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Saturday, May 9, 2020

Pliny the Elder

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Pliny the Elder
Gaius Plinius Secundus
Como - Dome - Facade - Plinius the Elder.jpg
Statue of Pliny the Elder on the facade of Cathedral of S. Maria Maggiore in Como
BornAD 23 or 24
DiedAD 79 (aged 55)
Stabiae, Campania, Roman Empire
CitizenshipRoman
EducationRhetoric, grammar
OccupationLawyer, author, natural philosopher, naturalist, military commander, provincial governor
Notable work
Naturalis Historia
ChildrenPliny the Younger (nephew, later adopted son)
Parent(s)Gaius Plinius Celer and Marcella

Gaius Plinius Secundus (AD 23/24–79), called Pliny the Elder (/ˈplɪni/), was a Roman author, a naturalist and natural philosopher, a naval and army commander of the early Roman Empire, and a friend of emperor Vespasian. He wrote the encyclopedic Naturalis Historia (Natural History), which became an editorial model for encyclopedias. He spent most of his spare time studying, writing, and investigating natural and geographic phenomena in the field.

His nephew, Pliny the Younger, wrote of him in a letter to the historian Tacitus:
For my part I deem those blessed to whom, by favour of the gods, it has been granted either to do what is worth writing of, or to write what is worth reading; above measure blessed those on whom both gifts have been conferred. In the latter number will be my uncle, by virtue of his own and of your compositions.
Pliny the Younger refers to Tacitus’s reliance upon his uncle's book, the History of the German Wars.
Pliny the Elder died in AD 79 in Stabiae while attempting the rescue of a friend and his family by ship from the eruption of Mount Vesuvius, which had already destroyed the cities of Pompeii and Herculaneum. The wind caused by the sixth and largest pyroclastic surge of the volcano’s eruption did not allow his ship to leave port, and Pliny probably died during that event.

Life and times

Background

One of the Xanten Horse-Phalerae located in the British Museum, measuring 10.5 cm (4.1 in). It bears an inscription formed from punched dots: PLINIO PRAEF EQ; i.e. Plinio praefecto equitum, "Pliny prefect of cavalry". It was perhaps issued to every man in Pliny's unit. The figure is the bust of the emperor.
 
Pliny's dates are pinned to the eruption of Mount Vesuvius in AD 79 and a statement of his nephew that he died in his 56th year, which would put his birth in AD 23 or 24.
 
Pliny was the son of an equestrian Gaius Plinius Celer and his wife Marcella. Neither the younger nor the elder Pliny mention the names. Their ultimate source is a fragmentary inscription (CIL V 1 3442) found in a field in Verona and recorded by the 16th-century Augustinian monk Onofrio Panvinio at Verona. The form is an elegy. The most commonly accepted reconstruction is
PLINIVS SECVNDVS AVGV. LERI. PATRI. MATRI. MARCELLAE. TESTAMENTO FIERI IVSSO
The Vs represent Us. It should say
Plinius Secundus augur ordered this to be made as a testament to his father [Ce]ler and his mother [Grania] Marcella
The actual words are fragmentary. The reading of the inscription depends on the reconstruction, but in all cases the names come through. Whether he was an augur and whether she was named Grania Marcella are less certain. Jean Hardouin presents a statement from an unknown source that he claims was ancient, that Pliny was from Verona and that his parents were Celer and Marcella. Hardouin also cites the conterraneity (see below) of Catullus.

City and Lake of Como, painted by Jean-Baptiste-Camille Corot, 1834

How the inscription got to Verona is unknown, but it could have arrived by dispersal of property from Pliny the Younger's then Tuscan (now Umbrian) estate at Colle Plinio, north of Città di Castello, identified with certainty by his initials in the roof tiles. He kept statues of his ancestors there. Pliny the Elder was born at Como, not at Verona: it is only as a native of old Gallia Transpadana that he calls Catullus of Verona his conterraneus, or fellow-countryman, not his municeps, or fellow-townsman. A statue of Pliny on the façade of the Duomo of Como celebrates him as a native son. He had a sister, Plinia, who married into the Caecilii and was the mother of his nephew, Pliny the Younger, whose letters describe his work and study regimen in detail. 

In one of his letters to Tacitus (avunculus meus), Pliny the Younger details how his uncle's breakfasts would be light and simple (levis et facilis) following the customs of our forefathers (veterum more interdiu). This shows that Pliny the Younger wanted it to be conveyed that Pliny the Elder was a "good Roman", which means that he maintained the customs of the great Roman forefathers. This statement would have pleased Tacitus.

Two inscriptions identifying the hometown of Pliny the Younger as Como take precedence over the Verona theory. One (CIL V 5262) commemorates the younger's career as the imperial magistrate and details his considerable charitable and municipal expenses on behalf of the people of Como. Another (CIL V 5667) identifies his father Lucius' village as Fecchio (tribe Oufentina) near Como. Therefore, Plinia likely was a local girl and Pliny the Elder, her brother, was from Como.

Gaius was a member of the Plinia gens: the insubric root Plina still persists, with rhotacism, in the local surname "Prina". He did not take his father's cognomen, Celer, but assumed his own, Secundus. As his adopted son took the same cognomen, Pliny founded a branch, the Plinii Secundi. The family was prosperous; Pliny the Younger's combined inherited estates made him so wealthy that he could found a school and a library, endow a fund to feed the women and children of Como, and own multiple estates around Rome and Lake Como, as well as enrich some of his friends as a personal favor. No earlier instances of the Plinii are known.

In 59 BC, only about 82 years before Pliny's birth, Julius Caesar founded Novum Comum (reverting to Comum) as a colonia to secure the region against the Alpine tribes, whom he had been unable to defeat. He imported a population of 4,500 from other provinces (not clear from where) to be placed in Comasco and 500 aristocratic Greeks to found Novum Comum itself. The community was thus multi-ethnic and the Plinies could have come from anywhere; whether any conclusions can be drawn from Pliny's preference for Greek words, or Julius Pokorny's derivation of the name from north Italic as "bald" is a matter of speculative opinion. No record of any ethnic distinctions in Pliny's time is apparent; the population prided themselves on being Roman citizens.

Pliny the Elder did not marry and had no children. In his will, he adopted his nephew, which entitled the latter to inherit the entire estate. The adoption is called a "testamental adoption" by writers on the topic, who assert that it applied to the name change only, but Roman jurisprudence recognizes no such category. Pliny the Younger thus became the adopted son of Pliny the Elder after the latter's death. For at least some of the time, however, Pliny the Elder resided under the same roof with his sister and nephew (whose husband and father, respectively, had died young); they were living there when Pliny the Elder decided to investigate the eruption of Mount Vesuvius, and was sidetracked by the need for rescue operations and a messenger from his friend asking for assistance.

Student and lawyer

Pliny's father took him to Rome to be educated in lawmaking. Pliny relates that he saw Marcus Servilius Nonianus.

