A Foundation for a "Cheerful Society": The Korean War and the Rise of Psychiatry.

One of the most remarkable medical achievements of the Korean War was the development of psychiatry. During the Korean War, soldiers and prisoners of war (POWs) experienced "gross stress reaction" and manifested poor concentration and memory as well as clinical depression and social alienation. Rest and relaxation rotations served as the primary treatment for their conditions. Civilians also bore the brunt of the war's effects. Delusions of grandeur and megalomania appear to have been common among Koreans, but there were few mental health facilities to provide treatment and care. Out of the furnace of war, psychiatry emerged as a newly specialized field, and in the 1950s, Korea became the very place where military psychiatry training under the U.S. military laid the groundwork for civilian psychiatry. This essay aims to enrich the study of mental illness during and after the Korean War by providing a more detailed picture of the mental problems experienced not only by veterans and POWs, but also by civilians in Korea. Examining mental health issues from this period is challenging due to the scarcity of resources for delving into the minds of the civilians involved. Taking military psychiatry as a starting point, this essay goes beyond existing scholarship to discuss psychiatry-related responses to the Korean War, including the influence of military psychiatry on civilian psychiatry, the endeavors of medical professionals and government policies, and contemporary expressions of mental distress during and after the war.

Predicting Depression Among Spouses of Ex-POWs: The Contribution of Exposure to Violence, Trauma, and Stress Through the Life Cycle.

The current longitudinal study focused on predicting depression among spouses of former Israeli war veterans (combat veterans or ex-prisoners of war [ex-POWs]). The research examined the direct and moderating role of secondary trauma related to their husbands' war-related experiences, stress related to being exposed to intimate partner violence in their relationship, being a second-generation Holocaust (SGH) survivor, and the effects of additional stressful life events (SLEs) since the end of the war. Wives of ex-POWs and combat veterans (N = 129) participated in two time measurements. Spouses of ex-POWs were found to be at higher risk of depression and psychological violence. Psychological violence was a risk factor for depression. The three-way interaction among psychological violence, being a SGH survivor, and experiencing SLEs was significant. In addition, experiencing earlier stressful events had a protective effect. The findings suggest that the association between early exposure and additive exposure through life is a complex iteration of factors and does not necessarily follow the vulnerability perspective.

A Cross-Sectional Study of Psychiatric Comorbidity in Croatian Homeland War Veterans Who Were Held as Prisoners of War and Are Affected by Posttraumatic Stress Disorder.

BACKGROUND: As a extremely traumatic experience, captivity may cause other mental disorders in addition to posttraumatic stress disorder, which is highly prevalent among ex-prisoners of war, and which often occurs in comorbidity with at least one other mental disorder. This objective of this study is to identify the incidence of comorbid mental disorders in Homeland war veterans ex-prisoners of war affected by posttraumatic stress disorder, as well as to identify the factors that influenced psychiatric comorbidity. SUBJECTS AND METHODS: The study sample comprised 264 subjects, all of whom were Croatian Homeland War veterans with combat experience in the defence of the Republic of Croatia, and all of whom fulfilled clinical criteria for posttraumatic stress disorder at the time of the study. The subjects were divided into two groups: the experimental group was composed of ex-prisoners of war, and the control group of veterans who had never been prisoners of war. The methods of sociodemographic questionnaire, posttraumatic stress disorder self-report checklist and the Harvard Trauma Questionnaire were used in the study. Psychiatric comorbidity data were retrieved from the subjects' anamnesis and medical records. RESULTS: The results showed that ex-prisoners of war were exposed to a statistically much higher number of traumatic events, and had a significantly higher total number of psychiatric comorbidities (p<0.01) than the control group. The incidence of acute and transient psychotic disorders, generalized anxiety disorders and psychological and behavioural factors associated with disorders or diseases classified elsewhere was significantly higher among ex-prisoners of war. There was no statistically significant difference in overall posttraumatic stress disorder intensity between the two groups (p<0.05). CONCLUSIONS: The results of the study confirm our hypothesis that the incidence of psychiatric comorbidity is higher in ex-prisoners of war.

The prevalence of depression among iran-iraq war veterans, combatants and former prisoners of war: A systematic review and meta-analysis.

