Psychiatric History
490 BCE, account by Herodotus, ancient Greece
The recognition that catastrophic experience could produce lasting psychological effects in otherwise healthy individuals was centuries in the making, but it was the industrialized slaughter of the First World War that forced the medical establishment to confront the phenomenon on an unprecedented scale. What soldiers called shell shock and what military authorities often dismissed as cowardice or malingering would eventually, through the accumulation of wars and advocacy, be formalized as Post-Traumatic Stress Disorder in 1980. The conceptual arc from moral failing to recognized psychological injury represents one of the most significant shifts in psychiatric history.
Historical Narrative
Long before formal diagnostic language existed, accounts of profound psychological disturbance following warfare appear scattered through historical records. The ancient Greek historian Herodotus described an Athenian soldier at the Battle of Marathon in 490 BCE who reportedly lost his sight permanently after witnessing the death of a comrade, without any physical wound to account for it. Samuel Pepys recorded disturbing dreams and persistent distress following the Great Fire of London in 1666. Military physicians in earlier centuries noted conditions they called soldier's heart, nostalgia, or Da Costa's syndrome, each attempting to name a cluster of persistent disturbances observed in veterans, though the frameworks used were those of physical medicine rather than psychological theory.
The American Civil War generated significant medical attention to what physician Jacob Mendes Da Costa described in 1871 as an irritable heart, a constellation of physical complaints observed in soldiers that he attributed to cardiac overstimulation. This cardiovascular framing reflected the era's tendency to look for organic rather than psychological explanations. Similar observations arose from the Franco-Prussian War and were further elaborated by European clinicians working within the emerging frameworks of neurology and early psychiatry.
The First World War created a crisis that no existing framework could adequately absorb. Industrial artillery barrages of a scale and duration previously unimagined produced thousands upon thousands of soldiers who could not speak, could not walk, trembled uncontrollably, or were paralyzed without any detectable physical injury. British medical officer Charles Myers coined the term shell shock in 1915, initially theorizing that concussive pressure waves from exploding shells caused microscopic neurological damage. This physical explanation was attractive to military authorities because it implied an identifiable external cause rather than psychological vulnerability or, worse in military culture's terms, cowardice.
As the war continued, it became clear that men who had never been near an exploding shell developed identical presentations, and the physical concussion theory collapsed. Military and medical authorities then divided sharply. Many in the military establishment insisted the condition reflected moral weakness or deliberate evasion of duty, and some soldiers were court-martialed or executed for what would later be understood as psychological injury. Meanwhile, physicians including W.H.R. Rivers at Craiglockhart War Hospital in Scotland developed early talking-based approaches, working with poet-soldiers such as Siegfried Sassoon and Wilfred Owen. Rivers drew on emerging psychoanalytic theory to argue that suppressed traumatic memory rather than physical damage was central to the condition.
After the war, the debate largely receded until the Second World War revived it under new names including combat fatigue and war neurosis. The Korean and Vietnam conflicts further accumulated evidence, and American Vietnam veterans and their advocates played a crucial role in pushing for formal recognition. The sustained efforts of psychiatrists including Chaim Shatan and Robert Jay Lifton, working alongside veterans' advocacy groups, resulted in the inclusion of Post-Traumatic Stress Disorder in the DSM-III in 1980, marking the first time the diagnostic framework formally acknowledged that trauma itself, rather than pre-existing weakness, could be the cause of lasting psychological injury.
Key Historical Figures
Historical narrative only — this page describes how Shell Shock and PTSD was understood historically. It is not medical advice and does not describe current diagnosis or treatment. Sourced from verified medical history references (NIH, Encyclopaedia Britannica, and standard medical history texts). See our medical disclaimer.