It is quite understandable that both terms were aligned with a military perspective. “Shell shock” identifies the experience of a shell exploding in one’s presence, while “battle fatigue” clearly described the physical and emotional drain of energy that accompanies not only action but also inaction (freeze). Stress is fatiguing, especially when accompanied by a sense of helplessness. The emotional casualties of war clearly called for a new assumptive world that was founded not in a sense of spiritual aberration, the blockage of energy or distortion of reality, social deviation—or even mental illness.
The assumptive world of shell shock and battle fatigue was one of warfare. This assumptive world requires a powerful and evil enemy, the myth of bravery and valor, and a yearning for a peace that never seems to arrive. It is an assumptive world that is also occupied by the “war on poverty”, the “war on drugs” and the war against anyone who is an “other” (racial, ethnic, gender, socio-economic level, and on and on).
What happens when our society introduces a new term (following the Korean War and, in particular, following the Viet Nam War). The new term is “posttraumatic stress disorder” (PTSD). Note the language being used. Three of these words come from the medical community: “traumatic”, “stress” and “disorder.” Our fourth assumptive world of mental illness has taken command: “move over military, we are now claiming the turf!”
The new label conveys not only something about the source (etiology) of the “disorder” (a traumatic event or lingering stay in a traumatizing environment), but also the ways in which this disorder relates to broader physical processes (the role played by stress). This framework makes it ripe for DSM to step in, for this diagnostic process is founded primarily on the observation and categorization of symptoms. And what are the symptoms? Many are the same as those observed during both World War I and World War II.
There is an important distinction to be drawn, however, that is contained in the fourth word (“post”). This is a disorder that is not about the immediate manifestations of emotional and mental dysfunction that takes place on the battlefield. We know that emotional and mental functions often operate at a high level in the midst of war. Adrenaline and other hormones and neurochemicals prime the pump for effective, immediate action. Fear and threat can drive action which is the natural and adaptive response to be taken by any organism.
