A Brief History of Wartime PTSD — From Ancient Greece to Afghanistan

PTSD may be only 30 years old as far as medical science is concerned, but the disorder dates back to the beginning of history. (Image source: WikiCommons)
PTSD may be only 30 years old as far as medical science is concerned, but the disorder dates back to the beginning of history. (Image source: WikiCommons)

“For centuries, even millennia, eye-witnesses of conflict have suffered from PTSD. Consider these early accounts.”

WHILE THE TERM post traumatic stress disorder (PTSD) wasn’t officially coined until 1980, psychologists, both civilian and military, have long been aware of the disorder.

Throughout the 1960s and 1970s, tens of thousands of American combat veterans from the Vietnam War returned from the jungles of South East Asia suffering from a range of symptoms stemming from their experiences on the battlefield.

Some were stricken with debilitating flashbacks, mood disorders and generalized feelings of emotional detachment, others presented with physical manifestations including headaches, chest pains and even dizziness.

And while neither the U.S. military or the medical community were well equipped to deal with the nearly one-in-five combat veterans afflicted, this was by no means the first time soldiers had come home from war with invisible injuries. In fact, for centuries, even millennia, eye-witnesses of conflict have suffered from PTSD. Consider these early accounts:

Herodotus makes early references to PTSD in his famous Histories.
Herodotus makes early references to PTSD in his famous Histories.

The First Sufferers

The ancient Greek historian Herodotus may have been one of the first to write about the emotional strain of combat. In his account of the Battle of Marathon in 490 BCE, the celebrated “Father of History” noted something akin to PTSD in the case of one veteran known only as Epizelus.

During the battle, which saw a force of 10,000 Greeks repel a Persian invasion of more than twice that number, Epizelus suddenly and inexplicably lost his sight. He was pulled from the field, which was littered with nearly 200 Greek dead and the bodies of more than 6,000 Persians, and promptly examined by army surgeons. Although the physicians could find no wounds whatsoever, Epizelus explained to them that he somehow lost his sight moments after a terrifying and near-fatal brush with a Persian.

“He said that a gigantic warrior, with a huge beard, which shaded all his shield, stood over against him. But the ghostly semblance passed him by, and slew the man at his side,” Herodotus wrote. [1]

Looking back, it’s believed the encounter brought on a case of hysterical blindness in Epizelus, a condition occasionally seen in combat survivors. He never regained his sight.

Warriors of the Middle Ages believed that faith in God would ward off the psychological trauma of battle. (Image source: WikiCommons)
Warriors of the Middle Ages believed that faith in God would ward off the psychological trauma of battle. (Image source: WikiCommons)

The Age of Chivalry

The psychological wounds suffered by warriors were not unknown in the medieval period either. So says Thomas Heebøll-Holm, a historian at the University of Copenhagen.

In an article in school’s own publication, The University Post,  Heebøll-Holm describes references to something similar to PTSD in the pages of a 14th Century treatise for warriors entitled On Chivalry. The volume was originally penned by a knight named Geoffroi de Charny.

According to Heebøll-Holm, the centuries-old book, which is effectively a how-to manual for young knights, warns those who don the mail and take up the sword of the horrors of combat that await them. [2]

“You will often be afraid when you see your enemies coming towards you with lowered lances to run you through and with drawn swords to cut you down. Bolts and arrows come at you and you do not know how best to protect yourself. You see people killing each other, fleeing, dying and being taken prisoner and you see the bodies of your dead friends lying before you. But your horse is not dead, and by its vigorous speed you can escape in dishonour. But if you stay, you will win eternal honour. Is he not a great martyr, who puts himself to such work?” wrote Charny in 1350.

Heebøll-Holm points out that even Charny recognized that traumatic experiences like the ones described, coupled with hardships experienced by knights in the field like sleep-deprivation, cold, hunger, exhaustion and isolation from family served as additional stressors.

And just what was the author’s prescribed treatment for knights’ anxiety and depression? A steadfast devotion to chivalric duty and a faith in God. But while Charny’s ecclesiastical cure-all was likely of little real benefit to those suffering from acute PTSD, his writings do stand as evidence that medieval military thinkers were aware of the effects combat had on the psychology of those who lived through such experiences. [3]

In the 18th Century, Soldiers' nervous disorders were attributed to a yearning for hearth and home. (Image source: WIkiCommons)
In the 18th Century, Soldiers’ nervous disorders were attributed to a yearning for hearth and home. (Image source: WIkiCommons)

Of Nostalgia and Homesickness

Seventeenth and 18th century physicians were increasingly becoming aware of the emotional toll wartime military service was taking on the soldiers and sailors on the front lines of seemingly endless wars of the age of gunpowder. While the symptoms of PTSD were evident to these observers, the medical minds of the day attributed the condition to simply being too long away from hearth and home.

Such was the conclusion of an Austrian physician name Josef Leopold Auenbrugger. At the tail end of the Seven Years War, Auenbrugger observed symptoms in soldiers consistent with what we would now call PTSD – depression, physical exhaustion and angst. However he blamed the source of the anxiety not on the horror of war but rather on homesickness. Accordingly, he called the illness “nostalgia.”

