Early History

Before PTSD was conceptualized in the United States, Swiss, German, French, and Spanish physicians identified the disorder (Bentley, 2005). Bentley (2005) noted that the symptoms of PTSD were first named by Swiss military physicians in 1678. “‘Nostalgia’ was the term they used to define a condition characterized by melancholy, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever” (Bentley, 2005). Around the same time, German doctors termed these symptoms “heimweh,” or “homesickness” (Bentley, 2005). Later, French doctors termed the symptoms, “maladie du pays,” and the Spanish termed it, “estar roto,” or “to be broken” (Bentley, 2005).

By the 1700s, physicians began to have clearer conceptualizations of the disorder which would eventually be known as PTSD. Dominique Jean Larrey, a prominent French surgeon, described the disorder as having three stages: 1) “heightened excitement and imagination,” 2) “period of fever and prominent gastrointestinal symptoms,” and 3) “frustration and depression” (Bentley, 2005).

Dominic Jean Larrey (Image source: http://www.virtualarc.com/officers/larrey/)

In the United States, Dorothea Dix advocated for the humane treatment of the mentally ill, and prompted the establishment of the Government Hospital for the Insane in Washington, D.C. in 1855 (U.S. National Library of Medicine, n.d.). Shortly thereafter, military physicians in the United States began documenting the occurrence of fears and stresses related to the military duties of Civil War soldiers. Jacob Mendez Da Costa, a cardiologist, described this constellation of symptoms as  “soldier’s heart,”or “irritable heart,” due to his observation that afflicted soldiers differed in their higher blood pressure and heart rate (Friedman, 2005). His findings from a clinical study about irritable heart were published in 1871 (Da Costa, 1871).

The sharp increase in PTSD symptomology during the Civil War years has been attributed to the advent of modern warfare, the horrifying results of which left many soldiers with psychological wounds which physicians were unsure of how to treat (Bentley, 2005). Thus, the role of the Government Hospital for the Insane expanded during the war (D.C. Department of Mental Health, n.d.).

Government Hospital for the Insane (Image source: http://www.allfortheunion.com/ste/history.htm)

Unfortunately, soldiers who suffered from the PTSD during this time were often seen as weak for succumbing to what was seen as the precursor of the disorder– homesickness. In fact, Robert C. Wood, the assistant surgeon general in 1864, stated, “It is by lack of discipline, confidence, and respect that many a young soldier has become discouraged and made to feel the bitter pangs of homesickness, which is usually the precursor of more serious ailments” (Bentley, 2005). That soldiers suffering from PTSD were merely weak or malingering remained in the American public sentiment for years to come (Bentley, 2005). Indeed, soldiers being treated at the Government Hospital for the Insane were ashamed of being treated there, and thus referred to it instead as “Saint Elizabeth’s Hospital” (U.S. National Library of Medicine, n.d.).

Inside St. Elizabeth's Hospital (Image source: http://www.shorpy.com/node/5476)

Yet elsewhere, the disorder was beginning to gain some legitimacy. By 1905, PTSD, then known as “battle shock,” was regarded as a legitimate medical condition by the Russian Army (Bentley, 2005).

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References:

Bentley, S. (2005). Short history of PTSD: From Thermopylae to Hue soldiers have always had a disturbing reaction to war. Vietnam Veterans of America: The Veteran. Retrieved from http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm

Da Costa, J. M. (1871). Art.I- On irritable heart; A clinical study of a form of functional cardiac disorder and its consequences. American Journal of the Medical Sciences, 121(1), 2-52. Retrieved from http://journals.lww.com/amjmedsci/Citation/1871/01000/Art__I__On_Irritable_Heart__a_Clinical_Study_of_a.1.aspx

District of Columbia Department of Mental Health (n.d.). St. Elizabeth’s Hospital’s expanded role during the Civil War. Retrieved from http://dmh.dc.gov/dmh/cwp/view,a,3,q,636030.asp 

Friedman, M. F. (2005). ‘Soldier’s heart’ and ‘shell shock’: Past names for PTSD. Retrieved from http://www.pbs.org/wgbh/pages/frontline/shows/heart/themes/shellshock.html

United States National Library of Medicine (n.d.). Saint Elizabeth’s Hospital. Retrieved from http://www.nlm.nih.gov/hmd/medtour/elizabeths.html

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