The history of PTSD is a history of finally listening — to soldiers, to survivors, to the people society found it most convenient to dismiss. Understanding where PTSD comes from illuminates both the condition itself and the ongoing struggle for those who live with it to be taken seriously.
Before PTSD Had a Name
The psychological wounds of war and violence have existed as long as war and violence themselves. Ancient texts describe warriors returning from battle with what we would today recognize as trauma symptoms. Homer’s Achilles, Herodotus’s account of the soldier blinded by terror at Marathon with no physical wound — the literature of antiquity is full of what modern clinicians would diagnose as PTSD. But for most of history, there was no framework for understanding these responses as medical conditions. They were dismissed as cowardice, weakness, or moral failure.
The American Civil War: “Soldier’s Heart”
Systematic medical observation of trauma responses began in earnest during the American Civil War. Physicians noticed that soldiers were returning from battle with an inexplicable cluster of symptoms: racing heart, fatigue, breathlessness, anxiety, and profound emotional disturbance. They called it “Soldier’s Heart” or Da Costa’s Syndrome, after the physician Jacob Mendes Da Costa who documented it. The assumption was cardiac — a physical disorder of the heart — because attributing it to psychological injury was not yet a framework available to Civil War medicine.
World War I: Shell Shock
“Shell Shock” emerged from the trenches of the First World War, where soldiers who had been exposed to relentless artillery bombardment began presenting with trembling, paralysis, mutism, amnesia, and what we now recognize as flashbacks. The name reflected the initial assumption that the symptoms were caused by the physical pressure waves of nearby shell explosions — a mechanical explanation that avoided the uncomfortable implication of psychological injury.
British physicians W.H.R. Rivers and Charles Myers were among the first to document these responses systematically and to argue for their psychological rather than physical origin. Rivers, in particular, developed early talking-based treatments at Craiglockhart War Hospital — work that anticipates modern trauma therapy by nearly a century. Many shell-shocked soldiers, however, were court-martialed for cowardice before the medical community’s understanding caught up with the reality of their experience. This is relevant to how military trauma is still sometimes treated today.
World War II: Combat Fatigue
By the Second World War, the medical community had abandoned the term shell shock — partly because it had become stigmatized, partly because the purely physical explanation had been discredited. The preferred terms were “Combat Fatigue” and “War Neurosis.” Military psychiatrists began to work closer to the front lines, recognizing that early intervention dramatically improved outcomes. The work of Roy Grinker and John Spiegel, documented in their 1945 book Men Under Stress, represented a significant advance in understanding the psychological dynamics of combat trauma.
Returning veterans still faced enormous stigma, and mental health treatment remained inadequate for the scale of need. The Veterans Administration of the 1940s and 50s was ill-equipped to address the psychological casualties of the war in anything like the numbers that presented.
Vietnam and the Birth of PTSD
The formal recognition of PTSD as a diagnosable condition emerged from two parallel movements in the 1970s. The first was the advocacy of Vietnam War veterans — through organizations like Vietnam Veterans Against the War — who were vocal about the psychological damage that the war had caused and that the medical establishment was failing to address. The second was the growing feminist movement’s documentation of the psychological aftermath of rape and domestic violence, which established that civilian trauma produced the same syndrome as combat trauma.
Psychiatrists Chaim Shatan and Robert Lifton worked extensively with Vietnam veterans and were instrumental in lobbying the American Psychiatric Association to formally recognize the syndrome. In 1980, Post-Traumatic Stress Disorder appeared for the first time in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) — a watershed moment in the history of psychiatry and in the recognition of trauma as a medical reality.
DSM-III to DSM-5: Refining the Diagnosis
Since 1980, the PTSD diagnosis has been refined in each successive edition of the DSM. The DSM-IV (1994) expanded the definition of qualifying traumatic events to include learning about trauma experienced by others and exposure to the traumatic experiences of others in the course of professional duties — a recognition of the occupational trauma experienced by first responders and clinicians. The DSM-5 (2013) reorganized PTSD into a new diagnostic chapter (“Trauma and Stressor-Related Disorders”) and expanded the symptom clusters from three to four, adding Negative Cognitions and Mood as a distinct cluster alongside Re-Experiencing, Avoidance, and Hyperarousal. It also added two specifiers: PTSD with Dissociative Symptoms and PTSD with Delayed Expression.
The World Health Organization’s ICD-11 (2018) took a different path, introducing Complex PTSD as a distinct diagnosis separate from standard PTSD — recognizing the distinct presentation that emerges from prolonged, repeated, or inescapable traumatic exposure.
The Neuroscience Revolution
Perhaps the most significant development in the history of PTSD understanding has been the application of modern neuroscience to trauma. Since the 1990s, neuroimaging studies have produced consistent evidence that PTSD produces measurable, observable changes in brain structure and function — in the amygdala, hippocampus, and prefrontal cortex. This has transformed PTSD from a contested psychological concept to a documented neurobiological condition, and has driven the development of evidence-based PTSD treatments that work with the brain’s plasticity rather than simply talking about the trauma.
Where We Are Now
Today, PTSD is one of the most researched and most treatable conditions in all of psychiatry. Evidence-based approaches including EMDR, Cognitive Processing Therapy, and Image Transformation Therapy achieve lasting recovery in the majority of treated individuals. Yet the gap between what is known in the research literature and what actually reaches survivors remains vast. Millions of people living with PTSD have never received appropriate treatment — many have never received any treatment at all.
Understanding the history of PTSD is not merely academic. It is a reminder of how long it took to take trauma seriously — and a call to ensure that the people who need care receive it. If you recognize the symptoms of PTSD in your own experience, support is available.