Posttraumatic stress disorder is one of the defining disorders of modern psychiatry. Although first officially accepted as a diagnosis in the early 1980s, many believe that it has always been with us, but two new studies suggest that this unlikely to be the case – it may be a genuinely modern reaction to trauma.
The diagnosis of PTSD involves having a traumatic experience and then being affected by a month of symptoms of three main groups: intrusive memories, hyper-arousal, and avoidance of reminders or emotional numbing.
It was originally called ‘post-Vietnam syndrome’ and was promoted by anti-war psychiatrists who felt that the Vietnam war was having a unique effect on the mental health of American soldiers, but the concept was demilitarised and turned into a civilian diagnosis concerning the chronic effects of trauma.
Since then there has been a popular belief that PTSD has been experienced throughout history but simply wasn’t properly recognised. Previous labels, it is claimed, like ‘shell shock’ or ‘combat fatigue’, were just early descriptions of the same universal reaction.
But until now, few studies have systematically looked for PTSD or post-trauma reactions in the older historical record. Two recent studies have done exactly this, however, and found no evidence for a historical syndrome equivalent to PTSD.
A study just published in the Journal of Anxiety Disorders looked at the extensive medical records for soldiers in the American Civil War, whose mortality rate was about 50-80 greater than modern soldiers fighting in Iraq and Afghanistan.
In other words, there would have been many more having terrifying experiences but despite the higher rates of trauma and mentions of other mental problems, there is virtually no mention of anything like the intrusive thoughts or flashbacks of PTSD.
In a commentary, psychologist Richard McNally makes the point that often these symptoms have to be asked about specifically to be detected, but even so, he too admits that the fact that PTSD-like symptoms virtually make no appearance in hundreds of thousands of medical records suggests that PTSD is unlikely to be a ‘universal timeless disorder’.
Taking an even longer view, a study published in Stress and Health looked at historical accounts of traumatic experiences from antiquity to the 16th century.
The researchers found that although psychological trauma has been recognised throughout history, with difficult events potentially leading to mental disorder in some, there were no consistent effects that resembled the classic PTSD syndrome.
Various symptoms would be mentioned at various times, some now associated with the modern diagnosis, some not, but it was simply not possible to find ‘historical accounts of PTSD’.
The concept of PTSD is clearly grounded in a particular time and culture, but even from a modern diagnostic perspective it is important to recognise that we tend to over-focus on PTSD as the outcome of horrendous events.
It notes that the single most common outcome after a traumatic event is recovery without intervention, and for those who do remain affected, depression and substance abuse problems are equally, if not more likely, than a diagnosis of posttraumatic stress disorder.