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Comment by speeder | Hacker News Reader

During WW1, the term "Shell Shock" showed up, that later got changed to PTSD, when people started to think it had to do with psychology, rather than physiology (when Shell Shock first showed up, it was blamed on constant explosions hurting people).

Then some days ago we had here on HN frontpage, research that shows that PTSD, even in more recent conflicts, IS shellshock, that the air pressure of the explosions and the shaking actually damage the brain, and cause inflammations that cause PTSD symptoms.

I wonder then, how bad it was for the WW1 people, those that were near the concentrated fire of 150 explosions per hour nearby, and survived, maybe some of them wished they had been hit instead of surviving...

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I was thinking the same thing when I read that article. The shell shock victims of world war one, do not look like PTSD victims today. They look physically brain damaged. Check out some of these videos of shell shock victims, the symptoms are very physical and severe: https://www.youtube.com/watch?v=cc7ehb8agWY

What about PTSD developed in non-combat zones? Or people who develop it and are not even in war zones? Do you know if there is any information on that?

Not trying to start a flame war. Just interested in the PTSD thing itself.

Pretty much any environment that causes your body to frequently flood with cortisol is a breeding ground for PTSD. The brain interprets the constant threats to its well-being as a signal to rewire itself to be trigger-happy on the flight-or-fight response to conditions that most others would not react as intensely to.

Examples: childhood poverty; abusive/neglectful parents; societal discrimination (especially if violence or a heightened possibility is a factor).

There is so much about PTSD we don't understand (or more accurately there is very little we do understand about it) that your claims are simply not true. We aren't sure what causes PTSD, we don't understand what physiological, neurological or psychological conditions are needed for "PTSD" to evolve.

As far as cortisol goes well it is again not that simple, both elevated and lowered cortisol levels have been recorded in PTSD cases which is why it's still debated if lower or higher levels of cortisol cause or are a symptom or an indicator of PTSD, and since cortisol levels are only usually tested in cases where the person has already been or being diagnosed the correlation is even harder to identify, especially when considering that both lowered and elevated levels of cortisol can be recorded in nominal people and in people suffering from other mental disorders.

PTSD is just another placeholder akin to "shell shock" and the later "combat fatigue", in the end it would be an umbrella of various disorders with various preconditions and causes expressing themselves in a similar fashion.

I find it ironic that while critizing someone for making bold claims, you make the unreserved assertion that their claims are false.

They could be correct, regardless of evidence.

One thing I've noticed is that there's a very severe bias in culture against PTSD. There's this idea that PTSD should be a "really big deal" and it only exists in the "goes to 11" mode and nothing else, that it has to be "earned" through truly great trauma. PTSD that exists from more minor things (such as childhood emotional trauma that didn't involve physical violence) is often ignored and sidelined. Consider, for example, the character of Clarice from The Silence of the Lambs. The event that gave that movie its name likely gave Clarice lasting PTSD that she had not overcome even as an adult. Her PTSD wasn't as life damaging as a veteran incapable of holding a job or staying sober, she obviously managed to prevent it from impacting her daily life too powerfully, but it still existed.

There are tons of people walking around with similar or even more "minor" forms of PTSD. And it's causing them stress and giving them potentially harmful behaviors like hypervigillance. Many of them will go through their lives not knowing or even recognizing the possibility that they're experiencing PTSD, because society says PTSD has to be a 500 pound gorilla, and a 2 pound monkey on your back is not even worth worrying about.

Also, there's apparently evidence that prior trauma puts you at greater risk of PTSD from subsequent trauma. Which helps explain why different people in more or less the same situation can have very different responses, because of their different experiences earlier in life.

Interesting idea - any resources that discuss this that you can provide?

I suspect we'll find that there's a difference between what was called shell shock (brain damage from blast waves) and PTSD (psychological trauma), and that it's possible to suffer from one or the other, or both.

It has already been confirmed, using a microscope:

http://www.nytimes.com/2016/06/12/magazine/what-if-ptsd-is-m...