Junior officer

In AD 46, at about age 23, Pliny entered the army as a junior officer, as was the custom for young men of equestrian rank. Ronald Syme, Plinian scholar, reconstructs three periods at three ranks. Pliny's interest in Roman literature attracted the attention and friendship of other men of letters in the higher ranks, with whom he formed lasting friendships. Later, these friendships assisted his entry into the upper echelons of the state; however, he was trusted for his knowledge and ability, as well. According to Syme, he began as a praefectus cohortis, a "commander of a cohort" (an infantry cohort, as junior officers began in the infantry), under Gnaeus Domitius Corbulo, himself a writer (whose works did not survive) in Germania Inferior. In AD 47, he took part in the Roman conquest of the Chauci and the construction of the canal between the rivers Maas and Rhine. His description of the Roman ships anchored in the stream overnight having to ward off floating trees has the stamp of an eyewitness account.

Map of Castra Vetera, a large permanent base (castra stativa) of Germania Inferior, where Pliny spent the last of his 10-year enlistment as a cavalry commander: The proximity of a naval base there means that he trained also in ships, as the Romans customarily trained all soldiers in all arms whenever possible. The location is on the lower Rhine River.

At some uncertain date, Pliny was transferred to the command of Germania Superior under Pomponius Secundus with a promotion to military tribune, which was a staff position, with duties assigned by the district commander. Pomponius was a half-brother of Corbulo. They had the same mother, Vistilia, a powerful matron of the Roman upper classes, who had seven children by six husbands, some of whom had imperial connections, including a future empress. Pliny's assignments are not clear, but he must have participated in the campaign against the Chatti of AD 50, at age 27, in his fourth year of service. Associated with the commander in the praetorium, he became a familiar and close friend of Pomponius, who also was a man of letters.

At another uncertain date, Pliny was transferred back to Germania Inferior. Corbulo had moved on, assuming command in the east. This time, Pliny was promoted to praefectus alae, "commander of a wing", responsible for a cavalry battalion of about 480 men. He spent the rest of his military service there. A decorative phalera, or piece of harness, with his name on it has been found at Castra Vetera, modern Xanten, then a large Roman army and naval base on the lower Rhine. Pliny's last commander there, apparently neither a man of letters nor a close friend of his, was Pompeius Paulinus, governor of Germania Inferior AD 55-58. Pliny relates that he personally knew Paulinus to have carried around 12,000 pounds of silver service on which to dine on campaign against the Germans (a practice which would not have endeared him to the disciplined Pliny).

According to his nephew, during this period, he wrote his first book (perhaps in winter quarters when more spare time was available), a work on the use of missiles on horseback, De jaculatione equestri. It has not survived, but in Natural History, he seems to reveal at least part of its content, using the movements of the horse to assist the javelin-man in throwing missiles while astride its back. During this period, he also dreamed that the spirit of Drusus Nero begged him to save his memory from oblivion. The dream prompted Pliny to begin forthwith a history of all the wars between the Romans and the Germans, which he did not complete for some years. 

Colossal head of Titus, son of Vespasian. Glyptothek, Munich

Literary interlude

At the earliest time Pliny could have left the service, Nero, the last of the Julio-Claudian dynasty, had been emperor for two years. He did not leave office until AD 68, when Pliny was 45 years old. During that time, Pliny did not hold any high office or work in the service of the state. In the subsequent Flavian Dynasty, his services were in such demand that he had to give up his law practice, which suggests that he had been trying not to attract the attention of Nero, who was a dangerous acquaintance. 

Under Nero, Pliny lived mainly in Rome. He mentions the map of Armenia and the neighbourhood of the Caspian Sea, which was sent to Rome by the staff of Corbulo in 58. He also saw the building of Nero's Domus Aurea or "Golden House" after the fire of 64.

Besides pleading law cases, Pliny wrote, researched, and studied. His second published work was a biography of his old commander, Pomponius Secundus, in two books. After several years in prison under Tiberius, AD 31-37 (which he used to write tragedies), Pomponius was rehabilitated by Caligula (who later married his half-sister, Caesonia) in 38, made consul in 41, and sent by Claudius as legatus to Germany, where he won a victory against the Chatti in 50 and was allowed a triumph. After this peak, he disappears from history, never to be mentioned again, except by the Plinies, and is not among either the friends or the enemies of Nero.

The elder Pliny mentions that he saw "in the possession of Pomponius Secundus, the poet, a very illustrious citizen", manuscripts in the "ancient handwriting of Tiberius and Caius Gracchus". The peak of Pomponius's fame would have been his triumph of 50 or 51. In 54, Nero came to power; at that time, Pliny was working on his two military writings. Pliny the Younger says that the biography of Pomponius was "a duty which he owed to the memory of his friend", implying that Pomponius had died. The circumstances of this duty and whether or not it had anything to do with his probable avoidance of Nero have disappeared with the work.

Meanwhile, he was completing the 20 books of his History of the German Wars, the only authority expressly quoted in the first six books of the Annals of Tacitus, and probably one of the principal authorities for the same author's Germania. It disappeared in favor of the writings of Tacitus (which are far shorter), and, early in the fifth century, Symmachus had little hope of finding a copy.

Like Caligula, Nero seemed to grow gradually more insane as his reign progressed. Pliny devoted much of his time to writing on the comparatively safe subjects of grammar and rhetoric. He published a three-book, six-volume educational manual on rhetoric, entitled Studiosus, "the Student". Pliny the Younger says of it: "The orator is trained from his very cradle and perfected." It was followed by eight books entitled Dubii sermonis, Of Doubtful Phraseology. These are both now lost works. His nephew relates: "He wrote this under Nero, in the last years of his reign, when every kind of literary pursuit which was in the least independent or elevated had been rendered dangerous by servitude."

In 68, Nero no longer had any friends and supporters. He committed suicide, and the reign of terror was at an end, as was the interlude in Pliny's obligation to the state.

Senior officer


At the end of AD 69, after a year of civil war consequent on the death of Nero, Vespasian, a successful general, became emperor. Like Pliny, he had come from the equestrian class, rising through the ranks of the army and public offices and defeating the other contenders for the highest office. His main tasks were to re-establish peace under imperial control and to place the economy on a sound footing. He needed in his administration all the loyalty and assistance he could find. Pliny, apparently trusted without question, perhaps (reading between the lines) recommended by Vespasian's son Titus, was put to work immediately and was kept in a continuous succession of the most distinguished procuratorships, according to Suetonius. A procurator was generally a governor of an imperial province. The empire was perpetually short of, and was always seeking, office holders for its numerous offices. 

Throughout the latter stages of Pliny's life, he maintained good relations with Emperor Vespasian. As is written in the first line of Pliny the Younger's avunculus meus:
Ante lucem ibat ad Vespasianum imperatorem (nam ille quoque noctibus utebatur), deinde ad officium sibi delegatum Before dawn he was going to the Emperor Vespasian (for he also made use of the night), then he did the other duties assigned to him.
In this passage, Pliny the Younger conveys to Tacitus that his uncle was ever the academic, always working. The word ibat (imperfect, "he used to go") gives a sense of repeated or customary action. In the subsequent text, he mentions again how most of his uncle's day was spent working, reading, and writing. He notes that Pliny "was indeed a very ready sleeper, sometimes dropping off in the middle of his studies and then waking up again."

