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.

Bakgrund: Ambulanspersonal är en yrkesgrupp som i sitt yrkesutövanden riskerar att utsättas för traumatiska händelser som kan vara mycket påfrestande och stressfulla. Trots erfarenhet och träning blir vissa trauman stundtals övermäktiga och kan ge reaktioner som posttraumatiskt stressyndrom. Risken att utveckla PTSD ökar med antalet upplevda trauman och prevalensen i yrkesgruppen är hög. Syfte: Syftet var att beskriva vilka traumatiska händelser ambulanspersonalen upplevde som mest stressfulla. Syftet var även att beskriva ambulanspersonalens upplevelser och hantering av posttraumatiskt stressyndrom i relation till traumatiska händelser i sitt yrkesutövande. Syftet var dessutom att granska artiklarnas kvalitet utifrån den metodologiska aspekten undersökningsgrupp. Metod: Beskrivande litteraturstudie innefattande elva vetenskapliga artiklar av både kvalitativ och kvantitativ ansats sökta i medicinsk och omvårdnadsorienterade databas. Huvudresultat: Traumatiska händelser som upplevdes mest stressfulla innefattade händelser som involverade akut sjuka och allvarligt skadade barn, vilka väckte en emotionell respons och där ambulanspersonalen identifierade sig med nödställda. Upplevelser av PTSD kännetecknades av överspändhet, sämre prestation, mental avstängning och återupplevande av minnesbilder. Hantering av PTSD utmärktes av copingstrategier som känslomässig distans, fokusering, stöd, återhämtning, kontroll och förberedelse. Slutsats: Ambulanspersonal upplever i sitt yrkesutövande traumatiska händelser som kan vara mycket stressfulla och som kan leda till posttraumatiskt stressyndrom. Upplevelserna kan ge psykiska och fysiska symtom som påverkar hälsa och funktionsförmåga. Ambulanspersonalen behöver utbildning i copingstrategier för att hantera kritiska incidenter på ett gynnsamt sätt, speciellt händelser som involverar barn. Strategier behövs för att stärka känslan av kontroll och förmågan till fokusering, där förberedelse, socialt stöd och återhämtningstid är betydelsefullt.

The main focus of this study is to explore Swedish soldiers’ experiences of the transition back to everyday life after international service missions. This includes the help and support that they have received and also what barriers to care they have experienced during the transition back to everyday life. The theoretical perspectives of this study are social identity and stigma theory. This study was performed using a qualitative method and includes six individual interviews with active duty officers within the Swedish armed forces. All of them have participated in international service missions. The results of this study show that the soldiers experience barriers to care during the transition back to everyday life in Sweden. What emerged is that they are experiencing mental depression and a need for a recovery period. It’s also revealed that the stigma surrounding mental illness in the military and in society precludes a good reintegration into everyday life. The study concludes that more research is needed on what support soldiers need when they return home, and that the responsibility for veterans support efforts need to be clearer between all responsible parties in Swedish society.

