After WWII, questions arose regarding the role of biology in soldiers’ psychological distress. A disease based model was proposed and psychiatric medications became more common (Marlowe, 2000). Unfortunately, this conceptualization of PTSD led to a great deal of stigmatization, because if biological factors were the sole cause of the development of these symptoms, then afflicted soldiers could be considered as “physiologically weak” or “constitutionally disordered” (Marlowe, 2000). Another explanation related to biology was that psychological problems arose from pathologies in early childhood, and that psychological problems were converted into physical symptoms, manifesting themselves in such diverse diseases as ulcers, arthritis, dermatitis, and hyperthyroidism (Marlowe, 2000).
Yet as psychology became more integrated with medicine, it became clear that PTSD was far more complex than the medical model or psychosomatic explanations would indicate. One neurologist, Harold Wolff, proposed a holistic model of stress based on evolutionary biology:
“Man is further vulnerable because he is so constituted that he reacts not only to the actual existence of danger, but to threats and symbols of danger experienced in his past which call forth reactions little different from those to the assault itself. Since his adaptive and protective capacities are limited, a man’s response to many sorts of noxious agents and threats may be similar, the form of the reaction to any one agent depending more on the individual’s nature and past experience than upon the particular noxious agent evoking it. Moreover, because of its magnitude and duration, the adaptive-protective reaction may be far more damaging to the individual than the effects of the noxious agent per se” (Wolff, 1953, p. 3, as quoted in Marlowe, 2000).
Such evolutionary explanations of stress were much closer to current conceptualizations of PTSD than any other explanations to that date, and sparked a great deal of research in neurobiology (Marlowe, 2000).
Another significant occurrence in the history of PTSD was the creation of the first diagnostic manual, the Diagnostic and Statistical Manual I (DSM-I) by the American Psychiatric Association (APA) in 1952. This manual included a diagnosis for “gross stress reaction,” which was thought to be related specifically to combat-related trauma. The DSM-I description of gross stress reaction indicated that anyone exposed to trauma was vulnerable to this disorder, even those without a history of psychological problems. It also described the disorder as a temporary reaction which would be alleviated once the solider was removed from the stressful situation (Scott, 1990). However, “Gross Stress Reaction” was dropped from the DSM-II in 1968, for reasons that remain unknown (Andreasen, 2004).
Turning to the Vietnam War period, it seemed that preventative measures were being taken to decrease the psychological impact of war on soldiers. From the very beginning of the war, the military provided each battalion with medical personnel trained to treat psychological problems (Scott, 1990). At first, these measures seemed hugely successful, as very few psychological casualties were reported in the war’s initial years (Marlowe, 2000). However, as the war waged on, and public outcry about the legitimacy of the war led to even greater stigmatization of soldiers, cases of combat fatigue increased. Estimates are varied, but the often cited Vietnam Veterans’ Readjustment Study of veterans’ self-reported symptoms indicate the following:
- 15.2% of male and 8.5% of female Vietnam theater veterans had PTSD 20 years after the war
- 11.1% of male and 7.8% of female Vietnam theater veterans had partial PTSD 20 years after the war
- 30.9% of male and 26.9% of female Vietnam theater veterans had PTSD at some time in their lives (Schlenger et al., 1992, as cited in Price, 2007).
Despite the vast psychological toll of Vietnam on soldiers, they received far from a “hero’s welcome” when they returned to the United States, and often had to face homecoming alone, or alongside few other soldiers who had shared their experiences and could offer social support. When they arrived in the U.S., they were not applauded for their victory, but were often met with hostile demonstrations by anti-war activists. American society offered little acceptance of Vietnam veterans even years after the war (Marlowe, 2000).
The harsh treatment of Vietnam soldiers, especially given their psychological afflictions, is unfortunate, to say the least. However, the Vietnam years did give rise to our current conceptualization of PTSD. Pettera, Johnson, and Zimmer (1969) referred to “Vietnam combat reaction” as a more extreme form of combat fatigue which was mostly seen in soldiers nearing the end of their tours, and would likely have long-term consequences (Marlowe, 2000). They provided a comprehensive description of the symptoms of Vietnam combat reaction, described as follows:
“The first symptoms of Vietnam combat reaction are either insomnia, anorexia or both, later progressing to a full blown syndrome which typically . . . includes: insomnia; recurrent terrifying nightmares, which are usually a reliving of a severe psychic trauma (friends and fellow combatants severely injured, mutilated, or killed, the subject himself wounded close to a vital organ, or perhaps his unit overrun by enemy with few survivors); anorexia progressing to nausea; vomiting (precipitated by enemy contact or explosions) and sometimes even watery diarrhea; depression, including guilt over not having saved his buddy’s life or perhaps not having grieved enough for him, as well as shame for having broken down when others in his unit maintained emotional control; and, most prominent, severe anxiety with tremulousness, to such a degree as to make the soldier ineffective in combat. . . . Subjectively the soldier experiences a deep fear of combat or the thought of it, and notices increasing tremulousness beyond his control when in the field, especially if actual enemy contact is made” (Pettera, Johnson, and Zimmer, 1969, p. 675, as quoted in Marlowe, 2000).
Elements of this definition can be seen in the current diagnostic criteria for PTSD.
Andreasen, N. C. (2004). Acute and delayed posttraumatic stress disorders: A history and some issues. The American Journal of Psychiatry, 161, 1321-1323. Retrieved from http://ajp.psychiatryonline.org/article.aspx?Volume=161&page=1321&journalID=13
Marlowe, D. H. (2000). Psychological and psychosocial consequences of combat and deployment with special emphasis on the Gulf War. Retrieved from http://www.gulflink.osd.mil/library/randrep/marlowe_paper/
Price, J. L. (2007). Findings from the National Vietnam Veterans’ Readjustment Study. Retrieved from http://www.ptsd.va.gov/professional/pages/vietnam-vets-study.asp
Scott, W. J. (1990). PTSD in DSM-III: A case in the politics of diagnosis and disease. Social Problems, 37(3), 294-310. Retrieved from http://www.jstor.org/stable/800744?seq=1