It’s a truth as old as conflict itself; where war goes trauma follows. Its far older then the World wars ‘Shell shock that brought it to the centre stage of psychological studies and sympathetic regards. The trauma suffered by soldiers was well known but poorly understood but known. The tragic fault was the lack of official treatment, worse, the utter taboo or shame that it carried with it. We first see the tender links between a mental and physical impact being considered as an epidemic in the 18th and 19th centuries. This is when treatment becomes more focused on medical or disciplinary treatments rather the religious penance seen in prior centuries.
In 1762 Robert Hamilton, an English physician, took in a new patient. A young soldier who had returned from fighting after only a few months. His condition was perplexing. Hamilton recorded:
“He complained of a universal weakness, but no fixed pain; a noise in his ears, and giddiness of his head. … As there were little obvious symptoms of fever, I did not well know what to make of the case. … Some weeks passed with little alteration … excepting that he was evidently become more meager. He scarcely took any nourishment … became indolent. … He was put on a course of strengthening medicines; wine was allowed him. All proved ineffectual. He had now been in the hospital three months, and was quite emaciated, and like one in the last stage of consumption. …”
His condition begins to improve gradually when the promise of returning home and leaving behind his position in the army abandoned.
Meanwhile, Spanish soldiers during The 30 years war (1618-1648) where being discharged on medical grounds for a condition that was coined as ‘el mal de corazon ‘ a severe form of homesickness’ that made them incapable of fighting. They are not alone. France, Germany and Switzerland are discharging soldiers for the same illness. Later and across a ocean men fighting in the American Civil war would be the victims of this ‘nostalgia’ on an epidemic level.
Johannes Hofer coined the term ‘nostalgia’ as a medical condition when he was a medical student in 1688. Symptoms that he noted among Swiss mercenaries included anxiety, lack of sleep, loss of appetite and heart palpitations. Patients where also characteristically young or unexperienced recruits. His remedy? Returning home for military leave. This acknowledgment and treatment quickly was adopted over Europe, as seen by Hamilton’s case nearly a century later. However this theory treated the emotional reaction was not directly collated with gritty life on the front or wars themselves. Rather the source of the problem in this early theory was related to being too fixated on the past and homelife. Therefore, the solution that was put forward as cure was like putting a plaster on an infected wound. Returning home gave an escape and relief but returning to their position as may be required started the whole process again.
The increase in cases of clear trauma in soldiers becomes more apparent when, perhaps obviously, the war has a greater emotional charge. To elaborate; the more dissociation that could be made between soldier and conflict the fewer obvious incidences of trauma can be seen. From the 17th century onwards conflict becomes less about the personal disputes of leaders or the acquisition of land and more concerned with social issues. War was increasingly about the values of the nation, its people and ideologies. It was made personal. A weaponised nostalgia.
It is unsurprising that soldiers believing that there was a greater personal cost to loosing war would be more psychologically venerable, it raised the stakes. They were now encouraged to believe that their personal values, life style and stability were the things they had to defend. This is obvious in the world wars. Slogans such as “For King and Country” and “Answer in your country’s hour of need” where plastered across Britain with visual images of the homestead and popular symbols of the nation used to bolster the campaign. Even major British companies and products became endorsements to war.(Insert image of cigarette poster working as an advertisement) Meanwhile in America the phrase “For Mom and Apple pie” became a phrase repeated by GI’s when asked who they fought for. However similar patterns are found centuries before. The American Civil war offers a horrifying example of men serving in the armies suffering greatly from the emotional labour in addition to the physical. Civil wars in themselves are already leaning heavily on ideas and personal identity, the enemy’s where not a foreign power but fellow countrymen. By extension the personalisation of war is concentrated even more as is the consequence of loss. Early stage recruitment took this into full force, charging their call to arms to protect their core values and state-based identities. It was inescapable. Clergymen talked about the war and a need to fight in services, public officials banded behind the causes and military leaders gathered personal regiments from their own states to fight in small groups comprised of men from the same local. The social pressure was suffocating. Who can forget the image of British men being given white feathers as a passive aggressive reaction for not enlisting during the first world war? Who could bear the idea that they where letting their cause down?
This idea of social pressure opens the floodgates for unexperienced recruits. Needless to say lack of experience is polarising enough for a soldier. But when it comes with being thrown into extremely bloody or large scale wars its fated for disaster. This change in the typical background of a recruit and their understanding shaped their experience- or rather- polarised them completely. In the case of the American Civil war the average age of a soldier in the first years was 25, similar to the conflicts prior. What differed was the backgrounds of the recruits, it was recruitment blind to experience. Man, of all walks of lives enlisted on both sides. So many where woefully unprepared for the harsh reality of life on the battle fields. This problem worsened as time progressed the age of recruits had dwindled to desperately resorting to relying on the young and elderly to fill the sheer loss of life whether it be by conscription or volenteering. A Common cycle to repeat for the larger scale wars of the 20th century. They where greeted by poor conditions, lagging enthusiasm and stories of dread coming from people who had already been serving. This is another notable factor when we look at historical cases of war related trauma; the time scale. Going back to the cases mentioned by Hamilton and Hofer this much is clear, hence why the psychological trauma was in many cases linked to ‘nostalgia’ alone. Indeed there is no shortage of stories relating to men trying to flee from the front in these particular years of conflict. In some cases it was prolonging their stay in hospitals but also in desertion; an action that could be punished by execution at worst and public disgrace at least.
