Posttraumatic Stress Disorder, History of

The diagnostic category of posttraumatic stress disorder (PTSD) has evolved during the past two centuries. This entry explores the evolution of the PTSD diagnostic category and the need for additional diagnostic categories for trauma. Historically, it has been recognized that trauma can cause long-term physiological and psychological problems. The word trauma is a direct borrowing of the ancient Greek word trauma, which was used to refer to the bodily wounds or injuries suffered by soldiers from the piercing of their armor. Later in history, particularly in medical and psychiatric literature, trauma was understood as a wound inflicted on the mind, rather than on the body. People's responses to psychological trauma might be understood as a result of “piercing” through their protective mental defenses. Homer's Iliad contained powerful descriptions of soldiers' reactions to war traumatization such as withdrawal, grief, and feelings of guilt toward fallen comrades, which emphasized three common events of heavy, continuous combat: betrayal of thémis (“what is right”) by a commander, the living feeling dead themselves, and berserk-like rage.

Many literary sources contain examples of trauma such as in the novel Oliver Twist, by Charles Dickens, the story of a boy who came to terms with the early death of his parents. The diarist Samuel Pepys described the extended sensory imprint of his fear of being overcome by fire while sleeping following exposure and the flashback recollection of the Great Fire of London in 1666 evoked by an insignificant trigger. In 1865, Dickens described suffering from symptoms of anxiety, memory and concentration problems, irritability, hyperarousal, disturbed sleep, sudden alarm, nightmares, dissociation, and multiple somatic complaints following his involvement in a train crash. Such suffering throughout history and over many wars was known variously as s oldier's heart, battle fatigue, shell shock, combat neurosis, combat exhaustion, and even pseudo combat fatigue. Today, such suffering would be classified as the characteristic symptoms of PTSD.