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“PTSD”: Normal human response or just another “story”?

Feb 27

“HE IMPAIRED HIS VISION BY HOLDING THE OBJECT TOO CLOSE. HE MIGHT SEE, PERHAPS, ONE OR TWO POINTS WITH UNUSUAL CLEARNESS, BUT IN SO DOING HE, NECESSARILY, LOST SIGHT OF THE MATTER AS A WHOLE. THUS THERE IS SUCH A THING AS BEING TOO PROFOUND.”

C.A. Dupin “The Murders in the Rue Morgue”

Sorry to be away from the blog for so long; I was having some long overdue orthopedic surgery done. I have been living with the injuries since my days as an Alouette and more recently as my alter ego “Iron Mike”. I figured it was time to take care of it, as I want to be at my fighting best if “Brutal Bobby P.” ever musters up the jam to enter the “square circle” with me. Is he unable to see that I hold the key to his salvation in the eyes of the Canadian Public? Within the space of 3 falls I could assist him in the regaining of his reputation (I know….I know) to say nothing of his public image. (And maybe even give him a leg up on one of those foreign posts he’s after e.g. London, New York).

Anyhoo on with the show. Once upon a time there was a “magician” by the name of Sigmund Freud who lived in the “magical” city of Vienna in Austria. Our hero spent his time listening to the stories of his patients’ troubles, and their much troubled lives. He found their stories strange, enigmatic, and often inexplicable (sound familiar?).

He employed the “magic” technique of hypnosis; under which his patients’ stories became even more mysterious, strange, and inscrutable. He pondered which version of the story (hypnotized or not) was the true one?

Now, being a modern and objective “magician” (read physician/psychiatrist) of his day, he figured the best way to explain someone’s behaviour was to postulate something inside the patient e.g. drives, instincts, etc. Once he did this he could categorize and explain his patients’ stories.

Then it followed naturally that he began to tell other “magicians” about the stories he had heard. As he was a doctor of medicine, Dr. Freud cobbled his stories out of the scientific, positivistic model of the day complete with categories, causes, mechanisms, forces, displacements, repressions, and resistances in an effort to explain “why” the troubling stories of the day occurred. (We might even be tempted to say that there is a certain scientific (metaphoric?) similarity between the good Dr. Freud and the not well informed “PTSD” proponents of today). And the world was caught in a spell; after all, these were stories from the magic land of Vienna where nothing was quite what it seemed to be (Mrs. Freud was thrilled with her “Siggy”).

Appreciatively, these ways of story telling were able to help some patients to develop new stories that were less painful. After a period of time other physicians (also priding themselves in their objectivism) found that they could use Dr. Freud’s method (remember psychoanalysis?) to develop less painful stories for their patients to carry around. “Ipso facto” a scientific/analytical paradigm i.e. a “storytelling” industry was born.

As all these physician/scientists were steeped in the scientific method (of the day) they believed the stories they were told were “gospel truth”. Throughout the faculty lounges and (men’s) clubs of the day there was not much argument against the idea that these traumatic stories were the products of broken minds, troubled souls, and tortured psyches. As time passed other therapists (scientifically/clinically) trained or not found the plots of these Viennese fantasies worthy of retelling; and thus the storytelling industry spread over the European continent and across the seas to the New World (sound familiar?).

In a land and a time far, far removed from Freud’s Vienna, military doctors were struggling with the human response to the horrors of combat. An early attempt (17th Century) resulted in the term “nostalgia”; that referred to a chronic longing to return home, that was thought unrelated to battle. Most of those afflicted were herded onto cattle cars with their names (or hometowns) pinned to their clothes; or simply left to wander about the country side. This tragic story lead to the establishment of the first US military hospitals (1863) where the “insane” were housed until claimed by family. As you can see the “new magicians” picked up Dr. Freud’s ball and used the inquisitive scientific model of their day to retell their patients’ stories in the most up-to-date theoretical frame of the day.

Later in the same century (1874) a certain Dr. J.M. Da Costa addressed the problem now referred to in stories as “disorderly action of the heart”; the disorder seemed to be based upon physiological changes during battle. The plot of the soldiers’ stories now became centred upon these physiological changes and officially referred to in the stories of the day as “soldiers’ heart”.

The brutal trench warfare of WWI stimulated more “magicians” comments on the number of psychological casualties. The story now used to describe troubled soldiers stated that the stress of combat could be found in the impact of the larger calibre shells that were disrupting neural function and causing “shell shock” (oh yes and by the way, there was no more science behind this story than there was behind Dr. Freud’s).

Unfortunately, the ugly story that combat stress reactions were due to weak character would not go away. Consequently more rigorous screening processes were developed for WWII.

As it was simply not believable that 37.5% of 800,000 troops who saw battle could develop such severe psychological symptoms, the belief in a weak character gained the socially acceptable labels of “battle fatigue” and “combat exhaustion”.

From the distant land of Korea where any humanity had been removed from the phenomenon of combat stress, those with symptoms were said to be suffering from “operational exhaustion”. One quarter of all personnel who saw combat in this campaign were classified as psychological casualties.

And then came Viet Nam: a more intense and physically gruelling war had never been fought. As the war progressed, the public began to increasingly question its’ legitimacy as the psychological breakdown amongst the troops continued to climb.

This war was followed by those in Iraq and Afghanistan where 30% of 2.5 million deployed suffered what was then (1980) called “PTSD”; as a new batch of “storytellers” had spun a new story and added it to the big storybook (the Diagnostic and Statistical Manual of the day).

To conclude, if you look intensely through the “looking glass” it will soon become clear that Dr. Freud’s questions derived from a Freudian plot that fit the Freudian theory; and the questions asked by the story tellers of the 17th Century fit the “nostalgia” plot; whereas the questions asked by the next bunch fit the “soldiers’ heart” plot; and so on it went with “battle fatigue”, “operational exhaustion”, “shell shock”, and “PTSD” (?).

The stories told by all the above noted story “re-tellers” are no longer modern; no longer scientific. These stories are not just the result of a troubled individual; they are also stories that reflect the interaction between the patient, the therapist, and any observers ( e.g. family, employer, insurer, colleagues, community, etc.). Stories of therapeutic “magicians” are not just tales that emerge from within the patient; rather they are stories that involve an interaction between the inside and the outside of the patient; most definitely including the interaction between the patient and the therapist.

“IN THE CASE OF ‘PTSD’ UNDERSTANDING IS NOT AS EASY AS IT LOOKS”

Dr. Mike Webster
Reg’d Psychologist
#0655

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