Since it was first included in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, post-traumatic stress disorder (PTSD) has become a medical and cultural phenomenon. Moreover, it has led to the belief that PTSD is a universal aspect of human experience. Traumatic Formations and Psychiatric Codifications: A Rhetorical History of Post-traumatic Stress Disorder challenges this view by examining the rhetorical processes by which PTSD and its predecessor diagnoses were codified. Using critical techniques taken from rhetorical studies, Science and Technology in Society studies, and historiography, this dissertation examines the social, medical, and institutional formations that created the need for psychological trauma to be codified as an actionable psychiatric diagnosis at four specific historical moments, beginning in Victorian England and culminating with the offical codification of PTSD in 1980. By attending to the rhetorical processes of codifying unique post-traumatic illnesses over the course of 150 years, this dissertation argues that post-traumatic illnesses are better understood as dynamic entities that respond to specific social problems. Furthermore, it finds that the diagnoses themselves must conform to the constraints of their day as determined by the institutions (government, military, or disciplinary) that call upon psychiatric medicine to intervene in social problems. Traumatic Formations presents four historical case studies: railway spine in Victorian England, shell shock in World War I, post-Vietnam syndrome in the 1970s, and PTSD in 1980. After introducing the project in the first chapter, Chapter 2 examines how British legal courts in the late ninteenth century called upon physicians to determine whether train accident survivors were entitled to monetary compensation for their psychological injuries. To make psychological trauma legible to legal courts, British physicians codified railway spine as a psychological effect of a physical injury, thus connecting victims' mental problems to the accidents they survived. Chapter 3 analyzes how the shell shock epidemic in World War I ushered in a shift in theoretical understandings of psychological trauma. When psychiatrists located near the frontlines of combat demonstrated that soldiers did not need to be exposed to exploding munitions to manifest the symptoms associated with shell shock, medical professionals and the British military came to understand shell shock as a psychological problem rather than a physical malady. Chapter 4 examines how a small group of antiwar psychiatrists advocated for military veterans who had trouble readjusting to civilian life after fighting in the Vietnam War. They persuaded the American public, the federal government, and mental health clinicians that the veterans' adjustment problems were the result of a new psychological illness called post-Vietnam syndrome. Chapter 5 analyzes how post-Vietnam syndrome become PTSD. In the process of convincing the APA to include PTSD in the 1980 edition of the DSM, many of the unique features of post-Vietnam syndrome were compromised so that the PTSD diagnosis could be applied to people who were traumatized by events other than war. / Ph. D. / <i>Traumatic Formations and Psychiatric Codifications: A Rhetorical History of PTSD</i> takes a historical case study approach to understanding post-traumatic stress disorder (PTSD) as a medical and cultural phenomenon. Working from the rhetorical tradition, as well as intersecting traditions of historiography, medical and scientific rhetorics, and Science and Technology in Society studies, it investigates how disciplinary medical science intervenes in social problems and codifies them as post-traumatic diagnoses in order to meet the needs of other institutions, like legal courts, the military, and the American Psychiatric Association. This project begins in Victorian England with railway spine, then examines shell shock in World War I, post-Vietnam syndrome in the 1970s, and culminates in a case study of PTSD in 1980. For each case study, I conduct a rhetorical analysis of a large corpus of documents, including archival medical sources, government documents, and cultural texts. By analyzing post-traumatic diagnoses over the course of 150 years, I demonstrate that psychiatric diagnoses are rhetorical repositories of historical social problems and institutional goals.

With the wars in Iraq and Afghanistan lasting over a decade, hundreds of military mental health providers have deployed to hostile environments and some on multiple occasions. Military mental healthcare providers can experience symptoms of acute and chronic stress resulting from exposures to horrific events while caring for soldiers in a deployed environment. Indeed, in treating these soldiers, clinicians may continue to experience the same traumatic events as their clients. The purpose of this phenomenological study was to understand and describe shared trauma and resilience for military mental health professionals who have deployed. The concept of shared trauma was defined as the experiences providers faced as they attempted to deliver clinical services while simultaneously addressing the same issue within their own lives. The concept of resilience was explored as how stressful situations were interpreted in relation to individuals' overall life experiences. The principle research question for this study examined how military mental health providers described dilemmas faced as they attempted to navigate the personal and professional aspects of shared trauma. This study utilized a purposive sample of 7 military mental health veterans who deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Data were collected through semi-structured interviews and analyzed using Moustakas's 5 steps of heuristic analysis. Key findings indicated participants' interpretations of experiences involved posttraumatic growth, lessons learned, and changes in belief systems. Findings of this study can assist military mental health leaders in developing support and protection programs to assist this overwhelmed population, ensuring service members receive the proper care they are entitled.

abstract: Approximately one-third of Iraq and Afghanistan veterans develop mental health problems, yet only 35-40% of those with mental disorders are seeking mental healthcare (Hoge, et al., 2004; Vogt, 2011). Military spouses may be an important resource for facilitating treatment seeking (Warner, et al., 2008), especially if service member mental health issues are impacting the marriage. Military spouses might be hesitant to encourage service member help-seeking, however, due to perceived threat of adverse military career consequences. For this study, 62 military wives completed an online survey. As part of the survey, participants were randomly assigned to one of four vignettes containing a description of a hypothetical military husband with mental health symptoms. Each vignette presented different combinations of marital conflict (high versus low) and service member concerns about adverse career consequences (high versus low). Wives rated on a five-point scale how likely they were to encourage the hypothetical military husband to seek help. It was hypothesized that spouses would be more willing to encourage help-seeking when concerns about adverse military career consequences were low and marital distress was high. No main effects or interaction effect were found for marriage and career. Perceived stigma about seeking mental health treatment in the military, psychological identification as a military spouse, and experience and familiarity with military mental healthcare policies failed to moderate the relationship between marital conflict, career concerns, and encouragement of help-seeking. Correlational analyses revealed that (1) greater experience with military mental healthcare (first- or secondhand), and (2) greater perceptions of stigma regarding seeking mental healthcare in the military each were associated with decreased perceptions of military supportiveness of mental healthcare. Therefore, although the experimental manipulation in this study did not lead to differences in military spouses' encouragement of a hypothetical military service member to seek mental health services, other findings based on participants' actual experiences suggest that experiences with military mental healthcare may generate or reinforce negative perceptions of military mental healthcare. Altering actual experiences with military mental healthcare, in addition to perceptions of stigma, may be a useful area of intervention for military service members and spouses. / Dissertation/Thesis / M.S. Psychology 2013

