What You Can’t See May Indeed Hurt You: A Historical Analysis of Post-Traumatic Stress Disorder

Anthony Mack is a third year Biological Chemistry major at Grinnell College. When not in class, he enjoys playing baseball and is one of the captains of Grinnell’s baseball team. After Grinnell, Anthony plans on attending a college of pharmacy where he would work toward obtaining his PharmD.

When a war ends, we are continuously reminded of the horrors that occurred every day when we see the veterans and soldiers that walk among us. We see their scars and other physical wounds and know that they have experienced events that we could barely fathom in even our wildest dreams. However, what we are not able to see is sometimes worse than what we can. The emotional, spiritual, and psychological trauma that comes as the result of being at war is something that we cannot even begin to imagine. Unfortunately, we do not have a foolproof way of remedying psychological injuries the same way that we can use stiches to sew up a wound. Post-traumatic stress disorder (PTSD), despite being a condition that has been unofficially diagnosed since 490 BC, is still a very much unknown disorder to this day.[1]

PTSD is characterized by a variety of symptoms, as each case is extremely individualized and will never effect two people in the exact same way. The majority of these symptoms can be divided into one of four groups: intrusive memories, avoidance (of thinking about the traumatic event, or of triggering places, people, and activities), negative changes in thinking and mood, and changes in emotional reactions (increased irritability and angry outbursts, guilt, paranoia, and especially anxiety). Since not all traumatic events affect one person in the same way it affects another, it makes sense that the symptoms reflect this. However, despite the uniqueness in cause and symptoms, there is no difference when it comes to gender diagnosis in soldiers. Male and female war veterans who have submitted themselves to VA hospitals are diagnosed with PTSD at the same rate.

Even though psychotrauma, or post-traumatic stress, has not officially been a medical term for very long, this does not mean that its symptoms have not been prevalent. Earliest evidence for this can be seen in the Greek historian Herodotus’ depiction of the effects of post traumatic injury at the Battle of Marathon in 490 BC:

“A strange prodigy likewise happened at this fight. Epizelus, the son of Cuphagoras, an Athenian, was in the thick of the fray, and behaving himself as a brave man should, when suddenly he was stricken with blindness, without blow of sword or dart; and this blindness continued thenceforth during the whole of his after life. The following is the account which he himself, as I have heard, gave of the matter: 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. Such, as I understand, was the tale which Epizelus told.”[2]

While the symptoms may have remained similar throughout the years, the names have changed drastically. In mid-17th century, the common diagnosis was “nostalgia,” or “homesickness.” During the American Civil War, soldiers often suffered from “irritable heart” or “soldier’s heart.” The fact that this disorder had been related to the heart, rather than the brain, sheds light on the lack of readiness to accept psychological or neurological defects as a legitimate origin of harm. This then evolved into “shell-shock” during WWI, “combat exhaustion” during WWII and the Korean War, and “stress response syndrome” during the Vietnam War. It was not until 1980 that the American Psychiatric Association (APA) officially added PTSD to its mental disorder classification scheme.

The official diagnosis of post-traumatic stress disorder did not come into the public’s vision until the beginning of the 20th century due to factors such as advanced warfare, likes more efficient killing machines, and the onset of modern psychology. However, because of the negative connotation that was associated with this and other psychological disorders, this name was actually stricken from records.

There is one book that added an additional dimension to my understanding of PTSD: Edward Tick’s War and the Soul: Healing Our Nation’s Veterans from Post-Traumatic Stress Disorder. The reason that this work remains engrained in my mind is that it focuses on the spiritual side of PTSD, an overlooked area of this overlooked disorder. Tick, a clinical psychotherapist, is Director of Sanctuary: A Center for Mentoring the Soul, an organization that runs therapy sessions that emphasize the healing of the mind through the soul. The main body of the book is made up of direct stories of war personnel, specifically focused on their spiritual and emotional states after returning from tours of duty. In most PTSD related news articles, the religious and spiritual aspect of readjusting to life back home seems to be woefully under investigated. In his book, Tick also illustrates the way that he utilizes traditional healing techniques from a variety of religious background. While I understand that religious healing may seem like quackery to some, I do think that Tick has found something that has the potential to help even those who may not be remotely religious. Rather than completely immerse a traumatized person back into the stress of everyday society, the treatment plan he uses eases them back into it, using the sanctuary he works at as a place where veterans and other traumatized people may ready themselves for society through traditional healing techniques.

Treatments for PTSD and similar types of mental disorders have really not come into the national spotlight until recently. Unfortunately, the main reason for this is the lack of knowledge of the cause of the disorder. For a large part of history, it was unknown whether or not PTSD was the result of physical damage to the brain, or a psychological condition that was not caused by any explosion or lesion to the brain. And there was not attempt to understand the underlying causes of it either. Those with the common symptoms were simply tossed into the general ward among the other less serious patients. Eventually, “forward psychiatry hospitals” were set up as more and more soldiers started to check themselves into field hospitals with no physical signs of trauma.

In the mid-20th century, researchers began to look at the experiments conducted by Ivan Pavlov3 and other behaviorists to start to develop behavioral brain therapy as well as the foundations for what would later become cognitive therapy. There two ideas would later combine during the late 1980’s to create cognitive behavioral therapy, one of the most common treatments for PTSD. It was not until 1989 when Francine Shapiro first started to experiment with a new technique called eye movement desensitization and reprocessing (EMDR) therapy that PTSD therapy begin to incorporate a more multidimensional approach to recovery.4 Opposed to a more individual and regimented treatment, EMDR incorporates a variety of treatments into one. Psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies can be personalized to each patient for a more comprehensive and holistic treatment plan.

With more and more soldiers returning from overseas, their adjustment back into civilian life is more imperative than ever. Putting their lives on the line so we could have the freedom to sit on our couches and watch Netflix and enjoy a day on the beach with our families, they deserve the best care that we can give them. It pains me, after extensive research on the state of this field, to see how little we actually know about a disorder that is so severely effecting the protectors of our freedom. The symptoms have been around for over 2400 years, and while excellent progress has been made in the recent years, there is much, much more still left to do.5

For as long as there have been organized civilizations on this Earth, there has been conflict. Wars have been started over land disputes, desire for power, in defense of one’s nation after a terrorist attack, and for religious motives. And there will always be war. As much as we would all like to have peaceful negotiations to resolve issues, that is an impractical and farfetched wish.  Physical wounds will always be part of violence and war. And so will the unseen mental, emotional, and spiritual injuries. Just because the scars and wounds are not visible to the naked eye does not mean they are any less important or deserve any less attention as a bullet wound.



Further Readings:

Marc-Antoine Crocq and Louis Crocq. “From Shell Shock and War Neurosis to Posttraumatic Stress Disorder: A History of Psychotraumatology,” Dialogues in Clinical Neuroscience (2000), 47–55. Print.

Shirley Dicks. From Vietnam to Hell: Interviews with Victims of Post-Traumatic Stress Disorder. North Carolina, McFarland, 1990.

E.B. Foa et al, eds., Effective treatments for PTSD, Second Edition. New York, Guilford, 2009.

Robert Laufer, et al. “War Stress and Trauma: The Vietnam Experience.” Journal of Health and Social Behavior 25 (1): 65-85. JSTOR.




[1] I feel is important to add that PTSD is not exclusive to war trauma. Because doctors and scientists are unsure of the exact origins of PTSD, there are actually many ways that could lead to one’s diagnosis. See Mayo Clinic PTSD Causes

[2] Herodotus, The Histories, The Sixth Book Entitled Erato

[3] Pavlov

[4] EMDR

[5] Awareness