| 490 B.C. |
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In writing about the Battle of Marathon, ancient Greek historian Herodotus describes the plight of Epizelus, an Athenian soldier who suddenly goes blind (and remains so for life) “without blow of sword or dart” after he witnesses a “gigantic warrior” from the other side kill an Athenian in front of him. A physical result of experiencing a traumatic event, this is the first historical mention of what would later be called post-traumatic stress. |
| A.D. 1190s |
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In the Itinerarium Peregrinorum et Gesta Regis Ricardi, an account of the Third Crusade (1187–1192) recorded immediately after soldiers returned from the Middle East, the writer notes that the men “survived unharmed, but their hearts were pierced by swords of sorrows from different sorts of suffering.” |
| 1350 |
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A French knight named Geoffroi de Charny writes The Book of Chivalry, a guidebook for fellow knights. It includes fair warning of what a knight in battle may suffer, including the horrors of killing and having to kill. He also writes of battles after the battles: “When they would be secure from danger, they will be beset by great terrors,” implying that a warrior may suffer psychological effects after the fact. |
| 1761 |
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Austrian doctor Josef Leopold writes about a condition common among veterans of wars that he calls nostalgia. Far different from the definition of what we’d call nostalgia today (an aching for a time or experience of long ago), Leopold reports that those soldiers who’d endured traumatic combat reported sadness, anxiety, sleep problems, and homesickness. Soldiers aren’t treated for nostalgia in any meaningful way. |
| 1860s |
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During the Civil War, American doctor Jacob Mendez Da Costa studies soldiers experiencing anxiety issues. Because they also experience elevated pulse and difficulty breathing (anxiety often manifests physically as well as psychologically), Da Costa concludes that there’s something wrong with the veterans’ hearts and diagnoses them with “Da Costa’s syndrome,” also known as “soldier’s heart.” Chalking it up to overstimulation of the heart and nervous system brought on by active duty, the doctor and his contemporaries prescribe a few days of bed rest and regular doses of foxglove (Digitalis). After that, they are returned to the front. |
| 1866 |
|
Meanwhile, doctors and scientists in Europe don’t realize it, but they are studying the same things as Da Costa. Research there holds that PTSD can result from any traumatic life event, not just combat. In 1866 British surgeon John Eric Erichsen publishes his study On Railway and Other Injuries of the Nervous System. It explores the phenomenon of “railway spine,” a commonly diagnosed condition among people who’d been in train accidents. For example, author Charles Dickens survived a railway mishap in 1865, and reported experiencing anxiety, difficulty sleeping, and nightmares thereafter. |
| 1887 |
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Doctors recognize that suffering from anxiety, nightmares, sadness, and other symptoms may not be a temporary condition that occurs right after a trauma. French doctor Jean-Martin Charcot publishes a study concluding that “hysterical attacks” could occur months or even years after the triggering event. |
| 1890s |
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The rise of psychotherapy and “talking cures” for psychological disorders, credited to Sigmund Freud, is first used to treat patients suffering from both soldier’s heart and railway spine. |
| 1915 |
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Thanks to research in the years after the Civil War, “soldier’s heart” is a bit better understood, and is widely referred to—particularly among World War I troops—as “shell shock.” Thought to be a reaction to the experience of being near (or the target of) exploding artillery shells, troops exhibit symptoms such as panic attacks, anxiety, and depression. Doctors don’t believe it is a psychological condition, but rather a neurological one. The prevailing science is that shell shock is the manifestation of a physical brain injury sustained in combat. Just as in the Civil War, treatment consists of a few days of R&R before returning to battle. That’s in the United States; in Europe, military doctors utilize electroshock therapy and hypnosis to treat what they call “war neuroses.” |
| 1941 to 1945 |
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During World War II, American soldiers fighting in Europe and Japan face extra-long tours of duty, leading to physical and emotional exhaustion. Military doctors diagnose them with what they are now calling “battle fatigue” or combat stress reaction (CSR). About half of all military discharges in World War II are due to CSR, and are routinely treated with rest. |
| 1945 |
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Every major war seemingly brings with it a reexamination (and better understanding) of the effects of combat on those who fight, and World War II is no exception. In one of the mainstream media’s first mentions of what we now call PTSD, Life magazine runs a photo of a painting called “Marines Call It That 2,000 Yard Stare,” by artist Tom Lea. It depicts a Marine at the Battle of Peleliu. He appears despondent and distant, and gazing off into the long distance. That alerts American civilians that their troops may not come home the same as they remember them. (It’s also the origin of the phrase “the 2,000-yard stare,” sometimes called “the 1,000-yard stare.”) |
| 1952 |
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The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), a standardized guide for recognizing and diagnosing every known mental disorder. Among its listings is a condition called “gross stress reaction,” which refers to a disorder in which people live relatively normal lives but continue to suffer psychological effects of a trauma, such as combat, a natural disaster, or a violent crime. While that opens up the definition of the disorder to include traumas other than combat, the DSM also holds that gross stress reaction generally resolves itself after six months. If the patient still suffers nightmares, flashbacks, and anxiety, the DSM recommends that doctors look for another condition to diagnose. |
| 1968 |
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In the first revision of the DSM, titled the DSM-II, gross stress reaction is eliminated in favor of “adjustment reaction to adult life.” Similar to previous diagnoses, such as CSR and shell shock, it recognizes certain symptoms (anxiety, sleep trouble) but limits its definition of trauma and post-event trauma to just three very specific situations: unwanted pregnancy with suicidal thoughts, military combat resulting in fear, and Ganser syndrome, which is a condition in which prisoners on death row are so distraught about their impending execution that they can’t process or answer questions correctly. |
| 1974 |
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Psychologist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom write about a disorder they call “rape trauma syndrome.” The researchers conclude that women who have suffered a sexual assault endure the same kinds of stress responses as soldiers in combat. |
| 1980 |
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After widespread research on Vietnam War veterans who served in the 1960s and 1970s—and factoring in studies like the one by Burgess and Holmstrom—the American Psychiatric Association adds post-traumatic stress disorder to the newly issued DSM-III. It creates a definitive, recognized link between the trauma of war and a struggle to adjust to post-service civilian life. |
| 1989 |
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Congress creates the National Center for PTSD. Administered by the Department of Veterans Affairs (VA), it becomes the leading researcher and treatment facility for the condition. |
| 2013 |
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Reflecting ongoing research at the VA and other facilities, the DSM-5 is published, and no longer classifies PTSD as an anxiety disorder. As PTSD is more specifically associated with “mood states” such as depression and reckless behavior, the APA now considers it a “trauma and stressor-related disorder.” The DSM-5 also lists four types of “official” PTSD symptoms: intrusion, or reliving the traumatic event (nightmares, flashbacks); eschewing situations that remind the patient of the traumatic event (a veteran avoiding fireworks); negative changes in beliefs and feelings (long confused with clinical depression); and feelings of being “charged up” (often confused with anxiety). PTSD is diagnosed if all four symptoms are present, last for a month or longer, and adversely affect the patient’s daily life and relationships. |