By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval = 15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.

Trajectories of depression in aging veterans and former prisoners-of-war: The role of social support and hardiness.

OBJECTIVES: Depression is a prevalent outcome of traumatic experiences, such as combat and war captivity. This study explores the heterogeneity of changes over time and assesses the contribution of trauma exposure (combat vs. war captivity), hardiness, and social support for depression trajectories. METHODS: Two groups of Israeli veterans were assessed in 1991, 2003, 2008, and 2015: 149 former prisoners-of-war (ex-POWs) and 107 combat veterans. Protective factors were evaluated in 1991. Group-based trajectory modeling was conducted to identify latent trajectories of change. RESULTS: Four trajectories of "resiliency" (62.8%), "delayed onset" (25.1%), "exacerbation" (6.2%), and "chronicity" (5.9%) were found. The majority of the resilient group were combat veterans whereas the clinical groups consisted primarily of ex-POWs. Lower hardiness and social support were related to more deleterious trajectories. CONCLUSIONS: Spirals of loss involving hardiness and social support, normative experiences, and contextual factors may present explanations for the various depression trajectories.

Premature Aging Among Trauma Survivors-The Longitudinal Implications of Sleep Disruptions on Telomere Length and Cognitive Performance.

OBJECTIVES: Sleep is necessary for brain function as well as physical and cognitive processes. Sleep disruptions, common with aging, intensify among trauma survivors. Moreover, former prisoners-of-war (ex-POWs) often experience premature aging. This study investigates the longitudinal effects of sleep disruptions for ex-POWs in relation to cognitive performance and telomere length as well as between cognition and telomeres. METHOD: This study included Israeli veterans from the 1973 Yom Kippur War who participated in four assessments (1991, 2003, 2008, 2015): (a) ex-POWs (n = 99), and (b) veterans who not were captured (controls) (n = 101). Among both groups, sleep disruptions were assessed using a self-report item in all four assessments. Cognitive performance was assessed using the Montreal Cognitive Assessment (MOCA) and telomere length was assessed via total white blood cells (leukocytes) from whole blood samples using Southern blot, both were measured only among ex-POWs in 2015. We conducted descriptive statistics, repeated measures, correlations, and path analyses. RESULTS: Sleep disruptions were related to lower cognitive performance but not to shorter telomeres. Moreover, cognitive performance and telomere length were found to be related when sleep disruptions were taken into consideration. CONCLUSION: Interpersonal trauma was shown to be a unique experience resulting in sleep disruptions over time, leading to cognitive impairment. These findings highlight the importance of viewing trauma survivors at high-risk for sleep disruptions. Therefore, it is imperative to inquire about sleep and diagnose cognitive disorders to help identify and treat premature aging.

What predicts unremitting suicidal ideation? A prospective examination of the role of subjective age in suicidal ideation among ex-prisoners of war.

OBJECTIVE: Research has demonstrated that traumatic experiences have significant links to suicidal ideation (SI), particularly among older adults. The present study examined SI among older adults with a history of war trauma and the role of perceptions relating to one's age (subjective age) in predicting SI. METHOD: Drawing from a larger longitudinal study, we analyzed data based on interviews with 125 ex-prisoners of war (ex-POWS) from Israel's 1973 Yom Kippur War and a control group of 101 veterans from the same war who did not fall captive (mean age at most recent measurement was 65.05, SDage = 5.29). Participants were interviewed in 2008 (T1) and again in 2015 (T2). RESULTS: Findings revealed significantly higher levels of SI among ex-POWs than evident among controls and significantly higher levels of SI and subjective age among ex-POWs with PTSD. Furthermore, a sequential mediation analysis indicated that among ex-POWs, the path from T1 PTSD symptoms to subsequent SI was mediated by subjective age at T1, and subjective age at T2, after controlling for age, self-rated health, and SI at T1. CONCLUSION: A subset of ex-POWs are exposed to continuous suicidal risk throughout their later life, more than 40 years after the war. Furthermore, an older subjective age mediated these associations, independent of the levels of T1 SI, actual age, and self-rated health. These findings suggest debilitating long-term effects of trauma for SI in later life and their connections to advanced psychological aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between hardiness, C-reactive protein, and telomere length among former prisoners of war.

