From shellshock to PTSD: A history of post traumatic stress disorder

Mental health concerns have always been amongst the least understood health problems in history. Even today there is still a stigma surrounding many mental illnesses, though some have had more research put into them than others. Post-Traumatic Stress Disorder, or PTSD, is one of the better understood conditions in our modern age. The tumult of the previous century meant that a lot of research and study was put into understanding soldiers who were affected by PTSD after battle, which ultimately led to looking at how trauma affects civilians also.

The study of PTSD is usually directly linked to the coining of the term Shellshock during the First World War, but analysis of the effects of trauma extends back to the 17th century. Swiss military physicians coined the term “nostalgia” in 1678 to describe symptoms experienced by soldiers after battle and war. The term described ‘melancholy’, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, heart palpitations, and even fever. They are all symptoms that we might recognise in patients suffering from trauma today. Around the same time German doctors characterised these symptoms as “heimweh” or “homesickness”; the French called it “maladie du pays” and the Spanish “estar roto” or, “to be broken”.

It wasn’t until the 1700s that physicians began to have a clearer conceptualization of the disorder. French surgeon Dominique-Jean Larrey described the disorder as having 3 stages. The first was a heightened sense of excitement and imagination, followed by a period of fever and prominent gastrointestinal problems. The last stage he characterised as being dominated by frustration and depression. Little was done however other than making note of the symptoms; treatment was something of an afterthought.

The 1800s brought about the advent of advocation for the humane treatment of the insane. Dorothea Dix was one of those at the forefront of this campaign and in 1855 she helped to establish the Government Hospital for the Insane. Soon after this, military physicians started to document the occurrence of fear and stresses that they believed to be related to military duties, especially with the advent of the American Civil War. Jacob Mendez Da Costa, a cardiologist, noted the increased blood pressure and heartrate of soldiers struggling owning to the traumas of war and referred to the illness as “soldier’s heart” or “irritable heart”.

Despite the sharp increase of cases due to the brutality of the American Civil War, the link had still not been drawn between modern warfare and the trauma that it inflicted in people mentally as well as physically. It was viewed simply as a sign of weakness in the individuals. This was made worse by the shift in gender ideals during the 1800s. Throughout the Victorian period, in both America and the UK, it was thought that men should be stoic and strong. Being overcome by emotion was seen less as an illness and more as a failure to live up to the masculine ideals of the time.

This attitude carried over to the First World War. Though rather than begin to recognise it as a negative psychological effect from the traumatic experiences the soldiers were in, they believed it was the result of being close to a bomb as it exploded, causing the brain to rattle in the skull. This is where the term “Shellshock” originated. Treatment consisted of only a few days comfort and rest before they were returned to active duty. Because most soldiers were returned to the front line, the treatment was deemed a success.

There were people that questioned the term “shellshock” however, believing it wasn’t an adequate descriptor and instead favoured the word “War strain”. This was accompanied by a slightly more modern view, formed as doctors started doing thorough patient histories of sufferers. They found that symptoms were present even before the explosion of a shell, and that that event was merely the straw that broke the camel’s back.

Since the First World War research has been continuously carried out into what we now call PTSD, first in relation to soldiers returning from war, and then slowly to the wider community and the affect more generally that traumatic experiences of different types can have on a person psychologically