The Politics of PTSD


How a Diagnosis Battled Its Way into the DSM

January/February 2004


In retrospect, it seems bizarre that hundreds of thousands of veterans, all suffering from similar, dramatic symptoms, could be largely ignored by the Veterans Administration (VA) and psychiatry in general. But before the 1970s, almost no mental health authorities--military or civilian--imagined, much less expected and prepared for, traumatic reactions to war to emerge years after the conflict ended. There was yet no official traumatic stress diagnosis, and the VA assumed that any psychiatric problem occurring more than one year after discharge couldn't be related to military service.

During the Korean War, for the first time, clinicians provided frontline treatment for psychiatric breakdowns, returning the soldiers to battle as soon as possible afterward. Because this approach had worked so well--only 6 percent of Korean War evacuations were for psychiatric reasons, compared with World War II, when 23 percent were--the military was prepared to use the same approach in Vietnam. Only, nobody sought help. In fact, during Vietnam, there were proportionately far fewer reported cases of trauma on the actual battlefield than there'd been in previous wars. The primary reason seems to have been that soldiers had one-year rotations and knew that if they could just hold themselves together for 12 months--often with a little help from their friends, marijuana and heroin--they'd be free.

But after they returned stateside full of relief and happy to be alive,…

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Topic: Trauma



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