A definitive study of the procuratorships of Pliny was compiled by the classical scholar Friedrich Münzer, which was reasserted by Ronald Syme and became a standard reference point. Münzer hypothesized four procuratorships, of which two are certainly attested and two are probable but not certain. However, two does not satisfy Suetonius' description of a continuous succession.[31] Consequently, Plinian scholars present two to four procuratorships, the four comprising (i) Gallia Narbonensis in 70, (ii) Africa in 70-72, (iii) Hispania Tarraconensis in 72-74, and (iv) Gallia Belgica in 74-76.




According to Syme, Pliny may have been "successor to Valerius Paulinus", procurator of Gallia Narbonensis (southeastern France), early in AD 70. He seems to have a "familiarity with the provincia", which, however, might otherwise be explained. For example, he says

" ... in the cultivation of the soil, the manners and civilization of the inhabitants, and the extent of its wealth, it is surpassed by none of the provinces, and, in short, might be more truthfully described as a part of Italy than as a province."
denoting a general popular familiarity with the region. 

Oasis at Gabès

Pliny certainly spent some time in Africa Province, most likely as a procurator. Among other events or features that he saw are the provoking of rubetae, poisonous toads (Bufonidae), by the Psylli; the buildings made with molded earthen walls, "superior in solidity to any cement;" and the unusual, fertile seaside oasis of Gabès (then Tacape), Tunisia, currently a World Heritage Site. Syme assigns the African procuratorship to AD 70-72. 

The procuratorship of Hispania Tarraconensis was next. A statement by Pliny the Younger that his uncle was offered 400,000 sesterces for his manuscripts by Larcius Licinius while he (Pliny the Elder) was procurator of Hispania makes it the most certain of the three. Pliny lists the peoples of "Hither Hispania", including population statistics and civic rights (modern Asturias and Gallaecia). He stops short of mentioning them all for fear of "wearying the reader". As this is the only geographic region for which he gives this information, Syme hypothesizes that Pliny contributed to the census of Hither Hispania conducted in 73/74 by Vibius Crispus, legate from the Emperor, thus dating Pliny's procuratorship there.

Las Médulas, Spain, site of a large Roman mine
 
During his stay in Hispania, he became familiar with the agriculture and especially the gold mines of the north and west of the country. His descriptions of the various methods of mining appear to be eyewitness judging by the discussion of gold mining methods in his Natural History. He might have visited the mine excavated at Las Médulas.

The Porta Nigra Roman gate, Trier, Germany
 
The last position of procurator, an uncertain one, was of Gallia Belgica, based on Pliny's familiarity with it. The capital of the province was Augusta Treverorum (Trier), named for the Treveri surrounding it. Pliny says that in "the year but one before this" a severe winter killed the first crops planted by the Treviri; they sowed again in March and had "a most abundant harvest." The problem is to identify "this", the year in which the passage was written. Using 77 as the date of composition Syme arrives at AD 74-75 as the date of the procuratorship, when Pliny is presumed to have witnessed these events. The argument is based entirely on presumptions; nevertheless, this date is required to achieve Suetonius' continuity of procuratorships, if the one in Gallia Belgica occurred.

Pliny was allowed home (Rome) at some time in AD 75–76. He was presumably at home for the first official release of Natural History in 77. Whether he was in Rome for the dedication of Vespasian's Temple of Peace in the Forum in 75, which was in essence a museum for display of art works plundered by Nero and formerly adorning the Domus Aurea, is uncertain, as is his possible command of the vigiles (night watchmen), a lesser post. No actual post is discernible for this period. On the bare circumstances, he was an official agent of the emperor in a quasiprivate capacity. Perhaps he was between posts. In any case, his appointment as prefect of the fleet at Misenum took him there, where he resided with his sister and nephew. Vespasian died of disease on June 23, 79. Pliny outlived him by two months.

Noted author

During Nero's reign of terror, Pliny avoided working on any writing that would attract attention to himself. His works on oratory in the last years of Nero's reign (67, 68) focused on form rather than on content. He began working on content again probably after Vespasian's rule began in AD 69, when the terror clearly was over and would not be resumed. It was to some degree reinstituted (and later cancelled by his son Titus) when Vespasian suppressed the philosophers at Rome, but not Pliny, who was not among them, representing, as he says, something new in Rome, an encyclopedist (certainly, a venerable tradition outside Italy).

In his next work, he "completed the history which Aufidius Bassus left unfinished, and... added to it thirty books." Aufidius Bassus was a cause célèbre according to Seneca the Younger, a man much admired at Rome. He had begun his history with some unknown date, certainly before the death of Cicero, so probably the Civil Wars or the death of Julius Caesar, ending with the reign of Tiberius. It was cut short when Bassus died slowly of a lingering disease, with such spirit and objectivity that Seneca remarked that Bassus seemed to treat it as someone else's dying.

Pliny's continuation of Bassus's History was one of the authorities followed by Suetonius and Plutarch. Tacitus also cites Pliny as a source. He is mentioned concerning the loyalty of Burrus, commander of the Praetorian Guard, whom Nero removed for disloyalty. Tacitus portrays parts of Pliny's view of the Pisonian conspiracy to kill Nero and make Piso emperor as "absurd" and mentions that he could not decide whether Pliny's account or that of Messalla was more accurate concerning some of the details of the Year of the Four Emperors. Evidently Pliny's extension of Bassus extended at least from the reign of Nero to that of Vespasian. Pliny seems to have known it was going to be controversial, as he deliberately reserved it for publication after his death:
It has been long completed and its accuracy confirmed; but I have determined to commit the charge of it to my heirs, lest I should have been suspected, during my lifetime, of having been unduly influenced by ambition. By this means I confer an obligation on those who occupy the same ground with myself; and also on posterity, who, I am aware, will contend with me, as I have done with my predecessors.

Natural History

Pliny's last work, according to his nephew, was the Naturalis Historia (literally "Natural History"), an encyclopedia into which he collected much of the knowledge of his time. It comprised 37 books. His sources were personal experience, his own prior works (such as the work on Germania), and extracts from other works. These extracts were collected in the following manner: One servant would read aloud, and another would write the extract as dictated by Pliny. He is said to have dictated extracts while taking a bath. In winter, he furnished the copier with gloves and long sleeves so his writing hand would not stiffen with cold (Pliny the Younger in avunculus meus). His extract collection finally reached about 160 volumes, which Larcius Licinius, the Praetorian legate of Hispania Tarraconensis, vainly offered to purchase for 400,000 sesterces. That would have been in 73/74 (see above). Pliny bequeathed the extracts to his nephew.

When composition of the Natural History began is unknown. Since he was preoccupied with his other works under Nero and then had to finish the history of his times, he is unlikely to have begun before 70. The procuratorships offered the ideal opportunity for an encyclopedic frame of mind. The date of an overall composition cannot be assigned to any one year. The dates of different parts must be determined, if they can, by philological analysis (the post mortem of the scholars).

