Writers have recorded the traumatic effects of war for thousands of years. Nearly three millennia ago, in Homer's Iliad, Achilles describes how the death in battle of his friend Patroclus caused him to have nightmares, and to isolate himself. Around 1200 BC, in Mesopotamia, soldiers wrote of being visited by the "ghosts they faced in battle". In his account of the battle of Marathon (490 BC), the historian Herodotus recorded that, in the midst of fighting, the warrior Epizelus "suddenly lost sight in both eyes, though nothing had touched him".


Fast-forward to Tudor England, and allusions to war trauma appear in the works of Shakespeare. In Henry IV, Part I, Lady Percy frets at her husband Hotspur's sorrowful state after he returns from war:

"Tell me, sweet lord, what is't that takes from thee / Thy stomach, pleasure and golden sleep? / Why dost though bend thine eyes upon the earth / And start so often when thou sit'st alone? / Why hast thou lost the fresh blood in thy cheeks / And given me treasures and me rights of thee / To thick-eyed musing and cursed melancholy?"

As the writings of Shakespeare, Herodotus and Homer attest, soldiers and civilians alike have been aware of the psychological impact of war for centuries. But, as the following examples prove, it would be a long time before this recognition was reflected in medical diagnosis or treatment.


The trauma with no name

Shakespeare’s histories may have alluded to war trauma but it would be another two centuries before the British public would experience vicariously the horrors of combat – courtesy of the Revolutionary and Napoleonic Wars and the birth of the military memoir.

More than 200 British veterans of the conflicts published their tales of life on the front line, and these autobiographies increasingly addressed the emotional impact of war. In one, Captain Howard chronicles his hallucinations in the catacombs of Paris, when touring the capital after 1814’s battle of Toulouse:

"Cold perspiration broke over my whole body; I stood fixed to the spot in a trance of horror and despair… the skulls with their eyeless sockets, seemed to scowl upon me – my head became dizzy… my brain reeled, and I fell against a crashing pile of mortality, where I swooned away."

Soldiers with ‘nostalgia’ were said to be gripped with fantasies about returning to their homeland

Despite many soldiers reporting disturbed post-battle mental states, there was still no medical recognition of war trauma. Instead, the condition was given a number of vague labels. One was le vent du boulet, translated as 'wind of a cannonball'. Another was 'nostalgia', derived from the Greek words nóstos, meaning 'homecoming', and álgos, meaning 'pain' or 'ache'. Medical records described soldiers with nostalgia to be gripped with fantasies about returning to their homeland.

These terms sparked a wider interest in bodily and mental suffering, which was communicated through the arts. Romantic poets like Wordsworth wrote of the returning soldier who had a "strange half-absence". In his caricature John Bull's Progress, James Gillray depicts a veteran returning home to his family, who cower in horror as he walks through the door. Although war trauma still had no name, it rippled through Britain's cultural landscape.


Undying pain for a broken infantryman

The American Civil War is often remembered through song. Its stirring anthems aimed to unify through patriotism, but many songs linger on the traumatic undercurrent of war. One such was Walter Kittredge’s ‘Tenting on the Old Camp Ground’:

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"Many are the hearts that are weary tonight,

Wishing for the war to cease;

Many are the hearts that are looking for the right

To see the dawn of peace."

Yet despite war’s traumatic cultural resonance, medical practitioners in late 19th-century America still struggled to distinguish between mental and physical illness. Da Costa’s Syndrome, named after the American Civil War physician Jacob Da Costa, was known informally as ‘soldier’s heart’. It was thought that post-battle mental states were brought on by a weak heart or overexertion.

Like the Napoleonic Wars half a century earlier, we can draw a picture of soldiers’ mental states from the letters and diaries they left behind. The Union soldier Oliver Wendell Holmes wrote: “Eaten nothing – suffered the most intense anxiety and everything else possible --…[Y]ou cannot conceive of the wear and tear.”

One of the most tragic stories of the war lies with the men of the 16th Connecticut Infantry regiment fighting for the Union. Barely trained, they took part in some of the bloodiest battles of the war, with most ending up in a Confederate prison camp. Some died in what were inhuman conditions, while those who did survive to be reunited with their families were described as “broken”. One of them, Wallace Woodford, continued to cry out in his sleep after his return: he died just a few weeks later, at the age of 22. His headstone reads: “Eight months a sufferer in Rebel prison; He came home to die.”

Although still undefined, it is clear that war trauma haunted the lives of many of the men who fought in the American Civil War, and that its effects were becoming widely recognised as the dawn of modern war approached.


How shell shock led to “dottyville”

It was the British psychologist Charles Myers who first coined the term ‘shell shock’, in 1915, at the height of the First World War.

