‘Railway spine’? ‘Soldier’s heart’? Try ‘PTSD.’
Throughout history, symptoms of Post-Traumatic Stress Disorder were observed among people exposed to traumatic events but were not recognized as real. They are—and a lot of people have them.
June is post-traumatic stress disorder (PTSD) awareness month. Sure, there are months for almost every medical condition imaginable. But this month's designation, which came about after Congress named June 27th national PTSD awareness day just last year, is a symbolic milestone in the mental health condition's history and struggle for legitimacy. The cluster of symptoms now known as PTSD—which can include having nightmares and flashbacks about a traumatic event, avoiding things that remind one of the event, feeling emotionally numb, easily startled, or "on edge," and others—has gone by many different names over the past 150 years.
In the mid-19th century, surgeon John Eric Erichsen coined the term railway spine to describe the symptoms he observed among people who survived or witnessed train accidents. American Civil War surgeon Jacob Mendez Da Costa described similar symptoms among soldiers he treated on the battlefield—a condition he called soldier's heart. Psychoanalysts Pierre Janet and Sigmund Freud documented the hysteria caused by childhood sexual abuse among their female patients. British military psychiatrist Charles Samuel Myers referred to the shell shock experienced by World War I soldiers after they returned from combat.
Time and time again, symptoms of PTSD were observed among people exposed to traumatic events, but were not recognized as "real" given social and political circumstances of the times. Things changed, however, when the forces of the women's liberation and anti-Vietnam War movements converged and PTSD was added to the Third Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The addition legitimized PTSD as a medical condition and provided a shared language and framework to study and ameliorate the effects of overwhelming human experiences.
With June upon us, let's take this opportunity to raise awareness about some of what we've learned about PTSD over the past 30 years.
PTSD is fairly common, but most people don't get sufficient treatment. Survey results indicate that about 7 percent of adults in the U.S. develop full-blown Post-Traumatic Stress Disorder at some point in their lives. It's estimated that 3.5% percent of American adults currently have the disorder or had it within the past year. Only one in five with PTSD receiving minimally adequate treatment or better.
PTSD is more common among women. On average, females are almost twice as likely to develop the disorder as males. While women generally experience a fewer number of potentially traumatic events than men, they are almost six times more likely to be sexually assaulted—an extremely traumatic event that leads to PTSD in about one-third of all survivors.
PTSD extends far beyond the military. While it's estimated that around 13% of Iraq War veterans have the disorder, studies have found that the lifetime prevalence ranges between 15 and 23 percent in urban communities plagued by violence. About 15 to 20 percent of homicide victims' family members develop PTSD.
PTSD can result from serious injuries. A systematic review of published research studies found between 20 and 51% of people have it at some point after sustaining a musculoskeletal injury. Twenty-one percent of adults were found to have PTSD one year after undergoing surgery for a serious injury. And an estimated 25 to 33% of car crash survivors develop the disorder.
PTSD is expensive. Using data from veterans in the U.S. military, the Rand Corporation estimated that the cost of a single case of PTSD ranged between $5,904 and $10,298 in medical costs and lost productivity over two years.
Regardless of the name we give it, PTSD always has, and likely always will be, an aspect of the human condition. As traumatic stress scholars Bessel van der Kolk and Alexander McFarlane note, "Experiencing trauma is an essential part of being human; history is written in blood." Accepting this reality, what can we do to prevent PTSD, or at least minimize its effects?
First, we can prevent exposure to traumatic events. PTSD is unique as a mental health condition in that it requires, for diagnosis, that a person experiences a horrible event. Societies typically strive to prevent these events—war, crime, accidents—from happening anyway, but recognizing the less visible, mental health consequences they produce ups the ante on the imperative to do so.
Second, we can provide targeted interventions to people known to have experienced traumatic events. This can prevent the development of PTSD and mitigate its effects. The Child and Family Traumatic Stress Intervention, for example, has demonstrated effectiveness in preventing the development of PTSD among youth who were exposed to trauma. It is offered to violently injured kids treated at St. Christopher's Hospital for Children in Philadelphia through the Healing Hurt People program (which I work for).
Lastly, we can continue to develop effective treatments for PTSD and ensure that they are accessible to those who need them. The National Center on PTSD has developed a collection of user-friendly resources about PTSD—such as an anonymous screening tool to find out if you might have PTSD, tips on how to select a therapist, and coping strategies to help manage symptoms.
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