The evolution of PTSD over the centuries

Exit Strategy CoverLast week, I wrote about “Shell Shock,” a term and condition that came into vogue in the midst of World War One. Shell shock was the precursor to today’s Post-Traumatic Stress Disorder. Since then, I had the pleasure of meeting with the world-renowned, Chicago-based physician Eugene G. Lipov M.D., who co-authored Exit Strategy for Post-Traumatic Stress Disorder: New Hope for Warfighters and Civilians Alike (Amazon).

With Dr. Lipov’s approval, I have excerpted and paraphrased some of the historical etymology of the condition known today as PTSD.

Signs and symptoms of PTSD have long been described in mythological, historical and literary sources including:

  • A dominant military power in the period before the Roman Empire, the Spartans described the symptoms of PTSD, which might be the earliest reference to the psychological condition.
  • Shakespeare’s character, Hotspur, in Henry IV became melancholy and withdrawn after losing a kinsman in battle.
  • In the 1600s, nostalgia was used to describe the deep despair among troops with little prospect of leave.
  • During the early 1800s, military doctors began diagnosing soldiers with exhaustion following the stress of battle. During the same period, the terms railway spine and railway hysteria emerged. These were used to describe the trauma of surviving a catastrophic railway accident. Both terms bear a remarkable resemblance to what we now call PTSD.
  • At the time if the Crimean War (1853-1856), many veterans were suffered with “Crimean Fever,” which was described as clammy sweats, irritable heart and being “utterly unnerved and violently agitated.”
  • Following the Civil War (1861–1865), veterans were described as having irritable heart or soldiers’ heart by Dr. Mendez DaCosta. In his 1876 research paper, Dr. DaCosta described startle responses, hypervigilance, and heart arrhythmias.
  • During the 20th century, two world wars and the ongoing war on terrorism introduced many more descriptions of PTSD-like symptoms. In World War I (1914-1918) the terms combat fatigue and shell shock were introduced, along with the term “wind contusion,” referred to what is now known as “traumatic brain injury” (or TBI), which described the symptoms exhibited by a soldier who was close to a passing projectile or near an explosion but who had no visible wound. In World War II (1939-1945) the term “battle fatigue” was coined. Following the Vietnam conflict (1961-1975), the term Vietnam Syndrome emerged.

The wide variety of mental health conditions were codified in 1952 when the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-I) was published. This first edition used the term stress reaction. In the 1980s, the term PTSD was finally introduced in the DSM-III.

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