A Soldiers Heart

A Soldier’s Heart

Post Traumatic Stress Disorder, or PTSD, is a psychiatric disorder that develops in a person who reacts to a traumatic event with a very strong stress reaction. Generally it involves the individual directly experiencing the event, like an earthquake, rape, combat experience or assault. Witnessing any type of personal or environmental disaster, or being in a life-threatening situation can lead to PTSD. In most cases this is because of the intense feelings of fear, horror or helplessness that tend to occur in these situations.

Scientific and clinical interest has peaked in the last 20 years, as it is no longer thought to be a problem for veterans alone. PTSD is now seen as a major public health problem for not only war veterans, but survivors of other catastrophic events (i.e. Hurricane Katrina, Columbine and 9-11). PTSD has also been diagnosed to the victims of assault, rape, child abuse and other traumatic events. People of any age, gender or social standing can develop PTSD. According to the National Center for PTSD, a world leader in research and education focusing on PTSD and other traumatic stress disorders, PTSD affects more than ten million American children or adults at some point in their lives.

The development of post traumatic stress disorder follows an interesting timeline, in that each discovery made requires the loss of thousands. What one also may find to be of particular interest, is the lack of initiative to produce effective treatment. This lack of treatment capability becomes even more intriguing when one considers that the population ultimately suffering from this disorder is this nations pride and joy. They come first in funding, secondary schooling and employment; but they are not privy to treatment when they don’t measure up to our standards of what it means to be a man.

During the Civil War, a physician named J.M. Da Costa identified a series of symptoms that lead him to conduct one of the first studies of a war syndrome. Da Costa studied 300 soldiers who suffered from a syndrome that he labeled “irritable heart syndrome.” These patients reported chest pains, palpitations, breathlessness, dizziness, diarrhea, obsessive thoughts of home and fatigue. Because symptoms of irritable heart syndrome were not limited to soldiers in combat, Da Costa classified this syndrome a war related illness.

Generally young soldiers who exhibited these symptoms accompanied by obsessive thoughts of home, apathy, loss of appetite and fever were diagnosed with “nostalgia.” But these symptoms were not consistent, and most patients seemed to be in fair overall health. This diagnosis then leads us down an all too familiar road, to an age old philosophical problem…the “mind body problem.” How can a homesick heart manifest physical symptoms?

Dr. Mathew Friedman, Executive Director of the VA’s National Center for Post-Traumatic Stress Disorder, had this to say in his October 7, 2004 PBS interview:

“The Parallel trajectory is about the psychological models. And in the Civil War, it was very interesting; the psychological model was nostalgia. The notion was that A Vermonter who found himself with Sherman marching through Georgia who exhibited psychological symptoms was doing so because he was nostalgic for being back in Vermont. Being in this alien Georgia terrain was somehow psychologically so disconcerting that he was having these kinds of symptoms.”

One must also keep in mind the culture and social pressures that confronted these individuals. Psychology was more of a pseudo-science at best in this era. It wasn’t uncommon for an individual unable to tame his fear and anxiety to be hot-iron branded with a “C” for coward.

The post-Civil War era coined a new term for this disorder, “Soldier’s Heart.” Civilians looked at their returning brothers, sons and fathers and noticed a precarious physical change in them. They were unable to work for long periods of time; they easily tired or became breathless. Soldiers heart is associated with the physiological changes, that are now associated with PTSD, but at the time were thought to be an isolated disorder. These individuals tended to have altered blood pressure, and pulse rates.

Soldiers in World War I were privy to a syndrome comparable to those studied by Da Costa in the Civil War. Many men were evacuated to England for shortness of breath, fatigue, headaches, confusion. This was generally attributed to the extremely frequent exploding shells. World War I put a new spin on this diagnosis, terming the physical and psychiatric symptoms “Shell Shock.”

While many military leaders were convinced that these “break-downs” were more likely to occur in weak or non-combat worthy individuals, psychologists began to argue that weakness or combat worthiness probably had very little to do with it. These cases raised the interest of psychologists, and numerous studies were done to gain insight on these phenomena. To the American families who had sent charming, healthy boys to war and received back broken, terrified shells of men; this research was supported.

The new warfare technology of World War I caught many off guard. These techniques that combined traditional strategy with new technology resulted in one of the greatest military errors, trench warfare. This stalemate forced soldiers to survive unthinkable circumstances that tested their ideals of bravery and manhood. Men waded through the limbs and bodies of their comrades, while being constantly bombarded by exploding shells. The high air pressure of these shells actually caused physiological damage, adding to the symptoms that many were experiencing.

Soldiers were ultimately forced to choose between the ideals of bravery and survival. The result of this mental conflict took the form of a nervous disorder, termed in 1915 by Physician C.S. Meyers as shell shock (Baggett & Winter, 1996). By the end of the war the syndrome became known as a “war neurosis” (Glass, 1969)

The idea of war related illness was beginning to perforate the ranks of the U.S. military, due to the extensive psychological research done in World War I. It was generally believed that predisposing factors, combined with traumatic battle experiences, were the cause of these breakdowns in soldiers. This belief was held into World War II.

Grinker and Spiegel (1945, p.34) cite a particularly interesting case involving a 25-year-old gunner who had served for 27 months and 25 combat missions on a B-24. In his short military career, this individual