'Flashbacks': A study

[CarylW]

Looking something up last night for a query from a member, I found a study that was published in the British Journal of Psychiatry titled "Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis" in 2003

http://bjp.rcpsych.o.../full/182/2/158

"Aims To test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat.

Method Random selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations.

Results The incidence of flashbacks was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars"

Conclusions Although this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesisthat some of the characteristics of PTSD are culture-bound.Earlier conflicts showed a greater emphasis on somatic symptoms

"........War pension files were used as the primary source because they contained detailed medical and military reports........"

I find it hard to understand how they reached the results and conclusions above using a primary source of war pension files.(?????)

Especially given the scale of the Great War

'Flashbacks', the symptom of PTSD, under study here, of course would not be referred to by that name in medical files from the Boer and Great War period, think the word is fairly new terminology (?), (as is PTSD)a fact I'm sure they were aware of, but would non visible symptoms such as 'flashbacks' (in war pension files described under another name and probably attributed to 'shellshock'-neurasthenia if mentioned at all) have been noted down by those keeping records? Would the soldiers themselves have even spoken about them at that time to medical boards or personnel interviewing them, at a time when many kept everything in and didn't speak about such things, or would even know how to describe what they were feeling that could have been interpreted as anything resembling 'flashbacks'?


So many first hand accounts from Great War veterans include sentences such as "I can still see them now..." "I can still see their/his face..." "I can still hear the sound of the guns/shells..." Surely, as well as 'memories', they would also have many incidences of 'flashbacks', where for a split second or longer, they were actually back 'there'? but just never spoke of them .


Caryl

[bill24chev]

Good afternoon (UK.

Im a bit short of time so only skimmed through the document but i would agree taking two WW1 and three ww2 veterans seems to be a very insignificant sample.

The Commanding general (wife) is the psychologist in my house so I will ask her to read it post a more detailed reply later.

[Piorun]

Caryl: saw your reply on the other post and agree with this. "Flashbacks", to my knowledge, is a relatively new term and, therefore, would not have been described as such by the ordinary Tommy. To have spoken with scores of WW1 veterans in the '40s and '50s and to hear and see them stop suddenly in mid-sentence as the tears rolled down their face is proof enough to me that so-called 'flashbacks' were very definitely a symptom of WW1 ptsd. As a sufferer of ptsd myself as one of the outcomes of an incident that resulted in an acquired brain injury, I've been told often enough that I experience 'flashbacks' - even tho' my own terminology for them doesn't include that, what I consider to be, overly facile term. Yours, Antony

[Pete1052]

A former colleague of mine said his father, a World War II veteran, had a flashback involving screaming and crying during the 1960s when he saw a car accident in which a small girl had been seriously injured. During the war he had been the driver of a Sherman tank in the 4th U.S. Armored Division. During the breakout from Normandy in 1944 in a liberated French village joyous crowds had swarmed around his tank while he was driving and he accidently ran over a small girl who had suddenly dashed in front of his tank.

[phil andrade]

Surely people have always experienced flashbacks, but, until relatively recently, weren't able or willing to be articulate about the experience.

A lot, I suspect, has to do with the intrusion of photographic and moving film media into everyday life.

The media are now so enhanced and immediate in their impact that people are not only encouraged, but almost expected - even pressured - to express "how they feel".

A huge cultural difference.

Phil (PJA)

[themonsstar]

Good posting Caryl

I was having a look at the references they have used from the NA/PRO for the servicemen for WW1.

First World War

Two hundred cases of disordered action of the heart and 200 cases of shellshock (reclassified as neurasthenia in 1917), together with 167 servicemen who had been gassed without permanent organic injury, were selected using a random number generator from all surviving First World War pension files. These case notes, held at the Public Record Office (PRO), were a representative 2% sample based on London and south-east England. Every pension for disordered action of the heart or neurasthenia awarded to a nurse was also included.

They have only listed 4 out of the 100s of cases they say they look at just for the First World War, but they look at other war before & after.

PIN 26/7145 Name: HINES J C Nature of Disability: Neurasthenia 1913-1923.

PIN 26/2370 Name: BUTCHER G W Nature of Disability: Neurasthenia 1915-1924.

PIN 26/21205 Name:BIRCH George H Nature of Disability: Neurasthenia 1916-1956.

PIN 26/20634 Name: HUGHES Thomas Nature of Disability: Neurasthenia 1913-1929.

