Combat Trauma from Ancient Times to Modern Day

 

 

Dr. Ruwan M Jayatunge and Lt Colonel Ivan Welch, PhD, US Army

 

Combat trauma has affected soldiers throughout history, from ancient times to the modern day. The psychophysical effects of combat have been recorded since the early days of human civilization. From the time of Homer’s ancient story of the battle between the Trojans and the Greeks (1200 BC), military personnel have been confronted by the trauma of war. According to the historians, Saul, the king of Israel (11th century BC), had abnormal behavior with an inclination towards violence. On one occasion, he went into a brutal rage and tried to kill his son Jonathan.

Alexander the Great (356 BC–323 BC), who had conquered a large portion of the known world at that era, suffered from combat stress. When his forces came near the Indus River, Alexander’s forces were exhausted and refused to march further. Alexander the Great's army experienced battle fatigue, which significantly impacted their willingness to fight.

The Emperor Ashoka (304 BC-232 BC) of India experienced a depressive reaction soon after the Kalinga War after witnessing deaths and destruction. He felt disheartened by his military actions and completely renounced violence and embraced Buddhism. His psychological shift away from violence denotes a drastic personality change following war trauma. The Emperor Ashoka was able to achieve post-traumatic growth.

The Roman Empire, which lasted from 27 BC to 1453, was filled with battle stress. A countless number of soldiers and civilians experienced a great deal of combat-related stress during this time period. Roman legionaries witnessed death, injury, and the brutality of battle as a result of close-quarters combat. Once archeologists discovered an ancient bunker from the Britannic Islands, which was used by the Roman soldiers. They found frescos that portrayed the isolation, nostalgia, uncertainty, and fear experienced by the soldiers.

The Crusades (1095-1291) were a series of religious wars between Christians and Muslims for control of the Holy Land, significantly impacting religious and political dynamics.  Many crusaders would have returned to Europe suffering with the mental consequences of war trauma, or the physical consequences of disability from weapon injuries.

The Great Oriental Conqueror Tamerlane (Timur) (1336-1405) was highly affected by the war stress and demonstrated aggressive and sadistic behavior. He was fond of building pyramids of human skulls. Once he made a giant pyramid after a war that contained some 40,000 skulls. Tamerlane had a link to trauma-induced aggression.

The prophet Nostradamus named Napoleon Bonaparte as an antichrist. Napoleon’s forces invaded many parts of Europe and North Africa. His Moscow invasion in 1812 caused heavy damage to the French forces. The French Army had to face the cold Russian winter, famine, and General Kutuzov’s cannon fire. After his disastrous retreat, Napoleon was sent into exile. He escaped from the island of Elba and engaged in the so-called Hundred Days of War. Finally, Napoleon Bonaparte was defeated by the Duke of Wellington—the Leopard of England. Napoleon's decision-making seemed to decline during later campaigns. This could be due to ongoing combat stresses that he experienced. According to the historical accounts, Napoleon was increasingly irritable and prone to bouts of melancholy. Napoleon went into post-combat depression and died on the island of St. Helena in 1821 while in exile.

During the US Civil War, Dr. Mendez Da Costa evaluated 300 soldiers referred to him for a syndrome that he called irritable heart. This syndrome was characterized by shortness of breath, palpitations, burning chest pain, fatigability, headache, diarrhea, dizziness, and disturbed sleep. This condition was later called Da Costa Syndrome. (A syndrome is a group of symptoms that occur together and that are characteristic of a disease or condition.) The civil war participants suffered from psychological wounds, often manifesting as anxiety, depression, and somatization.

At the beginning of World War one the Effort Syndrome was frequently attributed to cardiac hypertrophy caused by heavy marching and packs compressing the chest. The Effort syndrome was considered to be a psychoneurosis and not a medical disease. In 1938, Soley and Shock claimed that hyperventilation was responsible for the symptoms of effort syndrome.

Until World War I (1914-1918), psychological consequences of war trauma were considered merely manifestations of poor discipline and cowardice, and often the victims were severely punished. Some military records of WW1 indicate that a considerable number of shell-shocked soldiers were given the FP-1, or Field Punishment Number One. FP-1 involved the offender being attached to a fixed object for up to two hours a day and for a period of up to three months, often put in a place within range of enemy shellfire. Dr. Charles Myer suspected the psychological factors associated with shell shock.

The Nobel Prize Laureate Ernest Hemingway served in the Lincoln Brigade during the Spanish Civil War that erupted in 1936. Hemingway saw the horrendous war trauma in Spain, and that inspired him to write his famous novel A Farewell to Arms. Anyhow, in later years Ernest Hemingway experienced depression and took his own life. According to the military psychiatrist Dr. William Pike, half of the Spanish Civil War veterans suffered from severe combat-related stress. At one point, Dr. William Pike treated 28 shell-shocked men who were hiding in a wine cellar.

During World War II (1939-1945), battle stress was classified as operational fatigue or war neurosis. Chronic Fatigue Syndrome was evident during World War II, and most of the symptoms had a somatic nature. It has been estimated that 10% of US servicemen developed combat exhaustion in WW2. The military authorities were not very empathetic towards war-stressed sufferers, and on one occasion, General George S. Patton slapped and verbally abused Pvt. Paul G. Bennet and Pvt. Charles H. Kuhl, who experienced battle fatigue.

The term Section Eight was used to identify the victims of psychological effects of war trauma in the Korean War, which continued from 1950 to 1953. Psychiatric evacuations were considerably reduced during the Korean War due to the praiseworthy work of Dr. Albert Glass. However, in a recent study done by Dr. Malcolm Sim and colleagues of the Centre for Occupational and Environmental Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, it was found that anxiety, post-traumatic stress disorder, and depression were present in Korean War veterans 50 years after the war.