Hysteria had previously been understood as a female malady; now shell shock was framed as a ‘male hysteria’, implying a lack of masculine stoicism. Given that soldiers were expected to adhere to masculine ideals of bravery and resilience, shell shock – of which 80,000 cases were recorded in the First World War – was not always treated with sympathy. For example, while he was working at London’s National Hospital for the Paralysed and Epileptic, Dr Lewis Yealland applied electric shocks to men with mutism until they started to speak again.

There was a class dynamic in the symptoms and the treatment of shell shock, mirroring the structure of prewar society and its military hierarchies. Privates allegedly tended to exhibit more psychosomatic symptoms than officers, for example mutism or bodily contortions. Mutism may have been linked to the psychological pressures of constantly following orders without being able to speak your mind or articulate fears.

Some shell shock sufferers were treated humanely at institutions like the famous Craiglockhart in Scotland. Among them was the soldier-poet Siegfried Sassoon, who referred to Craiglockhart as “dottyville”, and spoke fondly of the place and his close relationship with his therapist WHR Rivers. However, Sassoon also wrote about the horror of shell shock: “By night each man was back in his doomed sector of horrorstricken front line, where the panic and stampede of some ghastly experience was re-enacted among the livid faces of the dead. No doctor could save him then, when he became the lonely victim of his dream disasters and delusions.”

Wilfred Owen was also a patient at Craiglockhart, and his treatment, and friendship with Sassoon, were catalysts for him to write his famous poetry. In fact it was in the hospital's magazine, The Hydra, that Owen produced some of his most deeply haunting pieces – ones that helped shape our cultural memory of the conflict.


Protesting the ‘PTSD blues’

The Vietnam War was a watershed in the recognition of war trauma as a mental health condition. Some veterans, mirroring the civilian antiwar movement, became activists, protesting the war itself as well as a lack of mental health support. In 1971 at ‘The Winter Soldier Investigation’, 100 veterans met in Detroit to discuss war violence they had witnessed or participated in. “I am here because I have nightmares about things that happened to me and my friends,” one of them declared.

Another landmark moment arrived in 1980, when Post-Traumatic Stress Disorder (PTSD) was listed in the third edition of the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders. In the mid-eighties, a state-mandated study recognised the prevalence and long-term impact of the condition upon veterans, citing depression, substance abuse, poor physical health and social problems.

Many veterans struggled to adapt to civilian life once the fighting was over. One of them, Louis A Griffiths, communicated his enduring torment via a poem, PTSD Blues:

"You'll never know how many times I have to see him die / The thing that hurts the most / It took 30 years to cry"

In all, around a quarter of American soldiers who served in Vietnam required psychological assistance as veterans. Their experiences undoubtedly drew attention to the gravity and long-term impact of military mental health issues.


When car exhaust becomes mustard gas

Contemporary studies suggest that as many as one in six veterans who served in Iraq or Afghanistan have symptoms of PTSD, including flashbacks, anxiety, depression and irritability. In his 2015 book The Evil Hours, former soldier David J Morris writes: "In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas."

Iraq veteran Kevin Powers portrays a soldier's guilt and trauma in his novel The Yellow Birds: "It felt like there was acid seeping down into your soul and then your soul is gone and knowing from being taught your whole life that there is no making up for what you are doing."

Research in Australia and the US suggests that rates of suicide for male veterans are twice as high as for civilian men; rates for female veterans are at least two-and-a-half times higher than their civilian counterparts. For some female soldiers, the trauma of war is compounded by the threat of sexual harassment.

You don’t have to be a soldier to suffer the negative consequences of war trauma

Many veterans suffer with alcohol and drug addiction, and homelessness linked to poor mental health. The nature of modern conflict has, in many ways, exacerbated these problems. Improvised Explosive Devices (IEDs), common in Iraq and Afghanistan, dominate the experience of being ‘beyond the wire’ outside of large bases. For soldiers on patrol, every step is potentially lethal. Hypervigilance is a fact of everyday life; feelings of powerlessness widespread.

Drone pilots are also suffering from PTSD, proving that you don’t need to be in a close physical proximity to the violence to experience its psychological impacts. Nor do you have to be a soldier to suffer the negative consequences of war trauma: rates of domestic violence are significantly higher than average in the homes of veterans with PTSD. And we shouldn’t forget civilian populations living in countries ravaged by conflict. In all too many cases, these have few resources to recognise or to treat the symptoms of war trauma.

Dr Emma Butcher is a BBC New Generation Thinker, based at the University of Leicester. Dr Hannah Partis-Jennings is a lecturer in international relations and security at Loughborough University. They will be discussing war trauma on our podcast historyextra.com/podcast


This article was first published in the September 2019 edition of BBC History Magazine