Pin covers pensions for solders from 1871-1950

Record Summary

Title

Ministry of Pensions and successors: Selected First World War Pensions Award Files

Scope and content

This series contains a representative selection of case files of the Ministry of Pensions and successors concerning war disability pension awards.

The cases selected cover all types of disability pensions awarded after the First World War, and include files for serving men and officers, army, navy and air force, widows and dependants, and nurses.

Covering dates 1871-1950

Arrangement

* The files have been transferred in two major tranches:

* PIN 26/1-203. These pieces (transferred to the PRO in 1975) have been listed in order of the date of termination of pension, or death; details of the type of award and other relevant information are indicated by a selection code letter.

* PIN 26/204-22756. These pieces (transferred to the PRO between 1989 and 1997) have been listed slightly differently. The list gives the covering dates of each file, the name of the individual, and an indication of the nature of the disability. In some cases, abbreviations have been used to indicate this, and are as follows:

* CSOM - Chronic Supperative Otitis Media

* DAH - Disease of action of the heart

* GP - Gun-powder injury

* GSW - Gun-shot wound

* ICT - Injury caused to

* POW - Prisoner of War

* PNO PUO PVO - Pyrexia of unknown origin

* TB - Tuberculosis

* VDH - Valvular disease of heart

Held by

The National Archives, Kew

Legal status Public Record(s)

Language English

Creator names

Ministry of Pensions, Awards Division, c 1917-c 1944

Ministry of Pensions, General Administration Division, c 1917-c 1944

Ministry of Pensions, Great War, Civilian and Mercantile Awards Division, c 1944-1949

Ministry of Pensions, General Division, c 1944-1949

Ministry of Pensions, New Services Awards Division, c 1944-1949

Ministry of Pensions, Pensions Policy and General Division, 1949-1953

Ministry of Pensions, Rehabilitation and Welfare and London Awards Division, 1949-1951

Ministry of Pensions, Awards Division (Blackpool), 1949-1951

Physical description 22829 file(s)

[geraint]

Very interesting topic Caryl, and one that leaves me unable to contribute any real information due to the experties of the authors and subject. Apart for concuring with other posters that the use of Crimea, Boer and Great War samples seem to be miniscule, and the criteria for ptsd/shellshock from all wars appears to the layperson (me) as being very difficult to compare objectively.

[phil andrade]

The very word "flashback" carries within itself an implication of modernity : the development of cine- photography, and the highly intensified role played by the media, and their intrusion, welcome or otherwise, into our lives.

The phenomenon must have afflicted veterans of all wars through the millennia, but its designation as "flashback" identifies it with modern times.

Writing half a century later, a veteran attempts to describe his own experience of "flashback" :

The hoarse and indistinguishable orders of commanding officers, the screaming and bursting of shells, canister and shrapnel as they tore through the struggling masses of humanity, the death screams of wounded animals, the groans of their human companions, wounded and dying and trampled underfoot by hurrying batteries, riderless horses and the moving lines of battle... - a perfect hell on earth, never, perhaps to be equaled, certainly not to be surpassed, nor ever to be forgotten in a man's lifetime. It has never been effaced from my memory, day or night, for fifty years.

We would probably describe this as "flashback" and associate it with PTSD, but in those days - 1913 - the writer, describing his experience in the Battle of Gettysburg, would not have encountered such a term.

Phil (PJA)

[CarylW]

PJA

I'm not sure if you have misunderstood my post, or I've misread yours

That's what I meant when I wrote this "...'Flashbacks', the symptom of PTSD, under study here, of course would not be referred to by that name in medical files from the Boer and Great War period, think the word is fairly new terminology (?), (as is PTSD), a fact I'm sure they were aware of...."

It isn't the phraseology that bothers me. I'm sure the pyschiatrists themselves would have been aware that the term would not have been used in the earlier time periods to describe 'flashbacks', and as you stated earlier "Surely people have always experienced flashbacks, but, until relatively recently, weren't able or willing to be articulate about the experience"

I agree, they probably or possibly would not have been able to articulate the experience, or it would have been described in another way, or never spoken about at all, as I wrote (I think!)

