Do You Have “Irritable Heart”? The History of PTSD

Debbie says:

Post-traumatic stress disorder as a publicly recognizable syndrome was first formally named when I was almost 30. I can remember the first time a friend told me she had it, and how it sounded kind of clunky and unreliable in my ears; I can trace the progression from there to now, when I am aware of it everywhere, understand it just about as well as a lay person can from the outside. I don’t have PTSD: I had the amazing luck to fall into a mostly protected childhood, and I’ve been lucky enough to miss most of the things that bring on shorter-term PTSD in adulthood.

That didn’t make me any less fascinated to read Charlie Jane Anders’ “secret history” of PTSD on io9. Anders starts with some ancient historical and literary instances of PTSD-like symptoms, including mentions from Herotodus to Shakespeare and Dickens. She then gives a list of earlier names for the condition, including:

Nostalgia This is the diagnosis given to Swiss soldiers in 1678 by Dr. Johannes Hofer. In 1761, Austrian physician Josef Leopold Auenbrugger wrote about the widely diagnosed condition of nostalgia in his book Inventum Novum, writing that soldiers “become sad, taciturn, listless, solitary, musing, full of sighs and moans. Finally, these cease to pay attention and become indifferent to everything which the maintenance of life requires of them. … French physicians in the Napoleonic wars believed soldiers were more likely to suffer nostalgia if they had come from a rural, rather than urban, background. They prescribed such cures as listening to music, regular exercise, and “useful instruction.”

Estar Roto Spanish physicians came up with this term for PTSD, which means “to be broken.”

Soldier’s Heart Internal medicine doctor Jacob Mendez da Costa studied Civil War veterans in the United States, and discovered that many of them suffered from chest-thumping (tachycardia), anxiety, and shortness of breath. He called this syndrome “Soldier’s Heart” or “Irritable Heart.” But it also came to be called “Da Costa Syndrome.”

I especially appreciate how “nostalgia” has moved in the last 350 years from something so serious to something rather wistful and sweet.

Some of the later ones, like “shell shock” are less surprising, but I didn’t know this one:

Compensation Sickness or Railway Spine As railroad travel became much more common in the late 19th century, so did railroad accidents — and psychologists started noticing a lot of cases of trauma among survivors of those accidents. … Psychologist CTJ Rigler coined the term “compensation neurosis” to describe these cases — with the “compensation” part referring to a new law that allowed people to sue for compensation for emotional suffering. Rigler believed people were more likely to report their traumatic symptoms — or possibly exaggerate them — if they were going to get paid. Victims of railway accidents were also referred to as having “Railway Spine,” as if their spinal cords had suffered a concussion that caused them to be more nervous or tramautized afterwards.

Note how economics and suspicion of any condition that could be compensated are already starting to creep into the story of human health.

Finally, Anders gives us a diagnostic history of how the syndrome has been viewed by doctors:

Starting after World War II, psychologists started classifying all of these cases of trauma, based on loads of notes that the Armed Forces had been collecting since 1933. There was just one trouble: the military shrinks were working on the assumption that all of these cases were “transitory” or “acute.” Meaning that otherwise normal people would have a short-term problem, after they got back from combat, but that by its nature this wouldn’t last long.

Because the psychological studies were based on the military data, which all made this assumption, psychologists also assumed that cases of PTSD would be short-term or temporary in nature.

After the Vietnam War, countless veterans were diagnosed with “stress response syndrome” — but the VA declared that if the problem lasted more than six months after the soldiers returned home, then it obviously was a pre-existing condition and had nothing to do with their wartime service. And thus, it was no longer covered.

So: let’s define it a particular way, and then exclude everything that looks almost like it but doesn’t do what we expect. To some extent, that’s how diagnosis is done, but it’s also how marginalization is done. Fortunately, the DSM-IV definition of PTSD goes in the other direction, having a defining criterion of “lasting more than one month.”

Knowing this history won’t change anyone’s PTSD; at the same time, the historical context and the clear improvement in acknowledging both the reality and the importance of PTSD in people’s lives has its own value.

I read io9 pretty regularly, but I missed this one; I’m very glad that wordweaverlynn pointed it out to me.