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A Brief History of Combat Trauma

Despite its martial traditions, Germany has lagged in coming to grips with post-traumatic stress disorder.

One side effect of NATO's 10-year war in Afghanistan is a steady rise in post-traumatic stress in Western Europe — especially Germany and Britain — for the first time since World War II.

The statistics are small compared to America's, but German experts were startled by a spike in the number of registered PTSD victims in the Bundeswehr, or German military. The Germans unexpectedly found themselves not in a peaceful reconstruction project but in a war. Car bombings and other attacks against German troops flared in provinces like Kunduz between 2006 and 2009, and the number of PTSD cases among Germans rose from 83 to 245.

It was a sensitive topic. Terms like kriegszittern ("war trembling," the German expression for shell shock) were part of the language, and Erich Maria Remarque made the aftereffects of the World War I as clear to German readers in the '20s and '30s as Hemingway made it to Americans. But Germans clammed up after 1945. PTSD became a taboo subject in Germany because the last time it became a problem — after World War II — the war itself went undiscussed.

"World War II is the most outstanding global, and eminently European, catastrophe," German psychiatrist Philipp Kuwert writes in a recent issue of Public Service Review. "It culminated in the mass murder of six million Jewish people and other crimes against humanity. Due to the highly ambiguous outcome that German civilians finally became victims of their own war of annihilation ... only sparse trauma research on German war trauma survivors has been carried out so far."

Not that much other research was done on non-Germans traumatized by the war and suffering things like "battle fatigue" or "gross stress disorder." A clinical understanding of the problem grew only after Vietnam, when American vets started to show symptoms like flashbacks and violent behavior. The 1980 edition of the American Psychiatric Association's bible of mental problems — the Diagnostic and Statistical Manual of Mental Disorders — formally classified "post-traumatic stress disorder" as a real syndrome, with real physiological effects. Only then did real, modern research begin.

A mental or spiritual disorder like PTSD can be highly suggestible; the way you view a mental problem can change the way it's expressed. So it's worth pointing out that the language and treatment for post-traumatic stress - the words I need to use just to discuss it in public — derive from America's therapeutic culture in the 1970s. That makes it sound sissy. That doesn't mean it is.

EUROPEAN DISPATCHMichael Scott Moore complements his standing feature in Miller-McCune magazine with frequent posts on the policy challenges and solutions popping up on the other side of the pond.

Michael Scott Moore complements his standing feature in Miller-McCune magazine with frequent posts on the policy challenges and solutions popping up on the other side of the pond.

During World War II, U.S. Gen. George Patton famously slapped one "malingerer" he found in an evacuation hospital, calling him "gutless." (Ironically, besides his diagnosed "psychoneurosis anxiety state," the soldier also had dysentery and malaria.)

"Before 1980, it just wasn't recognized as a disorder," says Ulrike Schmidt, a molecular biologist at Munich's Max Planck Institute of Psychiatry. For years, she says, people with PTSD were seen as cowards or weaklings who weren't truly ill. "But since 1980, the scientific community has worked on therapies for this disorder, and, in terms of research, that isn't very much time."

More noble vocabularies for the problem could be drawn from Shakespeare, from Homer, from ancient Egypt or from the Civil War. But the treatments come from modern science, and they have an American spin. New treatments involve surfing or even video games derived from the Xbox game Full Spectrum Warrior.

Games like Virtual Iraq or Virtual Afghanistan use "images delivered via a head-mounted display panel to plunge soldiers back into combat zones in Iraq or Afghanistan and recreate" certain war-zone experiences, according to France 24. "Researchers have found that by progressively raising a patient's feelings of anxiety up to a moderate level while simultaneously encouraging the patient to mentally process and talk about their traumatic experience, they can bring down anxiety levels and decrease PTSD symptoms."

It's not a treatment Homer would have recognized, but it is the brave new world of PTSD therapy. "The discussion," as one German documentary on post-traumatic stress among Bundeswehr soldiers puts it, "is no longer about cowardice."

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