What bothered me was how they could reach the "results" from a study of randomely selected war pension files as their primary source "Results The incidence of flashbacks was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars"

Surely the result should have been 'inconclusive' without a more thorough study of the effects of combat on veterans of those wars

It also bothers me that these 'findings', i.e. "flashbacks were conspicious by their absence in ex-servicemen from the Boer War and the First and Second World Wars" could be taken as fact given the source (BJP) and used and quoted from when it so plainly and blatantly not the case at all IMHO

Caryl

[Sue Light]

I completely agree Caryl. However, it seems to me that the credentials of so many eminent men and women producing this learned document really prevent anyone contradicting them. They virtually dismiss the fact that men of the Great War period might be reluctant to talk about such things, or that the right questions might not even have been asked. My rather suspicious nature leads me to wonder if this study might have been commissioned, or be used in the future, either by Government or other groups to 'prove' that things are so much worse for servicemen and women today, and if it didn't happen in the Great War, then it shows that the conditions that the military forces are exposed to today are far more damaging. I'm not making any personal observations on whether that might or might not be the case, but with the wide range of 'great' names at the top, it's going to be accepted with little question.

Sue

[themonsstar]

I agree with a lot of what's been said, as a veteran I was medically discharged with PTSD from the Army Feb 2006.

Some of the names which appear on the report do not surprise me in the least,after the government pumped millions of pounds into Combat Stress one of them was parachuted in as a trustee, soon after this event a lot of the older veterans were told they would not be getting the funding for their return visits to Combat Stress.

If you are a war pensioner and your PTSD is attribute to your service the Veterans Agency have to make a contribution to Combat Stress for your treatment there. In my case I was offered six weeks residential care, broken down into 3 two-week visits, last year I was informed that that had been cut down to 2 two-week visits, I was not the only veteran who is informed of this decision.

I would also say flashback is a modern term, but you only have to be around veterans from the Second World War, the Korean War, and some of the other operations the British Army's been involved in during the 1940s 50s, 60s and 70s, to know they never use that type of terminology.

Psychiatry as moved on with time like the rest of us have moved on time, I've spent a lot of time since being diagnosed with PTSD on the couch and know from personal experience if they don't ask you a specific question you are not voluntary going to give them information they are looking for.

Here's an example of a problem which occurred in recent years with myself.

I was involved in the 90s with bust injury which affected my hearing, unbeknownst to me I carried on not realising that I had a marked reduction with hearing loss and also with this peculiar noise which was in my ears all the time.

The other year my doctor sent me to see a specialist, at the consultation the specialist confirmed that I had hearing loss, one of the questions he asked did I hear bells ringing in my head I said no to this, it was only when I got home that I realised that he was talking about the noise in my head, so I went back and explained I don't hear bells but I do hear a constant static noise all the time of different frequencies depending on the ambient noise around me.

To me if he would've rephrased his first question I would have picked up on this straightaway, however because he asked the word bells it did not occur to me at the time he was talking about tinnitus.

[DrB]

Befoe I retired from the service, I used to teach "Combat Psychology" to junior officers. Several salient points here that I would like to discuss, especially from the US view and not necessarily the British one, although all mental problems are somewhat universal.

1. Several service members who returned from combat, be it WWI, WWII or Viet Nam suffered some sort of mental derangement. My feeling is that many of these poor souls had mental problems before they deployed and the combat situation, be it on the "pointy end" or in the "rear with the beer," were excaberations of the existing problem and not necessarily directly attributable to the combat situation which triggered it.

2. The return from WWII and the Viet Nam war were entirely different. WWII witnessed the return of the soldier who was surrounded by his buddies who had suffered similiar siturations and thus, were able to speak freely about what occurred in combat. Viet Nam returnees were simply tossed onto an airplane and in a few hours, returned to the "Land of the Round-Eyes" and were unable to vent their feelings over a period of time. Thus the "Flashbacks" and PTSD cases were more common that in the WWII vets. Add to this, the large number of "Wannabees" who flock to the Wall in Washington in their often mis-badged utilities (like poster children from a military surplus store) and "play the role" of combat vet who weeps, stares and generally makes an ass of himself for the tourists.

3. PTSD is a genuine problem. I witnessed such a case of a Navy chaplain (a vet of Khe Sahn) in Great Lakes who suffered from it. He was treated at a local VA hospital and cured by placing him in an enviroment surrounded by fellow veterans. He was allowed to express his feelings in a number of seminars and was, over a period of time, cured.

4. I was a veteran of Nam and suffered through some uncomfortable times. I was also quite happily married to a nurse (Still am) who was very understanding and, in time, the bad "stuff" went away. I was lucky.

5. I am extremely reluctant to discuss what I witnessed, or felt, unless I am talking with one who was actually there. It is like a member of AA who has a problem, but cannot discuss it with anyone who has not felt, or experienced, the same thing.