(NOTE: This is for some of what goes under the umbrella term "PTSD", so of course not for every single diagnosis. Only the people exposed to such shock waves.)

Shell Shock wasn't about brain damage it's what it just was called because it was a convenient name, later in Korea it was called combat fatigue and after vietnam we had PTSD. PTSD cases have been recorded in cases with or without physical trauma including TBI, and not everyone gets it even under the same circumstances. You can have a platoon of troops on the same deployment, going through exactly the same stuff day in and day out but not everyone would develop PTSD.

I think there are probably /some/ cases called PTSD which are actually physical injury from blasts, that have been conflated with other cases where people have lasting psychological damage after ongoing trauma.

"Shell shock" and "PTSD", like cancer, are symptoms clusters having possibly multiple causal factors, some compounded, some independent.

The YouTube video posted downstream in this thread, at about 7 minutes, touches on this -- both physical and psychological stresses would result in symptoms described as "shell shock".

https://m.youtube.com/watch?v=cc7ehb8agWY

Modern PTSD similarly describes a set of symptoms which may result from physical or psychological stresses. There was a commenter in the earlier thread who seemed to have a distinct inability to grasp this even when presented with NIMH and Mayo Clinic definitions of the condition:

https://news.ycombinator.com/item?id=12033214

Both causes are included.

My own lay sense is that the brain is a complex organ, and may well exhibit multiple modes of breakdown, several of which express similar end results. Whether it's repeat psychological strain or physiological disruption, or chemical or idiopathic causes, failure of proper neural function would seem likely to result in similar types of symptoms: shaking, loss of speech or senses, decline in mental function, paralysis.

This is a misreading.

PTSD is, and always has been, a thing of its own. But for a very long time people with explosive blast traumatic brain injury ("shell shock") were misdiagnosed as having only PTSD. In all likelihood many people with "shell shock" that has been misdiagnosed as PTSD alone also actually have PTSD as well.

The major symptoms of "shell shock" include disorientation, weakness or numbness in extremities, dizziness, memory problems, irritability, confusion, etc. Typical major symptoms of PTSD include reliving the event in your mind (such as through "intrusive imagery"), hyperarousal, hypervigillance, and emotional distress (especially negative changes in thinking, ideals, mood, etc.). There is some overlap because the stress aspect will make people irritable and distressed. Because all of these things are filtered through personalities and cognition it can be difficult to suss out the underlying true symptoms, especially if someone doesn't want to share their feelings.

But you can have both. And the fact that many soldiers who have been the victims of blast trauma almost certainly will have some degree of PTSD as well (due to the likelihood that the blast was a major traumatic incident in their life, possibly involving the death or grievous injury of someone close to them) has made it all the more difficult to suss out the particular role of "shell shock". I suspect that a lot of the research into traumatic brain injury in boxing and football has aided the discovery (or re-discovery) of "shell shock" greatly.

I came across this somewhere (probably here) recently.

https://angrystaffofficer.com/2016/07/01/anatomy-of-a-world-...

I think you're confusing TBI with PTSD.

Also, "that later got changed to PTSD" is a gross oversimplification.

Shell shock is not PTSD. Its related to brain trauma and Combat Stress Reaction[0]. PTSD is - as the name implies - something you experience later.

[0] https://en.wikipedia.org/wiki/Combat_stress_reaction

There was an pretty stellar coverage of the topic in the epic The Great War documentary from PBS sometime back. I can't find the video but I hit the 3rd episode title Mutiny that looks like its the one. Watching this as a young teen really haunted me back then, they created a whole ambiance to the film that still gives me chills. http://www.pbs.org/greatwar/chapters/ch3_mutiny.html

I feel that its probable that the symptoms that we link to PTSD today (and shell shock of the past) can arise from a variety of different stimuli. Maybe as we study in closer, we may find subtle differences in the exact responses due to actual physical trauma, versus things caused by psychological factors. The physiological and psychological symptoms and causes could all be linked in a this brutally complex web of causal factors and feedback cycles.

two months ago "What if PTSD is more physical than psychological?"

https://news.ycombinator.com/item?id=11883318

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