Post-traumatic stress disorder (PTSD) is a mental health condition characterized by a severe, prolonged stress response to a prior traumatic event such as combat, a natural disaster or sexual assault. Over eight million Americans over the age of 18 have PTSD. The understanding, clinical definition and treatment of PTSD have evolved over time, as the history of ptsd is closely linked to the history of combat.
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Early Depictions of PTSD: Epics and Classics
The history of PTSD includes recordings of trauma-related stress disorders in early literature, including the Bible, the Epic of Gilgamesh and works by Hippocrates.
In the Epic of Gilgamesh, when the title character loses his friend Enkidu, he experiences symptoms of intense grief and panic and believes that he too must die. This confrontation with death subsequently changes his personality. Tales within these early works include descriptions of how witnessing traumatic events such as death and war results in chronic psychological symptoms.
PTSD and The Civil War
The Civil War occurred before the age of modern psychiatry. At that time, the general consensus was that only weak-willed soldiers or persons with underlying health conditions suffered from PTSD. The horrific hand-to-hand combat was not considered a possible cause. Thus, Civil War PTSD was neither recognized nor treated at the time. However, detailed accounts of flashbacks, panic attacks, insomnia and suicidal thoughts were commonly documented among Civil War veterans.
Nostalgia, Soldier’s Heart and Railway Spine
Several alternative names have been used to describe trauma-linked stress disorders before the term post-traumatic stress disorder was coined. Swiss physician Dr. Johannes Hofer used the term “nostalgia” in the late 17th century to characterize soldiers who suffered from post-war symptoms such as anxiety, insomnia and homesickness.
The Industrial Revolution and the invention of the steam engine produced some of the first major human-made disasters. Physicians, confused by psychological symptoms displayed by survivors of major railway disasters, believed that the signs were caused by microscopic lesions on the spine or brain. This belief gave rise to the term ‘railway spine’. The term ‘soldier’s heart’ was coined after the Civil War by a doctor in Philadelphia, Dr. Jacob Mendes Da Costa, after mistaking post-combat psychological symptoms for a cardiac condition.
PTSD in World War I
Modern industrial warfare and modern psychiatry intersected in the aftermath of World War I (WWI). The mass casualties and extensive trauma experienced by millions of soldiers led to an explosion of psychiatric disorders. These conditions were initially referred to as ‘war neurosis’, because the source of these disorders was believed to be wartime experiences rather than childhood trauma or internal psychological problems.
Attempts by physicians and psychologists to characterize and diagnose WWI PTSD symptoms provided the initial basis for the clinical PTSD diagnosis.
PTSD was known as shell shock during WWI. Charles Myers, a Cambridge psychologist, introduced the term ‘shell shock’ in 1915 in response to the mass psychiatric casualties observed during WWI. Shell shock was defined by the same symptoms as PTSD, and treatments ranged from psychotherapy to electric shock therapy.
PTSD During World War II
World War II (WWII) and its resulting psychiatric casualties led to advancements in the understanding of PTSD. Of the total overseas forces in 1944, the rate of admissions for psychiatric reasons was 43 per 1000 men per year.
At the end of the war, Abram Kardiner published a revised version of a book he wrote on his psychiatric treatment of WWI veterans. Based on his experience with WWII soldiers, Kardiner wrote that psychiatric treatment at the frontlines was necessary to prevent chronic cases of the syndrome we now know as PTSD. He identified traumatic neurosis as having both physical and psychological symptoms.
The causes of chronic PTSD continued to be studied over the decades after the second world war, contributing to the understanding of the condition in the medical community. WWII PTSD statistics indicate that nearly 1 in 20 of the U.S.’s 2.5 million World War II veterans developed PTSD.
Battle Fatigue and Combat Stress
During WWII, British and American physicians used the terms ‘combat stress reaction’, ‘combat stress’, ‘battle fatigue’ or ‘exhaustion’ to describe traumatic stress responses to combat. Due to the stigma surrounding mental health conditions at the time, these terms were preferred because of the focus on combat, rather than psychiatric factors, as the cause of the condition we now know as PTSD.
