WWII lasted from September 1st, 1939 until September 2nd, 1945. The death toll during WWII has been estimated to be between 35,000,000 and 60,000,000. However, the exact number is unknown. With all those fatalities, it should not be surprising that it left so many lasting effects on the survivors. There have been many terms for these lasting effects over the decades. These terms include, but are not limited to, shell shock and combat fatigue. In 1980, the diagnosis of PTSD was added to the newly published DSM 3. A History of PTSD

Post Traumatic Stress Disorder(PTSD) was officially classified as a mental illness with the publication of the DSM 3 in 1980. However, records of PTSD symptoms trace back to ancient times. Modern records of PTSD can be traced back to the U.S. Civil War. Returning Civil War soldiers were reported as having a disordered palpitation of the heart, also known as soldier heart. Unexplained palpitations of the heart could categorize this. At the time, it was primarily associated with access to alcohol and tobacco usage. Today, distorted heart palpitation is considered one of the first combat-related PTSD symptoms. Following the Civil Wars, suicide rates among Union soldiers doubled. War neurasthenia was used to describe an undefined weakness in the nervous system. With WWI came the new diagnosis of Shell Shock. This new diagnosis theorized that compression and decompression of the brain due to being near explosions were the cause of various somatic symptoms. Under the shell shock terminology, a more psychological etiology. It was recognized that veterans often experience flashbacks and nightmares in association with their time in service. By the end of WWI 65, thousands of veterans relied on pensions based on their diagnosis of Shell Shock. At the end of WWII, up to 3% of WWII veterans were receiving government-based disability benefits due to neuropsychiatric diseases.

Post-traumatic stress disorder (PTSD) results after experiencing or witnessing a terrifying event which later leads to mental health problems. This disorder has always existed but has only been recognized as a psychological disorder within the past forty years. Before receiving its official diagnosis in 1980, when it was published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), Post-traumatic stress disorder was more commonly known as soldier's heart, irritable heart, or shell shock.Langer, Ron. "Combat trauma, memory, and the World War II veteran." War, Literature, and the Arts: An International Journal of the Humanities 23, no. 1 (2011): 50–58. http://www.pitt.edu/~nancyp/uhc-1510/CombatTraumaMemoryWWIIVet.pdf Shell shock and war neuroses were coined during World War I when symptoms began to be more commonly recognized among many of the soldiers that had experienced similar traumas. By World War II, these symptoms were identified as combat stress reaction or battle fatigue. In the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), post-traumatic stress disorder was called gross stress reaction which was explained as prolonged stress due to a traumatic event. Upon further study of this disorder in World War II veterans, psychologists realized that their symptoms were long-lasting and went beyond an anxiety disorder. Thus, through the effects of World War II, post-traumatic stress disorder was eventually recognized as an official disorder in 1980.

General overview Changing terminology

Nostalgia, soldier's heart, and railway spine

The term nostalgia was first coined in 1761 when soldiers reported feeling homesick, sleep disturbances, and anxiety after being in combat. Later, soldier's heart was used to describe these symptoms but instead blamed cardiac problems as the source of anxiety and overstimulation. Railway spine also explained physical causes for PTSD symptoms. After railroad accidents became more common, the victims of these accidents exhibited emotional distress.

Shell shock and war neuroses Before the term post-traumatic stress disorder was established, people that exhibited symptoms were said to have shell shock or war neuroses. This terminology came about in WWI when a commonality among combat soldiers was identified during psychiatric evaluations. These soldiers all appeared to be in a catatonic state following battle, or "shocked by shells", hence the term shell shocked.

Battle fatigue and combat stress reaction During World War II, the diagnosis for shell shock was replaced with combat stress reaction. These diagnoses resulted from soldiers being in combat for long periods of time. There was some skepticism surrounding this diagnosis as some military leadership, including George S. Patton did not believe "battle fatigue" to be real. Yet, due to evolving practices, such as proximity, immediacy, and expectancy (PIE), this new diagnosis was taken seriously and recovery was made the first priority.

