The irony of post-traumatic stress disorder is that it sounds modern — the term is so clinically bureaucratic some people think it may be the invention of some American psychological board. But the symptoms have been around for hundreds or thousands of years, or perhaps as long as there have been people. The symptoms were called "nostalgia" in the Civil War, "shell shock" in World War I, and Jonathan Shay, author of Achilles in Vietnam, has pointed out that The Iliad may be the first work of literature based on combat stress.
But Samuel Pepys may be the earliest historical figure diagnosed with PTSD in a formal paper.
Irish professor of psychiatry R. J. Daly noted the symptoms just after the American Psychiatric Association added post-traumatic stress to its diagnostic manual in 1980. "Despite being one of the newest categories of mental disorder in the official nomenclature," Daly wrote in the British Journal of Psychiatry in 1983, "post-traumatic stress disorder has obviously had a long existence."
Between details of the author's meals, The Diary of Samuel Pepys includes a vivid description of the Great Fire of London in 1666. The fire burned for three days, and the king ordered Pepys on the second day to bring a message to the Lord Mayor: Any houses in the way of the flames should be demolished to create a fire break (since wooden houses in a dense city were like tinder).
Pepys was not impressed by the mayor's behavior in a crisis.
"To the King's message, he cried like a fainting woman," he wrote. "'Lord, what can I do? I am spent' [said the Lord Mayor]. 'People will not obey me. I have been pulling down houses. But the fire overtakes us faster than we can do it.'"
Pepys goes on to describe the mounting horror of the fire, and Daly notes the mounting evidence of what would now be called PTSD.
First, Pepys personalized the threat. The fire was "a most horrid malicious bloody flame, not like the fine flame of an ordinary fire."
Afterward, he suffered insomnia. "The fears we have of new troubles and violence's, and the fear of fire among ourselfs, did keep me awake a good while," Pepys wrote about a week afterward.
Then came anxiety and vigilance, though his description of riding through smoking parts of London, where looters and thieves may have worked, was probably not just a psychiatric problem: "A foul evening this was tonight, and mightily troubled to get a coach home; and, which is now my common practice, going over the ruins in the night, I rid with my sword drawn in the Coach."
Even during the fire he began to forget events during the day — including meals — and he inserted some details afterward in the margin of his diary. He had nightmares afterward, and, writes Daly, "various ideas and physical situations brought forth anxious feelings" for about eight months.
There was also anger at authority, not unlike the anger some modern vets feel toward sub-competent former leaders. When the feckless Lord Mayor complained after the fire that Londoners were just worried about their own lives and property, Pepys noted, "A very weak man he seems to be."
The great London diarist doesn't write down a remedy for his condition. He doesn't even seem to notice that he has a condition, though he does describe the suicides of other Londoners after the fire. "One must conclude that he was psychologically very healthy," Daly writes.
Of course it isn't combat stress, and it may be a matter of the present looking at the past through its own selective lens. But it's interesting that what therapists call "trauma" in America followed similar patterns in Europe over four centuries ago.