How Doctors Discovered PTSD
On Tuesday June 26th, President Trump will award Garlin Murl Connor, a former 1st Lieutenant in the Second World War with a posthumous Medal of Honor, the highest military honor the United States can bestow on a citizen. Pauline Connor, Garlin’s widow, spoke to the media about her late husband’s experience after the war saying: “I’ve always said if anybody had PTSD, he did. Because many of the time, he’d wake up in the middle of the night with nightmares, and after I’d wake him up, he’d go outside, sit on the porch and smoke cigarettes for hours at a time.” Pauline Connor’s frank comments about her late husband’s secret struggles with his memory of the war highlight the corrosive effect violence can have on the human psyche. Our understanding of violence and its effects on the human brain, however, have mostly been unknown or denied throughout our history. It’s been only relatively recently that we have begun to understand the effects a traumatic experience can have on our mental and emotional health. However, PTSD is the latest iteration in an evolution of thought, which has evolved with us throughout the last century. To truly understand PTSD you have to examine the context through which it emerged: the violence of the twentieth century.
First, what is PTSD? Post Traumatic Stress Disorder is a cluster of symptoms that follow in the wake of a traumatic experience outside “the range of normal human experience.” These include accidents, natural disasters, rape, and war. Victims of PTSD are prone to experience essentially three sets of symptoms. The first set of symptoms is hyper vigilance and hyper arousal. The second set of symptoms is emotional numbing. And finally, and most importantly, victims of PTSD are prone to intrusive nightmares, flashbacks and hallucinations of the traumatic event, in crystal clear clarity.
There is sporadic and anecdotal evidence that ancient and not so ancient warriors suffered with the aftereffects of war. Herodotus, a Greek soldier, recalled an Athenian who went blind from fear during the Battle of Marathon. Thousands of Civil War veterans were admitted to insane asylums following Appomattox. However, neither medical professionals nor the public had any firm conviction that trauma could have psychological consequences. World War One changed that. The conflict was a seminal event that exposed what trauma could do to the nerves and the mind. Because of the sheer number of combatants—millions of men shouldered a rifle and stained the grass of Flanders Field and the plashing waters of the Somme with their blood—the numbers of emotional and psychiatric casualties were a global flood. Charging directly into murderous machine gun fire, or cowering in a trench during an artillery bombardment produced intense feelings of fear and helplessness in many combatants that sometime led to symptoms of psychiatric impairment. Doctors developed several diagnoses to classify those symptoms. “Shell shock” was the most emblematic and enduring of them. Artillery was the killing sword of WWI armies, leaving places like Verdun a veritable moonscape. Shell shock, then, was a linguistic reflection of this new killing machine. It was believed that concussive shocks of artillery explosions could damage the nerves, which led to crippling psychological consequences.
Once home, many veterans re-experienced terrifying memories through nightmares, such as British soldier Siegfried Sassoon, who wrote while convalescing in a hospital: “And when the lights are out…then the horrors come creeping across the floor: the floor is littered with parcels of dead flesh and bones. Yet I found no bloodstains there this morning.” Robert Graves recalled when he returned home he “was still mentally and nervously organized for War. Shells used to come bursting on my bed at midnight, even though Nancy shared it with me; strangers in the daytime would assume the faces of friends who had been killed.”
The G.I.’s who marched off to war in Europe and the Pacific in 1942 suffered through terrifying experiences that produced similar feelings of fear and helplessness. Instead of shell shock, psychiatric trauma during WWII was frequently diagnosed as “combat exhaustion” or “combat fatigue.” In WWII, the US Army had three times as many psychological breakdowns as it had in WWI. 314,500 men were discharged due to psychiatric symptoms in WWII, which constituted 43 percent of all men discharged for medical reasons. E.B. Sledge remembered watching men who were evacuated with psychiatric trauma fighting the Japanese in the Pacific. Sledge found these cases “distressing” and noted that their reactions ranged from “dull detachment” and “quiet sobbing” to “wild screaming and shouting.”