Laocoon and his Sons, a sculpture admired by Pliny

The closest known event to a single publication date, that is, when the manuscript was probably released to the public for borrowing and copying, and was probably sent to the Flavians, is the date of the Dedication in the first of the 37 books. It is to the imperator Titus. As Titus and Vespasian had the same name, Titus Flavius Vespasianus, earlier writers hypothesized a dedication to Vespasian. Pliny's mention of a brother (Domitian) and joint offices with a father, calling that father "great", points certainly to Titus.

Pliny also says that Titus had been consul six times. The first six consulships of Titus are in 70, 72, 74, 75, 76, and 77, all conjointly with Vespasian, and the seventh was in 79. This brings the date of the Dedication probably to 77. In that year, Vespasian was 68. He had been ruling conjointly with Titus for some years. The title imperator does not indicate that Titus was sole emperor, but was awarded for a military victory, in this case that in Jerusalem in 70.

Aside from minor finishing touches, the work in 37 books was completed in AD 77. That it was written entirely in 77 or that Pliny was finished with it then cannot be proved. Moreover, the dedication could have been written before publication, and it could have been published either privately or publicly earlier without the dedication. The only certain fact is that Pliny did no further work on it after AD 79. 

The Naturalis Historia is one of the largest single works to have survived from the Roman Empire to the modern day and purports to cover the entire field of ancient knowledge, based on the best authorities available to Pliny. He claims to be the only Roman ever to have undertaken such a work. It encompasses the fields of botany, zoology, astronomy, geology, and mineralogy, as well as the exploitation of those resources. It remains a standard work for the Roman period and the advances in technology and understanding of natural phenomena at the time. His discussions of some technical advances are the only sources for those inventions, such as hushing in mining technology or the use of water mills for crushing or grinding corn. Much of what he wrote about has been confirmed by archaeology. It is virtually the only work which describes the work of artists of the time, and is a reference work for the history of art. As such, Pliny's approach to describing the work of artists was to inform Lorenzo Ghiberti in writing his commentaries and Giorgio Vasari who wrote the celebrated Lives of the Most Excellent Painters, Sculptors, and Architects.

The work became a model for all later encyclopedias in terms of the breadth of subject matter examined, the need to reference original authors, and a comprehensive index list of the contents. It is the only work by Pliny to have survived, and the last that he published, lacking a final revision at his sudden and unexpected death in the AD 79 eruption of Vesuvius.

Death

Plaster casts of the casualties of the pumice fall, whose remains vanished, leaving cavities in the pumice at Pompeii
 
Pliny had received from Emperor Vespasian, who had died two months earlier, the appointment of praefectus classis (fleet commander) in the Roman Navy. He was stationed at Misenum, at the time of the great eruption of Mount Vesuvius, which destroyed and buried Pompeii and Herculaneum. He was preparing to cross the Bay of Naples to observe the phenomenon directly when a message arrived from his friend Rectina asking to rescue Pomponianus and her. Launching the galleys under his command to the evacuation of the opposite shore, he himself took "a fast-sailing cutter", a decision that may have cost him his life. His nephew, Pliny the Younger, provided an account of his death, obtained from the survivors. The nephew and his mother had decided not to go on the voyage across the bay.

As the light vessel approached the shore near Herculaneum, cinders and pumice began to fall on it. Pliny's helmsman advised turning back, to which Pliny replied, "Fortune favours the brave; steer to where Pomponianus is." (Stabiae, near the modern town of Castellammare di Stabia.) They landed and found Pomponianus "in the greatest consternation." Pliny hugged and comforted him. They could not find Rectina. They loaded the cutter, but the same winds that brought it to Stabiae prevented it from leaving. Pliny reassured his party by feasting, bathing, and sleeping while waiting for the wind to abate, but finally they had to leave the buildings for fear of collapse and try their luck in the pumice fall. Pliny sat down and could not get up even with assistance, and was left behind. His companions theorized that he collapsed and died through inhaling poisonous gases emitted from the volcano. On their return two days later after the plume had dispersed, his body was found under the pumice with no apparent external injuries. The problem with the toxicity theory is that his companions were unaffected by the same fumes, and they had no mobility problems, whereas Pliny had to sit and could not rise. As he is described as a corpulent man, who also suffered from asthma, his friends are thought to have left him because he was already dead.

The story of his last hours is told in a letter addressed 27 years afterwards to Tacitus by Pliny the Younger, who also sent to another correspondent, Baebius Macer, an account of his uncle's writings and his manner of life. The fragment from Suetonius (see under "External links" below) states a somewhat less flattering view, that Pliny approached the shore only from scientific interest and then asked a slave to kill him to avoid heat from the volcano. It is not as credible a source, as it is clear from the nephew's letter that the persons Pliny came to rescue escaped to tell the tale in detail. Moreover, Suetonius hypothesizes that a party witnessing events so agonizing as to destroy Pliny or cause him to order his own death are suspect as they apparently were subject to none of these fatal events themselves.

In 1859, Jacob Bigelow, M.D., after summarizing the widespread misinformation about Pliny's death, examined the evidence and concluded that Pliny was overweight, in poor health, and died of a heart attack. In 1967, science historian Conway Zirkle similarly stated that "there is widespread and persisting misinformation" about Pliny's death. He suggested that despite his rescue attempt, Pliny never came within miles of Vesuvius and no evidence has been found that shows he died from breathing in fumes, and like Bigelow, concluded that he died of a heart attack.

Complex post-traumatic stress disorder

From Wikipedia, the free encyclopedia
 
Complex post-traumatic stress disorder
SpecialtyPsychology

Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. C-PTSD relates to the trauma model of mental disorders and is associated with chronic sexual, psychological and narcissistic (child) abuse and physical abuse and neglect, chronic intimate partner violence, victims of prolonged workplace or school bullying, victims of kidnapping and hostage situations, indentured servants, victims of slavery and human trafficking, sweatshop workers, prisoners of war, concentration camp survivors, residential school survivors, and defectors of cults or cult-like organizations. Situations involving captivity/entrapment (a situation lacking a viable escape route for the victim or a perception of such) can lead to C-PTSD-like symptoms, which can include prolonged feelings of terror, worthlessness, helplessness, and deformation of one's identity and sense of self.
C-PTSD has also been referred to as DESNOS or Disorders of Extreme Stress Not Otherwise Specified.

Some researchers believe that C-PTSD is distinct from, but similar to, PTSD, somatization disorder, dissociative identity disorder, and borderline personality disorder. Its main distinctions are a distortion of the person's core identity and significant emotional dysregulation. It was first described in 1992 by an American psychiatrist and scholar, Judith Herman in her book Trauma & Recovery and in an accompanying article. The disorder is included in the World Health Organization's (WHO) eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). The C-PTSD criteria has not yet gone through the private approval board of the American Psychiatric Association (APA) for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Complex PTSD is also recognized by the United States Department of Veterans Affairs (VA), Healthdirect Australia (HDA), and the National Health Service (NHS).

Symptoms

Children and adolescents

The diagnosis of PTSD was originally developed for adults who had suffered from a single-event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, and a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who caused the [please edit unfinished sentence]. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child's development.

The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of C-PTSD. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Dr. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be brought on by subjective events such as betrayal, defeat or shame.

Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioural characteristics in seven domains:
  • Attachment – "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states"
  • Biology – "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
  • Affect or emotional regulation – "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
  • Dissociation – "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
  • Behavioural control – "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
  • Cognition – "difficulty regulating attention; problems with a variety of 'executive functions' such as planning, judgement, initiation, use of materials, and self-monitoring; difficulty processing new information; difficulty focusing and completing tasks; poor object constancy; problems with 'cause-effect' thinking; and language developmental problems such as a gap between receptive and expressive communication abilities."
  • Self-concept – "fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".

Adults

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.  This can become a pervasive way of relating to others in adult life, described as insecure attachment. This symptom is neither included in the diagnosis of dissociative disorder nor in that of PTSD in the current DSM-5 (2013). Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.

Six clusters of symptoms have been suggested for diagnosis of C-PTSD:
  • alterations in regulation of affect and impulses;
  • alterations in attention or consciousness;
  • alterations in self-perception;
  • alterations in relations with others;
  • somatization;
  • alterations in systems of meaning.
Experiences in these areas may include:
  • Changes in emotional regulation, including experiences such as persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or extremely inhibited anger (may alternate), and compulsive or extremely inhibited sexuality (may alternate).
  • Variations in consciousness, such as amnesia or improved recall for traumatic events, episodes of dissociation, depersonalization/derealization, and reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation).
  • Changes in self-perception, such as a sense of helplessness or paralysis of initiative, shame, guilt and self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings (may include a sense of specialness, utter aloneness, a belief that no other person can understand, or a feeling of nonhuman identity).
  • Varied changes in perception of the perpetrators, such as a preoccupation with the relationship with a perpetrator (including a preoccupation with revenge), an unrealistic attribution of total power to a perpetrator (though the individual's assessment may be more realistic than the clinician's), idealization or paradoxical gratitude, a sense of a special or supernatural relationship with a perpetrator, and acceptance of a perpetrator's belief system or rationalizations.
  • Alterations in relations with others, such as isolation and withdrawal, disruption in intimate relationships, a repeated search for a rescuer (may alternate with isolation and withdrawal), persistent distrust, and repeated failures of self-protection.
  • Changes in systems of meaning, such as a loss of sustaining faith and a sense of hopelessness and despair.

Diagnostics

C-PTSD was under consideration for inclusion in the DSM-IV but was not included when the DSM-IV was published in 1994. Neither was it included in the DSM-5. Post traumatic stress disorder continues to be listed as a disorder.

Differential diagnosis

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) was included in the DSM-III (1980), mainly due to the relatively large numbers of American combat veterans of the Vietnam War who were seeking treatment for the lingering effects of combat stress. In the 1980s, various researchers and clinicians suggested that PTSD might also accurately describe the sequelae of such traumas as child sexual abuse and domestic abuse. However, it was soon suggested that PTSD failed to account for the cluster of symptoms that were often observed in cases of prolonged abuse, particularly that which was perpetrated against children by caregivers during multiple childhood and adolescent developmental stages. Such patients were often extremely difficult to treat with established methods.

PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized. Most importantly, there is a loss of a coherent sense of self: this loss, and the ensuing symptom profile, most pointedly differentiates C-PTSD from PTSD.

C-PTSD is also characterized by attachment disorder, particularly the pervasive insecure, or disorganized-type attachment. DSM-IV (1994) dissociative disorders and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of C-PTSD, when some adults with C-PTSD become parents and confront their own children's attachment needs, they may have particular difficulty in responding sensitively especially to their infants' and young children's routine distress—such as during routine separations, despite these parents' best intentions and efforts. Although the great majority of survivors do not abuse others, this difficulty in parenting may have adverse repercussions for their children's social and emotional development if parents with this condition and their children do not receive appropriate treatment.

Thus, a differentiation between the diagnostic category of C-PTSD and that of PTSD has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone. PTSD can exist alongside C-PTSD, however a sole diagnosis of PTSD often does not sufficiently encapsulate the breadth of symptoms experienced by those who have experienced prolonged traumatic experience, and therefore C-PTSD extends beyond the PTSD parameters.

C-PTSD also differs from continuous traumatic stress disorder (CTSD), which was introduced into the trauma literature by Gill Straker (1987). It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression. The term is also applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services.

Traumatic grief

Traumatic grief or complicated mourning are conditions where both trauma and grief coincide. There are conceptual links between trauma and bereavement since loss of a loved one is inherently traumatic. If a traumatic event was life-threatening, but did not result in a death, then it is more likely that the survivor will experience post-traumatic stress symptoms. If a person dies, and the survivor was close to the person who died, then it is more likely that symptoms of grief will also develop. When the death is of a loved one, and was sudden or violent, then both symptoms often coincide. This is likely in children exposed to community violence.

For C-PTSD to manifest traumatic grief, the violence would occur under conditions of captivity, loss of control and disempowerment, coinciding with the death of a friend or loved one in life-threatening circumstances. This again is most likely for children and stepchildren who experience prolonged domestic or chronic community violence that ultimately results in the death of friends and loved ones. The phenomenon of the increased risk of violence and death of stepchildren is referred to as the Cinderella effect.

Similarities to and differentiation from borderline personality disorder

C-PTSD may share some symptoms with both PTSD and borderline personality disorder. However, there is enough evidence to also differentiate C-PTSD from borderline personality disorder.

It may help to understand the intersection of attachment theory with C-PTSD and BPD if one reads the following opinion of Bessel A. van der Kolk together with an understanding drawn from a description of BPD:
Uncontrollable disruptions or distortions of attachment bonds precede the development of post-traumatic stress syndromes. People seek increased attachment in the face of danger. Adults, as well as children, may develop strong emotional ties with people who intermittently harass, beat, and, threaten them. The persistence of these attachment bonds leads to confusion of pain and love. Trauma can be repeated on behavioural, emotional, physiologic, and neuroendocrinologic levels. Repetition on these different levels causes a large variety of individual and social suffering.
However, C-PTSD and BPD have been found by researchers to be completely distinctive disorders with different features. Notably, C-PTSD is not a personality disorder. Those with C-PTSD do not fear abandonment or have unstable patterns of relations; rather, they withdraw. They do not struggle with lack of empathy. There are distinct and notably large differences between Borderline and C-PTSD and while there are some similarities – predominantly in terms of issues with attachment (though this plays out in completely different ways) and trouble regulating strong emotional effect (often feel pain vividly), the disorders are completely different in nature – especially considering that C-PTSD is always a response to trauma rather than a personality disorder.
While the individuals in the BPD reported many of the symptoms of PTSD and CPTSD, the BPD class was clearly distinct in its endorsement of symptoms unique to BPD. The RR ratios presented in Table 5 revealed that the following symptoms were highly indicative of placement in the BPD rather than the CPTSD class: (1) frantic efforts to avoid real or imagined abandonment, (2) unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, (3) markedly and persistently unstable self-image or sense of self, and (4) impulsiveness. Given the gravity of suicidal and self-injurious behaviors, it is important to note that there were also marked differences in the presence of suicidal and self-injurious behaviors with approximately 50% of individuals in the BPD class reporting this symptom but much fewer and an equivalent number doing so in the CPSD and PTSD classes (14.3 and 16.7%, respectively). The only BPD symptom that individuals in the BPD class did not differ from the CPTSD class was chronic feelings of emptiness, suggesting that in this sample, this symptom is not specific to either BPD or CPTSD and does not discriminate between them.
Overall, the findings indicate that there are several ways in which Complex PTSD and BPD differ, consistent with the proposed diagnostic formulation of CPTSD. BPD is characterized by fears of abandonment, unstable sense of self, unstable relationships with others, and impulsive and self-harming behaviors. In contrast, in CPTSD as in PTSD, there was little endorsement of items related to instability in self-representation or relationships. Self-concept is likely to be consistently negative and relational difficulties concern mostly avoidance of relationships and sense of alienation.
In addition 25% of those diagnosed with BPD have no known history of childhood neglect or abuse and individuals are six times as likely to develop BPD if they have a relative who was so diagnosed compared to those who do not. One conclusion is that there is a genetic predisposition to BPD unrelated to trauma. Researchers conducting a longitudinal investigation of identical twins found that "genetic factors play a major role in individual differences of borderline personality disorder features in Western society." A 2014 study published in European Journal of Psychotraumatology was able to compare and contrast C-PTSD, PTSD, Borderline Personality Disorder and found that it could distinguish between individual cases of each and when it was co-morbid, arguing for a case of separate diagnoses for each. BPD may be confused with C-PTSD by some without proper knowledge of the two conditions because those with BPD also tend to suffer from PTSD or to have some history of trauma.

