Dr Ruwan M Jayatunge 

Sigmund Freud used the term Traumatic Neurosis that resembles the present day PTSD. The term traumatic neurosis designates a psycho-pathological state characterized by various disturbances arising soon or long after an intense emotional shock. Freud specifically wrote about effects of traumatic memories and traumatic shock.

In Freud’s words, “The symptomatic picture presented by traumatic neurosis approaches that of hysteria in the wealth of its similar motor symptoms, but surpasses it as a rule in its strongly marked signs of subjective  ailment   . . . , as well as in the evidence it gives of a far more general enfeeblement and disturbance of the mental capacities” (1920g, p. 12).

Freud’s understanding of trauma was well represented in his works mainly in Mourning & Melancholia (1917), Beyond the Pleasure Principle (1920), and Symptoms, Inhibitions & Anxiety (1926). Freud assumed that the negative emotional energy associated with traumatic memories   unconsciously converted into the somatic manifestations of hysteria. Freud’s lectures in 1917–1918 eloquently described the broad clinical picture of PTSD.

In one of his famous lectures- Fixation upon trauma / the unconscious which was conducted in America Freud states thus…..

The closest analogy to this behavior in our nervous patients is provided by the forms of illness recently made so common by the war – the so-called traumatic neurosis. Of courses, similar cases have occurred before the war, after railway accidents and other terrifying experiences involving danger to life. The traumatic neurosis are not fundamentally the same as those which occur spontaneously…..

….. The traumatic neurosis demonstrates very clearly that a fixation to the moment of the traumatic occurrence lies at their root. These patients regularly produce the traumatic situation in their dreams, in case showing attacks of a hysterical type in which analysis is possible; it appears that the attack constitutes a complete reproduction of this situation. It is as though these persons had not yet been able to deal adequately with the situation, as if this task were still actually before them unaccomplished. 

In 1910 Freud stated that hysterical patients suffer from intrusive reminiscences. There are many suggestive evidence  to prove that Sigmund Freud knew the spacious clinical picture of PTSD.

Shell shock

By 1918, British Military Doctors identified a group of symptoms included tiredness, irritability, giddiness, lack of concentration and headaches among the soldiers who fought in the World War one. A British Pathologist Col Fredrick Mott coined the term Shell Shock and he considered shell shock as an organic condition produced by miniature hemorrhages of the brain. Between 1914 and 1918, the British Army identified 80,000 men as suffering from shell shock. Shell shock was generally seen as a sign of emotional weakness or cowardice.

Wilfred Owen was a Captain of the British Army and   witnessed the atrocities of WW 1 first hand. He wrote his famous anti-war poem  “Dulce et Decorum Est” while  receiving treatment for shell shock in Craiglockart.

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of tired, outstripped  Five-Nines that dropped behind.

Gas! Gas! Quick, boys! –  An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling,
And flound’ring like a man in fire or lime . . .
Dim, through the misty panes and thick green light,
As under a green sea, I saw him drowning.
In all my dreams, before my helpless sight,
He plunges at me, guttering,  choking, drowning.