jumpy (startling easy), having problems concentrating or sleeping, being easily angered or irritated and engaging in reckless or self-destructive behavior.

What Is PTSD?

It's not entirely known what causes PTSD to develop, but it may be related to the stress hormones.

That is, traumatic events put the body into a survival "fight or flight" mode, in which body releases stress hormones (adrenaline and norepinephrine) to provide a burst of energy while pausing some of the brain's other tasks, such as filling short-term memories.

People with PTSD continue to produce high amounts of these hormones outside of dangerous situations and their amygdala-the part of the brain that handles fear and emotion-is more active than people without PTSD.

Over time, PTSD changes the brain, including by causing the part of the brain that handles memory (the hippocampus) to shrink.

PTSD in Epics and Classics

Long before the dawn of modern psychiatry, people and situations depicting PTSD may have been recorded in early works of literature.

For example, in the Epic of Gilgamesh, the earliest surviving major work of literature (dating back to 2100 B.C.), the main character Gilgamesh witnesses the death of his closest friend, Enkidu. Gilgamesh is tormented by the trauma of Enkidu's death, experiencing recurrent and intrusive recollections and nightmares related to the event.

Later, in a 440-B.C. account of the battle of Marathon, Greek historian Herodotus describes how an Athenian named Epizelus was suddenly stricken with blindness while in the heat of battle after seeing his comrade killed in combat. This blindness, brought on by fright and not a physical wound, persisted over many years.

Other ancient works, such as those by Hippocrates, describe soldiers who experienced frightening battle dreams. And outside of Greco-Latin classics, similar recurrent nightmares also show up in Icelandic literature, such as Gísli Súrsson Saga.

In the Indian epic poem Ramayana, likely composed around 2,500 years ago, the demon Marrich experiences PTSD-like symptoms, including hyper-arousal, reliving trauma, and avoidance behavior, after nearly being killed by an arrow. Marrich also gave up his natural duty of harassing monks and became a meditating recluse.

Nostalgia and Soldier's Heart

In the last several hundred years, medical doctors have described a few PTSD-like illnesses, particularly in soldiers who experienced combat.

In the late 1600s, Swiss physician Dr. Johannes Hofer coined the term "nostalgia" to describe Swiss soldiers who suffered from despair and homesickness, as well as classic PTSD symptoms like sleeplessness and anxiety. Around the same time, German, French and Spanish doctors described similar illnesses in their military patients.

In 1761, Austrian physician Josef Leopold Auenbrugger wrote about nostalgia in trauma-stricken soldiers in his book Inventum Novum. The soldiers, he reported, became listless and solitary, among other things, and efforts could do little to help them out of their torpor.

PTSD in the Civil War

Nostalgia was a phenomenon noted throughout Europe and the "disease" reached American soil during the U.S. Civil War (1861-1865). In fact, nostalgia became a common medical diagnosis that spread throughout camps. But some military doctors viewed the illness as a sign of weakness and one that only affected men with a "feeble will"-and public ridicule was sometimes the recommended "cure" for nostalgia.

While nostalgia described changes in veterans from a psychological perspective, other models took a physiological approach.

After the Civil War, U.S. doctor Jacob Mendez Da Costa studied veterans and found that many of them suffered from certain physical issues unrelated to wounds, such as palpitations, constricted breathing, and other cardiovascular symptoms. These symptoms were thought to arise from an overstimulation of the heart's nervous system, and the condition became known as "soldier's heart," "irritable heart," or "Da Costa's syndrome."

Interestingly, PTSD-like symptoms weren't restricted to soldiers in the 1800s. During the Industrial Revolution, rail travel became more common-as did railway accidents.

Survivors of these accidents displayed various psychological symptoms (anxiety and sleeplessness, for instance), which collectively became known as "railway spine" and "railway brain" because autopsies suggested railway accidents caused microscopic lesions to the central nervous system.

Shell Shock

Post-traumatic stress disorder was a major military problem during World War I, though it was known at the time as "shell shock."

The term itself first appeared in the medical journal The Lancet in Feb. 1915, some six months after the "Great War" began. Capt. Charles Myers of the Royal Army Medical Corps documented soldiers who experienced a range of severe symptoms-including anxiety, nightmares, tremor, and impaired sight and hearing-after being exposed to exploding shells on the battlefield. It appeared that the symptoms resulted from a kind of severe concussion to the nervous system (hence the name).