In Trauma and Recovery, Herman expresses the additional concern that patients who suffer from C-PTSD frequently risk being misunderstood as inherently 'dependent', 'masochistic', or 'self-defeating', comparing this attitude to the historical misdiagnosis of female hysteria. However, those who develop C-PTSD do so as a result of the intensity of the traumatic bond – in which someone becomes tightly biolo-chemically bound to someone who abuses them and the responses they learned to survive, navigate and deal with the abuse they suffered then become automatic responses, imbedded in their personality over the years of trauma – a normal reaction to an abnormal situation.

Treatment

While standard evidence-based treatments may be effective for treating post traumatic stress disorder, treating complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. According to the United States Department of Veteran Affairs:
The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events.
The utility of PTSD-derived psychotherapies for assisting children with C-PTSD is uncertain. This area of diagnosis and treatment calls for caution in use of the category C-PTSD. Dr. Julian Ford and Dr. Bessel van der Kolk have suggested that C-PTSD may not be as useful a category for diagnosis and treatment of children as a proposed category of developmental trauma disorder (DTD). According to Courtois & Ford, for DTD to be diagnosed it requires a
history of exposure to early life developmentally adverse interpersonal trauma such as sexual abuse, physical abuse, violence, traumatic losses of other significant disruption or betrayal of the child's relationships with primary caregivers, which has been postulated as an etiological basis for complex traumatic stress disorders. Diagnosis, treatment planning and outcome are always relational.
Since C-PTSD or DTD in children is often caused by chronic maltreatment, neglect or abuse in a care-giving relationship the first element of the biopsychosocial system to address is that relationship. This invariably involves some sort of child protection agency. This both widens the range of support that can be given to the child but also the complexity of the situation, since the agency's statutory legal obligations may then need to be enforced.

A number of practical, therapeutic and ethical principles for assessment and intervention have been developed and explored in the field:
  • Identifying and addressing threats to the child's or family's safety and stability are the first priority.
  • A relational bridge must be developed to engage, retain and maximize the benefit for the child and caregiver.
  • Diagnosis, treatment planning and outcome monitoring are always relational (and) strengths based.
  • All phases of treatment should aim to enhance self-regulation competencies.
  • Determining with whom, when and how to address traumatic memories.
  • Preventing and managing relational discontinuities and psychosocial crises.

Adults

Trauma Recovery Model - Judith Herman

Dr. Judith Lewis Herman, in her book, Trauma and Recovery, proposed that a complex trauma recovery model that occurs in three stages:
  1. establishing safety,
  2. remembrance and mourning for what was lost,
  3. reconnecting with community and more broadly, society.
Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship. This healing relationship need not be romantic or sexual in the colloquial sense of "relationship", however, and can also include relationships with friends, co-workers, one's relatives or children, and the therapeutic relationship.

Complex trauma means complex reactions and this leads to complex treatments. [need reference] Hence, treatment for C-PTSD requires a multi-modal approach.

It has been suggested that treatment for complex PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. Six suggested core components of complex trauma treatment include:
  1. Safety
  2. Self-regulation
  3. Self-reflective information processing
  4. Traumatic experiences integration
  5. Relational engagement
  6. Positive affect enhancement
The above components can be conceptualized as a model with three phases. Every case will not be the same, but one can expect the first phase to consist of teaching adequate coping strategies and addressing safety concerns. The next phase would focus on decreasing avoidance of traumatic stimuli and applying coping skills learned in phase one. The care provider may also begin challenging assumptions about the trauma and introducing alternative narratives about the trauma. The final phase would consist of solidifying what has previously been learned and transferring these strategies to future stressful events.

Neuroscientific and Trauma Informed Interventions

In practice, the forms of treatment and intervention varies from individual to individual since there is a wide spectrum of childhood experiences of developmental trauma and symptomatology and not all survivors respond positively, uniformly, to the same treatment. Therefore, treatment is generally tailored to the individual. Recent neuroscientific research has shed some light on the impact that severe childhood abuse and neglect (trauma) has on a child's developing brain, specifically as it relates to the development in brain structures, function and connectivity among children from infancy to adulthood. This understanding of the neurophysiological underpinning of complex trauma phenomena is what currently is referred to in the field of traumatology as 'trauma informed' which has become the rationale which has influenced the development of new treatments specifically targeting those with childhood developmental trauma. Dr. Martin Teicher, a Harvard psychiatrist and researcher, has suggested that that the development of specific complex trauma related symptomatology (and in fact the development of many adult onset psychopathologies) may be connected to gender differences and at what stage of childhood development trauma, abuse or neglect occurred. For example, it is well established that the development of dissociative identity disorder among women is often associated with early childhood sexual abuse.

Use of Evidence Based Treatment and Its Limitations

One of the current challenges faced by many survivors of complex trauma (or developmental trauma disorder) is support for treatment since many of the current therapies are relatively expensive and not all forms of therapy or intervention are reimbursed by insurance companies who use evidence based practice as a criteria for reimbursement. Cognitive behavioral therapy, prolonged exposure therapy and dialectical behavioral therapy are well established forms of evidence based intervention. These treatments are approved and endorsed by the American Psychiatric Association, the American Psychological Association and the Veteran's Administration.

While standard evidence-based treatments may be effective for treating standard post traumatic stress disorder, treating Complex PTSD often involves addressing interpersonal relational difficulties and a different set of symptoms which make it more challenging to treat. The United States Department of Veterans Affairs acknowledges,
the current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events.
For example, "limited evidence suggests that predominantly cognitive behavioral therapy (an evidenced based treatment)[is]effective, [it does not] suffice to achieve satisfactory end states, especially in Complex PTSD populations". 