Prevalence Post-traumatic stress disorder has always been prevalent whether it was recognized as a psychological disorder or not. Yet, because PTSD was not recognized as an official disorder, it is difficult to estimate what the prevalence rate during WWII was. A rough estimate, found through hospitalization records, suggests that approximately 43 per 1000 soldiers were hospitalized due to war traumas. Again, however, this estimate is only based upon those who actually sought help, with many at this time not seeking help. Another prevalence rate, found in the 1950s, suggests that about 10% of WWII soldiers had PTSD at some point. While it is difficult to retroactively discern prevalence for PTSD in WWII soldiers, what is clear is that it is prevalent now more than ever due to the long-lasting effects of combat in World War II. For example, half of all male veterans 65 and older have had military experience, which predisposes them to the acquisition of PTSD. Thus, PTSD continues to affect World War II veterans and their families.

In the 1990's a questionnaire was given to a sample of Dutch WWII veterans. Out of 4057 veterans 66 of them fall under the qualifications for a PTSD diagnosis. The higher percentage of these were people, who had been victims of persecution. The next highest was among military veterans. The lowest level was among those who served as civilians. In the 1990's VA treatment centers saw an increase of WWII vets reporting PTSD symptoms. This can be attributed to them entering retirement age: their children were now grown, which left them with more time alone with their thoughts.

PTSD symptoms can often come in waves for many WWII veterans. The media or other memorial services honoring those who served in the war can usually act as a trigger for PTSD. Longitudinal studies show a spike in PTSD symptoms among WWII veterans around the time of the 50th anniversary of the war. Some veterans reported a loss of interest in hobbies, being acutely aware of those around them, restlessness, and loss of sleep. These symptoms progressed following a television program documentary about Auschwitz. The symptoms gradually decreased in the months following the program. Other veterans reported having recurring symptoms of PTSD, such as flashbacks and anxiety. These symptoms increased around the 50th anniversary in 1995.( International journal of geriatric psychiatry 12.8 (1997): 862-7. ProQuest. Web. 17 Mar. 2024.)

Symptoms Symptoms of post-traumatic stress disorder differ from person to person in that they can begin shortly after a traumatic event or even years after the event. Moreover, symptoms can continue to present long after the traumatic event's occurrence, with some people experiencing symptoms for the rest of their lives. Symptoms of PTSD can be grouped into four main categories: "Intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions".

Intrusive memories can include symptoms such as nightmares, flashbacks, recurring memories of the event, and emotional and physical stress upon encountering things that remind them of their trauma. Symptoms for avoidance behavior include avoiding thoughts and conversations surrounding the event, as well as people, places, or other things that remind them of what happened. This, understandably, occurs due to intrusive memories that persistently take place, which makes PTSD patients want to avoid these feelings. Negative changes in thinking and mood can force patients into experiencing memory loss (especially in regard to the traumatic event), hopelessness about themselves and their future, difficulty maintaining relationships, and a struggle in experiencing positive emotions. Changes in physical and emotional reactions are seen through behaviors such as trouble sleeping, difficulty concentrating, always being on guard, and becoming startled easily. Some people experience these symptoms when they hear unexpected loud noises, which causes them to "[lose] their cool over minor everyday things". Other symptoms can include self-destructive actions such as excessive drinking or driving too fast and outbursts of anger or overwhelming guilt.

Treatment Treatments used during WWII

New treatment methods for PTSD emerged during WWII, likely due to the high demand for care, and the subsequent increase in investigation. Interestingly, despite little understanding of the mechanisms whereby PTSD happened, much of the early interventions by psychiatrists in the 1940s remain similar to the methods still used today, such as medications and group therapy.

One early treatment plan, from 1944, suggests a three part treatment to PTSD through use of sedatives to secure rest; use of intravenous barbiturates to promote mental catharsis, thereby assisting in the recall of a suppressed episode and use of drugs acting directly on the autonomic nervous system. In addition to medication plans, another method that was utilized for PTSD during WWII was the principle of proximity, immediacy, and expectancy, or "PIE". In essence, the PIE method emphasized immediate action in the treatment of PTSD. While first treatment plans for PTSD were crude and simplistic, they demonstrated the rapidly changing field of psychiatry that WWII initiated, as will be further discussed below.

Present Treatments

Some successful treatment opinions for PTSD include exposure treatment, group therapy, or Cognitive behavior therapy. However, PTSD research is limited among the elderly. Because many elderly PTSD sufferers choose not to seek treatment or drop out of treatment before it is finished. This has been a significant problem when diagnosing and treating WWII veterans. Many WWII veterans had delayed diagnoses. Because PTSD did not become a recognized diagnosis until 1980, by that time, WWII veterans were already entering their senior years.

Broader impacts Divorce rates following WWII