Early Records of Trauma

The of this is to trace the history of trauma as well as investigate the background of trauma-related concepts and experiences in human history. In light of this, classical papers and research were reviewed in order to outline their contributions to trauma related issues. The mental illness known as Post Traumatic Stress Disorder (PTSD) was first defined only in 1980. The question is: Was it a completely new phenomenon? Definitely it wasn’t. The history and experience of trauma is as old as human history. Right from the early days of human history and existence, natural disasters, tribal wars, serious injuries and losses have been part and parcel of everyday life. Among psychologists, counselors, clergymen and other helping professions, there has always been an increasing interest in the causes and effects of trauma. Citing early


Ancient Times
Historically, the phenomenon of trauma was conceptualized under hysteria. However, it was not until the 19 th century that the traumatic dimension of hysteria was recognized [1]. The old generic term "hysteria" originated from Egyptian and Greek medicine which simply meant "uterus." Even though some symptoms were recorded, the traumatic aspects of hysteria were not recognized until the 19 th century [2]. Ancient scientists identified drying up of the uterus that leads to it wandering round the body in search of moisture as symptoms of hysteria. Therefore, on many occasions throughout history hysterical women were advised to marry and live a satisfactory sexual life in order to serve as a cure for their uterus dryness. Pedophilic acts were very common practice among the ancient Greeks, particular homosexual activities between boys and adult men [3,4]. In those early days, boys were not only raped and forced into sexual slavery but many were castrated. In the later eras, according to Rush [4] the Bible and Talmud encouraged sexual relationships between men and young girls. Similarly, ancient Roman literatures provided numerous examples of sexual abuses of very young children and incest [3]. It was also reported that the Romans had a Law of Retaliation backed by an accepted phenomenon in the Old Testament forgetting that in many circumstances, the immediate response in trauma situations and circumstances may be an automatic response which is not under the victim's control which was therefore socially sanctioned. Later on, in one of the frequently cited cases is the description of the seventh century "Welsh legends surrounding King Arthur". In that story Merlin was described to be a wild man who at some point lived alone in the woods for years. As a result of been affected by the sounds of terrible battle, he avoided people and lived in solitary for several years. It is obvious from this description without doubt that he suffered from flashbacks, intrusive memories as well as social isolation and loss of his former interests. This fits very well in our modern concept of PTSD [5].

Middle Ages, Dark Ages
In the 13 th century, England Church laws were separated from civil laws which evolved the crime of statutory rape. Having intercourse with a girl under the age of 12 was deemed a misdemeanor whereas in the 16 th century, a girl could legally give consent to sexual intercourse at age 10 and to marriage at 12 [3]. During these dark eras in Europe that is from the 15 th to the 18 th centuries, children were forced to marry at the age of 6 in France which at that time was the legal age but usually without sexual intercourse until menarche. As young as 6 years old, girls were seen old enough to copulate with the devil and thus old enough to stand trials to be persecuted as witches. Moreover, sex offenders at that time were considered to possess evil spirits. In 1624, the Prince and Bishop of Wurtzburg is said to have said "there have been 300 children of three and four who are said to have intercourse with the devil. I have seen seven of them put to death" [3]. When these children got pregnant, they were accused of being possessed by the devil and were burnt alive. Also, in the 17 th century, numerous nuns and schoolgirls reported being sexually tormented by demons in France and they exhibited symptoms of dramatic convulsions, writhing and vomiting. They were accused of being possessed by the devil as well as seducing innocent and naive men.
The modern etiology of PTSD started around the end of the 16 th century. Edward Jordan (1569-1632) postulated that the cause of hysteria was natural and not supernatural. He linked it causes to brain functions. Similarly, Thomas Willis (1621-1673) reported that the uterus was completely normal in hysterical women and refused the notion of the "wandering womb" theory. However, it is interesting to also know that Andrew Coombe (1797-1847) a physician was the first to use the "functional" word in relation to hysterical symptoms [6].

