Blog: 100 Years of Understanding War-Related Trauma

 

100 Years of Understanding War-Related Trauma

Why after every war do “we” look for the newest, most cutting-edge treatments for war-related trauma, rather than simply going to a library?  In his book, War of Nerves, Ben Shepard draws attention to this tendency to “forget” the clinical and theoretical contributions that evolved out of previous wars, rush to reinvent the wheel as clinicians are faced with symptomatology arising from a current conflict.  Granted the time between major wars is enough time for many seasoned clinicians to retire and take with them accumulated knowledge. But their accumulated knowledge does live on and is easily accessible. Yet, many clinicians working with men and women returning from our current wars express dismay when in response to the most recent wave of war related trauma, new “evidence based” treatment approaches are rolled out and mandated.           

Meanwhile, psychoanalytic contributions to the understanding of war related trauma began during WW l. For many years, war neurosis was used as an umbrella term to cover the many acute and subacute psychological symptoms observed in combatants during and after the war. A good number of the early analysts were drafted as psychiatrists. As the early writings indicate, they had first-hand experience working with men suffering from the consequences of war.  In 1918 as the war was winding down a psychoanalytic congress was held in Budapest. At this meeting a symposium on Psychoanalysis and War Neurosis was presented with papers by Sandor Ferenczi, Karl Abraham, Ernst Simmel and Ernest Jones. Each author referenced their experience treating men suffering from psychological symptoms related to their war experience. Their papers were published as a book with the same title with an introduction by Freud in 1921.
 

While Freud was generally laudatory in his introduction, he went in a radically different direction in Beyond the Pleasure Principle also published in 1921. What is remarkable about these early works is that many of the psychological phenomenon we currently associate with war related post-traumatic stress disorder were observed, commented on, theoretically accounted for along with treatment approaches inspired by psychoanalytic theory presented.

In Beyond the Pleasure Principle, Freud differentiated war neurosis vs. the traumatic neurosis of peace. Both he felt were caused by “severe mechanical concussions involving a risk to life.” Yet, there was something distinctly different about the symptoms caused by what he termed “this terrible war.”  These early works lay out many of the symptoms we recognize today: an event that cannot be integrated or forgotten, seeming innocuous events that trigger a reliving of the traumatic event, dreams that repeat the event, efforts to forget experience, withdrawal from relationships, difficulty with tension regulation, and striving for mastery. Also noted was something different than trauma and its psychological consequences-a conflict between the ego developed during peace time and the new war-time ego. The symptoms described by these early theorists will be reworked by subsequent scholars until our present time. Some phenomenon will be given more importance than others, different concepts will evolve and theoretical explanations will follow the progression of psychoanalytic theory.
 

Psychoanalytic theory is a constantly evolving enterprise. Concepts build upon each other, change over time, and are influenced by cultural and philosophical forces. The APsaA Service Members and Veterans Initiative in partnership with the Chicago Institute for Psychoanalysis are offering a four part webinar on Psychoanalytic Contributions to Understanding War Trauma. We will overview contributions from the early efforts of Freud to present day research. We invite all clinicians working with veterans or service members to participate and learn ways to integrate psychoanalytic concepts into their daily work. To learn more about the course and to register visit www.apsa.org/war-trauma-series.

Psych groups offer historic perspective on war trauma, Military Times, 12/25/15

R. Dennis Shelby, MSW, PhD, member of the APsaA’s Service-members and Veterans Initiative, faculty member at the Chicago Institute for Psychoanalysis and former director of the Military/Veterans Specialization of the Institute for Clinical Social Work.