The history of Posttraumatic Stress Disorder (PTSD) encompasses a journey of not only history, but also psychiatry, as the foundation that is PTSD. From research, there is little published on the history overall, although when all pieced together, a more figurative time-line of events pre-date Christ; outlining the same effects we experience now, they experienced then. It is only natural to assume, since the dawn of man that they also succumbed to fears. Stone Age; would it not be human nature to have nightmares after a fearful day hunting or fighting for your life?
This page is a brief synopsis of trauma over time; highlighting what is now, was once before. What you will recognize, and reasonably conclude, is that over time, humanity progressively got smarter and fundamentally more complex the more we discovered. For health in general, we are collectively smarter, we live longer, and increasingly we have become more aware, and gained a greater understanding of the complex nature of the brain and human physiology as a whole.
PTSD Within History
1000 BC an Egyptian combat veteran named Hori wrote about the feelings he experienced before going into battle: “You determine to go forward… Shuddering seizes you, the hair on your head stands on end, your soul lies in your hand.”
Herodotus wrote of the Spartan commander Leonidas, who at the battle of Thermopylae Pass in 480 BC dismissed his men from joining the combat because he clearly recognized they were psychologically spent from previous battles. “They had no heart for the fight and were unwilling to take their share of the danger.”
Herodotus tells of another Spartan named Aristodemus who was so shaken by battle he was nicknamed “The Trembler” – He hung himself in shame.
Herodotus described, during the Battle of Marathon, an Athenian soldier who suffered no injury from war but became permanently blind after witnessing the death of a fellow soldier, yet the blinded soldier was not wounded.
1003 A.D. the Anglo Saxon Chronicle recounts a battle between the English and the Danes in which the English commander Alfred reportedly became so violently ill that he began to vomit and was not able to lead his men.
Diary of Samuel Pepys in 1666; six months after Pepys survived the Great Fire of London, he reported that “it is strange to think how to this very day I cannot sleep a night without great terrors of the fire; and this very night could not sleep to almost two in the morning through great terrors of the fire.” Pepys continued, “A most horrid, malicious, blood fire… So great was our fear… It was enough to put us out of our wits.”
1859 the French scientist Briquet elucidated an association between childhood histories of trauma and symptoms of “hysteria,” such as somatization, intense emotional reactions, dissociation and fugue states.
DaCosta in 1861, an American physician treating casualties of the American Civil War, described increased arousal, irritability, and elevated heart rate in soldiers exposed to combat.
Jon Eric Erichsen, a British surgeon, in 1867 published a book called “On Railway and Other Injuries of the Nervous System”. In it he argued that an unseen physical injury to the spine and brain caused the condition ‘railway spine.’
This period is where the conflict between organic and psychological origins was at the centre of traumatic discussion; malingering or genuine breakdown! Erichsen ascribed the psychological problems of severely injured patients to organic causes and warned against confusing these symptoms with those of hysteria, a condition that he, and most of his contemporaries, claimed only occurred in women.
Not unlike today, physicians in those days struggled with trying to understand body-mind relationships; anxiety then, as now, was easily misdiagnosed as an organic illness.
The German neurologist, Herman Oppenheim, first used the term “traumatic neuroses” in 1889. He proposed that functional problems were produced by subtle changes within the central nervous system.
Past Century & PTSD
Pierre Janet, 1904, began reviewing others information on trauma; Charcot, 1887, Bergson, 1896, and with his own work believed that with one’s personal past, combined with accurate perceptions of current surroundings, determined the capacity to respond appropriately to stress. Janet coined the term “subconscious” to describe the collection of memories forming the mental schemes that guide a persons’ interaction with the environment.
Janet proposed that when people experience “vehement emotions,” the mind might not be able to match what is going on with existing cognitive schemes. As a result, memories of the experience cannot be integrated into personal awareness. Instead, they are split off (dissociated) from conscious awareness and from voluntary control. Thus the first comprehensive formulation of the effects of trauma on the mind was recorded. This was based on the notion that failure to integrate traumatic memories due to extreme emotional arousal results in the symptoms of what we today, call PTSD.