The psychological effects of WWII on the “greatest generation” remain shrouded in secrecy, because as writer Karl Shapiro wrote, it was also a “generation of silence.” Americans who volunteered went to war on the heels of the Great Depression, and came from a social and cultural landscape that stressed stoicism and uncomplaining fortitude. As long as they could generally function in society it was believed that they were recovered. So the GI’s who came home from Berlin or Tokyo stayed quiet, the emotional toll of the war remained secret. Readers of this paper can easily recall a father, uncle or grandfather who never talked about the war. “I believe, as I’ve never believed in anything else before,” wrote J.D. Salinger in one of his stories, “that it’s the moral duty of all men who have fought and will fight in this war to keep our mouths shut, once it’s over, never again to mention it in any way.”
Despite their inclination towards silence, the vast psychological toll of the war was reflected in postwar culture. William Wyler’s 1946 film “The Best Years of Our Lives” frankly portrayed returning veterans who were struggling with alcoholism, marital problems, and frightening dreams of combat. John Huston’s stunning film “Let There Be Light,” chronicled veterans suffering with nervous conditions recovering in a military psychiatric facility. The movie was considered so controversial by the Army that they suppressed production of the film for several decades. Sloan Wilson’s The Man in the Gray Flannel Suit portrayed a WWII veteran struggling with the aftereffects of his time in uniform. Kurt Vonnegut’s Slaughterhouse Five is the consummate PTSD novel. The protagonist, Billy Pilgrim becomes literally unstuck in time, transporting from his near death experience at the bombing of Dresden, to his life back in the states with no rhyme or reason. Clearly, enough veterans were haunted by the war that the culture reflected it in books and film.
The War in Vietnam, however, was the catalyst that created PTSD. American soldiers came home from Saigon with what psychiatrists began calling “delayed psychiatric trauma” and “post-Vietnam syndrome.” Symptoms often seemed to emerge months or even years after a soldier was on tour, and included nervousness, anger, excessive emotional reactions, sleeplessness, feelings of intense guilt and shame, and intrusive flashbacks and nightmares. In 1970, Jan Barry, a member of the group Vietnam Veterans Against the War wrote to psychiatrist Robert Lifton asking for his help. Many Vietnam veterans in the group were suffering with severe psychological problems, caused by their traumatic experiences in the conflict and aggravated by their sense of exploitation by the government, isolation from civil society, and a lack of accomplishment. Lifton began holding informal “rap sessions” in the VVAW’s headquarters in midtown, letting members pour their feelings out. He increasingly felt this was a new and singular disorder that deserved recognition.
In 1973, the American Psychiatric Association began the early work of revising the Diagnostic and Statistical Manual of Mental Disorders. The DSM is a collection of more than 200 classified mental disorders, the bible for psychiatrists. Chaim Shatan, Lifton and others began lobbying psychiatrists in charge of the revision to add a new diagnosis recognizing the trauma these men were suffering. In 1980, the third edition of the DSM was published, and with it a new diagnosis: PTSD.
PTSD has evolved with us, reflecting our changing understanding of trauma and what it can do to the mind. It is a patchwork of the new and the old. It reflects both what we have known, and what we are learning. And it reminds us that war is not only destructive work, but self-destructive work
 Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington: American Psychiatric Association, 2013), 271-280.
 Rupert Hart-Davis, ed., Siegfried Sassoon Diaries, 1915-1918 (London: Faber and Faber, 1983), 161.
 Robert Graves, Goodbye to All That (New York: Vintage Press, 1958), 288.
 William C. Menninger, “Psychiatry and the War,” Atlantic Monthly 176 (November 1945): 110-114; Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997), 154-181; Kenneth D. Rose, Myth and the Greatest Generation: A Social History of Americans in World War II (New York: Routledge, 2008), 30-34.
 E.B. Sledge, With the Old Breed: At Peleliu and Okinawa (New York: Oxford University Press, 1990), 264.
 Paul Fussell, Wartime: Understanding and Behavior in the Second World War (New York: Oxford University Press, 1989), 134
 Kenneth Slawenski, J.D. Salinger: A Life (New York: Random House, 2012), 185.
 The New York Times (New York City), 3 May 1972; The New York Times
(New York City), 7 June 1971.
 The New York Times (New York City), 2 June 1974.
 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge: Harvard University Press, 2001), 355-357.