A History of PTSD Part 1: A Soldier’s Heart
The symptoms of post-traumatic stress disorder were first noticed as far back as three thousand years ago when an Egyptian named Hori wrote: “You determine to go forward. . . . Shuddering seizes you, the hair on your head stands on end, your soul lies in your hand,” in regards to his experiences preceding battle. Nearly five hundred years later the Greek historian Herodotus wrote of an Athenian warrior who was stricken with blindness upon the sight of nearby soldier being killed—a condition called a “conversion reaction” that remains common in soldiers today and is also associated with deafness and paralysis. And yet, countless other mentions of these symptoms remain through history until the present day.
It wasn’t until the 18th century that doctors began to consider these symptoms as anything other than a natural fear of death. The most common diagnoses merely regarded the condition as a kind of homesickness (nostalgia, heimweh, and maladie du pays). Incidents of suicide, extreme physical and mental fatigue, and the refusal to work, fight, or even eat and drink fueled the widely accepted notion that the symptoms stemmed from a soldier’s desire to return home rather than a legitimate medical condition. These symptoms, it was believed, occurred in three stages. The first being heightened anxiety; the second, a prolonged fever and gastrointestinal problems; the final, severe depression, which are, to some degree, consistent with common contemporary progressions of PTSD.
The moment at which PTSD became a legitimate concern to the medical and military community came at the hands of doctor Jacob Mendes Da Costa During the American Civil War. Da Costa’s syndrome, or Soldier’s Heart as it is colloquially known, is generally classified as a physical manifestation of an anxiety disorder, or a somatoform autonomic dysfunction. It was first observed in Union Soldiers in hospitals away from the field. Da Costa believed that the symptoms developed due to the level of stress that was maintained during a Civil War soldier’s active duty. These symptoms were primarily cardiac in nature, including: chest pains, palpitations, breathlessness, and extreme fatigue with or without physical exertion. However, during Da Costa’s residency at a union hospital, he observed that the majority of cardiac patients exhibited no physical abnormalities, such as hypertrophy or dilation, which should cause such symptoms. His conclusion was ultimately that the stress of being perpetually on guard and regular activity on the battlefield would leave a soldier traumatized by things he or she had seen or heard. Furthermore, soldiers would become used to being constantly vigilant making it difficult for them to abandon that state when they were no longer in battle, or even when they were no longer in the military. Da Costa also observed that in later stages soldiers would even be stricken with bouts of severe fever, diarrhea, and other gastrointestinal disorders.
Given the conditions that Civil War soldiers experienced, there is little doubt that Soldiers Heart is the first mention of PTSD as a true medical diagnosis. Previously known as, battle fatigue, homesickness, effort syndrome, and a host of other nicknames, it wasn’t until Da Costa’s observations, medical study, and application of proper medical terminology that these symptoms, which are identical to those of post-traumatic stress disorder, were given the attention they deserved. For more information on Da Costa’s Syndrome please consult the article Da Costa’s Syndrome or Neurocirculatory Asthenia by Oglesby Paul in the Harvard Medical School Journal, available here at PubMed Central.