“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:

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.

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 14^th 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]

Of Nostalgia and Homesickness

Seventeenth and 18^th 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.

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 19^th 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 20^th Century that doctors reclassified Soldier’s Heart as a psychological condition.

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]

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.

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