In 1965, the United States sent troops to South Vietnam to help fight communist guerrillas. US troops fought in hostile territory, facing sudden ambushes and booby-trap mines. US forces faced defeat and were forced to withdraw from Vietnam in 1975. During the Vietnam War, 2.8 million US servicemen served in Southeast Asia, mainly in Vietnam, and almost one million were exposed to active combat. By the end of the war, over 50,000 Vietnam veterans were diagnosed with combat-related post-traumatic stress disorder. PTSD has been found in 15% of 500,000 men who were in Vietnam. It is said 20,000 veterans committed suicide in the war's aftermath.

On December 25, 1979, the Soviet Union sent forces to Afghanistan. By 1986, about 118,000 Soviet troops and 50,000 Afghan government troops were facing perhaps 130,000 Mujahideen guerrillas. Following the conflict, over one million Afghans had died, and the Soviet army lost 14,427 combatants. When Mikhail Gorbachev became the Soviet leader in 1985, he was keen to get Soviet troops out of Afghanistan. The Soviet withdrawal was completed in February 1989. Although the Soviet health authorities did not comment on psychological casualties of the Afghan War, there were significant numbers of PTSD victims in the Red Army who fought in Afghanistan. Since PTSD was not recognized in the Soviet Union at that era, the Afghan veterans did not receive proper psychological and psychiatric treatment. Many veterans are still haunted by the war's intrusions.

The Persian Gulf War (2 August 1990 – 28 February 1991), also known as the First Gulf War, was conducted by the Coalition Forces to free Kuwait from Iraqi forces led by Saddam Hussein. The number of coalition wounded in combat seems to have been 776, including 458 Americans. Iraq sustained between 20,000 and 35,000 fatalities. The Gulf War Syndrome was evident during the Persian Gulf War, and many returning coalition soldiers reported illnesses such as headaches, memory loss, fatigue, sleep disorders, intestinal ailments, and unusual loss of hearing. Nearly 150,000 veterans have shown symptoms of Gulf War illness.

According to Toomey R and Kang HK, Karlinsky ("Mental health of US Gulf War veterans 10 years after the war," British Journal of Psychiatry 2007) found that deployment in the Gulf War was associated with increased levels of mental disorders, psychological symptoms, and a lower quality of life—beginning during the war and persisting at a lower rate 10 years later. Around 700,000 US military personnel were deployed to the Middle East during the 1991 Persian Gulf War. These veterans reported greater psychological symptoms immediately after the war than veterans who were not sent to the Gulf. 10 years later, these cases of depression and non-PTSD anxiety disorders remained significantly more prevalent among deployed compared with non-deployed veterans. PTSD was over 3 times more prevalent among deployed veterans.

The War in Afghanistan was a prolonged armed conflict that began on October 7, 2001 and ended with United States troop withdrawal in 2021. The Second Gulf War, also known as the Iraq War, can be considered an ongoing military campaign that began on March 20, 2003, with the invasion of Iraq by a multinational force led by troops from the United States and the United Kingdom. These are massive military campaigns in the present day. These conflicts have produced a large number of psychological casualties. The researchers say nearly 20 percent of military service members who have returned from Iraq and Afghanistan—300,000 in all—report symptoms of PTSD or major depression. According to a 2005 VA study of 168,528 Iraq veterans, 20 percent were diagnosed with psychological disorders, including 1,641 with PTSD.

The armed conflict in Sri Lankan which lasted for nearly three decades, had generated a large number of combatants, members of the LTTE, and civilians affected by war trauma, especially PTSD. Studies have shown significant rates of PTSD among individuals exposed to the conflict, including combatants and civilians. Most of these war stressors were not diagnosed sufficiently, and they are not receiving adequate treatment. Therefore, war stress can affect Sri Lankan society for a long time.

Chechen Wars (1994-1996) and the Second Chechen War (1999-2009) resulted in widespread psychological trauma for both civilians and combatants, with high rates of post-traumatic stress disorder (PTSD) and other mental health issues. A study in Chechnya found that 86% of the population experienced physical or emotional "distress" due to the conflict. 

The Ukrainian War began in February 2014. It has generated increased rates of anxiety, depression, and post-traumatic stress disorder (PTSD) among the war victims. The war has become a collective trauma for the Ukrainians. The World Health Organization (WHO) reports that 68% of Ukrainians report a decline in their health, with mental health concerns.

Trauma is a universal human experience, and it is cumulative and reverberates across generations. The experience of combat trauma is a constant across time. Understanding combat trauma from ancient times to the present day provides valuable insights about warfare and its impact on individuals and their society and how societies interpreted and responded to the psychological effects of combat. It provides a deeper understanding of the psychological and emotional toll of combat. This insight would help culturally appropriate and effective interventions to deal with war trauma.

  

About the Authors

 Dr. Ruwan M. Jayatunge, M.D., Ph.D., is a medical doctor and a clinical psychologist, as well as a member of the American Psychological Association (APA). He is a member of the International Scientific Committee of the Post-Traumatic Embitterment Disorder (PTED) panel, representing Canada. He has authored a number of books on PTSD and war trauma and is a guest lecturer at Sri Lankan and North American universities.

Lieutenant Colonel Ivan Welch, PhD, US Army, Retired LTC Welch served twenty-seven years in the US Army as an enlisted soldier and as an officer. As an Infantry Officer he served in international peacekeeping, ground combat, and high level staff positions. He taught in military training and education settings as well as a civilian university. He was a researcher and writer for the US Army Foreign Military Studies Office. He received his PhD in Geography from the University of Kansas.