What is it and who has it? The traumatic effects of war have long been recognized and described, whether as irritable heart (Revolutionary War), nostalgia (Civil War), shell shock (World War I), or combat exhaustion (World War II & Korean War). Historically, however, these effects were typically considered to be time limited and self-correcting for the vast majority of Veterans, and not to require special attention or intervention (medical treatment).
Veterans whom a time-limited course and self-correction did not show improvement were considered to be manifesting the effects of preliminary psycho pathology or underlaying character defects. The same treatment as for non-veterans (civilians) was considered to be appropriate for these Veterans.
These beliefs have been challenged by experience with the Vietnam War. Vietnam Veterans resisted the conceptualization of their problems in traditional psychiatric terms, terms which failed to appreciate the important differences between wartime trauma and civilian life trauma. Increasingly, the persistence of extreme stress reactions to experiences in the war forced professionals to acknowledge that traditional psychiatric conceptions and treatment interventions were inadequate to deal with these reactions.
The VA had an extremely difficult time in admitting the war traumas experienced by Veterans in Vietnam was different from traumas experienced in civilian life. Surprisingly, the first specialized programs for PTSD in the VA were started in the mid-1970's. All of these were inpatient programs. Over the succeeding years, similar specialized inpatient programs for PTSD were initiated in other VA Medical Centers was well. The first type of specialized inpatient program became known as the SIPU (Specialized Inpatient PTSD Unit).
Traditional beliefs gradually gave way to a new understanding of the traumatic effects of war, giving proper recognition to the debilitating role of the traumas themselves. In 1979, Congress authorized and funded the VA to establish Vietnam Veterans Readjustment Counseling Centers (Vet Centers) in store fronts and other community locations across the country.
This new understanding of the enduring impact of wartime stress was codified for the medical profession and for the larger society as well when the American Psychiatric Association formally recognized the existence of severe and long-lasting stress reactions to specific traumas as a diagnostic entity, Post-traumatic Stress Disorder. (American Psychiatric Association, 1980)
Once the existence of PTSD had been acknowledged and its symptoms described, a major issue for policy makers was to determine the precise prevalence of PTSD among Vietnam Veterans. In 1984 the VA commissioned the National Vietnam Veterans Readjustment study to address this and related issue as definitively as possible. This study estimated the prevalence of current PTSD among Vietnam Veterans to be 15.2% nationally, with an additional 11.1% currently suffering with some symptoms of PTSD. The study also found that only 22% of male Vietnam Theater Veterans with current PTSD had received treatment from any source, including the VA during the previous year.
In 1987 the VA launched a mental health initiative to provide for the outpatient treatment of PTSD, with the establishment of fifteen PTSD Treatment Teams (PTT’s). Although successfully implemented at many sites, monitoring by the Mental Health and Behavioral Sciences Service (MHBSS) and the Chief Medical Director’s Special committee on PTSD revealed deficiencies in the basic implementation at several sites.
In response to these deficiencies, MHBSS restructured the PTT program to meet its objectives beter. For the VA’s Fiscal Year (FY) 1989 Public Law 100-104 was part of the VA’s budget allocated by Congress, MHBSS established the PCT programs (PTSD Clinical Teams) now known as PCT Units. Iin 1989 with the funding from Congress twenty four PCT Units were established as out patient treatment centers. In 1990 twenty more PCT Units were established and twelve more in 1991 with an additional PCT Unit established in 1992 for a total of fifty seven PCT Units.