Geschichte einer politisch unerwünschten diagnose: Die posttraumatische belastungsstörung

Severe psychological responses to war and violence were already described in Greek antiquity. However, an officially acknowledged diagnosis was introduced only as recently as 1980. This paper describes the historical development of the diagnosis "Posttraumatic Stress Disorder", and investigates why it took so long for the diagnosis to be officially accepted. A first concept goes back to the London Surgeon Eric Erichsen, who in 1866 developed the influential hypotheses that psychological symptoms after railway accidents were caused by a concussion of the spine followed by "molecular changes" in the spinal cord ("railway spine syndrome"). At the same time, Pierre Janet and Sigmund Freud investigated the aetiology of hysteria. In World War I and II, up to 10% of the soldiers were exempted from further service because they suffered from nervous breakdowns caused by the experience of war ("shell shock"). Insights into the psychological long-term effects of Nazi Germany's concentration camps, the political activities of the Vietnam Veterans, and evidence from clinical studies resulted in the introduction of the newly defined diagnosis "Post-traumatic Stress Disorder" into DSM-III in 1980. In the past few years, several aspects of this diagnostic concept were legitimately criticized. Nevertheless, the official introduction of the diagnosis led to the acknowledgement of personal suffering and to the development of specific and efficacious therapies.