Treatment Challenges

It is widely acknowledged by those who work in the trauma field that there is no one single, standard, 'one size fits all' treatment for complex PTSD. There is also no clear consensus regarding the best treatment among the greater mental health professional community which included clinical psychologists, social workers, licensed therapists MFTs) and psychiatrists. Although most trauma neuroscientifically informed practitioners understand the importance of utilizing a combination of both 'top down' and 'bottom up' interventions as well as including somatic interventions (sensorimotor psychotherapy or somatic experiencing or yoga) for the purposes of processing and integrating trauma memories. 

Survivors with complex trauma often struggle to find a mental health professional who is properly trained in trauma informed practices. They can also be challenging to receive adequate treatment and services to treat a mental health condition which is not universally recognized or well understood by general practitioners. 

Dr. Allistair and Dr. Hull echo the sentiment of many other trauma neuroscience researchers (including Dr. Bessel van der Kolk and Dr. Bruce D. Perry) who argue:
Complex presentations are often excluded from studies because they do not fit neatly into the simple nosological categorisations required for research power. This means that the most severe disorders are not studied adequately and patients most affected by early trauma are often not recognised by services. Both historically and currently, at the individual as well as the societal level, "dissociation from the acknowledgement of the severe impact of childhood abuse on the developing brain leads to inadequate provision of services. Assimilation into treatment models of the emerging affective neuroscience of adverse experience could help to redress the balance by shifting the focus from top-down regulation to bottom-up, body-based processing."
Complex post trauma stress disorder is a long term mental health condition which is often difficult and relatively expensive to treat and often requires several years of psychotherapy, modes of intervention and treatment by highly skilled, mental health professionals who specialize in trauma informed modalities designed to process and integrate childhood trauma memories for the purposes of mitigating symptoms and improving the survivor's quality of life. Delaying therapy for people with complex PTSD, whether intentionally or not, can exacerbate the condition.

Recommended Treatment Modalities and Interventions

There is no one treatment which has been designed specifically for use with the adult complex PTSD population (with the exception of component based psychotherapy) there are many therapeutic interventions used by mental health professionals to treat post traumatic stress disorder. As of February 2017, the American Psychological Association PTSD Guideline Development Panel (GDP) strongly recommends the following for the treatment of PTSD:
  1. cognitive behavioral therapy (CBT) and trauma focused CBT
  2. cognitive processing therapy (CPT)
  3. cognitive therapy (CT)
  4. prolonged exposure therapy (PE)
The American Psychological Association also conditionally recommends
  1. brief eclectic psychotherapy (BEP)
  2. eye movement desensitization and reprocessing (EMDR) 
  3. narrative exposure therapy (NET)
While these treatments have been recommended, there is still on-going debate regarding the best and most efficacious treatment for complex PTSD. Many commonly used treatments are considered complementary or alternative since there still is a lack of research to classify these approaches as evidenced based. Some of these additional interventions and modalities include:
  1. biofeedback
  2. dyadic resourcing (used with EMDR)
  3. emotionally focused therapy
  4. emotional freedom technique (EFT) or tapping 
  5. Equine-assisted therapy
  6. expressive arts therapy
  7. internal family systems therapy
  8. dialectical behavior therapy(DBT)
  9. family systems therapy
  10. group therapy
  11. neurofeedback
  12. psychodynamic therapy
  13. sensorimotor psychotherapy
  14. somatic experiencing
  15. yoga, specifically trauma-sensitive yoga

Arguments Against Complex PTSD Diagnosis

Though acceptance of the idea of complex PTSD has increased with mental health professionals, the fundamental research required for the proper validation of a new disorder is currently insufficient.  The disorder was proposed under the name DES-NOS for inclusion in the DSM-IV but was rejected by members of the Diagnostic and Statistical Manual of Mental Disorders (DSM) committee of the American Psychiatric Association for lack of sufficient diagnostic validity research. Chief among the stated limitations was a study which showed that 95% of individuals who could be diagnosed with the proposed DES-NOS were also diagnosable with PTSD, raising questions about the added usefulness of an additional disorder. Following the failure of DES-NOS to gain formal recognition in the DSM-IV, the concept was re-packaged for children and adolescents and given a new name, developmental trauma disorder. Supporters of DTD appealed to the developers of the DSM-5 to recognize DTD as a new disorder. Just as the developers of DSM-IV refused to included DES-NOS, the developers of DSM-5 refused to include DTD due to a perceived lack of sufficient research. 

One of the main justifications offered for this proposed disorder has been that the current system of diagnosing PTSD plus comorbid disorders does not capture the wide array of symptoms in one diagnosis. Because individuals who suffered repeated and prolonged traumas often show PTSD plus other concurrent psychiatric disorders, some researchers have argued that a single broad disorder such as C-PTSD provides a better and more parsimonious diagnosis than the current system of PTSD plus concurrent disorders. Conversely, an article published in BioMed Central has posited there is no evidence that being labeled with a single disorder leads to better treatment than being labeled with PTSD plus concurrent disorders.

Complex PTSD embraces a wider range of symptoms relative to PTSD, specifically emphasizing problems of emotional regulation, negative self-concept, and interpersonal problems. Diagnosing complex PTSD can imply that this wider range of symptoms is caused by traumatic experiences, rather than acknowledging any pre-existing experiences of trauma which could lead to a higher risk of experiencing future traumas. It is also asserts that this wider range of symptoms and higher risk of traumatization are related by hidden confounder variables and there is no causal relationship between symptoms and trauma experiences. In the diagnosis of PTSD, the definition of the stressor event is narrowly limited to life-threatening events, with the implication that these are typically sudden and unexpected events. Complex PTSD vastly widened the definition of potential stressor events by calling them adverse events, and deliberating dropping reference to life-threatening, so that experiences can be included such as neglect, emotional abuse, or living in a war zone without having specifically experienced life-threatening events. By broadening the stressor criterion, an article published by the Child and Youth Care Forum claims this has led to confusing differences between competing definitions of complex PTSD, undercutting the clear operationalization of symptoms seen as one of the successes of the DSM. 

One of the primary arguments for a new disorder has been the claim that individuals who experience complex post traumatic stress symptomatology are often misdiagnosed, and as a consequence may be given inappropriate or inadequate treatment interventions.

The movement to recognize complex PTSD has been criticized for approaching the process of diagnostic validation backwards. The typical process for validation of new disorders is to first publish case studies of individual patients who manifest all of these issues and clearly demonstrate how they are different from patients who experienced different types of traumas. There are no known case reports with prospective repeated assessments to clearly demonstrate that the alleged symptoms followed the adverse events. Then the next step would be to conduct well-designed group studies.[citation needed] Instead, supporters of complex PTSD have pushed for recognition of a disorder before conducting any of the prospective repeated assessments that are needed.

Intersex people and military service in the United States

From Wikipedia, the free encyclopedia

The regulations regarding the service of intersex people in the United States Armed Forces are vague and inconsistent due to the broad nature of humans with intersex conditions. The United States Armed Forces as a whole does not officially ban intersex people from service but does exclude many based on the form of their status. Policies regarding all intersex people are not addressed formally although depending on the type of sex variation some intersex people are allowed to serve.