Another social factor that can be considered as a trigger to these reactions is the increased sense of cohesion among those who served. They shared close quarters and fought under the same goal- or at least socialised into committing to such goals. This however is a catch 22. Comradery among men in battle can be a life saver, bringing relief in the form of shared experience or increasing confidence from the safety of a unite. Even the simply having human contact was valuable. Playing cards on grim night in a bunker may seem like a jarring image but the small acts of normality kept people grounded. Some even theorise that this feeling of brotherhood could outweigh the ultimate goal itself. In the words of S.L.A.Marshall (In his book ‘Men against fire’) “when the chips are down, a man fights to help the man next to him. Men do not fight for a cause but because they do not want to let their comrades down” The problem comes when situations become dire. When one or more members of a unite pose potential danger to the group it can sour relationships in the blink of an eye. With no wonder; a seconds hesitation or panic could cost lives. This is further compounded by the treatment of those who failed to fulfil their duties. It was common to see this fear echoed in the letters and diaries of soldiers. Soldiers feared letting down the unit, being branded as a coward and shunned. Worse; being responsible for the death even if there is no genuine blame it was easy to find it in oneself or another. It’s a coping mechanism to aim the cause of grief on one thing. Like a lightning rod, it concentrates the pain to process it. Albeit in a unhealthy manner.
Although there was an developing understanding of the emotional reactions to war where being recognised in this era it was still common to think of PTSD as a physical illness. This is not wholly ignorant for the time in question. Obviously, we know that physical symptoms manifest in cases of PTSD. It appears to be in the reverse order to our modern understanding. Believing that the physical symptoms caused the psychological ones. The term ‘Soldiers heart’ was branded by Dr. Jacob Mendes De Costa, who noticed the epidemic unfolding during the American Civil war. Symptoms he noticed in patience included fatigue, palpitations, chest pain and breathing problems. Hindsight allows us to see this as being related to anxiety. But the internal struggles where unthought of, instead doctors focused on the physical strains of war as the cause. Surely it was the lack of sleep, transporting heavy cargo, lacking nutrition and long travels where the cause? After all they were common causes of heart issues in civilian society. It followed with the assumption that the change in mood and ‘irritability’ was caused by the strain of the physical illness. Unfortunately, those embroiled in the height of a civil war wanted quick solutions and answers. De Costa studied a sample of 300 men, all of which had returned to the battle font after a period in hospital. All shared the aforementioned physical symptoms and by their own admission felt as though they now struggled to ‘keep up with comrades’. Thus the horrifying mistake of treating these men with medications classically used to treat heart conditions. This offered no solution to the mental problems (Other than potentially acting as a placebo for some) and only worsened the stereotype that those suffering where in some way weak in character and physic.
This is not exclusive to the American experience, in Europe there had also been an inclination to treat physical symptoms of trauma and hope for a full recovery. So called ‘Railway Spine’ was a significant problem in 19th Century Europe. Emerging from obvious trauma manifesting in survivors of train crashes it was the physical reactions that made doctors and scholars believe it was in part a result of an injury from the accident that could be healed like a broken limb. Charles Dickens himself was involved in a railway accident in 1865, his carriage overturning. Although emerging from the crash unharmed, months later he was suffering from an assortment of ailments. He spent weeks speaking in a shaken stutter, became distant from relatives and friends, would physically shake and when seated he would occasionally freeze and clutch the arms of his chair in terror. These symptoms in survivors emerging weeks or months after the railway accidents became thought of as the result of a physical jolt to the spine or brain.
Assigning the symptoms to a physical problem can also present another harsh reality of medical science and social aspects of this time period; that being that a physical illness was far more culturally acceptable and sympathised with then a mental illness. Making potential treatment easier to access and the individuals not victims to having a social stigma pinned upon them. Emotional and mental issues where for the most part still seen as the fault of the individual. A fundamental weakness in their character, in a soldier in particular this was abhorrent. These where the people trusted in upholding the values and strength of a nation. Their personal failures (Or so perceived) where seen as potentially reflecting the army in a poor light a. Making the armed forces look weak; or so the society feared that they could be seen as such.
These are but a few of the tangled stories that lead us to a gradual understanding of PTSD as a psychological condition. From a point of hindsight, it may be horrifying to many and perhaps can even garter anger or resentment to some looking back. There is justification in that, this article explores the more positive though greatly flawed aspect of trying to understand and resolve the problems faced. The sheer horror of blame culture, mistreatment, hatred and chastising of those afflicted with trauma is itself a subject that must be presented in its own story. Miscalculated as these early attempts to decode and treat trauma where they are the first indications of effort and partial sympathy to treat what they believed to be the cause. This is like so many other paths in history a deeply tender and emotionally weighted one to reflect on.