During the U.S. Civil War, soldier's
heart was the name given to a syndrome similar to today's Post Traumatic
Stress Disorder (Jacob DaCosta's paper in 1871 on Irritable Heart).
In fact clinicians have long noted that traumatic events can lead to
psychological disturbance. At the end of the Nineteenth and the
beginning of the Twentieth centuries, railway disasters, the World
Wars, the Holocaust, atom bombs on Hiroshima & Nagasaki prompted
systematic descriptions of the symptoms associated with traumatic
stress reactions. These included:
re-experiencing of aspects of the traumatic events
- Startle responses
- Impairment in
concentration and memory
- Disturbed sleep,
- Depression, guilt,
- Psychic numbing
- Multiple somatic
The stress reactions were
christened varyingly, depending on the traumatic events preceding the
cluster of symptoms. Many different labels were in vogue.
- Fright Neurosis
- Combat / War Neurosis
- Survivor Syndrome
- Operational Fatigue
- Compensation Neurosis
The first half of the last
century witnessed intense debate on the actual cause of these
syndromes and post trauma states.
Charcot, Janet, Freud and
Breurer suggested that psychological trauma caused hysterical
symptoms, but their views were not widely accepted. Most opined that
a traumatic event in itself was not sufficient cause of post trauma
symptoms. The search went on, mainly for organic causes.
- Damage to the spinal cord
was suggested as the cause of the 'Railway Spine Syndrome'.
- Microsections of exploded
bombs entering the brain as the cause of the 'Shell-Shock' of
World War I
- Brain damage resulting
from starvation as the cause of 'Survivor Syndrome' in the Post
- Many doubted the validity
of the symptoms and suggested malingering for compensation and
coined the term 'Compensation Neurosis'
- Finally the symptoms were
attributed to psychological dysfunction. It was hypothesized
that those with unstable personalities, pre-existing neurotic
conflicts were prone to develop chronic post trauma states.
This view was held till the
Vietnam War. But it changed with the recognition of long standing
psychological problems in many war veterans. This convinced
clinicians and researchers that even people with sound personalities
can develop clinically significant psychological symptoms if they
are exposed to horrific stressors. This prompted the introduction of
Post Traumatic Stress Disorder (PTSD) as a diagnostic category into
And thus finally the fact
that traumatic events such as combat, rape, man made or natural
disaster give rise to a characteristic pattern of psychological
symptoms was given due credence.