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Psychological trauma is known as damage that affects the mind after an individual has been exposed to a distressing event. Shock occurs when a person is overwhelmed by stress or emotions associated with a particular experience to a point where they cannot cope. Therefore, a traumatic event may involve one's experience or a repetition of events of being overwhelmed, which can be triggered after weeks, months, years, or even decades as the individual tries to cope. Traumatic events may result in serious and long-term health complications.
Psychological trauma may differ between different individuals depending on their personal experiences. This means that people exposed to a similar event may show different reactions. For instance, while an individual may be traumatized by an event, another person may not show any signs of psychological trauma after being exposed to the same event. However, it is possible for traumatic events to cause Posttraumatic Stress Disorder (PTSD). The difference between those who can and cannot be affected by trauma can be associated with various protective factors. These factors are related to environmental and temperamental factors, and they enable individuals to cope with trauma. A good example of protective factors is the active seeking of help or having resilience characteristics. Also, individuals who have been exposed to mild stress at a young age may also be resilient from trauma.History of Trauma
Throughout history, there have been several changes in how psychological trauma is perceived and how it is managed. Before the 1970s, some argued an individual who comes from a family with no history of mental illness was in no danger of developing long-term psychological-related problems. It was believed if such an individual was to be exposed to a traumatic event, he/she would develop acute psychological distress, but then recovery would take place. The Vietnam War led to the discovery of the Delayed Stress Syndrome, where healthy soldiers exposed to traumatic events suffered long-lasting, adverse effects that were not obvious during exposure. The trigger which made these soldiers to relieve their terrifying experiences became significant in the description and management of psychological trauma that followed (Mullins 1999).
Before the 1970s, any soldier who was found to suffer from long-term effects of trauma was considered vulnerable, or that the individual came from a degenerate family. The individual took the blame for their suffering. If an individual suffered from a recognized disorder, they were compensated through 'secondary gains,' which entailed rewards and attention. After the discovery of the Delayed Stress Syndrome, it was believed the 'secondary gain' hindered the process of recovery among the affected. Posttraumatic Stress Disorder (PTSD) was admitted to DSM-III in 1980, and as a result, the affected individuals were no longer blamed for their suffering.
The admission of PTSD marked a new dawn for psychological casualties. During the 1st and the 2nd World Wars, some argued having united goals, training, and comradeship could help protect the vulnerable from chronic adverse effects. It was later found out that organization and leadership were the only factors that could influence a different outcome for the vulnerable. The anti-Vietnam War movement led to the acceptance of PTSD by the American Psychiatric Association (Winter 2000).The First World War
The First World War entailed recruitment of a mass civilian army, which was not prepared for the emotional stress associated with trench warfare. This resulted in an epidemic of psychological post-trauma illness, which was then referred to as Shell Shock. Experts tried to explain the epidemic by arguing that it was caused by a microscopic cerebral hemorrhage resulting from the toxic or the concussive effects of an exploding shell. Further research revealed that many of the affected servicemen had not been exposed to combat or were not close to an explosion. This led to a search of other explanations, and as a result, the immediate prospect of battle or the intense stress associated with it was identified as spontaneous causes.
Medical experts who treated the soldiers argued that unlike the regular soldiers, the recruited mass civilian army did not have enough time to build up an effective coping mechanism to take them through the war. The Southborough Committee established in 1920 also concluded that with high morality and good leadership, the trained units would be immune from post-trauma illnesses. Such arguments led to the belief that war-related psychological illness could be averted.
