How old is post-traumatic stress disorder?

It is very hard, and very weird to try to get a handle on how human health has changed between the 19th century and today. Obviously, the way we live has changed dramatically. But understanding how that impacts health (or doesn't) is complicated by the fact that healthcare, science, and public health research changed dramatically during those years, as well.

And all that science hasn't happened in a vacuum. The names we give various disorders change. Whether or not we consider something to be a disorder, at all, might change. And our cultural understanding changes, too—especially when it comes to mental illness.

At the Mind Hacks blog, Vaughn Bell has an excellent breakdown of two recent studies that try to put the modern diagnosis of post-traumatic stress disorder (PTSD) into a cultural and historical context. Many people assume that PTSD is just a new name for something that has always existed—look at shell shock, which made it onto Downton Abbey last season. But these new papers suggest that the distinction between what soldiers experienced in the past and what they experience today might go deeper than naming conventions.

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 ... 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.

Read the rest at Mind Hacks

David Dobbs adds some more context to Bell's post at the Neuron Culture blog.