Jonathan Shay

Last updated
Jonathan Shay
Born1941 (age 81–82)
NationalityFlag of the United States.svg  United States
Alma mater University of Pennsylvania
Known forResearch on complex post-traumatic stress disorder, Homeric literature
Awards MacArthur Fellows Program (2007); Salem Award (2010)
Scientific career
Fields Psychiatry
Institutions Veterans Administration, Boston (1987–2008)

Jonathan Shay (born 1941) [1] [2] is an American doctor and clinical psychiatrist. He holds a B.A. from Harvard (1963), and an M.D. (1971) and a Ph.D. (1972) from the University of Pennsylvania. [3] He is best known for his publications comparing the experiences of Vietnam veterans with the descriptions of war and homecoming in Homer's Iliad and Odyssey .

Contents

Work with Vietnam veterans

Shay's early medical work was laboratory research on how central nervous system cells are affected by strokes, [4] [5] [6] [7] but after suffering a stroke himself, he went to work for the United States Department of Veterans' Affairs outpatient clinic in Boston. [8] While working there, in his words, "The veterans simply kidnapped me," [9] and his work with them "utterly redirected my life." [10]

In 1987, Shay shifted from neuropathology to the study of posttraumatic stress disorder (PTSD) and published a short article linking the combat histories of patients at the VA with the experience of war described in Homer's Iliad. [11] He was then approached by classics professor Gregory Nagy who suggested that the topic might be expanded into a full-length book on the nature and treatment of PTSD.

He has written two books, Achilles in Vietnam: Combat Trauma and the Undoing of Character (1994) [12] and Odysseus in America: Combat Trauma and the Trials of Homecoming (2002), [13] which discuss PTSD by reference to the experiences of American veterans of the Vietnam War, and the experiences depicted in the Iliad and the Odyssey . Shay's research uncovered what may be the earliest historical reference to PTSD, in Lady Percy's soliloquy in Henry IV, Part 1 (act 2, scene 3, lines 40-62). Written around 1597, it represents an unusually accurate description of the symptom constellation of PTSD. [12]

Shay has also done research on the use of Prozac in treating PTSD in Vietnam veterans. [14]

Views on PTSD

Shay writes, "For years I have agitated against the diagnostic jargon 'Posttraumatic stress disorder' because transparently we are dealing with an injury, not an illness, malady, disease, sickness, or disorder." [15]

Shay argues that PTSD is not an illness but the persistence of adaptive behaviors needed to survive in a stressful environment. For example, emotional numbing is useful in a disaster situation and maladaptive in a family setting, and loss of trust enhances survival in a prison but not in a community setting. Like Derek Summerfield, he also argues against labeling and patronizing treatment. Shay recommends that we resocialize trauma survivors as a means of promoting socially acceptable behavior patterns. [16] He cites classical Greek theater [12] and the collective mourning described in the Iliad as possible precedents. In Odysseus in America he writes of "the circle of communalization of trauma": "When trauma survivors hear that enough of the truth of their experience has been understood, remembered and retold with enough fidelity to carry some of this truth ... then the circle of communalization is complete." [13]

Prevention of PTSD

Shay is a passionate advocate of improved mental health treatment for soldiers and of more vigorous efforts to prevent PTSD, [10] in addition to structural reform of the ways the U.S. armed forces are organized, trained, and counseled. He has collaborated with General James Jones, the past commandant of the Marines, and Major General James Mattis of the Marines. [17] He has promoted the concept of preventative psychiatry in support of military cohesion, leadership and training: [18]

Prevention of psychological and moral injury in military service has three axes: cohesion, leadership, and training. First is keep people together. Train them together, send them into danger together, bring them home together, and give them time together to digest what they've just been through ... The second axis is expert, ethical, and properly supported leadership ... The third axis of prevention is prolonged, progressive, realistic training for what the troops have to do and face. [19]

Concept of moral injury

Shay introduced the concept of "Moral injury" and recommended treatment strategies for it in his two books. Moral injury is a distinct syndrome from (but often co-morbid with) PTSD and is one of the primary themes for the veterans described in his books, often leading to personality changes and obstructing successful treatment. [20] [21]

Shay writes that his "current most precise (and narrow) definition of moral injury has three parts. Moral injury is present when (1) there has been a betrayal of what is morally correct; (2) by someone who holds legitimate authority; and (3) in a high-stakes situation." Factor (2) is an instance of Shay's concept of "leadership malpractice". [20] Other authors have alternative definitions where (2) is by the individual. [22] [23]

