Would post-traumatic stress disorder exist identically in a pre-industrial warfare setting?

Question

I'm not into psychology, but I've heard a lot about veterans who have committed suicide, went crazy, became addicted or have their lives ruined in other ways because of the shock they lived through the warzone.

The constant exposure to danger, explosions, filth, blood, human remains and such are indeed negative in respect to the human mind, but warzones used to be different before the invention of guns and other portable gunpowder-based weapons. It means that the entire mentality of warfare was different.

Is PTSD possible in case of veterans in such a world? To be more precise: I think it likely is, but then what's the difference from the aforementioned, present-days example?

Answer 1

There is some evidence that what we recognize as PTSD has been round for as long as there has been warfare (and possibly long before). The warriors in the Iliad are reacting in very strange and exaggerated manners to emotional events, indicating that they have been affected by the constant grind of siege warfare around Troy.

PTSD is generally recognized as being the result of an extreme stressor and associated emotional trauma, which means that memories of the event and emotional responses tend to be linked strongly together, and memories can trigger unwanted or inappropriate emotions or conversely an emotional trigger can cause a "playback" of an unpleasant or traumatic memory of an event.

Warfare in ancient times was generally at hand to hand distance using edged weapons, so you were close enough to the person you killed to see their death, and possibly even feel it as your weapon crunched through the enemy's body, actions that would trigger extreme emotions and trauma in ordinary people. Starting in the 1400's, firearms and artillery complicated the situation, since the soldiers were now subjected to extreme noise impulses and threatened with essentially random death (cannonballs bounced across the field to smash into columns of troops would not be moving in straight lines, for example).

Over the years many slang terms to describe the changes in soldiers have been coined, including "shell shock", "battle fatigue", "thousand yard stare", "losing his bottle", "occupational stress injury" and so on, so even if the actual nature of the damage wasn't understood, there was an understanding that something was wrong.

Answer 2

I should think so. I take part in battle re-enactment and have fought in shield walls and, despite it being perfectly safe and not real, that's still a terrifying experience. Melee combat is frantic, chaotic and stressful. Imagine being in a shield wall in medieval or even pre-medieval times; knowing that there is a high chance you won't see the end of the day or if you do, there is a strong chance of being permanently injured.

Archers were the terror of the medieval battlefield, firing huge swarms of arrows into the air. Imagine looking up and seeing death raining down on you.

PTSD would have been very common, but would not have been recognized as such. Even as recent as WWI some sufferers of PTSD were shot as cowards or deserters.

Edit: As this is a hard-science question I'll add some sources. A 14th-century French knight named Geoffroi de Charny, who was also a diplomat and trusted adviser to King John II, once wrote the following (emphasis mine):

In this profession one has to endure heat, hunger and hard work, to sleep little and often to keep watch. And to be exhausted and to sleep uncomfortably on the ground only to be abruptly awakened. And you will be powerless to change the situation. You will often be afraid when you see your enemies coming towards you with lowered lances to run you through and with drawn swords to cut you down. Bolts and arrows come at you and you do not know how best to protect yourself. You see people killing each other, fleeing, dying and being taken prisoner and you see the bodies of your dead friends lying before you. But your horse is not dead, and by its vigorous speed you can escape in dishonour. But if you stay, you will win eternal honour. Is he not a great martyr, who puts himself to such work?

Source

Answer 3

I think there are two ways of looking at your question, and I feel like I have read discussion on this topic before, but sadly I can't find the references again right now. If your question is primarily technological, then I agree with all the other answers here – given all other variables being held essentially the same, death by drone vs. death by mustard gas vs. death by catapult are probably essentially equivalent. As others have mentioned, post traumatic stress is a response to trauma, which can be caused by essentially any event involving extreme stress – so you should find "PTSD" resulting from medieval combat.

The alternative perspective, which again I was unable to find academic discussion about, is to look at whether a different society would experience post traumatic stress in the same way. Since we don't have experimental evidence on hand, we can only do thought experiments here, but would the experience of mass death in warfare (regardless of the weapons involved) be different for people with a radically different psychological makeup? It's often said that in earlier eras "life was cheaper" – average lifespans were much shorter and random death was much more common: through unchecked violent crime, rape and pillage raids, constant epidemics, starvation, industrial accidents, animal attacks, and so on. In such an environment, is there any sense in which the terror of combat would be less terrifying comparable to the baseline level of terror experienced in daily life? You could argue that in such a case everyone would be traumatised, but that would mean that veterans (and their PTSD) might not "stand out" enough to be recognised as experiencing a specific category of psychological harm? So that's our hypothesis one: a society could exist where the PTSD experienced by combatants was not noticeable/remarkable in the context of broader society.

For hypothesis two, consider a hypothetical society with a "martial culture". Many of the problems we face in integrating veterans into modern society involve issues specific to re-integration into civilian life: e.g. how to teach a person not to be in a constant state of readiness (which in civilian society is not normal), or how to teach a person not to respond to potential threats with violence, or how to teach a person new skills that will get them a civilian career. Here on worldbuilding we could posit a society where the is no reintegration into civilian life – a warrior culture, to lean on a cliche. In such a situation, an individual might still be traumatised by our definition, but they remain in the military context where the symptoms of this trauma may be normal, and less likely to interfere with their ability to lead a meaningful life. This kind of society could view the psychological changes wrought by combat experience to be a natural progression in an individual's life – the example of this attitude that comes immediately to mind is in Kubrick's Full Metal Jacket:

"The thousand-yard stare. A Marine gets it after he's been in the shit for too long. It's like you've really seen...beyond. I got it. All field Marines got it. You'll have it, too."

Psychology is both a taxonomy of individual experiences and a system for comparing experiences to a baseline. We observe a set of behaviours which differ from the observed norm, and we infer that these behaviours are brought on by stressful experiences, and so the concept of PTSD is created. But (and keeping in mind the distinction between psychology and neuroscience) we are talking about a discipline which deals in fairly subjective data, and tends to arrive at conclusions which are predicated upon a set of unexamined assumptions received from broader culture. So, in an attempt to work all of that into a "hard science" answer to your question, I agree that evidence shows that to experience terrifying events causes a certain set of observable consequences for those involved. In that sense, you should expect PTSD as we define it to appear in any society which is likely (in the context of their culture/psychology) to have the same basic worldview as ours. However, I see no "hard science" reason why ours is the only possible worldview, so you could maybe tell a psychologically interesting story about the kind of society that does not have a concept of PTSD.

Answer 4

PTSD isn't about trauma itself so much as it is about powerlessness against trauma and about lack of support in response to trauma.

WWI was the first war where a person's injuries weren't based exclusively on his own skill against an opponent that he could see face to face: toxic clouds, invisibly-distant artillery, staying still in the trenches waiting to get shot instead of rapidly advancing...