The addition of PTSD

  The Effect of Vietnam on the Addition of PTSD to the DSM-III.

In 1952 the DSM-I was released and in it was the diagnosis for something called ” Gross Stress Reaction” which was included as a response to the psychological damage that mental health professionals had seen in soldiers that had fought during WWII.  This was also referred to as “shell shock” by the British physicians who treated soldiers during WWI, and noted symptoms of withdrawal and anxiety.   Gross Stress Reaction was listed as a reaction that soldiers may face due to combat, but should recover from once removes from the combat situation.  However, work had already been done by Grinker and Spielgel in 1945 that showed many WWII soldiers were experiencing greater problems when they returned home versus when they were actually in combat zones.  This seemed to suggest that there could be a chronic Gross Stress Reaction that lasted far longer than the war itself.

Due to the large number of soldiers that had to be sent home during WWII and the Korean War due to psychological issues, the military decided to implement a new plan to treat troops during the Vietnam War.  During the Vietnam War each battalion was required to have staff with them who specialized in the treatment of psychological conditions.  At the first sign of a soldier reporting psychological difficulties they were sent to talk to the psychological specialist, and then sent right back into the battlefield.  The reduction in the number of troops being sent home for psychological reasons was startling, and military leaders believed that they had found a solution to Gross Stress Reaction.

Vietnam Soldiers. Photo retrieved from the Encyclopaedia Britannica online.

Ironically, it was during the Vietnam War that the DSM-II was published (1968), and the news of the military and mental health professionals “solving” Gross Stress Reaction caused it to be removed from the DSM, thus the DSM-II was published with no category to place combat related stress into.  However, mental health professionals back in the United States soon realized what a problem this was going to cause.  While there was a lower rate of troops returning home due to mental health issues, there were many coming back after serving their time overseas with severe mental health issues.  Veterans of Vietnam were presenting with issues of anxiety, nightmares, little emotional affect, and avoidance of situations that reminded them of the war.  Many were turning to alcohol to help them sleep, to forget what they had seen, and just to get through the day.  Some psychologists at the VA initially called these veterans crazy, and didn’t believe the horrible accounts of war they were being told.  Over time the doctors and mental health professionals began realizing that what the veterans were describing wasn’t crazy, and that they truly were suffering severe mental disturbances.  However, with there no longer being a diagnoses for these veterans in the DSM, they were not eligible to receive VA benefits and get the help they needed.

As news of the DSM-III being in the works began circulating many mental health professionals were wondering and hoping that Gross Stress Reaction may be added back into the DSM -III.  By this point many papers and articles had been written about what Vietnam veterans were experiencing upon their return home, something that a doctor named Shatan called “Post Vietnam Syndrome” in his papers.  Despite the amount of literature being written about this “Post Vietnam Syndrome”, Spitzer, a man who was highly involved in the development of the DSM-III, told the mental health professionals that there was no plan to add Gross Stress Reaction ( or anything similair) back into the DSM.  A group of influential mental health professionals of the time called a meeting with Spitzer and showed him all the cases the VA had of soldiers returning home with severe ailments and no way to diagnose them.  This had a strong enough effect on Spitzer that he suggested to the APA that a diagnoses be added.  In 1980 the DSM-III was published with Post Traumatic Stress Disorder to take into account those who are exposed to traumatic situations and experience strong emotional experiences afterward that are related to the event.

All information was referenced from:

Scott, W. J., 1990. PTSD in DSM-III : A case in the politics of diagnoses and disease.  Social Problems, 37 (3).

This page was created by Mary Hannick

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