Post-Traumatic Stress Disorder (PTSD) is the modern diagnosis for a condition resulting from exposure to severe trauma. While the diagnosis of PTSD was formalized in the 1980s, the psychological distress it describes is not new, especially in the context of combat. Understanding what combat trauma was called during the Vietnam War requires looking at the historical evolution of how the medical community understood psychological injuries of war. The progression of diagnostic terms reflects a growing recognition that trauma can lead to chronic mental health conditions.
Historical Precursors to Trauma Diagnosis
The psychological impact of combat has been recognized for centuries, but its naming and understanding evolved significantly in the 20th century. During World War I, the common term for soldiers suffering from nervous symptoms, tremors, and anxiety was “Shell Shock.” This diagnosis initially suggested a physical injury to the nervous system caused by the concussive force of exploding artillery shells, implying a temporary physical rather than psychological ailment.
By World War II, the terminology shifted to “Combat Fatigue” or “Combat Exhaustion.” This change reflected a move away from a purely physical cause, suggesting symptoms resulted from prolonged stress and the weariness of battle. These diagnoses were still largely viewed as acute reactions, expected to resolve quickly once the soldier was removed from the stressful combat environment. This model of temporary distress heavily influenced the initial approach to treating Vietnam-era service members.
The Diagnostic Terms Used During the Vietnam War
When the Vietnam War was underway, the official medical classification system, the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II), offered few suitable categories for long-term combat trauma. The closest official diagnosis for acute stress reactions was Transient Situational Disturbance (TSD). This term implied that psychological symptoms—such as anxiety, sleeplessness, and irritability—were brief, temporary stress reactions that would disappear once the stressful situation ended.
This diagnostic label proved inadequate for the unique and prolonged psychological strain of the Vietnam conflict. Vietnam veterans often faced an intense, non-linear guerrilla war, experiencing constant, unpredictable exposure to trauma. Unlike previous wars, where soldiers often recovered together, Vietnam service members were frequently deployed and returned home individually, often within 24 hours. This led to a jarring and isolating transition.
As these veterans returned, they exhibited chronic symptoms that did not resolve, including intrusive memories, emotional numbing, and hyperarousal. This contradicted the “transient” nature of the official diagnosis. This disconnect led to the emergence of unofficial terms used by veterans and early advocates, such as “Post-Vietnam Syndrome” (PVS). PVS described the persistent, delayed mental health issues that the psychiatric establishment failed to categorize with available short-term labels.
Veteran Advocacy and the Formalization of PTSD
The pressure to create a more accurate diagnosis came largely from veteran advocacy groups and researchers who conducted extensive interviews with Vietnam veterans. These advocates argued that the experience of trauma itself, not a pre-existing personality flaw, caused the debilitating, chronic symptoms. Their work highlighted that official diagnoses failed to capture the profound, long-lasting nature of the veterans’ suffering.
This advocacy led to a significant shift in the psychiatric community’s understanding of trauma. In 1980, the American Psychiatric Association (APA) formally recognized Post-Traumatic Stress Disorder (PTSD) with its inclusion in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This was a landmark change because it recognized that a psychological disorder could be caused by an external, traumatic stressor. This was a fundamental departure from previous models that focused on individual weakness.
The new PTSD diagnosis provided a legitimate framework for understanding the chronic, delayed symptoms experienced by Vietnam veterans, validating their reality. The inclusion of PTSD recognized a specific syndrome of symptoms—re-experiencing, avoidance, and hyperarousal—that could follow any catastrophic event, not just combat.