Abstract
John Ellard, Sydney, Australia:
In his article ‘Traumatic stress in the 21st century’ in the December issue of the Journal, McFarlane states ‘The general reluctance to accept the importance of horrific and life-threatening adult experience as an important cause of psychopathology is somewhat perplexing’ [1] and then cites an article I have written as an example [2]. Had he read it carefully he would have encountered the sentence ‘calamitous experiences can indubitably cause severe psychiatric disorder, which may be long lasting’. This is the exact opposite of the opinion attributed to me.
I had 18 years of military experience, including two wars, and was involved in the assessment of psychiatric casualties therefrom. Additionally, it was my unhappy experience to interview some of the prisoners-of-war returning from Japanese captivity. In World War II – apart from the demobilization – psychiatric disorder was the most common cause of separation from the services. No one with this background could possibly hold the view attributed to me.
The problem is that none of us immersed in the disturbing consequences of severe trauma while it was going on (and after) encountered the neat tick-a-box presentation of posttraumatic stress disorder first to be found in DSM-III in 1980. Instead, we saw the whole range of psychopathology: acute psychosis, severe depression, disabling anxiety, conversions, you name it. In an article published in the Medical Journal of Australia, I gave references to some of the many military psychiatrists who described what they saw. Since then I have acquired the detailed report on the psychiatric experiences of the Eighth Air Force [3]. This formation took very severe casualties over Germany from July 1942 to July 1943. The two main syndromes observed were severe anxiety, or disabling somatic complaints: ‘nausea and vomiting, headache and dizziness, rapid heart and palpitations, weakness and easy fatiguability or any of the myriad somatic symptoms that may be associated with an anxiety state’. The syndrome of DSM-III (and -IV) PTSD does not get a mention.
It is difficult to believe that those of us concerned with service personnel who had experienced major trauma, and those of us who had shared some of those experiences, could not see what we were looking at and that a syndrome first described in 1980 could be a paradigm which escaped notice in two World Wars, Korea and Vietnam.
As I point out in the article, with examples, each war from the American Civil War on has produced its own particular epidemic of one or more psychiatric syndromes and I believe that we should be cautious if we find ourselves discovering the same syndrome wherever we look, particularly if many other observers with a special interest in the matter failed to notice it over many decades.