Seventeenth Century Europe
Samuel Pepys' a seventeenth century physician gave one of the most elaborate descriptions of trauma in his diary as a result of the horrible Fire of London in 1666. In his diary, he mentioned being able to rescue his family and possessions from the fire. However; he also recorded psychological reactions to the event: People were terrified with nightmares of the fires and houses sinking. Not all of the symptoms fit PTSD but some were close to PTSD criteria [7].

Eighteenth Century Europe
From the eighteenth century, Parry-Jones [8] illustrated a natural disaster. The essence of the traumatic event was that three females of the same family were confined for 37 days in a six foot by four-foot barn. The barn they were sheltering in was buried in the snow. They showed acute psychological reactions. The three women become very popular in their survival stories and were invited to many charitable receptions to share their painful experiences. Maybe the portrayal does not tell us about a traumatic event, but it was a recognition of a traumatic experience.

Nineteenth Century Europe
During the 19 th century in Europe, sexual exploitation of children was very common [9]. There was massive production and distribution of child pornography [3,4]. Prostitution was legalized in 1873 in France and the age of consent was 14. Ambroise Tardieu (1860) reported from the University of Paris, [10] documented the physical and sexual abuse of children mostly by their own caretakers. Also, Krafft-Ebbing [10] notes that between 1829 and 1870, 36,176 cases of child rape/assault were reported. During this period, prepubescent children were institutionalized for excessive masturbation. However, recent empirical research suggests that children who have been sexually abused may engage in excessive masturbation.

Nineteenth Century America
In the nineteenth century in America, the arrival of railways brought a new illness called "railway spine" [6]. Fatalities and injuries were reported among laborers and passengers from the first day of commercial services. Some workers sought compensation (for the first time in the history of PTSD) due to impairment. In those cases, psychological suffering was reported along with physical injury. Indeed, train accidents were common during that era. The famous novelist Charles Dickens was involved in a train crash in which 10 were killed and 49 wounded. He wrote about being weak, not being able to eat and sleep as well as being unable to concentrate on his writing because of feeling "faint and sick" and anxious about the exposure. At that moment, there was a big dispute as to whether the cause was physical or psychological. Some authorities supposed the symptoms to due to degeneration in nervous systems; some disagreed and proposed a purely psychological explanation that centered on hysteria. During the American Civil War (1861-1866), soldiers complained about the signs of lethargy and withdrawal sometimes called nostalgia as it is thought to be caused by overwhelming distress from being way from home. Later accounts have more to do with "heartache" and psychological discomfort. Although the motive and interest of soldiers participating in the civil war is not very clear and there were no objective descriptions of the symptoms dating back to that time so there is no doubt that many soldiers suffered from traumatic exposure.

Psychology
At the turn of the twentieth century, Janet [11] noted there is possible causal relationship between trauma and hysteria in their work with traumatized persons. Janet thought that traumatic memories of traumatic events persist as unassimilated fixed ideas that act as foci for the development of alternate states of consciousness, including dissociative phenomena, such as fugue states, amnesias and chronic states of helplessness and depression. Unbidden memories of the trauma may return as physical sensations, horrific images or nightmares, behavioral reenactments or a combination of these. Janet showed how traumatized individuals become fixated on the trauma and have difficulty in assimilating subsequent experiences as well. She stated that it was "as if their personality development has stopped at a certain point and cannot expand anymore by the accommodation or assimilation of new elements" Janet [11]. Furthermore, Janet proposed the role of dissociation between cognition and affect in the etiology of hysteria. Likewise, Janet's belief that posttraumatic sequelae were based in dissociation and that treatment consisted of synthesis and integration of traumatic material was widely accepted until psychoanalysis gained popularity at the beginning of the 20 th century [12]. Since then, Janet's ideas about dissociation and its relation to hysteria have been forgotten.