History

When the skeleton of Casimir Pulaski, a famed American Revolutionary War general, was exhumed and studied, several female features were found which led to speculation that Pulaski was likely intersex.

Between 1905 and 1945, the term "hermaphroditism" was used as a general term to refer to several urological conditions which made someone unable to enrol as a cadet at West Point Military Academy. Barring of people with actual "hermaphroditic" diagnosable medical conditions dates back at least as far back as 1951. In 1988 most forms of so called "true hermaphroditism" and "pseudohermaphroditism" excluded a person from serving in the military.

Policies and treatment

People born with non-standard genital anatomy or ambiguous genitalia are largely excluded from military service. This practice is believed to have been first introduced in 1961, alongside a ban on transvestites. According to a 2007 report from the Michael D. Palm Center, there is a long list of disqualifying genital differences that are used to bar individuals from service. For example, having one undescended testicle can make a man ineligible for service.

Enclosure 4 of "Induction in the Military Services; dated April 10, 2010" instruction, entitled "Medical Standards For Appointment, Enlistment, Or Induction", is the one that identifies the preclusion of some intersex people from serving in the military.
  • Paragraph 14. (Female Genitalia), subparagraph e.:
History of major abnormalities or defects of the genitalia such as change of sex (P64.5) (CPT 55970, 55980), hermaphroditism, pseudohermaphroditism, or pure gonadal digenesis (752.7).
  • Paragraph 15. (Male Genitalia), subparagraph l.:
History of major abnormalities or defects of the genitalia such as change of sex (P64.5) (CPT 55970, 55980), hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis (752.7).
According to The Crimson, the military's policy on genital differences is explicitly discriminatory. Despite the steady increase of other previously excluded members into the military since the repeal of "Don't ask, don't tell", there has not been much change with respect to the status of intersex people. Military medical policies still prevent intersex people from serving uncloseted. However, the military does provide some surgeries for intersex people which they deem 'medically necessary' as opposed to 'cosmetic'. The Veterans Health Administration does distinguish between surgeries for transgender individuals and intersex persons. In 2015, this allowed intersex persons to receive medically necessary treatment that was still prohibited for transgender people. This was because of the belief that intersex surgery caused "fewer practical concerns". However, a history of genital surgery prior to service is considered an acceptable reason to discharge a service member. The acceptance of transgender individuals in 2016 by the Armed Forces did not touch on intersex people and they are still subject to specific reviews before enlistment, as noted before.

The updated version of DoDI 6130.03's genital guidelines are as follows:
  • Female Genitalia:
History of major abnormalities or defects of the genitalia, such as hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis.
  • Male Genitalia:
History of major abnormalities or defects of the genitalia such as hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis.
The subsequent attempt at banning transgender troops by President Donald Trump in 2017 also did not touch on the state of intersex personnel, and it was unclear if the ban would have any intentional or unintentional effects on them.

Intersex activist and Navy veteran Dana Zzyym has expressed that their family's military background made it out of the question for them to be associated with the queer community as a youth due to the prevalence of homophobia in the armed forces. Their parents hid Zzyym's status as intersex from them and Zzyym discovered their identity and the surgeries their parents had approved for them by themselves after their Navy service. Zzyym is the first veteran to be issued a gender-neutral passport.

Opinions

In 2010, Republican representative Duncan D. Hunter implied that intersex people were always banned from service. However, this claim was contradicted by a veteran who stated that they were allowed to serve openly and be deployed to Desert Storm as an intersex woman. Activist Autumn Sandeen also refuted Hunter's claims in a statement on her blog. In contrast, another response to Hunter was from Choire Sicha of The Awl who stated that "intersex people aren’t welcome to serve, but no one’s quite sure how and why", but did not elaborate on if they believed this referred to all conditions or just visible ones. Along with trans and non-heterosexual people, Hunter includes intersex people on his list of queer groups which he believes to be unfit for service because he holds the belief that they would disrupt unit cohesion. At the time when speaking about the subject he referred to intersex people by the term "hermaphrodites", which drew criticism from several intersex advocates and allies since it is a medically inaccurate term for a human being and is seen as a slur in the 20th century. His comments were also mocked on the NPR comedy news show Wait Wait... Don't Tell Me! which joked about his opinion on the subject, claiming that including intersex people would be advantageous to the military, since they could "pursue enemies into both men’s and women’s restrooms". This joke was poorly received by some, including writers of ShadowProof, who stated that it was both insulting to intersex people and a play on the negative stereotype of trans people as potential bathroom sexual predators, and Queerty. Hunter's comments were also ridiculed by the cast of the FOX News show Red Eye who felt that his comments were merely about his dislike of homosexuals and not really about how intersex people would affect the military. They stated that since there are so few intersex people the question was not very relevant to the subject of "Don't ask, don't tell" which they felt was what Hunter was trying to imply. The cast of The Tony Kornheiser Show dismissed Hunter's concerns as well, expressing too that the number of intersex people that exist who want to join the military could not be enough to disrupt any operations.

In 2007, the Palm Center released a report concluding that most of the military's beliefs about intersex people were myths and that neither intersex nor transgender peoples' medical problems posed any barrier to effective service. The study also argues that the rigidity of sexual difference, gender roles, and sexuality are "becoming increasingly less absolute," which could raise questions regarding the admission, retention, training, housing, and other services of intersex individuals in the armed forces. Publications by the United States National Center for Biotechnology Information recommends that intersex individuals be allowed to serve in the armed forces, but not combat units.

Veterans

Intersex veterans are entitled to "medically necessary" surgeries. When transgender people were banned from receiving sex reassignment surgery, intersex people were also banned from these surgeries. This meant that someone who was in the military presenting as male in their records could not transition to a female identity with help from the United States Department of Veterans Affairs, even if they were always predominantly female in all but writing.

By service

United States Air Force

Many U.S. Air Force recruiters think that intersex people should be disqualified from service due to "the expected increased demand for medical treatments" but intersex persons are still allowed to serve in the Civil Air Patrol.

United States Army

In the U.S. Army, the official policy is that individuals who identify as intersex or have other sex-related disorders are medically problematic and/or psychologically disturbed; hence, they are not eligible to serve.

United States Coast Guard

Intersex people are allowed to serve in the Coast Guard Auxiliary. However, they must choose to be represented as either "male" or "female" on their records.

United States Marine Corps

The USMC takes the same stance as the Army, disqualifying both intersex people and transgender people from service.

United States Navy

In 2008, many U.S. Navy recruiters believed that intersex people should be disqualified from service, mainly due to the expectation that they would cause increased demand for medical treatment.

ROTC

The Reserve Officers' Training Corps is obliged to follow the guidelines set by the military and has rejected intersex youth because of this. This, along with their exclusion of transgender people, has led to criticism from and of schools such as Harvard which did not allow the ROTC until "Don't ask, don't tell" was repealed in 2010, but welcomed them afterwards. The critics argue that the return of the ROTC to campus violates the school's non-discrimination clause.

Inequality (mathematics)

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Inequality...