Career recognition

Shay is respected in military circles, having conducted the Commandant of the Marine Corps Trust Study (1999–2000); serving as visiting scholar-at-large at the U.S. Naval War College (2001); Chair of Ethics, Leadership, and Personnel Policy in the Office of the U.S. Army Deputy Chief of Staff for Personnel; and was Omar Bradley Chair of Strategic Leadership at the US Army War College and Dickinson College (2008–2009). [24]

In 2007 he received a MacArthur "Genius Grant" fellowship. [3] In 2010 he was awarded the Salem Award for Human Rights and Social Justice for "building public awareness and acceptance of post-traumatic stress disorder as a serious and bona fide war injury." [17]

In 2018, Volunteers of America established The Shay Moral Injury Center, named in his honor and dedicated to deepening understanding about moral injury in the many populations who experience it. [25]

Related Research Articles

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.

<span class="mw-page-title-main">Combat stress reaction</span> Medical condition

Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder.

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.

A trauma trigger is a psychological stimulus that prompts involuntary recall of a previous traumatic experience. The stimulus itself need not be frightening or traumatic and may be only indirectly or superficially reminiscent of an earlier traumatic incident, such as a scent or a piece of clothing. Triggers can be subtle, individual, and difficult for others to predict. A trauma trigger may also be called a trauma stimulus, a trauma stressor or a trauma reminder.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

<span class="mw-page-title-main">Yuval Neria</span>

Yuval Neria is a Professor of Medical Psychology at the Departments of Psychiatry and Epidemiology at Columbia University Medical Center (CUMC), and Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) and Columbia University Department of Psychiatry. He is a recipient of the Medal of Valor, Israel's highest decoration, for his exploits during the 1973 Yom Kippur War.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

Bessel van der Kolk is a psychiatrist, author, researcher and educator based in Boston, United States. Since the 1970s his research has been in the area of post-traumatic stress. He is the author of The New York Times best seller, The Body Keeps the Score.

Jon Elhai is a professor of clinical psychology at the University of Toledo. Elhai is known for being an expert in the assessment and diagnosis of Posttraumatic stress disorder (PTSD), forensic psychological assessment of PTSD, and detection of fabricated/malingered PTSD; as well as in internet addictions.

Because of the substantial benefits available to individuals with a confirmed PTSD diagnosis, which causes occupational impairment, the distinct possibility of false diagnoses exist, some of which are due to malingering of PTSD. Malingering of PTSD consists of one feigning the disorder. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual experiences a traumatic event. In the United States, the Social Security Administration and the Department of Veterans Affairs each offer disability compensation programs that provide benefits for qualified individuals with mental disorders, including PTSD. Malingering can lead to a decline in research and subsequent treatment for PTSD as it interferes with true studies. Insurance fraud may also come about through malingering, which hurts the economy.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Perpetrator trauma, also known as perpetration- or participation-induced traumatic stress , occurs when the symptoms of posttraumatic stress disorder (PTSD) are caused by an act or acts of killing or similar horrific violence.

A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

<span class="mw-page-title-main">Post-traumatic stress disorder among athletes</span> Prevalence of PTSD among athletes

Posttraumatic stress disorder (PTSD) is a cognitive disorder, which may occur after a traumatic event. It is a psychiatric disorder, which may occur across athletes at all levels of sport participation.

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

<span class="mw-page-title-main">Post-traumatic stress disorder after World War II</span>

Post-traumatic stress disorder (PTSD) results after experiencing or witnessing a terrifying event which later leads to mental health problems. This disorder has always existed but has only been recognized as a psychological disorder within the past forty years. Before receiving its official diagnosis in 1980, when it was published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), Post-traumatic stress disorder was more commonly known as soldier's heart, irritable heart, or shell shock. Shell shock and war neuroses were coined during World War I when symptoms began to be more commonly recognized among many of the soldiers that had experienced similar traumas. By World War II, these symptoms were identified as combat stress reaction or battle fatigue. In the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), post-traumatic stress disorder was called gross stress reaction which was explained as prolonged stress due to a traumatic event. Upon further study of this disorder in World War II veterans, psychologists realized that their symptoms were long-lasting and went beyond an anxiety disorder. Thus, through the effects of World War II, post-traumatic stress disorder was eventually recognized as an official disorder in 1980.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

