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A recent article in the National Geographic goes back one hundred years covering the evolution of post-traumatic stress disorder (PTSD). The article points out that only after a century or more did physicians recognize PTSD as an illness that warrants a certain type of treatment.

Then and Now

Consider World Wars I and II and the thousands of soldiers who, after coming home, still fought nightmares, depression, and flashbacks which we now call PTSD. The list of wars marches on but the symptoms remain the same.

Many veterans were unable to talk about their experience on the battlefield but it remained in their thoughts day and night.

PTSD was first recognized in combat. Now psychiatrists acknowledge that PTSD is also experienced by civilians after traumatic events. These events may be serious injuries, violence, or death threats. They have a decided effect on an individual’s coping mechanism.

Ghosts of War

We can go back even further to war in Mesopotamia over three thousand years ago. The symptoms of the armies have been recorded on ancient tablets. At that time soldiers who had symptoms of trauma were considered to be haunted by ghosts. Today of course they would be treated by psychiatrists and diagnosed as having PTSD.

Through the years, physicians suspected physical causes. Around 1880, psychiatrists began looking at these symptoms as somehow associated with the brain. The neurologist Jean-Martin Charcot first identified symptoms as traumatic events and coined the phrase “traumatic hysteria.”

World War I saw the symptoms of PTSD displayed on a scale never seen before in human history.

Soldiers who were at the front line left the field completely shattered.  The diagnosis of “shell shock” seemed to be the best description of the combat fatigue experienced by the soldiers.

Thousands of soldiers returned home only to be vilified. Although there were attempts at psychiatric therapy it was overshadowed and contradicted by strong beliefs that heroism and courage should prevail. Their wounds were invisible.

There were slight acknowledgments to the invisible illness after the Second World War with the emergence of terms such as “psychiatric collapse”, “war neurosis,” and “battle shock.”

By this time psychiatrists recognized that combat generates mental issues. After observing the battle shock syndrome of the previous war, they felt that it would be necessary to weed out men who had neurotic tendencies.

Six times the number of men were rejected to serve in the U.S. Army in the Second World War as were selected to serve in World War I. Nevertheless, twice the number of soldiers during World War II exhibited PTSD symptoms.

Officials removed men with PTSD from combat thinking that would relieve their symptoms. Soldiers were also treated with sodium amytal without success. Records show that 1.4 million men out of 16.1 million serving in the Second World War were treated for combat issues. Forty percent of the military were discharged as a result of combat fatigue.

And Now the Post-Vietnam Syndrome

 In 1941, a book by psychiatrist Abram Kardiner, the Traumatic Neuroses of War, had a significant influence on changing views about PTSD. But in spite of showing the public that symptoms of war-related stress remained with a veteran for years, soldiers faced the unrealistic belief that they could recover quickly.

Veterans’ PTSD symptoms had been categorized as schizophrenia or depression rather than a specific diagnosis.

In 1972 the term “Post-Vietnam syndrome” emerged after Vietnam veterans returned home with flashbacks, rage, and emotional numbness. Again, since this was an invisible wound, benefits and treatment were denied to many veterans.

Self-help communities were set up and in 1980 PTSD became a formal diagnosis. It was adopted as a WHO disease classification a decade later.

From Battle Shock to Mass Shootings

Today the definition of PTSD includes a broad array of causes such as sexual abuse, assault, natural disasters, accidents, and mass shootings.

A host of symptoms also come under the PTSD umbrella such as nightmares, flashbacks, dissociation, low self-esteem, amnesia, and many others.

Not only are researchers developing new treatments, but they are also learning the effects of trauma on the body and brain. They believe that future generations may experience chemical changes in DNA passed down from an older generation. This theory was introduced by an earlier study suggesting that Holocaust survivors’ offspring inherited hormones that were different from their peers.

A University of Suffolk clinical psychologist studying systemic racism determined that African-Americans experience symptoms similar to those of PTSD when they are subjected to a new race-related issue.

She explained that just watching footage of police in certain circumstances can cause emotional responses when there is a flashback to previous personal experiences.

Just recently, researchers began looking at the effects of COVID-19. They expect to receive patients who are traumatized not only after they survived but because they may have lost a member of their family, a co-worker, or a friend to the virus.

The Hong Kong SARS epidemic in 2003 caused healthcare workers and some patients to develop PTSD. Studies also showed that people who were confined during quarantine had more symptoms of PTSD than people who were not quarantined.

One doctor offered a ray of hope. He said that first of all, not everyone who survives a traumatic event will develop PTSD. It is also possible for the disorder to eventually go into remission.

Rather, it can be thought of not as a sign of weakness or defeat but as a heroic attempt by the brain to heal itself.