The Vietnam War and PTSD
The knowledge learned about treating psychiatric conditions from prior wars was applied during the Vietnam War, resulting in fewer acute casualties on the battlefields. Despite advances in treating psychiatric symptoms during wartime, the delayed effects of combat exposure caused a significant impact among Vietnam veterans in the United States. Nearly a quarter of all soldiers sent to Vietnam from 1964 to 1973, totaling an estimated 700,000, later required help with PTSD symptoms.
The prevalence of Vietnam War era PTSD led to new diagnostic developments. Post-Vietnam syndrome studies eventually led to the inclusion of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Today, PTSD disability benefits for Vietnam veterans are available through the VA for veterans living with PTSD due to their military service.
Introduction of PTSD to the DSM
PTSD was first mentioned in the DSM-I in the 1950s under the term ‘gross stress reaction’. Although this diagnosis included psychological problems related to traumatic events such as wartime combat, it limited symptoms to 6 months. Surprisingly, this diagnosis was removed from the DSM-II in 1968, representing a regression in accurate PTSD characterization.
The long-term psychological disabilities experienced by trauma survivors, including Vietnam veterans, sexual assault victims and Holocaust survivors led to the introduction of PTSD in the DSM-III in 1980. For the first time, the definition of PTSD in the DSM highlighted the critical connection between traumatic events and long-term psychological symptoms.
Modern-Day Understanding and Treatment of PTSD
The characterization and diagnostic criteria for PTSD have been revised in subsequent DSM versions in response to extensive research studies. PTSD in the DSM-V, the current manual version, is categorized as a trauma- and stressor-related disorder. This diagnosis requires exposure to a traumatic or stressful event. PTSD treatment options include:
- Medications such as Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Cognitive processing therapy (CPT), which helps people understand how trauma alters the ways they think and feel, and develop new ways to think about the experience
- Prolonged exposure therapy (PET), which involves gradual exposure to trauma-related memories, thoughts and emotions
- Eye movement desensitization and reprocessing (EMDR) is a technique where a person concentrates on trauma-related memories, feelings, thoughts and bodily sensations while focusing on alternating visual or auditory signals. EMDR for PTSD is a VA-approved therapy and has been shown to be effective in treating the condition.
- Cognitive-behavioral therapy (CBT) involves focusing on harmful thoughts, beliefs and attitudes and learning how these relate to problematic behaviors
If you or a loved one live with PTSD and a co-occurring substance use disorder, contact The Recovery Village and speak with a representative who will guide you through the initial steps of getting treatment. You deserve a healthier future. Call us today.
U.S. Department of Veterans Affairs: National Center for PTSD. “PTSD Basics.” Accessed August 14, 2019. Anxiety and Depression Association of America. “Posttraumatic Stress Disorder (PTSD).” Accessed August 14, 2019. Crocq, Marc-Antoine; Crocq, Louis. “From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology.” Dialogues in Clinical Neuroscience, March, 2000. Accessed August 14, 2019. U.S. Department of Veterans Affairs. “VA disability compensation for PTSD.” Accessed August 16, 2019. U.S. Department of Veterans Affairs: National Center for PTSD. “PTSD and DSM-5.” Accessed August 14, 2019. Substance Abuse and Mental Health Services Administration. “Treatment Improvement Protocol (TIP) Series, No. 57.” Trauma-Informed Care in Behavioral Health Services, 2014. Accessed August 30, 2019.
U.S. Department of Veterans Affairs: National Center for PTSD. “PTSD Basics.” Accessed August 14, 2019.
Anxiety and Depression Association of America. “Posttraumatic Stress Disorder (PTSD).” Accessed August 14, 2019.
Crocq, Marc-Antoine; Crocq, Louis. “From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology.” Dialogues in Clinical Neuroscience, March, 2000. Accessed August 14, 2019.
U.S. Department of Veterans Affairs. “VA disability compensation for PTSD.” Accessed August 16, 2019.
U.S. Department of Veterans Affairs: National Center for PTSD. “PTSD and DSM-5.” Accessed August 14, 2019.
Substance Abuse and Mental Health Services Administration. “Treatment Improvement Protocol (TIP) Series, No. 57.” Trauma-Informed Care in Behavioral Health Services, 2014. Accessed August 30, 2019.