“When young men who are still growing are forced to enter military service and thus lose all hope of returning safe and sound to their beloved homeland, they become sad, taciturn, listless, solitary, musing, full of sighs and moans. Finally, these cease to pay attention and become indifferent to everything, which the maintenance of life requires of them,” wrote Auenbrugger in his 1761 book Inventum Novem. “Neither medicaments, nor arguments, nor promises, nor threats of punishment are able to produce any improvement.”[4] While Auenbrugger documented his study of the disorder in his book, a Swiss physician a century earlier by the name of Dr. Johannes Hofer noted a similar condition among his country’s troops. He also blamed it on homesickness.[5] Later still, the great medical minds of the Napoleonic era would again attribute combat-related stress to a longing for home.

Army doctors thought heavy packs were the cause of the nervous disorders suffered by Civil War veterans. (Image source: WikiCommons)
Army doctors thought heavy packs were the cause of the nervous disorders suffered by Civil War veterans. (Image source: WikiCommons)

Soldiers’ Heart

It wasn’t a figurative ‘heartache’ that American Civil War era doctors thought was responsible for what we would now call PTSD, but a bona fide cardio-vascular ailment associated with military service known as “soldiers’ heart”.

Following the war, which would claim 600,000 lives and injure more than a million combatants, a surgeon named Jacob Mendes Da Costa studied 300 soldiers who complained of physical symptoms strangely consistent with heart disease: chest pains, palpitations, fatigue, shortness of breath and physical exhaustion. He and other doctors in the late 19th Century attributed the condition to the physical stressors of wartime: sleep deprivation, long marches, prolonged exposure to the elements, malnutrition, the exertion of close order drill and especially the effects of carrying heavy packs and equipment on the chest and heart. [6] In particular, it was thought loaded ruck sacks and their tight straps exerted damaging pressure on the upper torso and internal organs, thus leading to the disorder. Looking back, the condition, also known as “Da Costa’s Syndrome,” was more than likely a manifestation of long-term exposure to stress and anxiety associated with battlefield carnage – something that Civil War vets experienced in abundance. It wasn’t until the 20th Century that doctors reclassified Soldier’s Heart as a psychological condition.

Many generals refused to recognize PTSD in World War One, or "shell shock" as it was known at the time. (Image source: WikiCommons)
By 1916, nearly half of all casualties in the British army were shell shock cases. Yet many generals refused to recognize PTSD. (Image source: WikiCommons)

Shell Shock

Although science and medicine had made considerable advances by the outbreak of the First World War, the brightest minds of that era were still in the dark about a seemingly ‘new’ disorder that was plaguing the armies of the Western Front.

Almost from the start of hostilities, soldiers in combat curiously began exhibiting signs of anxiety, dizziness, tremors and hypersensitivity to noise. These ailments were attributed to neurological damage caused by artillery fire. Few suspected that the disorders had to do with the emotional trauma associated with trench warfare, like poison gas, machine guns or the horror of No Man’s Land. Instead, experts believed that the concussion of artillery bursts were physically damaging the brain and nervous systems of soldiers leading to the symptoms described. They famously called it “shell shock”. And to the armies of the First World War, this newly discovered disorder was fast-becoming a drag on the war effort.

Whereas by the end of 1914, roughly between four and 10 percent of soldiers and officers were presenting with symptoms of shell shock, by 1916, as many as 40 percent of all casualties were attributed to the phenomenon. [7] In the U.K. alone, no fewer than 19 special hospitals were established to treat acute shell shock cases. [8] The condition itself became controversial with many in the military’s upper echelons rejecting it outright as an excuse for cowardice or “low moral fibre.”

A variety of treatments were attempted, which including everything from temporary withdraw from combat duty to disciplinary measures. By 1917, frustrated generals went so far as to ban all diagnoses of shell shock and began to censor all references to it in official reports as well as the media. As many as a quarter-million courts marshal were convened to try what are now believed to be sufferers of PTSD. [9] More than 3,000 victims were sentenced to death — nearly 350 of those executions were actually carried out. [10]

Despite all of this, neither the medical corps nor the military justice system could stem the tide of shell shock cases that were piling up as the war slogged on. By 1918, military hospitals throughout Europe and the United States were clogged with traumatized soldiers. As many as 65,000 victims were still in hospital in Britain up to 10 years after the armistice. [11]

Shell shock was known in the Second World War as "battle fatigue".
While shell shock was known in the Second World War as “battle fatigue”, the symptoms of the condition hadn’t changed.

Battle Fatigue

By World War Two, military psychologists were beginning to recognize that shell shock was a legitimate psychological disorder that represented an estimated 10 percent of all combat casualties. Although it went by different names (battle fatigue, combat fatigue, combat neurosis, war neurosis) armies on both sides of the war were fast gaining an understanding of the condition, its true nature and were desperately testing new methods of treatment aimed at returning casualties to the front as soon as possible. Treatments included evacuation from combat, rest in a hospital, sedation and even hypnosis. These remedies had mixed results and countless veterans from World War Two continue to suffer from the effects of their wartime experiences even to this day.