BACKGROUND: War captivity and posttraumatic stress disorder (PTSD) are known to be associated with several poor health outcomes of an accelerated aging process. However, the contribution of personality protective factors to this phenomenon are rarely studied. The present 24-year prospective study examined associations between psychological hardiness and three health outcomes: C-reactive protein (CRP) levels, metabolic syndrome (MetS), and telomere length (TL). METHOD: Eighty-eight Israeli former prisoners of war (ex-POWs) were assessed 18 (T1) and 42 (T2) years after repatriation. Data on hardiness was collected at T1 while leukocyte TL, CRP, and MetS data was collected 42 years after the war. RESULTS: While adjusting for age, body mass index (BMI), self-rated health, depressive and PTSD symptoms at T2, higher levels of hardiness at T1 predicted decreased CRP and longer TL at T2. CONCLUSIONS: Long-term health vulnerabilities of traumatized ex-POWs are manifested in an accelerated aging process and cellular senescence. Raising awareness of the importance of protective factors such as veterans' hardiness might be associated with improving their longevity and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Far away, so close: The role of self-differentiation in psychopathology among spouses of ex-POWs and comparable combatants.

OBJECTIVE: War captivity entails severe posttraumatic implications for ex-prisoners of war (POWs) and their partners. This study examines the role of self-differentiation in secondary traumatization and dyadic adjustment among ex-POWs' spouses. METHODS: A total of 106 spouses of Israeli ex-POWs and 56 matched spouses of ex-combatants completed self-report questionnaires assessing secondary posttraumatic stress disorder symptoms (SPS), self-differentiation (fusion, cut-off, balanced), general psychiatric distress (GPD), and dyadic adjustment. RESULTS: Ex-POWs' spouses reported lower dyadic adjustment and higher levels of SPS, GPD, and fusion and cut-off differentiation, compared to ex-combatants' spouses. A "mixed" differentiation style characterized by high levels of both fusion and cut-off was associated with particularly high distress levels. Fusion differentiation moderated the association between SPS/GPD and dyadic adjustment. CONCLUSION: Self-differentiation plays an important role in posttraumatic spousal relationships. Women showing unstable differentiation may be particularly vulnerable when living with a veteran. Treatments for posttraumatic couples should target dysregulated interpersonal distance and promote adaptive differentiation.

Women in refuge: Syrian women voicing health sequelae due to war traumatic experiences and displacement challenges.

OBJECTIVE: The Syrian war created a mass exodus of people to neighboring countries. Jordan hosts approximately 1.4 million Syrians who sought refuge and protection. This research represents an effort to understand the subjective narratives of Syrian refugee women's war traumatic experiences and displacement challenges while living in Jordan and the consequences on their physical and mental health. METHODS: Data gathered between March and June 2014 included 24 in-depth interviews with Syrian refugee women who sought services from humanitarian organizations in Jordan. Interviews were conducted in Arabic and were audio recorded. A team of four researchers translated and transcribed the interviews. Group narrative methodology was utilized to analyze the interviews. RESULTS: The study suggests that Syrian refugee women experienced diverse war atrocities including shelling, loss of property, separation from family members, and threats to their lives and their beloved ones, among a few. In Jordan, they reported on multiple displacement challenges, which are perceived as a continuous traumatic experience, as well as somatization. Narratives of women also included sequelae to their physical and mental health due to such stressors. Barriers to obtaining physical and mental health services are discussed, including inadequate medical treatment, lack of mental health services, and stigma on mental health, which might be associated to somatization of mental illnesses. CONCLUSION: It is crucial that humanitarian organizations and host countries like Jordan bear the responsibility to enhancing accessibility to comprehensive trauma-focused physical and mental health services for Syrian refugees in a culturally and gender sensitive manner.

The link between attachment orientations and cellular aging among former prisoners of war.

