It’s Time to Make Effective PTSD Treatments Widely Available

After each of the major conflicts of the past 200 years, there has been a wave of awareness about posttraumatic stress disorder (PTSD). The first identifiable wave in the United States occurred after the Civil War ended in 1864. War had clearly changed many combatants and, for the first time, society gave their malady a name.

It was called “soldier’s heart” or what we would today call PTSD. In 1870 the symptoms of civil war veterans were described, and included many of those found in the current diagnosis of PTSD (Myers, 1870).

Yet as the memory of each conflict faded in public awareness, the wave passed, and the experiences of traumatized people faded into the background of our collective consciousness (van der Kolk, 2014).

Another wave occurred after WWI. Psychoanalyst Abram Kardiner wrote a report about the symptoms of soldiers called The Traumatic Neuroses of War. He observed that even people who had been highly functional before combat were now dissociated from their bodies and their emotions. They might become hypervigilant, constantly scanning their surroundings for imagined threats.

Wounded Australian soldiers, Ypres, 1917.
Wounded Australian soldiers, Ypres, 1917.

Kardiner recognized that soldier’s heart, now renamed “shell shock,” was rooted in the body and not just the mind. He described it as a “physioneurosis.” By using the word “physio” in his description, he indicated clearly that PTSD was a physical malady and not just a psychological one. A doctor who treated Civil War veterans half a century earlier also pointed to the physical basis of PTSD by calling it “irritable heart” (Da Costa, 1871).

Yet the army, and society, didn’t want to deal with PTSD after the need for soldiers was over, and the wave of sympathy and attention subsided once more. Kardiner’s report was shelved, unpublished. The U.S. Congress had promised bonuses to WWI veterans to compensate them for wages lost while in military service. Congress and the president clashed repeatedly on how and when to pay them.

In 1932, at the depths of the Great Depression, about 20,000 destitute veterans and their family members converged on Washington, DC, in an effort to pressure the government into paying their long-delayed bonuses. They set up a shantytown and became increasingly insistent in their demands.

A force that included tanks and machine guns eventually dispersed them. Many famous military figures played a role in the rout. General Douglas MacArthur led the operation, with Major Dwight Eisenhower and Major George Patton playing supporting roles.

The shanties of the "Bonus Army" burning after the assault.
The shanties of the "Bonus Army" burning after the assault.

After the drama, awareness of and interest in the plight of veterans waned again. After WWII began, and a fresh wave of veterans began returning from the front, the medical establishment needed information about their malady. Kardiner’s long-ignored report was finally published (Kardiner, 1941).

The wave subsided after WWII and Korea. By the time of the Vietnam War, the lessons learned in the earlier wars about the profound damage done to body and psyche by combat had again been forgotten. Returning veterans faced a lack of social and medical recognition of the severity of their plight. Some were spat on or assaulted by anti-war protesters.

Yet their problems could not be ignored. These included alcoholism and other addictions, domestic violence, joblessness, and mental disorders (Church, 2015). By the mid 1980s, around half the inmates in federal prisons were Vietnam veterans. Along with social focus on their plight came a new name: PTSD .

The first cohort of warriors began returning from deployment in Iraq in 2003, bringing with them the familiar symptoms of PTSD. This spurred a fresh wave of research into the condition. The initial assessment was bleak. Reviews of the published scientific research showed that current therapies had little effect and that PTSD in veterans was particularly “treatment-resistant” (Iribarren et al., 2004; Kulka et al., 1990).

The treatment time frames required, from four to ten sessions, represent a very modest investment of therapeutic hours, while the successful results last over time (Karatzias et al., 2011; Church et al., 2013, Church, 2014).

Though the wave of interest in PTSD has declined after all of the previous major conflicts, I see signs that it will not abate this time around. As a society, we’re increasingly aware that many traumatized people who have never seen combat live among us.

Traumatized child.
Traumatized child.

An estimated one girl in five, and one boy in 10, is sexually abused (Gorey & Leslie, 1997). Sixty percent of older children witness or experience victimization each year, half have experienced physical assault, and 25% have seen community or domestic violence (US Department of Health and Human Services, 2012). Even in the absence of war, the homes in which many children grow up are a battleground.

For all these groups of suffering people, effective treatments are a necessity. Research now shows that most PTSD cases are curable with a short course of therapy. The current wave of concern may not subside like the others; the momentum is now present for widespread implementation of these evidence-based treatments.


Da Costa, J. M. (1871). On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences. American Journal of Medical Science, 61, 17–52.

Kardiner, A. (1941). The Traumatic Neuroses of War. New York, NY: P. B. Hoeber.

Myers, A. B. R. (1870). On the Etiology and Prevalence of Diseases of the Heart among Soldiers. London: John Churchill & Sons.

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