Tomorrow marks the 50th anniversary of the assassination of John F. Kennedy. We will be reminded – repeatedly – of the events that fateful day and the legacy JFK left behind. Some typical themes:
- Where were you (if you are old enough to remember)?
- How did his assassination change the world?
In his memory, I’ve added some slides to my PowerPoint presentation on PTSD tomorrow at The College of New Jersey. After all, how many people who were physically present must have sustained PTSD? And what about the emergency workers and society who were exposed to the images and breaking news stories, over, and over, and over?
Of course, we know that there are rules as to what the objective criteria are that must be established in order to diagnose PTSD. There is a decision tree, and the most recent version is encapsulated in DSM-5 that was just published this year (2013).
Notwithstanding changes in criteria, have traumatic events themselves changed such that the criteria have had to change? Would an earthquake devouring a village a hundred years ago, a thousand years ago, have resulted in a different traumatic experience than one in 2013? Would the recent typhoon in the Philippines that claimed the lives of more than one thousand have left a different PTSD experience merely because of definitional criteria?
Let’s take a closer look at the timeline of the development of DSM:
1952: The DSM-I
1968: The DSM-II
1974: The DSM-II Reprint
1980: The DSM-III
1987: The DSM-III-R
1994: The DSM-IV
2000: The DSM-IV-TR
2013: The DSM-5
And what about the term PTSD?
There was no such diagnosis in DSM-I. Nor did it exist in DSM-II that was published in 1968, after JFK’s assassination.
A psychologist working with traumatized victims in 1963 would have turned to his or her trusty DSM-I and seen the predecessor of PTSD: Goss Stress Reaction.
Goss Stress Reaction was defined as a transient personality disorder in which, under conditions of great or unusual stress, a normal person utilizes neurotic mechanisms to deal with danger.
A brief history reveals:
In 1980, the American Psychiatric Association (APA) added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
The diagnosis first appeared in the official nomenclature when Diagnostic and Statistical Manual of Mental Disorders(DSM)-I was published in 1952 under the name gross stress reaction. It was omitted, however, in the next edition in 1968, after a long period of relative peace. When DSM-III was developed in the mid-1980s the recent occurrence of the Vietnam War provoked a more thorough examination of the disorder. PTSD was defined as a stress disorder that is a final common pathway occurring as a consequence of many different types of stressors, including both combat and civilian stress.
The symptoms, however, as I noted above, were recognized much earlier:
The 1800’s saw names used such as; Hysteria, Soldiers Heart, Soldiers Irritable Heart, Irritable Heart, DaCosta’s Syndrome, Railway Spine, Traumatic Neuroses & Fright Neuroses.
The 1900’s saw names such as; Disorderly Action of the Heart, Neurocirculatory Asthenia, Shell Shock, War Neurosis, War Hysteria, Stress Response Syndrome, Combat Stress Reaction, Concentration Camp Syndrome, War Sailor Syndrome, Rape Trauma Syndrome, Battered Woman Syndrome, Vietnam Veterans Syndrome, Abused Child Syndrome and inevitably in 1980, Posttraumatic Stress Disorder (PTSD)
Whatever nomenclature and diagnostic criteria we choose to rely on now, 50 years after such a traumatic event, it is clear to me that the nation as a whole was traumatized, and classic PTSD symptoms were to be seen in many nooks and crannies on November 22, 1963 and in the ensuing days after the tragedy.
I am left with the disturbing thought: what if we had our modern-day technology back then? And, alternatively, what impact would a “9/11” tragedy of such magnitude have had 50 years ago? What similarities? What differences?
And, because we are inundated with pieces of information to the point of overloading, how much can we take in and how much attention can we direct to so many “sound bites?” We have difficulty gauging the relative significance of one piece of information over another. There is an emotional dulling as our attention span shortens and amount of input increases. Sound bites can be manipulated with greater ease to suit the author’s needs or interests.
On the other hand, a cursory look at the events that transpired 50 years ago on November 22, 1963 on the Internet today will produce something along the magnitude of 500 million hits depending on the search parameters.
Those of us who were not alive then can witness in tremendous detail the events of that day. Far more than what was available via traditional news reporting methods back then.
Perhaps our modern technology creates a bifurcated emotional pathway: increased sensitivity and decreased sensitivity. The former is a more heightened awareness and profound emotional experience; and the latter, more of an emotional desensitization.
Change is the law of life. And those who look only to the past or present are certain to miss the future.