By the following year, however, medical and military authorities documented shell shock symptoms in soldiers who had been nowhere near exploding shells. These soldiers' conditions were considered neurasthenia-a type of nervous breakdown from war-but was still encompassed by "shell shock" (or war neurosis).

There were some 80,000 cases of shell shock in the British army alone by the end of the war. Soldiers often returned to the war zone after only a few days' rest, and those who were treated for longer periods of time sometimes underwent hydrotherapy or electrotherapy.

In World War II, British and American described traumatic responses to combat as "battle fatigue," "combat fatigue" and "combat stress reaction"-terms that reflected the belief that the conditions were related to long deployments. Up to half of military discharges during the war may have been related to combat exhaustion, according to the National Center for PTSD.

Modern-Day PTSD

In 1952, the American Psychiatric Association (APA) added "gross stress reaction" to its first Diagnostic and Statistical Manual of Mental Disorders, or DSM-I. The diagnosis related to psychological issues stemming from traumatic events (including combat and disasters), though it assumed that the mental health issues were short-lived-if the problem lasted for more than 6 months, then it was thought that it had nothing to do with wartime service.

In the DSM-II, published in 1968, the APA removed the diagnosis but included "adjustment reaction to adult life," which did not efficiently capture PTSD-like symptoms. This removal meant that many veterans who suffered from such symptoms weren't able to receive the proper psychological help that they needed.

Drawing on research involving people who survived severely traumatic events, including war veterans, Holocaust survivors and sexual trauma victims, the APA included post-traumatic stress disorder in the DSM-III (1980). The diagnosis drew a clear distinction between traumatic events and other painful stressors, such as divorce, financial hardships and serious illnesses, which most individuals are able to cope with and don't produce the same symptoms.

The diagnostic criteria for PTSD was revised in the DSM-IV (1994), and DSM-IV-TR (2000), and DSM-5 (2013) to reflect ongoing research. In the DSM-5, PTSD is no longer considered an anxiety disorder because it's sometimes associated other mood states (depression), as well as angry or reckless behavior; it's now in a category called Trauma- and Stressor-Related Disorders.

Today, about 7.7 million American adults have PTSD, according to the Anxiety and Depression Association of America.

Sources

Post-traumatic stress disorder (PTSD) - Causes; NHS.
What is PTSD?; WebMD.
What Is PTSD?; Everyday Health.
What is Posttraumatic Stress Disorder?; American Psychiatric Association.
Sheth et al. (2010). "Anxiety disorders in ancient Indian literature." Indian Journal of Psychiatry.
Marc-Antoine Crocq and Louis Crocq (2000). "From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology." Dialogues in Clinical Neuroscience.
History of PTSD in Veterans: Civil War to DSM-5; VA.
When Nostalgia Was a Disease; The Atlantic.
Timeline: Mental illness and war through history; Minnesota Public Radio.
Did Civil War Soldiers Have PTSD?; Smithsonian.
Anderson, David (2010). "Dying of Nostalgia: Homesickness in the Union Army during the Civil War." Civil War History.
The Shock of War; Smithsonian.
History of PTSD in Veterans: Civil War to DSM-5; National Center for PTSD, VA.
When Soldiers Snap; The New York Times.
PTSD; Anxiety and Depression Association of America.

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PTSD, or post-traumatic stress disorder, leapt to the public's consciousness when the American Psychiatric Association added the health issue to its diagnostic manual of mental disorders in the 1980s. But PTSD-known to previous generations as shell shock, soldier's heart, combat fatigue or war neurosis-has roots stretching back centuries and was widely known during ancient times.

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* elaborates on initial shell shock in war and its transition into post-war PTSD

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From shell-shock to PTSD, a century of invisible war trauma

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Mental health trauma has always been a part of war. Treatments have come a long way over the last century, but we still don’t understand why the responses change for different people and times.

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elaborates on America's debt to its veterans

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brief description of Dept. of Veterans Affairs

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various sources- first person accounts

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veterans returning home from the war