From “Irritable Heart” to “Shellshock”: How Post-Traumatic Stress Became a Disease
When people have suffered a violent or horrifying experience, the trauma can follow them around for years — and we call that Post-Traumatic Stress Disorder (PTSD). From soldiers to accident victims to rape survivors, tons of people have found themselves haunted by their terrible experiences.
But PTSD didn’t enter our vocabulary until 1980, when it was added to the DSM-III. Before that, there were many terms for the condition, and many people wrote about it, including Dickens and Shakespeare. How did people describe PTSD before 1980, and how did it come to be recognized as a syndrome, separate from grief or regular depression? Here’s the secret history of trauma and recovery.
Many ancient religious texts talk about the terrible aftermath of trauma — including the Book of Job, in which Job appears to be suffering from mental disturbance after his horrible experiences. And the Mahabharata describes the combat-related stress of warriors in the Mahabharat War.
The Greek historian Herotodus writes a lot about PTSD, according to a presentation by Mylea Charvat to the Veterans Administration in the US. One soldier, fighting in the battle of Marathon in 490 BC, reportedly went blind after the man standing next to him was killed, even though the blinded soldier “was wounded in no part of his body.” Also, Herotodus records that the Spartan leader Leonidas — yes, the guy from 300 — dismissed his men from combat because he realized they were mentally exhausted from too much fighting.
Also, some experts think the Iliad is describing PTSD when Homer says Ajax went mad under Athena’s spell, slaughtering a herd of sheep that he thought were the enemy, and then killing himself.
Shakespeare writes a pretty dead-on description of PTSD in Henry IV Part 2, as Michael R. Trimble points out in Trauma and its Wake Vol. 1. Lady Percy observes Harry Percy having terrible nightmares in which he murmurs “tale of iron wars,” and talks to his “bounding steed.” And when he’s awake, Harry is like a ghost. She says to him:
Tell me, sweet lord, what is’t that takes from thee
Thy stomach, pleasure, and thy golden sleep?
Why dost thou bend thine eyes upon the earth,
And start so often when thou sit’st alone?
Why hast thou lost the fresh blood in thy cheeks,
And given my treasures and my rights of thee
To thick-eyed musing and cursed melancholy?
There’s also that speech in Macbeth, where he asks, “Canst thou not minister to a mind diseased/Pluck from the memory a rooted sorrow?”
Likewise, Trimble notes, Samuel Pepys describes his trauma after the Great Fire of London, which left him with “dreams of the fire and the falling down of houses.” He had a hard time sleeping due to his “great terrors of fire,” and actually considered suicide.
Charles Dickens writes about being “curiously weak… as if I were recovering from a long illness,” after a traumatizing railway accident in which the front of the train plunged off a bridge under repair and 10 people died, with another 49 injured. Dickens wrote in letters to people: “I begin to feel it more in my head. I sleep well and eat well; but I write half a dozen notes, and turn faint and sick… I am getting right, though still low in pulse and very nervous.” Dickens also writes about being unable to travel by rail, because he keeps getting the feeling that the train carriage is tipping over on one side, which is “inexpressibly distressing.” Dickens was never as prolific after this incident, and he died on the fifth anniversary of the train crash.
But it’s also true that PTSD wasn’t fully recognized until around 100 years ago — and there are a few factors, including:
- the rise of modern psychology
- modern warfare, with all of its huge explosions and ever-more-efficient killing machines
- the rise of things like worker’s compensation and lawsuits, making people more likely to report when they’ve been traumatized after an incident. So what did people call this condition in the past?
According to psychologist Edward Tick, PTSD has had more than 80 names over the years. Here are just some of them:
Nostalgia: This is the diagnosis given to Swiss soldiers in 1678 by Dr. Johannes Hofer. In 1761, Austrian physician Josef Leopold Auenbrugger wrote about the widely diagnosed condition of nostalgia in his book Inventum Novum, writing that soldiers “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. This disease is called nostalgia.”
French physicians in the Napoleonic wars believed soldiers were more likely to suffer nostalgia if they had come from a rural, rather than urban, background. They prescribed such cures as listening to music, regular exercise, and “useful instruction.”
Homesickness: Around the same time, German soldiers were calling the same condition heimweh, and the French called it “maladie du pays” — both terms basically mean “homesickness.”
Estar Roto: Spanish physicians came up with this term for PTSD, which means “to be broken.”
Soldier’s Heart: Internal medicine doctor Jacob Mendez da Costa studied Civil War veterans in the United States, and discovered that many of them suffered from chest-thumping (tachycardia), anxiety, and shortness of breath. He called this syndrome “Soldier’s Heart” or “Irritable Heart.” But it also came to be called “Da Costa Syndrome.”
Neurasthenia/Hysteria: These classic Victorian descriptions for anybody who suffered from excessive neurosis or nervousness included many symptoms that would now be considered signs of PTSD, judging from James Beard’s definitive text on neurasthenia, published in 1890.
Compensation Sickness or Railway Spine: As railroad travel became much more common in the late 19th century, so did railroad accidents — and psychologists started noticing a lot of cases of trauma among survivors of those accidents. (Just like Charles Dickens.)
Psychologist CTJ Rigler coined the term “compensation neurosis” to describe these cases — with the “compensation” part referring to a new law that allowed people to sue for compensation for emotional suffering. Rigler believed people were more likely to report their traumatic symptoms — or possibly exaggerate them — if they were going to get paid. Victims of railway accidents were also referred to as having “Railway Spine,” as if their spinal cords had suffered a concussion that caused them to be more nervous or traumatised afterwards.
Shell Shock: Dating from World War I, “shell shock” is probably the most famous term for PTSD. By December 1914, up to 10 percent of officers were suffering from shell shock, and 40 percent of casualties from the Battle of the Somme were shell-shocked.
Combat Exhaustion: That’s what it started being called during World War II and the Korean War. People also called it “combat fatigue.” The Army studied the problem, and decided that “unit cohesion” was a crucial factor in surviving this syndrome, and replacement soldiers were more prone to it because they were new to their units. And as Charvat notes, there’s an ad in the September 17, 1945 issue of Life Magazine touting Wyeth Pharmaceuticals’ products in treating both colic and “battle reaction and mental trauma.”
Stress Response Syndrome: That’s the term it was given in the DSM-I in 1952. And that’s the condition that Vietnam War soldiers were diagnosed with. In the DSM-II this syndrome was lumped in with some others, in a new category called “situational disorders.”
Once it was recognized as a medical condition, the nature of PTSD was still up for a lot of debate,