Bakgrund Posttraumatiskt stressyndrom bör betraktas som en folkhälsosjukdom där diagnostisering och behandling behöver uppmärksammas. Ungdomar som överlevt livshotande händelser tenderar att återuppleva dessa traumatiska händelser och undviker att handskas med känslorna som uppkommer, vilket kan leda till psykiska besvär. Syfte Att undersöka riskfaktorer som finns för att utveckla posttraumatiskt stressyndrom bland ungdomar samt undersöka vilka datainsamlingsmetoder de inkluderade artiklarna valt. Metod Deskriptiv design användes i litteraturstudien som inkluderar 13 stycken vetenskapliga artiklar från databaserna PsycInfo och PubMed. Likheter och skillnader i artiklarnas resultat identifierades och använda datainsamlingsmetoder sammanställdes. Huvudresultat Att vara utsatt för våld och traumatiska händelser såsom fysisk skada eller se någon lida/dö, vara tjej, äldre ungdom, utsatt för daglig stress, splittrad familj och sämre socialt stöd var riskfaktorer för att utveckla posttraumatiskt stressyndrom. Tio av tretton artiklar hade kvantitativ ansats och använde frågeformulär för att få svar på vilka riskfaktorer det fanns. En artikel hade kvantitativ ansats men använde inte frågeformulär och två hade endast kvalitativ ansats i form av intervju som datainsamlingsmetod. Slutsats Denna litteraturstudie identifierade olika riskfaktorer som ligger till grund för utveckling av PTSD bland ungdomar. De vanligaste som återkom i nästan alla studier var att utsättas för våld, vara med om traumatiska händelser, vara tjej, sämre socialt stöd inom familj och skola, förlora en anhörig och vardagliga stressorer. Att som sjuksköterska och övrig vårdpersonal inneha denna kunskap kan bidra till att tidigare kunna identifiera ungdomar med PTSD samt anpassa omvårdnaden till denna grupp på bästa sätt. / Background Posttraumatic stress disorder should be considered as a public health disease where diagnosing and treatment require attention. Adolescents who have survived life-threatening events tend to relive these traumatic events and avoid to deal with the emotions that occur, which can lead to mental disorders. Aim Identify which risk factors there is to develop posttraumatic stress disorder among adolescents and examine which data collection methods the included articles have chosen. Method Descriptive design has been used in this literature study including 13 articles collected from the databases PsycInfo and PubMed and has been categorized by similarities and differences. The articles data collection methods has been presented from the methodological aspect. Main results To be exposed to violence and traumatic events as physical injury or see someone suffer/die, be a girl, older adolescent, exposed to daily stress, broken family and have less social support were some risk factors for developing posttraumatic stress disorder. Ten of thirteen articles had a quantitative approach and used questionnaire to get responses for which risk factors there was. One article had a quantitative approach but did not use a questionnaire and two articles had qualitative approach and used interview as data collection method. Conclusion In this literature study different risk factors were identified underlying to develop PTSD among adolescents. The most common risk factors in almost all of the studies were to be exposed to violence, experience traumatic events, be a girl, have less social support from family and school, lose a family member and daily stress. As a nurse it is important to keep this in mind so the care for the adolescents are as good as possible and that coping is used in the right way.

<p>Validerat; 20151026 (global_studentproject_submitter)</p>

Syftet med denna uppsats är att undersöka vilka hot och risker svenska officerare upplever underutlandstjänstgöring. Detta för att kanske i framtiden kunna förhindra att officerare drabbas avPTSD(Post Traumatic Stress Disorder), eftersom en ökning av dessa fall på senare tid har noterats.Metoden som har använts är kvalitativ intervjustudie där författaren går på djupet för att skapa sig enförståelse för den intervjuades värld. Med inriktning av upplevelser kommer uppsatsen att behandlafysiska och psykiska upplevelser under utlandstjänstgöring samt om dessa hade kunnat förebyggas.Deltagarna i intervjustudien är fyra officerare, samtliga män, med varierande bakgrund och samtligaarbetade vid intervjutillfället inom Försvarsmakten.Resultaten av denna studie och tidigare forskning är att upplevelser av Svenskars hot och risker, kanriskera att leda till PTSD. Resultaten visade också att upplevelser är skiftande och individuella menäven att det finns likheter i upplevelserna om utlandstjänstgöringen har genomförts på sammageografiska plats. PTSD kan förhindras genom kunskap i hur stress motverkas och förhindras. / The purpose with this paper is to examine officers experience of threats and risks during serviceabroad. This because maybe in the future be able to create an embryo to prevent officers to developPTSD (Post Traumatic Stress Disorder), since an increase of PTSD cases has been noticed.The method that is used in this paper is qualitative interview study where the author is trying to get adeeper understanding.The paper is to examine physical and psychological experiences of threats and risks during serviceabroad and if it would be possible to prevent.The participants in the study are four officers all male, with different backgrounds and all wasworking in the Swedish army at the time of the study.The results of this paper and previous research have found that experiences of threats and risks canlead to PTSD. The results also show that experiences are different and individual and that PTSD canbe prevented through knowledge of stress.

