Medicine: Mobilization and Deployment, Vol. 1 (2003); and Military Preventive Medicine: Mobilization and Deployment, Vol. 2 (2005). This chapter also discusses the differences between the previous conflicts and the current wars in Iraq and Afghanistan.


In effect, PTSD has existed for centuries, although it has been given various names (Bille, 1993; Thakur, 2008). Early Greek, Roman, and Egyptian descriptions of the effects of war refer to acute stress reactions (Kennedy and Duff, 2001). Gabriel (1987), for example, cited many references to psychologic casualties in the Greek and Roman armies, noting that combat-related mental health problems are well known throughout history. In ancient Rome, legionnaires were encouraged to settle in rural areas after their wars, to “decompress” gradually in the serenity of isolation from the city's activity. Japanese lore tells of samurai warriors who retired to tend the “perfect garden,” away from other people and the stresses of warfare (Williams, 1987). Nostalgia was a term coined in the late 17th century to describe young soldiers returning from war who “cease[d] to pay attention and [became] indifferent to everything which maintenance of life requires of them” (Auenbrugger and Neuberger, 1966). During the Napoleonic wars, physicians recognized multiple factors related to nostalgia—including cultural, social, and environmental issues—in addition to participation in battle itself (Thakur, 2008).

Prevention of and treatment for nostalgia were important interests during the Civil War (Hammond, 1883), generally viewed as the first modern war. Nostalgia was seen as including a cluster of stress-induced symptoms known as soldier’s heart, irritable heart, and effort syndrome—symptom patterns classified in more recent times under the various rubrics of combat fatigue, battle shock, combat stress reaction, and PTSD (IOM, 2008; Marlowe, 2001). During the Russo-Japanese War (1904–1905), the first detailed description of “war neurosis” emerged with the first use of psychiatric specialists by the Russians (Thakur, 2008).

Not surprisingly, the evolving perceptions of warfare and its aftermath over many centuries are reflected in the folklore and literature of various cultures and societies. For example, Boman (1987) provides a broad historical perspective documenting that the stereotyped representation of the dangerous and unpredictable ex-serviceman—as reflected in adverse publicity about the propensity of veterans of the Vietnam conflict to indulge in violent, antisocial, and criminal behaviors—is by no means a modern phenomenon. Sir James Frazer in The Golden Bough (1978) and Sigmund Freud in Totem and Taboo (1960) both noted how returning warriors in primitive societies were regarded as dangerous and tainted and often requiring a period of ritual isolation and cleansing before being accepted back into the community. Western civilization since Homeric times has displayed a morbid fascination with the violent (and quite often gruesome) deeds of veterans of the Trojan wars, as amply documented in the Iliad and the Odyssey and retold for Roman audiences in the Aeneid. Several Shakespearean plays refer to acute stress reactions and include particularly adverse characterizations of a “nefarious collection of war veterans,” including Sir John Falstaff, Richard III, Iago, Macbeth, and Cassius.

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