Stress and Anxiety in New Missions: The Case of PTSD
Henning Sørensen & Claus Kold
Stress is a mental disorder, anxiety is a disease ignited by stress you cannot come to grips with. The two concepts are cause and effect. The most common and costly type of mental disorder is Post-Traumatic Stress Disorder, PTSD. Seven “Cs” describe here PTSD: Concept, Content, Chronology, Contributors, Consequences, Coping and Costs.
Two types of mental stress disorder for veterans exist related to the time for their occurrence: An acute Combat Stress Reaction, CSR, and a delayed reaction, Post-Traumatic Stress Disorder, PTSD. The PTSD concept is rather new, introduced in 1980. Two models show the rather different perceptions of how to define PTSD. One is a process model issued by the American Psychiatric Association, APA, including elements other than the “pure” diagnosis of PTSD. The other model suggested by National Institute of Mental Health, NIMH, deepens just the contents of PTSD itself by defining its biological, medical, chemical, social, functional, and psychological symptoms. Then, the content or specific symptoms of PTSD according to the APA model of 2013 is presented, problematized, and compared with the NIMH model. The chronology of PTSD-like symptoms in war history are old, however, with different names attached. PTSD has developed from ignorance for many centuries via recognition in the last half of the Nineteenth century of stress caused even for psychological reasons, then to be forgotten up to and after WWI, and since 1980 named, accepted, and attended. Four contributors or risk factors may create/increase PTSD, in particular. One civilian: Personal background and three military: Combat exposure, military organization and type of war waged. The new types of wars are identified, including missions led by the UN, NATO, the OSCE and others. They have not reduced the prevalence of PTSD. PTSD can lead to two types of consequence: Medical diseases and social disabilities, of which only the former is analysed. Its perspective has shifted from military effectiveness to society´s political, economic and ethical responsibility towards the veterans to minimize/cure medical illnesses and social inabilities caused by PTSD. Consequently, coping strategies have moved from zero, i.e. for the individual veteran self to handle to a massive effort for society to relieve PTSD sufferers, even if no single cure has yet proven to do so. Accordingly, costs for the caring of suffering veterans will increase for the simple reason that they first reach their peak decades after wars ended. Much research on PTSD are based on U.S. data; so, is this article.
Stress, in general, is not “inevitably followed by symptoms or illness” (Clausen 1981: 393). It is like the “zero” in Mathematics. It has no value standing alone, but elements before and after define it. Stress, you can manage makes you stronger and more robust. Stress you cannot is characterised by a variety of symptoms that may develop illnesses and social inabilities. Stress “developing within one hour of exposure to the exceptional mental or physical disorder” (Weisaeth & Eitinger 1991:1) is “acute” stress, “delayed” stress begins six months after the trauma. Short-term stress may improve your concentration, for instance before a competition. Long-term stress weakens the resistance of your body. A “chronic” stress lasts for more than three months. Six cross-national PTSD studies give an impression the increased interest in PTSD veterans research over time: In 1991, Weisaeth & Eitinger only registered 50 articles on all PTSD suffers including concentration-camp inmates, children, Prisoner-of-War, veterans, etc. from 11 nations in Europe, the Middle East and Africa (Algeria). In 1994, Orr presented 10 articles and other 20 articles were annotated on PTSD veterans only from 11 countries). In 1999, Schnurr & Friedmann 1999 counted around 1.100 articles published from 1989 to 1999 by the National Center for PTSD in PTSD Research Quarterly and told that the number of connections/users to the Pilots Data Base has increased from 821 in 1992 to 2596 in 1999. In 2003, Taylor (2004:6) on a web search on “peacekeeping and stress” in four data bases, found 654 entries. In May 2015, 371.000 entries in Google was listed, while “stress and peacekeeping” gave 396.000 entries. In 2006, Peleg & Shalev could tell that studies of PTSD have increased from 159 in 1988 to 990 in 2004, and that the number of the costly, longitudinal PTSD studies went up from 2-9 studies in the period 1988-1997 to 31-33 studies in 2003-2004. In 2013, Norris & Slone informed on the worldwide research over the last ten years on PTSD in public and military populations. Finally, in 2014, Hunt et al. (2014) present the research efforts of 97 references of the last twelve years on the mental health of mostly just UK military personnel.
Psychologists and psychiatrists define the PTSD concept differently. In psychology, stress is defined as a special mental relationship between a person and his/hers environment, perceived as a strain threatening the well-being of that person. In psychiatry, stress is a mental as well as a physical disorder (due to an intracranial injury named Traumatic Brain Injury, TBI) having either a physiological or a psychiatric distorted impact on the body.