Människor med allvarligare missbruksproblem lider ofta av samsjuklighet. Syftet med studien var att undersöka kvantitativ förekomst av PTSD bland klienter med diagnosen missbruk/beroende på ett behandlingshem i Sverige samt skillnader i förekomst av PTSD mellan män och kvinnor. Även ett kvalitativt syfte fanns avseende missbrukande människors livsvärld och deras syn på sambandet mellan trauma och missbruk samt behandling. Urvalet bestod av 41 individer med diagnosen missbruk/beroende som testats med mätinstrumentet PCL-C vilket mäter problem och besvär som människor kan få som en reaktion på stressande upplevelser. Två av individerna från urvalet valdes för djupintervjuer. Studiens kvantitativa resultat visade att urvalsgruppen i förhållande till en normalpopulation, har betydande större del individer med indikationer på PTSD (65% mot 5,6%). Mer än dubbelt så många kvinnor som män indikerade förekomst av PTSD vilket överensstämmer med normalpopulationen. 90% av kvinnorna hade värden över det kritiska värdet på PCL-C. Studiens kvalitativa resultat visade på ett möjligt samband mellan tidigare svåra upplevelser i livet och situationen idag. Båda de intervjuade individerna hade erfarenhet av svåra händelser i barndomen, tonåren och i vuxenlivet. Båda såg de svåra händelsernas påverkan på psykisk- och fysisk hälsa och relationer samt en koppling mellan svåra händelser och missbruk. Båda hade också tankar om att fokus på/behandling av svåra händelser kan påverka missbruket. Slutsatser av studien kan sammanfattas i att många människor med missbruksproblem också har en traumabakgrund, att kvinnor har det i större utsträckning än män och att detta bör beaktas vid mötet med, och i behandlingen av missbrukare.

The purpose of this essay is to give the reader an insight in the subject of torture. This is done through both an historical perspective and by showing how torture methods are used today, even though torture is prohibited by law. Many refugees who come to Sweden today have survived torture, and the trauma can cause multiple illnesses related to the tragic memories. In addition to physical damage many also suffer from depression and post traumatic stress, due to the experiences of torture. Together with the Swedish Red Cross we designed a questionnaire which was sent to politicians and elected officials. In the questionnaire we asked questions concerning knowledge of injuries due to torture and what treatment options these people have in Sweden. Some of the questions are based in the concept of solidarity. The responses from this survey are the basis for analysis and discussion and are linked to our theories of organization and solidarity. The analysis shows that the knowledge is generally good, and the political parties in general have a collective solidarity approach to the care of people who are victims of torture.

PTSD (Post Traumatic Stress Disorder) has impacted veterans of combat throughout history. With current advances in protective combat armor and in combat medical treatment, more and more of the soldiers who would have perished in the battlefield are being saved and returned home. While their physical wounds may heal, the traumatic events experienced on the battlefield continue to impact their personal, social, and vocational lives. This study explores the perceptions of veterans with respect to their vocational stability and the impact that PTSD has had on their vocational functioning. Eleven veterans were selected to participate in this qualitative study. These veterans were all veterans of combat actions ranging from the Vietnam War to the current military actions in Iraq and Afghanistan. Once selected, these veterans participated in interviews which explored their vocational history, their perceptions of their employment instability, and their perceptions of the impact that PTSD had on their vocational functioning and employment instability. Once the interviews were completed, they were transcribed and analyzed using open coding to identify common themes throughout the data. These themes included behavioral issues, perception of treatment, and their military experiences. Each theme was explored and interpreted to identify how PTSD impacted these participants in maintaining employment instability. Interpretations of the data lead to the conclusion that combat-related PTSD does, as the literature identifies, cause vocational instability. However, the data shows that while the participants did experience vocational instability, it was not because they were typically fired or dismissed from employment, but rather, they quit jobs prior to being fired. The participants were able to identify their triggers and stressors to the point that they simply quit their jobs when these triggers and stressors arose. Thus, much of their vocational instability may possibly have been prevented had they been able to effectively communicate their stressors and triggers to their employers and co-workers. Limitations of the study as well as implications for practice and future research are discussed. / text

Att söka stöd och hjälp efter internationell militär insats om det uppstått fysiska skador är för de flesta fullt naturligt och accepterat. Vid psykisk ohälsa är det tyvärr inte lika självklart att erkänna för sin omgivning att man behöver stöd och hjälp. Problematiken kan utgöras av stigma, vilket innebär att man inte vill ses som avvikande eller annorlunda, att utpekas som den som inte orkade med psykiskt.   Är det så att vårdbehovet inte är känt av Försvarsmakten uppstår ett mörkertal för dem som enligt lag har uppföljningsansvar, dvs. FM.   Arbetet syftar till att undersöka hur stor påverkan rädslan för stigmatisering är, efter avslutad internationell militär insats. / Receiving support and help for physical injuries when returning from a military operation is natural and fully acceptable. As far as doing the same thing when having mental illness is not as likely to happen. The shame of admission in front of the people around you holds you back.  The problem might be stigma; you do not want to be seen as odd or different, seen as someone who mentally could not cope with the experience.   If the need for care is unknown to the Armed Forces then there will be an unknown number of individuals who do not receive the support they are entitled to by law.   This thesis aims to investigate how much impact the fear of stigmatization is after an international military operation.