Objective: Ex-prisoners of war (ex-POWs) experience prolonged distress that in some cases may influence their cellular aging (telomere length). The current research examines whether attachment orientations of ex-POWs and their spouses can explain individual differences in telomere length 40 years after the experience of captivity.Methods: Eighty-eight Israeli ex-POWs were assessed at four time points since captivity, whereas their spouses at three time points. Attachment orientations (anxiety, avoidance) were assessed in three time points and telomere length was measured at time four.Results: Findings indicated that ex-POWs' attachment avoidance was associated with shorter telomere length. In addition, spouses' attachment anxiety was associated with shorter telomere length among ex-POWs, whereas spouses' attachment avoidance was unexpectedly related to longer telomere length among ex-POWs.Conclusions: Results suggest that the effects of trauma on cellular aging are not uniform and that intrapersonal and interpersonal variables may moderate responses to trauma at the cellular level.

Health-Related Quality of Life of Ex-Prisoners of War Affected by Posttraumatic Stress Disorder 25 Years After Captivity.

BACKGROUND: War captivity is one of the most difficult human experiences and can cause long-lasting effects on mental and physical health. Posttraumatic Stress Disorder (PTSD), as one of the frequent consequences of war trauma, is often associated with the psychiatric and/or somatic comorbidity. Therefore, PTSD results in impaired Health-Related Quality of Life (HRQoL). This study aimed to investigate the HRQoL in the Croatian Homeland War ex-POWs affected by PTSD, regarding the intensity of PTSD symptoms, sociodemographic characteristics and somatic comorbidity, and to identify predictors of poor HRQoL. SUBJECTS AND METHODS: The study sample consisted of two groups (45 participants each) based on whether they were POWs or not (control group). All study participants were diagnosed with PTSD according to the ICD-10 criteria and had combat experience as active participants in defence of the Republic of Croatia during the Homeland War. The subjects were evaluated using the sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. The data on participants' physical diseases were collected from medical anamnesis and medical records in the last five years. RESULTS: In relation to ex-POWs, the control group had significantly smaller number of retirees, more unemployed persons, smaller number of married subjects, and higher number of divorced persons. Low socioeconomic status and intensity of PTSD symptoms has been confirmed as a significant predictor of impaired HRQoL in both subject groups. The most commonly PTSD associated physical diseases were musculosceletal, cardiovascular, and gastrointestinal diseases. Endocrine and metabolic diseases were more frequent in the ex-POWs' group. CONCLUSIONS: PTSD was associated with the HRQoL, whether the veterans were ex-POWs or not. The hypothesis that exposure of ex-POWs to the trauma of captivity experience impaired HRQoL to a greater extent, compared to the non-detained veterans, was not confirmed. Low socioeconomic status has proved to be the most significant predictor of poorer HRQoL.

Sexual Satisfaction in Spouses of Ex-POWs: The Role of PTSD Symptoms and Self-Differentiation.

Spouses of former prisoners-of-war (ex-POWs) are at risk for posttraumatic stress symptoms (PTSS) and marital distress. This study assessed the implications of PTSS and self-differentiation for sexual satisfaction among 90 ex-POWs' spouses and 75 matched combatants' spouses from the 1973 Yom Kippur War. Standardized questionnaires were used. Ex-POWs' spouses had elevated PTSS and imbalanced self-differentiation. PTSS were associated with poorer self-differentiation and lower sexual satisfaction. Imbalanced self-differentiation mediated the association between PTSS and sexual satisfaction. The findings imply that PTSS and imbalanced self-differentiation contribute to low sexual satisfaction among spouses of primary trauma survivors.

War Imprisonment and Clinical Narratives of Psychiatric Illness, Psychiatric Hospital Charité, Berlin, 1948-1956.

While the historical analysis of psychological trauma from warfare has been extensive, traumatic illness in East German psychiatric practice after the Second World War has drawn little attention. The dominant literature uses West German political and medical discourses as sources to investigate the relationship between traumatic experience and psychiatric illness. This paper instead draws from East German patient files from 1948 until 1956 to examine efforts at the Charité Hospital in Berlin to interpret the psychiatric illness of former prisoners of war (POWs). By examining Socialist Party discourse at the time, the paper argues that psychiatric explanations created parallels with political debates by foregrounding social readjustment difficulties as the cause of postwar illness. Against this background, the final section explores the way in which war imprisonment could constitute a challenge to the clinical restructuring of former POWs' patient histories. Using strategies of confabulation, POWs confronted the documentary negotiation between bodies and meaning, provoking ambivalence.

