BROOKE GLADSTONE:
As Mark Benjamin said, Post Traumatic Stress Disorder, or “PTSD,” is an injury that hasn’t garnered many major headlines, but that’s changing. The Department of Veterans’ Affairs reports treating 73,000 Iraq and Afghanistan war veterans suffering from what they call “mental disorders.”

It’s too early to tell what the true number of PTSD sufferers will be. Whatever it is, these veterans will be among the first to receive this diagnosis during wartime. The psychological damage wrought by war is as old as war itself, but it’s only since 1980 that the mental health community, the government, soldiers and the media have adjusted to the new clinical phrase PTSD.

Dr. Matthew Friedman is the executive director of the Veteran’s Affairs National Center for Post Traumatic Stress Disorder. Matthew, welcome to the show.
DR. MATTHEW FRIEDMAN:
Well, thank you for the invitation.
BROOKE GLADSTONE:
So PTSD is just the most recent term for Post Traumatic Stress Disorder. When was trauma that you couldn’t see first recognized?
DR. MATTHEW FRIEDMAN:
The first people that really recognized it were poets and writers. There are a number of books suggesting that Achilles suffered from what we would now call PTSD after his best friend and lover Patricles was slain in the Trojan War. Shakespeare’s Henry V had what are clearly traumatic nightmares.

Shifting to the medical realm, the American Civil War is when medical folks got into the act. When people were unable to function effectively as soldiers, the medical hypothesis was that something had shifted in the person’s physiology that couldn’t be seen outwardly, so we had the term “Soldier’s Heart.” People making the same observations called this “nostalgia.” The idea behind it was that someone from Vermont Brigade who found himself fighting the Battle of Vicksburg in Mississippi was missing his New England home so much that he was incapacitated.
BROOKE GLADSTONE:
So let’s go to World War I--a new war, a new term for this kind of trauma.
DR. MATTHEW FRIEDMAN:
It was “shell shock,” and the presumption was that proximity to the big artillery guns was somehow destroying some of the neural architecture in the brain, so people’s nerves were kind of jangled--a lot of theories about the nervous system, which of course was a good repository for speculation, because there was no way to test these things.
BROOKE GLADSTONE:
And then you come to World War II and they chose a more general term. They called it “combat fatigue” or “battle fatigue” or “combat neurosis?”
DR. MATTHEW FRIEDMAN:
Well, you see, those terms are not equivalent--the physical explanation being combat fatigue. The body was depleted, exhausted in some way, unable to rise to the occasion.

War neurosis came out of a psycho-analytic tradition based strongly on the work of Sigmund Freud, and the Freudian hypothesis was these people really had a neurosis before they were actually put in uniform, but it was the stress of the combat theater that unmasked this.
BROOKE GLADSTONE:
By the Thirties and Forties, you had the rise of American movies and also the depiction of this condition in such films as The Best Years of Our Lives.
DR. MATTHEW FRIEDMAN:
Right.
BROOKE GLADSTONE:
What do you think the impact of that kind of cinematic depiction was?
DR. MATTHEW FRIEDMAN:
I think that what it did for the American public was focus attention on the plight of veterans, because I think that what is historically the case following all wars is that the public, in its eagerness to move forward and put the war behind it, neglects, forgets its veterans.

I think that until recently, I think there was no real way to understand why these people who were so vital, so strong, so brave, were unable to get on with their lives.
BROOKE GLADSTONE:
If we jump from the Forties to the Eighties, and the term PTSD, did the Vietnam War give rise to this term?
DR. MATTHEW FRIEDMAN:
The veterans of the Vietnam War and the clinicians, and I’m one of them, who tried to help them with their psychological distress were clearly a part of the movement that created what we now call PTSD, but we weren’t alone.

There were other people who’d been working in other domains with other kinds of traumatized groups. There were people who’d been working with concentration camp survivors, prisoners of war. There was something called “Rape Trauma Syndrome.”

When they all came together, they recognized that yes, the trauma itself had been very different, but the kinds of symptoms, the kinds of clinical demands, were very, very similar, and I believe it really did provide an umbrella, if you will, a construct under which all of these different syndromes could be understood.
BROOKE GLADSTONE:
Now, some historians of PTSD have said that for the medical community, and the press and the public, there’s been a pattern of hyper-awareness during times of war, and then a kind of oblivion sets in as soon as the immediate problem recedes from view. Is that your observation?

DR. MATTHEW FRIEDMAN:
I think that that has generally been the case. I’m not sure it’s still the case. The media really discovered PTSD around the eighties. They didn’t quite get it right, I think, until the Nineties, and I think that with that recognition, this kind of cycle that you describe and that I agree with, I think it’s gotten to a point where I don’t think that the people are going to forget PTSD. I don’t think they can.
BROOKE GLADSTONE:
Dr. Friedman, thank you very much.
DR. MATTHEW FRIEDMAN:
Thank you.
BROOKE GLADSTONE:
Dr. Matthew Friedman is the executive director of the Veteran Administration’s National Center for Post Traumatic Stress Disorder.