The Swiss psychiatrist Edouard Stierlin, 1909, can be considered the first researcher in disaster psychiatry, with his study of nonclinical populations from the Messina earthquake in 1907, and a mining disaster. Stierlin found that a substantial proportion of victims developed long-lasting posttraumatic stress symptoms; for example, after the Messina earthquake killed 70,000 of the town’s inhabitants, 25% of the survivors suffered from sleep disturbances, including nightmares.
PTSD in Germany during World War 1 (WW1) and subsequent decades was recast as a failure of individual soldiers’ willpower. As a result, treatment comprised “Casual Will Therapy”. Patients desire for health had to be stimulated by psychological exercises. Because the treatment was so painful, many patients preferred front-line duty and were considered cured.
Sarah Haley was one of the people most directly involved in the acceptance of PTSD as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM III). Haley wrote the first comprehensive paper on the problems in tolerating reports of atrocities in the therapeutic setting.
Scientific field trials were not conducted until the PTSD diagnosis was reconsidered for the DSM IV, and the results of those studies, which present a more complex impact of trauma across various victim populations and developmental periods, were not included into DSM IV, except for the study that focused on the A stressor criterion.
As part of the DSM process, another group of researchers and clinical psychiatrists created a diagnostic system for dissociative disorders, without any known communication with the PTSD work group. Initially, there simply seems to have been no awareness about the relationship between trauma and dissociation, thus an entirely separate classification was established for dissociative disorders. Even though these groups later recognized the overlapping of diagnostic systems, and unanimously agreed that merging was in the best interest of psychiatry, the DSM III and IV committee’s refused their joining to become a single group. Go figure!
And here we are, 2011 and the DSM V is now in field trials, preparing for release in 2013. Finally smarter, the committee has joined forces to make “The Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group”; all working together with common goals, particularly covering overlapping disorders. So far, the results are extremely promising. Dissociative category has significant change and amendments in line with trauma, PTSD has been turned upside down and refined far greater than the DSM IV version, to alleviate much misdiagnosis from broadening of terms that has occurred. Overall, the DSM V is looking very smart as a major improvement for the mental health industry and future diagnosis.
22nd May, 2013, the DSM V is now current doctrine. PTSD has changed from an anxiety disorder to a Trauma & Stressor Related Disorder. Significant changes have been made to criterion A, restricting it to the intended severity spectrum, whilst including dissociation and derealisation sub-types to cover complex traumatic symptoms.
Referred Names Over Time
PTSD has had many names across time, wars, and countries; included are as many as I could find, though are certainly incomplete due to the limited documentation on trauma from earlier 1900’s. Names given at specific times where not necessarily specific or related to what we have now as PTSD, though more they all formed and became part of the PTSD history to create what we have today.
The 1800’s saw names used such as; Hysteria, Soldiers Heart, Soldiers Irritable Heart, Irritable Heart, DaCosta’s Syndrome, Railway Spine, Traumatic Neuroses & Fright Neuroses.
The 1900’s saw names such as; Disorderly Action of the Heart, Neurocirculatory Asthenia, Shell Shock, War Neurosis, War Hysteria, Stress Response Syndrome, Combat Stress Reaction, Concentration Camp Syndrome, War Sailor Syndrome, Rape Trauma Syndrome, Battered Woman Syndrome, Vietnam Veterans Syndrome, Abused Child Syndrome and inevitably in 1980, Posttraumatic Stress Disorder (PTSD).
Pivotal Books Towards PTSD
Most PTSD authors agree that Abram Kardiner’s “Traumatic Neuroses of War and War Stress and Neurotic Illness”, are the seminal psychological works on PTSD. In these works Kardiner distilled much psychiatric thought on the traumatic syndrome resulting from World War II, with what he had termed “neurosis of war.” The symptoms of this syndrome included features such as fixation on the trauma, constriction of personality functioning and atypical dream life. Kardiner provided powerful new insights in these classic texts on the phenomenology, nosology, and treatment of war-related stress, thereby anticipating virtually every aspect of contemporary research on PTSD.
Another seminal work on PTSD was “Psychological Aspects of Stress”, edited by Harry S. Abram. This small text, which was composed of six presentations given at a University of Virginia symposium entitled “Psychological Aspects of Catastrophic Events”, 1967, is cited frequently in trauma literature as a major contribution in PTSD development. This symposium, which examined human response to stressful events, included papers on psychological reactions to life-threatening illness, concentration camps, emergency situations, combat, and the stresses of outer space.