Mental health in the military continues to be an epidemic and results in mental health issues, social isolation, deprivation, and alienation from roles and occupations. The social stigmas military personnel experience is linked to significant barriers to acquiring the necessary help for military personnel. The common concerns regarding seeking help for military personnel were being perceived as weak, being treated differently by unit leadership, personal perception of stigma, lack of education and members having less confidence in the individual (Gould, Greenberg, & Hetherton, 2007). The lack of preventative care for military personnel and barriers to seeking help, has resulted in decreased occupational performance and decreased quality of life for military personnel. Therefore, the implementation of preventative and early intervention techniques using occupational therapy approaches aims to address mental illness in the military and improve overall quality of life using effective intervention methods. This dissertation aims to identify gaps in practice, assess problem areas, and effectively demonstrates the role of occupational therapy in improving mental illness in the military.

Post-traumatic stress disorder (PTSD) is a heterogenous psychiatric condition that affects thousands of individuals each year. Of those who experience this condition, military members including members of the Canadian Armed Forces (CAF) are particularly vulnerable, demonstrating high prevalence rates of PTSD-related symptoms. Moreover, individuals with PTSD are at increased risk for comorbid conditions and are at greater risk for suicide due to the overwhelming, debilitating nature of PTSD symptoms. In previous research, hyperarousal symptoms associated with PTSD have been linked to dysregulation in the locus coeruleus norepinephrine (LC-NE) system, a vast neuromodulatory system responsible for regulating arousal, attention, autonomic and memory-related functions. Advancements in neuroimaging methods have advanced our ability to study connectivity in vivo such that small structures like the LC can be further studied in human samples. Specifically, neuromelanin-sensitive MRI (NM-MRI), a novel, non-invasive neuroimaging method has been shown to detect changes in neuromelanin (NM)-related signal in both the LC and substantia nigra (SN). NM is a dark pigment that accumulates over the lifespan in catecholamine-dominant centers such as the LC and SN and is the by-product of catecholamine oxidation. NM-MRI can be used to image these centers in vivo due to the paramagnetic properties offered by NM. Furthermore, when excess cytosolic catecholamine levels are present in select neurons, NM production is thought to be increased, resulting in increased NM signal from the LC. This could potentially be a marker for dysregulation as many conditions have been associated with variability of this system. Previously, NM-MRI has been used in other clinical settings such as in Parkinson’s disease (PD), Alzheimer’s disease (AD), schizophrenia and depression; however, this current investigation is the first to utilize this imaging modality in the context of PTSD. Specifically, we hypothesized that increased NM-MRI signal in the LC would correlate with increasing severity of hyperarousal symptoms in individuals with PTSD. We also predicted that the opposite would be true for comorbid depression symptom severity, as reduced LC signal has been previously correlated with clinical measures of comorbid depression using NM-MRI. As per our primary hypothesis, we observed a significant positive correlation between NM-MRI signals in the caudal elements of the LC with hyperarousal symptom severity in 22 PTSD subjects (r= 0.54, p= 0.017; partial correlation controlling for depression symptom severity, age, and sex). In contrast, we did not find any evidence to support our secondary hypothesis, because a non-significant trend correlating LC NM-MRI signal and depression symptom severity was obtained (r= -0.30, p=0.22; partial correlation controlling for hyperarousal severity, age, and sex). Based on these results, we were able to build on previously conducted work to further investigate the utility of NM-MRI in the detection of variability in LC-NE system as it pertains to psychiatric conditions known to show dysregulation of this system such as PTSD. In addition, this thesis provides further evidence to support the automation of NM-MRI analytical methods, thus supporting their potential utility for future clinical research. Our findings also provide support for the use of NM-MRI as a potential measure of NE activity; further, this work provided preliminary evidence supporting the use of NM-MRI in a clinical, psychiatric setting, where the technique may serve as a biomarker of PTSD pathology. With these findings in mind, additional validation studies can be conducted to verify the use of NM-MRI as a biomarker for NE system dysregulation. This would potentially allow for advancements in targeted treatment options for PTSD, particularly those targeting the LC-NE system, thus potentially increasing patient stratification and treatment efficacy.

With the current military mental health crisis, it is important to understand the role of the leader in military mental health. First, the impact of military leader behaviors on the well-being of military personnel is reviewed. Next, the role of leader attitudes as a precursor to leader behaviors is discussed. The relation of leader behaviors to leader personality using the NEO Five Factor Model (FFM) is reviewed, as well as the relation of prejudicial attitudes to the NEO FFM personality factors. A research project is described that attempted to draw these concepts together, assessing the NEO FFM personality dimensions and mental health attitudes of US Army ROTC cadets, the future leaders of the US Army. No significant relations were observed between NEO FFM personality traits and mental health attitudes, even after controlling for Impression Management. Also, the predicted positive correlation between positive mental health attitudes and Impression Management was not found. These results suggest that more research and more refined measures are needed in the area of leader attitudes toward soldier mental health problems, and how those attitudes might impact the soldiers.