PTSD, or post-traumatic stress disorder, leapt to the public’s consciousness when the American Psychiatric Association added the health issue to its diagnostic manual of mental disorders in the 1980s. But PTSD—known to previous generations as shell shock, soldier’s heart, combat fatigue or war neurosis—has roots stretching back centuries and was widely known during ancient times.
Post-traumatic stress disorder is a mental health condition that occurs when someone witnesses or experiences a severely traumatic event. This can include war or combat, serious accidents, natural disasters, terrorism, or violent personal assaults, such as rape.
People with the disorder may experience PTSD symptoms such as frequent fear, stress, and anxiety stemming from the traumatic event. They may relive the event through flashbacks or nightmares and have intense, disturbing thoughts and feelings related to the event. They sometimes avoid people, places and situations that remind them of the trauma.
They may also experience increased arousal and reactive symptoms, such as feeling jumpy (startling easy), having problems concentrating or sleeping, being easily angered or irritated and engaging in reckless or self-destructive behavior.
What Is PTSD?
It’s not entirely known what causes PTSD to develop, but it may be related to the stress hormones.
That is, traumatic events put the body into a survival “fight or flight” mode, in which body releases stress hormones (adrenaline and norepinephrine) to provide a burst of energy while pausing some of the brain’s other tasks, such as filling short-term memories.
People with PTSD continue to produce high amounts of these hormones outside of dangerous situations and their amygdala—the part of the brain that handles fear and emotion—is more active than people without PTSD.
Over time, PTSD changes the brain, including by causing the part of the brain that handles memory (the hippocampus) to shrink.
PTSD in Epics and Classics
Long before the dawn of modern psychiatry, people and situations depicting PTSD may have been recorded in early works of literature.
For example, in the Epic of Gilgamesh, the earliest surviving major work of literature (dating back to 2100 B.C.), the main character Gilgamesh witnesses the death of his closest friend, Enkidu. Gilgamesh is tormented by the trauma of Enkidu’s death, experiencing recurrent and intrusive recollections and nightmares related to the event.
Later, in a 440-B.C. account of the battle of Marathon, Greek historian Herodotus describes how an Athenian named Epizelus was suddenly stricken with blindness while in the heat of battle after seeing his comrade killed in combat. This blindness, brought on by fright and not a physical wound, persisted over many years.
Other ancient works, such as those by Hippocrates, describe soldiers who experienced frightening battle dreams. And outside of Greco-Latin classics, similar recurrent nightmares also show up in Icelandic literature, such as Gísli Súrsson Saga.
In the Indian epic poem Ramayana, likely composed around 2,500 years ago, the demon Marrich experiences PTSD-like symptoms, including hyper-arousal, reliving trauma, and avoidance behavior, after nearly being killed by an arrow. Marrich also gave up his natural duty of harassing monks and became a meditating recluse.
Nostalgia and Soldier’s Heart
In the last several hundred years, medical doctors have described a few PTSD-like illnesses, particularly in soldiers who experienced combat.
In the late 1600s, Swiss physician Dr. Johannes Hofer coined the term “nostalgia” to describe Swiss soldiers who suffered from despair and homesickness, as well as classic PTSD symptoms like sleeplessness and anxiety. Around the same time, German, French and Spanish doctors described similar illnesses in their military patients.
In 1761, Austrian physician Josef Leopold Auenbrugger wrote about nostalgia in trauma-stricken soldiers in his book Inventum Novum. The soldiers, he reported, became listless and solitary, among other things, and efforts could do little to help them out of their torpor.
PTSD in the Civil War
Nostalgia was a phenomenon noted throughout Europe and the “disease” reached American soil during the U.S. Civil War (1861–1865). In fact, nostalgia became a common medical diagnosis that spread throughout camps. But some military doctors viewed the illness as a sign of weakness and one that only affected men with a “feeble will”—and public ridicule was sometimes the recommended “cure” for nostalgia.
While nostalgia described changes in veterans from a psychological perspective, other models took a physiological approach.
After the Civil War, U.S. doctor Jacob Mendez Da Costa studied veterans and found that many of them suffered from certain physical issues unrelated to wounds, such as palpitations, constricted breathing, and other cardiovascular symptoms. These symptoms were thought to arise from an overstimulation of the heart’s nervous system, and the condition became known as “soldier’s heart,” “irritable heart,” or “Da Costa’s syndrome.”
Interestingly, PTSD-like symptoms weren’t restricted to soldiers in the 1800s. During the Industrial Revolution, rail travel became more common—as did railway accidents.
Survivors of these accidents displayed various psychological symptoms (anxiety and sleeplessness, for instance), which collectively became known as “railway spine” and “railway brain” because autopsies suggested railway accidents caused microscopic lesions to the central nervous system.
Post-traumatic stress disorder was a major military problem during World War I, though it was known at the time as “shell shock.”
The term itself first appeared in the medical journal The Lancet in Feb. 1915, some six months after the “Great War” began. Capt. Charles Myers of the Royal Army Medical Corps documented soldiers who experienced a range of severe symptoms—including anxiety, nightmares, tremor, and impaired sight and hearing—after being exposed to exploding shells on the battlefield. It appeared that the symptoms resulted from a kind of severe concussion to the nervous system (hence the name).
By the following year, however, medical and military authorities documented shell shock symptoms in soldiers who had been nowhere near exploding shells. These soldiers’ conditions were considered neurasthenia—a type of nervous breakdown from war—but was still encompassed by “shell shock” (or war neurosis).
There were some 80,000 cases of shell shock in the British army alone by the end of the war. Soldiers often returned to the war zone after only a few days’ rest, and those who were treated for longer periods of time sometimes underwent hydrotherapy or electrotherapy.
In World War II, British and American described traumatic responses to combat as “battle fatigue,” “combat fatigue” and “combat stress reaction”—terms that reflected the belief that the conditions were related to long deployments. Up to half of military discharges during the war may have been related to combat exhaustion, according to the National Center for PTSD.
In 1952, the American Psychiatric Association (APA) added “gross stress reaction” to its first Diagnostic and Statistical Manual of Mental Disorders, or DSM-I. The diagnosis related to psychological issues stemming from traumatic events (including combat and disasters), though it assumed that the mental health issues were short-lived—if the problem lasted for more than 6 months, then it was thought that it had nothing to do with wartime service.
In the DSM-II, published in 1968, the APA removed the diagnosis but included “adjustment reaction to adult life,” which did not efficiently capture PTSD-like symptoms. This removal meant that many veterans who suffered from such symptoms weren’t able to receive the proper psychological help that they needed.
Drawing on research involving people who survived severely traumatic events, including war veterans, Holocaust survivors and sexual trauma victims, the APA included post-traumatic stress disorder in the DSM-III (1980). The diagnosis drew a clear distinction between traumatic events and other painful stressors, such as divorce, financial hardships and serious illnesses, which most individuals are able to cope with and don’t produce the same symptoms.
The diagnostic criteria for PTSD was revised in the DSM-IV (1994), and DSM-IV-TR (2000), and DSM-5 (2013) to reflect ongoing research. In the DSM-5, PTSD is no longer considered an anxiety disorder because it’s sometimes associated other mood states (depression), as well as angry or reckless behavior; it’s now in a category called Trauma- and Stressor-Related Disorders.
Today, about 7.7 million American adults have PTSD, according to the Anxiety and Depression Association of America.
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