By Joshua A. Jones
Post-traumatic stress disorder (PTSD) is a relatively new label for a condition that has plagued combat veterans throughout the history of warfare. Looking at the evolution of our understanding of PTSD helps us to learn how we can better support individuals who are affected by it.
Symptoms demonstrative of the deteriorating psychological state of troops can be found in accounts from the Battle of Marathon (490 B.C.) and the infamous Spartan stand at Thermopylae. A 14th century treatise was even uncovered wherein a knight instructs young soldiers on how to defeat the melancholy and stress associated with combat hardships.
Military doctors made the first concerted attempts to categorize and diagnose the manifestations of acute combat stress for which Johannes Hofer championed the term “nostalgia” in his 1688 medical dissertation. Through the Seven Years War, the symptoms were believed to be associated with soldiers’ longing to return home and unrelated to actual battlefield experience.
Military physicians were barely able to discharge the most severe cases of psychological breakdown during the first few years of the American Civil War. Sadly, most afflicted troops were corralled into train cars with the names of their home towns or states pinned to their clothing. Others were left to wander the countryside until they succumbed to exposure. The number of these wayward veterans was sufficient to prompt a public outcry that led to the establishment of the first American military hospital for the insane in 1863, where patients were expected to remain until they could be claimed by a family member.
Jacob Mendes Da Costa first described “disorderly action of the heart” during a lecture on cardiac strain in 1874. His original explanation of the condition was based on his observations of soldiers during the Civil War. Physicians were merely trying to explain in etiological terms what they were observing in veterans: increased pulse rate and blood pressure, breathlessness, palpitations, dizziness, and fatigue. This led to the condition becoming colloquially known as “soldier’s heart.”
Modern war casualties
Not surprisingly, the uniquely brutal nature of trench warfare during the First World War resulted in a significant number of psychological casualties. However, Western commanders seemed oblivious to any instances of combat stress. Researchers of the era attributed the condition to the new weaponry of war; namely large-caliber artillery and explosives. The unfounded belief that the impact of shells produced concussions capable of disrupting neural function birthed the term “shell shock.”
Still under the impression that the condition only afflicted men of weak character, physicians contended that the solution was to develop more thorough military entrance screening processes, particularly in sifting through draftees to mediate the potential for emotional breakdown. With the aid of psychiatric testing, the military rejected some five million men from service on this presumption.
Of the 800,000 American troops who actually saw combat during the Second World War, 37.5 percent displayed such severe psychological symptoms that they were permanently discharged.
Since obviously it's not that so many men of the Greatest Generation were not encumbered by a weak character, the military adopted a subtle change in terminology that birthed the practice of describing wartime stress reactions with euphemistic language. Ergo, this stigma-laced condition was subsequently referred to as “battle fatigue” or “combat exhaustion.”
By the time the United States intervened in Korea, the humanity of combat stress had been almost completely removed and its perceived seriousness diminished. Those displaying symptoms of traumatic reactions were said to have suffered from “operational exhaustion,” which further distanced observers from the reality of the disorder. One-quarter of all soldiers who saw combat during the Korean War were classified as psychiatric casualties.
It is no longer a topic of debate that the fighting during the Vietnam War was demonstrably more intense than was ever experienced in previous American conflicts. As the war progressed and the public began to question its legitimacy, instances of psychological breakdown increased.
The American Psychiatric Association first codified post-traumatic stress disorder and included it in the Diagnostic and Statistical Manual of Mental Disorders III in 1980. The oft-cited National Vietnam Veterans’ Readjustment Study concluded that nearly one-third of Vietnam veterans have had PTSD at some point in their lives.
Researchers have estimated that about 30 percent of the 2.5 million troops who have deployed to Iraq and Afghanistan suffer from PTSD. The psychological effects of combat have long been a silent plague throughout the country, crippling families and robbing communities of their greatest citizens. Suicide is now the leading cause of death among active duty service members. This is a heart-wrenching tragedy.
What lies ahead
With America’s latest global campaign, the two longest wars in its history, nearing an end, we take stock. We bury our dead, patch our wounds, and begin the process of healing. It is now that we begin to recognize the social problems that were hidden for so many years behind yellow ribbons and gun smoke. At the end of any given day in the United States, 53 veterans have died while awaiting a decision on their VA disability claims, 22 of them by suicide, while more than 300,000 sleep on the streets and in shelters throughout the land they gave so much to defend.
Our modern understanding of PTSD and its effects put us in a position to truly help those who are afflicted. As we enjoy a time of relative peace in the developed world, it is important that we do not forget our veterans or the effects of their service that can persist long after the end of hostilities.
This encompasses all aspects of life, including education. Many institutions of higher learning are making a concerted effort to support veterans, particularly those with PTSD. In my experience at American Military University, I found that support for active and veteran service members is ingrained in the culture. The faculty is aware of PTSD and empowered to offer course extensions and other flexible options that accommodate military students.
About the author
Joshua A. Jones is a U.S. Marine Corps veteran who deployed to both Iraq and Afghanistan as an enlisted infantryman. He is the author of The Warrior’s Journey: From Conflict to Finding Peace. He served on the Officer Board of the Student Veterans of America chapter at American Military University, where he received his BA in Criminal Justice. Joshua is currently pursuing graduate studies in Emergency & Disaster Management.