When was PTSD discovered?

Post-traumatic stress disorder, commonly referred to as PTSD, is a stress-related mental health disorder that involves symptoms of re-experiencing, avoidance, reactivity, and cognition.

Once referred to as ‘shell-shock’ and commonly attributed to soldiers and others who had experienced combat, the understanding of the disorder has developed over time, and it is now believed that it can be caused by any type of traumatic event, such as abuse, assault, and natural or man-made disasters. ^[1]

History of PTSD

Exposure to trauma has been part of the human experience since the beginning of time. The exact nature of the trauma throughout history may change – clubbed by a caveman, shot with an arrow, cannon ball or bullet – but the impact of that trauma on the psyche has likely not altered all that much. ^[2]

Terms such as “shell-shock”, “soldier’s heart”, and “war neurosis” appear throughout history. However, the correlation between psychological responses and traumatic events has been documented for thousands of years. As early as 440 BC, from an account of the battle of Marathon by Herodotus, a long-lasting mental anguish caused by “sudden fright” in the battlefield was reported. Other accounts from different battles, different centuries, and across ancient cultures are documented findings of emotional and behavioural re-experiencing of battle during sleep ^[3].  

Before the industrial revolution, these findings were to be found mainly in veterans, or other war survivors. However, once steam-driven machinery was widely used then the man-made disasters occurred more regularly within the civilian population. In the mid to late 19th century, physicians were confused as to the cause of the psychological effects railway accidents had on survivors. The connection with “war neurosis” was not made until 1907 when a German physician, Honigman, noted the similarities in symptoms between the two groups. ^[3]

Arguably the most important discoveries for diagnosis and treatment of trauma-related disorders have been made in the last century, mainly due to the two world wars and the Vietnam war ^[3]:

• World War 1 is arguably the first war where “modern” warfare and “scientific” psychiatry coincided.Meaning, there were considerable advancements made in diagnosing and treating “shell-shock” as it was then called.
• World War 2 was the first “total war”where civilians were targeted, hugely impacting whole populations. This, again, helped with the continued recognition of trauma-related illnesses, not just in soldiers but throughout civilian societies.
• At the time of the Vietnam War, the overall principle of treating psychiatric patients was “forward psychiatry”, a treatment plan that seemed to help in the short-term. However, this meant that the longer-termsymptoms, such as the delayed effects to combat exposure, were more clearly seen. Some of these longer-term symptoms have since been included in the definition of PTSD.

Post-traumatic stress disorder, or PTSD, was first clinically recognized in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll) published by the American Psychiatric Association ^[4]. At that time, it was controversial as the diagnosis moved the emphasis from an internal issue to an external stressor (i.e. that PTSD is due to witnessing or experiencing a traumatic event and not an individual weakness). ^[2] However, since first recognized, PTSD has been defined and redefined many times, as more research exposes the effect trauma has on the human mind.