  1. ↑ "Jonathan Shay" entry in Contemporary Authors
  2. ↑ 2007 MacArthur Foundation Awards
  3. 1 2 Jonathan Shay, Clinical Psychiatrist / Classicist
  4. ↑ Shay, J (1973). "Morphometry of an ischemic lesion of cat spinal cord". The American Journal of Pathology. 72 (3): 397–402. PMC   1904035 . PMID   4728890.
  5. ↑ Shay, J.; Gonatas, N. K. (1973). "Electron microscopy of cat spinal cord subject to circulatory arrest and deep local hypothermia (15 C)". The American Journal of Pathology. 72 (3): 369–396. PMC   1904024 . PMID   4728889.
  6. ↑ Parks, J. M.; Shay, J.; Ames, III (1976). "Cell volume and permeability of oxygen-and glucose-deprived retina in vitro". Archives of Neurology. 33 (10): 709–14. doi:10.1001/archneur.1976.00500100043014. PMID   973808.
  7. ↑ Shay, J.; Ames, III (1976). "Retina Subjected to Components of Ischemia In Vitro: Selective Vulnerability and Minimum Lethal Exposure of Neurons and Glia to Oxygen and/or Glucose Deprivation and to Loss of Exchange With Incubating Medium". Archives of Neurology. 33 (10): 715–21. doi:10.1001/archneur.1976.00500100049015. PMID   973809.
  8. ↑ Joseph Shapiro, "Psychiatrist Who Counsels Vets Wins Genius Grant," NPR, September 25, 2007.
  9. ↑ Moral Wounds of War: Jonathan Shay Part 1 Dec 20, 2010
  10. 1 2 Badkhen, Anna (2007-09-25). "Psychiatrist treated veterans using Homer". The Boston Globe.
  11. ↑ Shay, J (1991). "Learning about combat stress from Homer's Iliad". Journal of Traumatic Stress. 4 (4): 561–579. doi:10.1002/jts.2490040409.
  12. 1 2 3 Shay, Jonathan. Achilles in Vietnam: Combat trauma and the undoing of character. Simon and Schuster, 1994. ISBN   978-0-684-81321-9
  13. 1 2 Shay, Jonathan. Odysseus in America: Combat Trauma and the Trials of Homecoming. New York: Scribner, 2002. ISBN   978-0-7432-1157-4
  14. ↑ Shay, J (1992). "Fluoxetine reduces explosiveness and elevates mood of Vietnam combat vets with PTSD". Journal of Traumatic Stress. 5 (1): 97–101. doi:10.1002/jts.2490050110.
  15. ↑ Shay, J (2011). "Casualties". Daedalus. 140 (3): 179–188. doi: 10.1162/DAED_a_00107 . PMID   21898967. S2CID   231592169.
  16. ↑ Jonathan Shay, quoted from transcript of his interview in the documentary film Voices in Wartime (2005). Written and directed by Rick King.
  17. 1 2 The Salem Award for Human Rights and Social Justice: Dr. Jonathan Shay: Advocating for Veterans. Archived 2013-06-15 at the Wayback Machine
  18. ↑ Shay, Jonathan (2009). "The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan". Smith College Studies in Social Work. 79 (3–4): 286–298. doi:10.1080/00377310903130332. S2CID   144386817.
  19. ↑ Jonathan Shay, "Achilles and Odysseus Today: What Homer Can Tell Us About Military Leadership."
  20. 1 2 Shay, J., Munroe, J. "Group and Milieu Therapy for Veterans with Complex posttraumatic stress disorder," in posttraumatic stress disorder: A Comprehensive Text, Edited by Saigh, Philip A. and Bremner, J. Douglas. Boston: Allyn & Bacon, 1998. Pp. 391-413
  21. ↑ Maguen, S.; Litz, B. T. (2012). "Moral injury in veterans of war" (PDF). PTSD Research Quarterly. 23 (1): 1–6.
  22. ↑ Litz, Brett T. (2009). "Moral injury and moral repair in war veterans: A preliminary model and intervention strategy". Clinical Psychology Review. 29 (8): 695–706. doi:10.1016/j.cpr.2009.07.003. PMID   19683376.
  23. ↑ "Moral Injury" Video of Dr. Jonathan Shay at the Narrative Medicine VA Workshop, March 9, 2012. Columbia University Medical Center.
  24. ↑ Dickinson College, Awards to Members of the Faculty Archived 2012-06-06 at the Wayback Machine
  25. ↑ "Introducing The Shay Moral Injury Center at Volunteers of America". Volunteers of America Shay Moral Injury Center. Retrieved 2019-04-10.
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