The First World War was characterized by severe shortages of a workforce, a factor which led to the urgent need for an effective post-trauma illness treatment. Several experts proposed the Forward Psychiatry method as the most suitable solution. This form of treatment is also known as the PIE method, as it relied on three principles, which include Proximity to battle, Immediacy of treatment, and Expectation of recovery. The method entailed referring soldiers to specialist units which were located about 15 to 20 miles away from the battlefront. In the units, the soldiers were taken care of through healthy feeding, rests, and were then enrolled in a programme of graduated exercise for a period of between 2 and six weeks. This method proved to be effective as up to 80% of the admitted soldiers were sent back to combat units. The PIE method has been the established standard intervention for combat stress reaction. The treatment has been applied to other wars such as the Vietnam War, the Korean War, and also Lebanon and the Gulf conflicts.The Second World War
In 1939, the term 'Shell Shock' was outlawed by both the military and the civil authorities to avert the epidemic of 1914 to 1918. The pensions awarded to psychiatric war illness victims were also withdrawn. Soldiers showing symptoms of combat stress reaction were from then to be diagnosed with 'exhaustion,' and the soldiers were to be kept in the forces. This implied that the disorder was not that serious and that it would recover. The most emphasized treatment for the condition was the restoration of physical well-being and the control of fear. The large numbers of seasoned and highly effective troops that developed the psychiatric illness in Dunkirk, and the poor performance of other troops in Normandy that had proved effective before, led to the notion that posttraumatic illness could not be fully averted. Medical experts found out that even the elite soldiers could cease to function once they were exposed to intense stress. Treatment, as prescribed by clinics in the First World War, was ineffective. Only 20% to 30% of troops returned to their combat units. This led to questions by both the public and the parliament on the ban on the psychiatric pensions.The Vietnam War
After the Second World War, a psychiatrist in the United States military conducted several studies aimed at discovering the performance of troops in battle, and also the frequency of psychiatric casualties. Specialist psychiatrist deployed during the Korean War led to the publication of DSM-I in 1952. The publication introduced the gross stress section, which was a description of the extreme behavioral responses of normal people to events that cause exceptional stress. As the Vietnam War was in progress, DSM-II was published in 1968. The publication introduced 'Transient Situational Disturbance,' which entails all acute reactions to exceptional stressors. According to the formulations presented by both DSM-I and DSM-II traumatic reactions would last for a short while after some rest. If symptoms of psychological trauma did not stop, some argued the true cause of trauma was associated with earlier life, and that war was only a trigger.
DSM-III, which was later published in 1980, introduced PTSD. PTSD was referred to as Post-Vietnam Syndrome or Delayed-Stress Syndrome. This was because the condition was first identified among veterans who had returned to the US. Military psychiatrist in various combat divisions solved cases of acute combat fatigue. Psychiatric injury rates in the Vietnam War were therefore low. However, soldiers who had returned home after the war exhibited what seemed to be a range of delayed symptoms. Mental health specialists who examined them argued that the toll of war affected the servicemen far beyond the battlefronts. These specialists comprised individuals who were opposed to the United States engagements in the Vietnam War. PTSD was later recognized by the American Psychiatric Association as a mental disorder.Current Discussions around Trauma
Since PTSD was formally recognized in 1980, it is ranked among the high profile psychiatric disorders. Over the years, the PTSD stressor criteria has transformed from the initial notion of a life-threatening experience to the current notion, where an individual is expected to have experienced, or witnessed events that caused serious injuries, involved death, threatened death or injuries, or threatened self-integrity or that of others. Changes that have taken place in the society have shifted focus from groups to individuals. These changes alongside increasing media coverage and public awareness have contributed to the popularity and acceptance of PTSD.
In the 1990s, the notion of false memories effects among individuals with PTSD took centre stage. According to Moradi (2015), when individuals who have been exposed to trauma especially in combat, are reminded or shown footage of attacks related to their individual trauma, they may begin to have false memories. These false memories usually have ties to the individual's actual memories. In court cases involving repressed memories, false memories may significantly impact the outcome of the case. Repression basically happens when a traumatic event happens, and the mind pushes the memory to some inaccessible part of the unconscious. The memory may later emerge after a long time.
A good example repression is the 1990 murder court case involving 51-year-old George Franklin, Sr. The murder had occurred about 20 years earlier, where Franklin had raped and murdered 8-year-old Susan Kay Nason. Major evidence against Franklin was provided by his daughter, Ellen, who was also eight years old at the time of the murder. Ellen's memory of the murder had been repressed, but it came to surface to her consciousness 20 years later (Loftus 1993). The memory had so much detail such that her father was found guilty of first-degree murder. In the case that Ellen's memories were corrupted by false memories, a wrong conviction had been issued. A research carried out by Otgaar et al. (2017) states that individuals with PTSD and a history of trauma may be susceptible to false memories when exposed to the associative material. This might be dangerous in legal proceedings or in clinical settings when exploring treatment options.