Trajectories of attachment in older age: interpersonal trauma and its consequences.

Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991-2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.

The Downside Risk of Failing to Transcend Extraordinarily Negative Experiences: A Narrative Analysis.

Introduction: American service members who survived a trauma like a prisoner of war (POW) experience and successfully rebounded afterwards present outcomes of resilience that merit further exploration. Difficulties in defining or measuring human resilience in the clinical setting have been acknowledged for some time, with a call for greater openness to lessons from other disciplines. Transcendence as an identity-enhancing experiential process of meaning-making may offer insights that complement medical and psychological care. If a person fails to make meaning of an extraordinarily negative event, he may experience anti-transcendence, or an anti-process that results in by-products that are antonymous to transcendence, like destabilization of one's sense of self or the fracturing or disintegration of connections within and beyond the self. Such outcomes may trigger a crisis of identity. Materials and Methods: Eight memoirs of resilient American POW survivors from two time periods and the text were digitized and converted using optical character recognition software (Foxit PhantomPDF) to enable scanning for repetitious word patterns and themed searches. As passages were selected, sorted, and tagged, I designed a database in Microsoft Access to enter and query the fragments. Everyday baselines were established for each memoirist, and instances of transcendence and anti-transcendence were analyzed. Results: While evidence was found across all memoirists for transcendence of personally relevant, extraordinarily positive and negative events, instances of failure to transcend extraordinarily negative events were found in only three of the narratives. Given that the sample consisted of resilient service members who appeared not only to rebound but also to thrive after their experience, this scarcity of failure to transcend personally relevant, extraordinarily negative events is not surprising. Types of personally relevant, extraordinarily negative events discussed included multiple instances of forced desecration of local graves to make way for construction projects by captors and breaking points after torture. Conclusion: Transcendence as an experiential meaning-making process may utilize existential resources that enable one to make sense of personally relevant, extraordinarily positive, and negative events. If identity-relevant experiences are more powerful predictors of distress and well-being than those not relevant to one's sense of identity, then there should be greater focus on those kinds of experiences when working with service members struggling to bounce back from trauma. There are many contexts in which this can be done. Military chaplains, for example, are potentially very well suited to help service members reconnect with existential resources to help them make meaning of a traumatic event. Military psychologists can make space in their conversations discuss identity-relevant experiences. Examining written narrative can also help narrow the focus on identity-relevant experiences, both positive and negative. Written narrative about traumatic experiences as a form of self-narration carries with it an interpretive aspect that may help the person make meaning of it in way that he or she could not in a clinical setting. Although assessment of the potential therapeutic effect of written narrative was beyond the scope of the study, this might be one area to investigate.

One 'knows': self-rated health and telomere length among ex-prisoners of war.

OBJECTIVE: Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length. METHODS: Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3. RESULTS: The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3. CONCLUSIONS: These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.

Intergenerational transmission of paternal trauma among US Civil War ex-POWs.

We study whether paternal trauma is transmitted to the children of survivors of Confederate prisoner of war (POW) camps during the US Civil War (1861-1865) to affect their longevity at older ages, the mechanisms behind this transmission, and the reversibility of this transmission. We examine children born after the war who survived to age 45, comparing children whose fathers were non-POW veterans and ex-POWs imprisoned in very different camp conditions. We also compare children born before and after the war within the same family by paternal ex-POW status. The sons of ex-POWs imprisoned when camp conditions were at their worst were 1.11 times more likely to die than the sons of non-POWs and 1.09 times more likely to die than the sons of ex-POWs when camp conditions were better. Paternal ex-POW status had no impact on daughters. Among sons born in the fourth quarter, when maternal in utero nutrition was adequate, there was no impact of paternal ex-POW status. In contrast, among sons born in the second quarter, when maternal nutrition was inadequate, the sons of ex-POWs who experienced severe hardship were 1.2 times more likely to die than the sons of non-POWs and ex-POWs who fared better in captivity. Socioeconomic effects, family structure, father-specific survival traits, and maternal effects, including quality of paternal marriages, cannot explain our findings. While we cannot rule out fully psychological or cultural effects, our findings are most consistent with an epigenetic explanation.