PTSD is more than feeling bad about being in a war, or grief at the loss of a buddy. Here are the diagnostic guidelines. Note how a diagnosis requires one intrusion symptom (involuntary and instrusive memories, dreams, flashbacks, marked physiological reactions) and persistent avoidance of stimuli associated with the trauma and two negative alterations in cognition and mood associated with the trauma and two marked alterations in arousal and reactivity associated with the trauma. A lot of the examples being cited in the comments do not come anywhere near meeting that criteria. As I read and understand that, an individual who is voluntarily recounting the trauma – much less re-exposing themselves to it by going out to fight again – without significant reactions (read the guidelines – these are really very significant reactions) doesn’t fit the criteria. They may well have another form of mental wound, mind you; grief, fear, loss, guilt and so on are all very real things. But they do not, by our current medical definition, have this wound. Specificity here is necessary because we aren’t asking a question about grief or loss or guilt – feelings which all humans feel at one point or another – but about a very specific mental wound that combat (or other trauma) may inflict.)

That is often not the impression that you would get from a quick google search (though it does seem to be the general consensus of the range of ancient military historians I know) and that goes back to arguments ex silentio. A quick google search will turn up any number of articles written by folks who are generally not professional historians declaring that PTSD was an observed phenomenon in the deep past, citing the same small handful of debatable examples. But one thing you learn very rapidly as a historian is that if you go into a large evidence-base looking for something, you will find it.

That’s not a species of research positivity – it’s a warning about confirmation bias, especially if you do not establish a standard of proof before your investigation. It is all too easy to define down your definition of “proof” until the general noise of the source-base looks like proof. In this case, we have to ask – before we go looking – what would evidence of PTSD in ancient societies (I’m going to start there because it is where I am best informed) look like?

Well, ancient societies engaged in a lot of warfare. Among the citizenry – the sort of fellows who write to us and are written about in our sources – combat experience was almost ubiquitous. That only really changes as we get into the Roman Empire, as violence levels both decline generally and are pushed to the frontier via a professional army. The percentage of veterans in the citizen population (again, citizen here is an important caveat, but then those fellows basically are our primary source base) probably equaled that of the WWI generation in Britain or France, except all the time (there’s a point in the Second Punic War where the Roman censors went through the entire rolls, checking to see how many had managed to avoid military service and found only a few thousand in a citizen body of c. 150,000 adult males). So what ought we expect from our sources? We should expect to see signs of PTSD everywhere. It should be absolutely pervasive in a source-base produced almost entirely by, for and about combat veterans, in societies where military mortality exceeded modern rates by a robust margin.

And it simply isn’t there. There is one very frequently cited account in Herodotus (Hdt. 6.117) of a man named Epizelos experiencing what is generally understood as “conversion disorder” (which used to be badly labeled “hysterical blindness”) in combat. Without being wounded he went blind at a sudden terror in battle and never recovered his sight. Herodotus terms it a θῶμα – a “wonder” or “marvel”, a word that explicitly implies the strange uncommonness of the tale. Herodotus is concerned enough about how exceptional this sounds that he is quick not to vouch for its veracity – he brackets the story (beginning and end) noting that it was what he was told (by someone else) that Epizelos used to say happened to him. In short, this was uncommon enough that Herodotus distances himself from it, so as not to be thought as a teller of tall-tales (though Herodotus is, in fact, a teller of tall tales).

This one example – cited endlessly and breathlessly in internet articles – is remarkable not because it is typical, but because it is apparently very unusual (also, it is my understanding – with the necessary caveat that I am not an expert – that while conversion disorder is a consequence of emotional trauma, it is not clear that it is associated with PTSD more generally). Meanwhile, in the war literature of the Romans, in their poetry (including that by folks like Horace, who fought in quite terrible battles), in the military literature of the Greeks, in the reflections of Xenophon (both on his campaigns and his commands), in the body of Greek lyric poetry … all of it – nothing. It is simply not there – not as a concern that such a condition might befall someone, nor a report that it had done so. Nothing. The lacuna baffled me for years.

My impression is that the medieval literature looks much the same: a few scattered passages that, if you squint hard enough, might be PTSD set against a vast backdrop of nothing in a society where literature was dominated by the war-fighting class. More examples than in the classical corpus (but then the medieval corpus is much larger; oddly, the examples I’ve seen all seem to concern crusading particularly), but nothing close to what we would expect given a literary tradition absolutely dominated by military aristocrats and their (often clerical) families. I call this my impression, because the medieval corpus is both much larger and I have read much less of it; but if there is a hidden reservoir of accounts showing clear symptoms of PTSD, I have not found it yet. I was always struck that – despite the fact that monastic life was often a destination for medieval military aristocrats troubled by their life of violence – none of the monastic rules I have read (admittedly, not all of them), which often have guidelines for abbots to deal with difficult monks, have had anything about how to deal with the symptoms of PTSD.

Now that’s not to say there isn’t grief at loss, mind you! The lamentations of defeat, the sorrow of losing a loved one (even in victory), the misery of war – that you find in the ancient texts in abundance. It occupies literary topoi, it is depicted in artwork, it gets entire tragedies to stretch out in, it is addressed by great big political speeches, it sits at the cornerstone of the Iliad‘s narrative (one reason, no doubt, that the Iliad remains a useful text for soldiers working through their experiences). But the persistent symptoms of PTSD, no. I haven’t been able to find one “flashback” or combat-memory related dissociative episode in ancient literature. You might argue that they simply weren’t recorded, but that strikes me as unlikely in societies where other forms of war-damage were so fiercely valorized and which would have often seen – as with Epizalos – such symptoms as divine omens. There should be dozens and dozens of them. These are societies with active medical literature, after all!

I think the evidence strongly suggests that ancient combatants did not experience PTSD as we do now. The problem is that the evidence of silence leads us with few tools with which to answer why. One answer might be that it existed and they do not tell us – because it was considered shameful or cowardly, perhaps. Except that they do tell us about other cowardly or shameful things. And the loss and damage of war – death, captivity, refugees, wounds, the lot of it – are prominent motifs in Greek, Roman and European Medieval literature. War is not uniformly white-washed in these texts – not every medieval writer is Bertran. We can’t rule out some lacuna in the tradition, but given just how many wails and moans of grief and loss there are in the corpus it seems profoundly unlikely. I think we have to assume that it isn’t in the sources because they did not experience it or at least did not recognize the experience of it.

Bret Devereaux, “Fireside Friday”, A Collection of Unmitigated Pedantry, 2020-04-24.