Army doctors have a better understanding of PTSD than in previous wars, but militaries are still criticized for being unresponsive to the walking wounded. (Image source: U.S. Dept. of Defense)
Army doctors have a better understanding of PTSD than in previous wars, but militaries are still criticized for being unresponsive to the walking wounded. (Image source: U.S. Dept. of Defense)

PTSD Today

As western militaries continue their war in Afghanistan and Iraq, army medics, the media and the general public are well aware of the causes and effects of PTSD, although identifying and treating the disorder still remains a tremendous challenge. Today, not only war veterans are diagnosed with the disorder. Police and fire fighters, accident and crime victims, and even cancer sufferers are among those treated. Therapies include everything from cognitive behavioural techniques and medication to eye movement desensitization and reprocessing. [12]

(Originally published on MilitaryHistoryNow.com on Sept 17, 2012)

Sources:

  1. http://www.alandiashram.org/school/school_html/articles/ptsd.html
  2. http://universitypost.dk/article/medieval-knights-were-stressed-out
  3. Ibid
  4. http://minnesota.publicradio.org/projects/2010/02/beyond-deployment/ptsd-timeline/index.shtml
  5. http://io9.com/5898560/from-irritable-heart-to-shellshock-how-post+traumatic-stress-became-a-disease
  6. http://en.wikipedia.org/wiki/Da_Costa’s_syndrome
  7. http://en.wikipedia.org/wiki/Shell_shock
  8. Ibid
  9. Ibid
  10. Ibid
  11. Ibid
  12. http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

23 thoughts on “A Brief History of Wartime PTSD — From Ancient Greece to Afghanistan

    1. My grandfather was a Tommy in the Artists Rifles in 1917. He only offered fragments of his experiences, but towards the end in 1991, he disclosed more and more of it to my grandmother. She never told us until after he was gone, but the consensus is that he wanted to get it off his chest.

    1. I don’t imagine that the military medical establishment understood the disease — remember, just a few decades prior, army doctors thought the symptoms of PTSD were the result of wearing too heavy a back pack “soldier’s heart”.

  1. Its interesting to note as a result of their experiences in WWI the British used the term nervous hysteria to replace shell shock and associated terms. The British claim it reduced such casualities by over 40% compared to WWI. On the flip side the British army suffered much higher dessertions than it did in WW!. One wonders if these two are not linked.

  2. There was a similar condition from the New Zealand Colonial/Maori wars (1845 -1870) known as “Bush Fright”. Although not representing most of the population, the Maori that fought the colonials were highly skilled, well organised and led, as well as disciplined and resourceful. There are claims to the first real use of trench warfare, they also used surprise raids in the thick forests. After months/years of this guerrilla war, Many Colonial Soldiers developed what now appears to be classic PTSD

  3. Bravo Zulu, a fine article on a subject, many, especially civilians little understand and has unfortunately been falsely reported about by much of the media.
    After particularly bloody battles,Israelite warriors during their invasion of Canaan would isolate themselves from the people due to the Hebrew law of having shed blood, but many historians think it was also to give them a chance to rest and recover from the violence they saw and inflicted.
    Years ago, I had an uncle whose great grandfather fought with the Confederacy with Hood’s Texas Brigade during the Civil War, His military records show that he was wounded at Antietam and captured at Gettysburg but released during a prisoner swap and returned to duty.
    My uncle recalled as a young boy that his grandfather would occasionally go out into the nearby woods and silently sit on a stump for hours. His grandmother told him to just leave his grandfather alone for those periods but never told him why except that he needed the time alone..

  4. “An abnormal reaction to an abnormal situation is normal behavior.”

    –Man’s Search For Meaning by Viktor E. Frankl M.D., Ph.D., World War 2 Holocaust Survivor

  5. Mental Cases
    By Wilfred Owen – 1893-1918

    Who are these? Why sit they here in twilight?
    Wherefore rock they, purgatorial shadows,
    Drooping tongues from jaws that slob their relish,
    Baring teeth that leer like skulls’ tongues wicked?
    Stroke on stroke of pain,—but what slow panic,
    Gouged these chasms round their fretted sockets?
    Ever from their hair and through their hand palms
    Misery swelters. Surely we have perished
    Sleeping, and walk hell; but who these hellish?

    —These are men whose minds the Dead have ravished.
    Memory fingers in their hair of murders,
    Multitudinous murders they once witnessed.
    Wading sloughs of flesh these helpless wander,
    Treading blood from lungs that had loved laughter.
    Always they must see these things and hear them,
    Batter of guns and shatter of flying muscles,
    Carnage incomparable and human squander
    Rucked too thick for these men’s extrication.

    Therefore still their eyeballs shrink tormented
    Back into their brains, because on their sense
    Sunlight seems a bloodsmear; night comes blood-black;
    Dawn breaks open like a wound that bleeds afresh
    —Thus their heads wear this hilarious, hideous,
    Awful falseness of set-smiling corpses.
    —Thus their hands are plucking at each other;
    Picking at the rope-knouts of their scourging;
    Snatching after us who smote them, brother,
    Pawing us who dealt them war and madness.

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