A Lecture ON THE SOLDIER'S HEART AND WAR NEUROSIS: A STUDY IN SYMPTOMATOLOGY: Delivered at the Clinical Institute, St. Andrews

Primitive mechanisms of trauma response: an evolutionary perspective on trauma-related disorders

The symptoms we identify and the behaviors we recognize as defenses define which symptoms we see as trauma-related. Early conceptions of trauma-related disorders focused on physical signs of distress while current ones emphasize mental symptoms, but traumatizing experiences evoke psychobiological reactions. An evolutionary perspective presumes that psychophysical reactions to traumatizing events evolved to ensure survival. This theoretical review examines several primitive mechanisms (e.g., sensitization and dissolution) associated with responses to diverse stressors, from danger to life-threat. Some rapidly acquired symptoms form without conscious awareness because severe stresses can dysregulate mental and physical components within systems ensuring survival. Varied defensive options engage specialized and enduring psychophysical reactions; this allows for more adaptive responses to diverse threats. Thus, parasympathetically mediated defense states such as freeze or collapse increase trauma-related symptom variability. Comorbidity and symptom variability confuse those expecting mental rather than psychophysical responses to trauma, and active (sympathetically mediated flight and fight) rather than immobility defenses. Healthcare implications for stress research, clinical practice and diagnostic nosology stem from the broader evolutionary view.

Anxiety and the heart--a historical review

A review is presented of literature describing cardiovascular manifestations of anxiety until the end of the second World War. Clear observations of this important group of somatic anxiety symptoms have been made throughout history, although then, as now, the interpretation of these observations has varied according to the point of view and orientation of the writer. An understanding of the interrelationships between somatic and psychic symptoms of anxiety is particularly necessary now that certain specific symptomatic treatments are available.