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By Expert ID: 5045, Ph.D.

As a young doctoral student at the University of Arizona in the early 1970s, I had the opportunity to work with what was then known as the Veterans’ Administration, providing counseling services for men and women returning from Vietnam and related combat zones.

Not surprisingly, the VA began to send out questionnaires regarding what sort of mental health problems were being diagnosed in these young people since it was obvious there were things very much amiss. Their average age was 19.

I had been a combat veteran with the U.S. Navy’s Underwater Demolition and SEAL Teams, serving as an officer. I was older than the returning vets in the 1970s.

Problems developing from combat are nothing new. WWI soldiers who endured lengthy battles while huddled in trenches were diagnosed with NYDN (Not Yet Diagnosed Neurologic), neurasthenia, shell shock or combat battle fatigue.

These individuals had syndromes featuring (but not limited to) persistent headaches, memory problems, ataxia, sleep disorders, mood disorders, altered mental status, behavioral changes, depression, nightmares, flashbacks, anxiety, despondency, fatigue & dizziness, irritability, hyper-vigilance, impulsive behavior, angry outbursts, poor judgment, indecision, and inability to concentrate. They had general health problems, abused substances and exhibited suicidal behavior.

These symptoms were so severe that many soldiers could not perform their military duties. A surge in hospitalizations resulted with a spike in attempted and completed suicides.

At that time, experts felt that these unknown physical and psychological changes were due to some sort of biological variable or related to the treacherous emotional turmoil and repressed memories that were attendant to combat stress.

Over time, more attention was paid to this constellation of problems. During and after the Vietnam War, psychologists and psychiatrists worked with veterans to try to address these neuropsychological symptoms, substance abuse and suicidal behavior.

Current literature indicates that while over 50,000 U.S. military personnel died in combat during the Vietnam War, more than double that figure of Vietnam veterans died by suicide.

The term Post-Traumatic Stress Disorder (PTSD) was finally developed in the late 1970s to describe these problems.[1]

Within a few years, the diagnosis of Post-Traumatic Stress Disorder was officially established in 1980 for soldiers suffering after a military conflict.[2]

The diagnostic terms shell shock and combat fatigue were replaced by the term PTSD.

A Napa County Superior Court Judge recently provided an example of PTSD from the Bible, a Psalm of David. “Be gracious to me, Oh Lord, for I am in distress; my eyes grow weak with sorrow, my soul and my body with grief. My life is consumed by anguish and my ears by groaning; my strength fails because of my affliction, and my bones grow weak … deliver me from my enemies and those who pursue me. – Psalm 31; 9, 10, 14-16.

It is reasonable to assume that over the course of centuries, this type of mental disorder has been present in one form or another; more recently and in all probability, presenting along with Mild Traumatic Brain Injury (M-TBI) which are felt to be the two signature combat-related injuries for active duty military personnel.

Over time, the diagnosis of PTSD has been expanded.  It is proposed to expand even more to individuals who have not necessarily been confronted with death (or imminent death), but who were involved in motor vehicle accidents; many of which are not considered serious. It may also be expanded to various types of domestic conflicts, as well as areas which have caused concerns among professional groups who are attempting to maintain a more strict diagnosis.  The upcoming DSM-V will have less stringent guidelines than the DSM-IV for clinicians to consider when evaluating and developing treatment plans.

Given current events in Iraq, Afghanistan and other parts of the world where combat troops are being deployed, it is anticipated that there will be an increase in PTSD diagnoses, in all probability, co-occurring with M-TBI, depression, substance abuse and other emotional and behavioral symptoms.


[1] Neurosurgical Focus, Vol. 31, Nov., 2011, pps 1-10.

[2] Journal of Head Trauma Rehabilitation, Vol. 27, 2012, pps 234-239.

By Expert ID: 5045, Ph.D.