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Writer's pictureMarsha Rogers

Tracing the Evolution of PTSD: From Shell Shock to Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a condition that has plagued humanity since time immemorial, yet its formal recognition in the medical community is a relatively recent development. Before PTSD gained widespread acknowledgment in 1980, individuals grappling with its symptoms were often described using various terms, reflecting the evolving understanding of trauma and its psychological impact.


One of the earliest documented terms resembling PTSD was "nostalgia," coined by Swiss physician Dr. Johannes Hofer in the late 1600s. He observed soldiers experiencing profound despair and homesickness, alongside symptoms like sleeplessness and anxiety, following prolonged periods of military service. While the term "nostalgia" may seem quaint today, it captured the essence of what we now recognize as PTSD.


During the American Civil War, physicians noticed a peculiar set of symptoms in soldiers that couldn't be attributed to physical injuries sustained in battle. Dr. Jacob Mendez Da Costa referred to these symptoms as "soldier's heart" or "irritable heart," describing conditions like constricted breathing, heart palpitations, and other cardiac issues. These terms highlighted the physiological toll of combat stressors on the human body, laying the groundwork for later understandings of PTSD's somatic manifestations.


The advent of rail travel in the 19th century brought with it a new set of traumatic experiences. Survivors of railway accidents often exhibited symptoms akin to PTSD, such as anxiety and sleep disturbances, leading to the terms "railway spine" or "railway brain." These descriptors underscored the psychological toll of industrial accidents, highlighting the broader societal recognition of trauma beyond the battlefield.


World War I ushered in a new era of warfare, characterized by industrialized violence and unprecedented carnage. Soldiers returning from the front lines exhibited a myriad of symptoms, including anxiety, nightmares, impaired vision, and tremors. The term "shell shock" emerged to describe these symptoms, attributed to the exposure to exploding shells on the battlefield. "Shell shock" encapsulated the visceral horror of modern warfare, sparking public awareness and debate surrounding the psychological effects of combat trauma.


With the onset of World War II, new terms emerged to describe similar phenomena among soldiers. "Battle fatigue," "combat fatigue," and "combat stress reaction" highlighted the psychological toll of prolonged military deployments. These terms underscored the importance of understanding the psychological resilience of servicemen and women in the face of adversity.


In the DSM-I (1952), psychological issues related to trauma were categorized under "gross stress reaction," with the belief that symptoms would typically subside within six months. However, as cases persisted beyond this timeframe, the limitations of this classification became apparent.


In 1968, the DSM underwent revisions, replacing PTSD-related descriptions with the term "adjustment reaction to adult life." Yet, many experts felt that this term failed to capture the complexity of the disorder and its enduring impact on individuals' lives.


Finally, in 1980, PTSD was formally recognized in the DSM-III, drawing from the experiences of war veterans, Holocaust survivors, and others to formulate its diagnostic criteria. This marked a significant milestone in the medical community's understanding and acknowledgment of PTSD as a distinct psychological condition deserving of recognition and treatment.


The journey to comprehending PTSD spans centuries, from ancient battlefields to modern conflicts. By exploring the historical terminology and insights preceding its formal recognition in 1980, we gain profound insights into the resilience of the human spirit and the lasting ramifications of trauma. Let us continue to deepen our understanding of PTSD to better support individuals and communities affected by its complexities.


 

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Sandra Hertkorn

For over 26 years, Sandra Hertkorn has been a dedicated small business owner, specializing in physician practice management, particularly in small, solo provider offices. Drawing on her expertise in compliance, insurance reimbursement, and staffing solutions, Sandra provides indispensable support to healthcare practices.

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