Although PTSD is prevalent among the entire population, post-war veterans are the hardest hit. In realization of this, the society is committed to ensuring that these individuals get the help they deserve. Typically, veterans are given the PTSD services that help them in their recovery programs. However, the majority of veterans do not use the services and most specifically the mental health care. Interestingly, these patients are not aware of their problem, and they become reluctant in attending the veterans' affairs services. Research has suggested that war veterans who use the services are safe and recover from the condition faster than those who fail to attend. The increasing number of patients with PTSD has caused the government to devise tactics to engage them in the services. Apparently, the government has introduced the brief motivational interviewing intervention to assist the non-users to actively participate. However, some of the patients attend private facilities, making it easy to reduce the effect of PTSD on the war veterans.
Today, psychological trauma is treated through different approaches. Psychotherapists or psychologists may decide to analyze a traumatized person to identify the individual's defense mechanisms in cases of trauma, which reveals the symptoms. Unlike the early notions of psychological trauma, which focused on physical signs to determine psychological distress, modern strategies and methods are based on mental symptoms. When it comes to psychological interventions of trauma, several approaches have been developed. These approaches include cognitive behavioural therapy (CBT), cognitive restructuring therapy, exposure-based therapies, rational emotive behavioural therapy (REBT), critical incident stress management (CISM) and critical incident stress debriefing (CISD), psychological first aid (PFA), coping skills therapy, eye movement desensitization and reprocessing (EMDR), among other therapies.Cognitive Behavioural Therapy (CBT)
Cognitive behavioral therapy (CBT) is the best treatment for trauma-related cases. CBT is a therapeutic approach that is based on the learning principles and a theory that cognitive processes influence behavior. CBT applies to the treatment of a range of therapies. However, for traumatic experiences, specific strategies such as cognitive restructuring, exposure, and several coping skills may be applied either individually or in combination. In most cases, trauma-focused CBT is brief and require the patient to be taken through weekly sessions, which may last between 60 to 90 minutes. The treatment may be administered to a group or an individual.
Cognitive restructuring is based on the notion that a person's mood is determined by the interpretation of the traumatizing event, rather than the actual event. The therapy leverages Epictetus words and Selye's approach. The purpose of this form of therapy is to help the victim to face the distorted thoughts and beliefs caused by the traumatic experience and to identify the dysfunctional thoughts also related to the trauma. Afterward, the patient is helped to replace these thoughts and beliefs with more positive, rational and adaptive thoughts.
Exposure-based therapy entails the step by step confrontation of the stimuli causing the trauma. The therapy is continued until the patient stops experiencing anxiety. The exposure, in this case, entails the creation of mental imagery from the memory or a video presentation of scenes developed by the therapist. In cases where the traumatized individual has a poor imagination, and there is the presence of an environment to the traumatic one, exposure is carried out in vivo. This type of therapy aims to eliminate the conditioned emotional response to the traumatic stimuli. This is achieved by helping the traumatized mind to learn that nothing bad will happen when the traumatic event occurs. This ultimately helps the patient to overcome their fears. Exposure-based therapy usually involves weekly or biweekly sessions of up to 12 weeks, with each session lasting between 60 to 90 minutes.
In conclusion, this paper has explored the different approaches to traumas that were developed during the First World War, Second World War, and the Vietnam War. Apart from the historical discussions about trauma, the paper has also presented the discussions that take place today. PTSD has been discussed as a common mental condition that affects wars veterans because of their exposure to violence. Although anyone can be affected by trauma, the causes and the impacts on a war veteran are different from civilians. As far as the general signs and symptoms are the same, they become more disturbing to war veterans. Among the many available therapies, CBT has been identified as the most effective therapeutic approach.
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