Post-traumatic stress disorder (PTSD) is a common theme in any discussion of modern war and its devastating ramifications. But did you know PTSD wasn’t formally recognized and described until 1980?

Before its formal recognition by psychiatrists, PTSD’s symptoms had been observed and documented under various names and contexts, particularly in relation to war experiences. During World War I, it was called “shell shock,” and in World War II, it was referred to as “combat fatigue” or “war neurosis.” Despite these observations, it wasn’t until the Vietnam War that the psychological impact on soldiers led to a concerted effort to understand and categorize the condition.

However, war predates history itself and one can confidently assume PTSD has haunted veterans since time immemorial. In this context, recent research of ancient clay tablets dating to 1300 BCE from Mesopotamia documents the earliest instances of war-related PTSD known thus far.

These revelations suggest that Mesopotamian cultures took the specter of war quite literally. In an interview with BBC News, study authors Walid Khalid Abdul-Hamid of Queen Mary University of London and Jamie Hacker Hughes of the Veterans and Families Institute at Anglia Ruskin University said that the Assyrian soldiers “described hearing and seeing ghosts talking to them, who would be the ghosts of people they’d killed in battle – and that’s exactly the experience of modern-day soldiers who’ve been involved in close hand-to-hand combat.”

Nothing new under the sun

Professional soldiers enlisted by the Assyrian Dynasty in Mesopotamia, present-day Iraq, first went through a year-long bootcamp, which could have also involved civil works like building roads, bridges, and other infrastructure for the kingdom. The soldiers were then sent to war for a year and, if they made it back in one piece, they were allowed to return to their families for one year before repeating the three-year rotation.

However, the Assyrians were an extremely aggressive and expansionist state. Virtually every spring, they would launch a new military campaign, so each surviving soldier was expected to fight in many different wars throughout their careers.

But as the ancient texts analyzed by the researchers showed, although their bodies might have come back home from a campaign intact, some of these ancient soldiers’ minds were in shatters. Some of the tablets were written by Assyrian physicians, who — with the limited scientific knowledge and obligatory superstitious mindset typical of the time — performed diagnoses on soldiers returning from battle and prescribed more or less unorthodox remedies.

Ancient PTSD uncovered

Some of the tablets diagnose the Assyrian soldiers with “mental wounds”. In the case of one patient, the doctor mentions “his words are unintelligible for three days” and “in the evening, he sees either a living person or a dead person…and becomes afraid; he turns around but…his mouth is seized so that he is unable to cry out to one who sleeps next to him.” The ward off these spirits, the doctors prescribed medicine and religious rituals.

As in other ancient cultures, the Assyrians believed that the fate and destiny of each person were intertwined, as ordained by the gods. It followed that many diseases were the patient’s fault — an act of divine punishment for some past transgression.

In the case of veterans, what we would now call mental illness caused by extreme psychological trauma was pegged to ghosts and demons visiting the tormented patient. However, we now know that flashbacks or re-experiencing is a core symptom of PTSD. It involves vividly recalling the traumatic event as if it were happening again, often triggered by reminders of the original trauma — something that could have easily been mistaken for ghostly apparitions.

Before this study, the oldest reference to PTSD-like symptoms came from ancient Greece, in texts by Herodotus describing the aftermath of the infamous Battle of Marathon in 490 BCE. Herodotus claimed that some Athenian warriors had hallucinations and suffered from spontaneous blindness following their close encounter with death on the battlefield. Achilles, hero of the Trojan War, is commonly held to be an ancient patient of PTSD as well. In one potential account of Medieval PTSD, one chronicler described the Crusaders coming home from the Third Crusade (1189-92), writing that though these men “survived unharmed … their hearts were pierced by swords of sorrows from different sorts of suffering”.

All that’s to say that PTSD and war have always been an inescapable duo. According to a 2016 study, 10% of male and 20% of female veterans who served on combat tours in the U.S. military suffer from PTSD, with some studies reporting much higher figures. Although I can only speculate, one can fairly assume the rates of PTSD were much worse in ancient times for the simple reason that war used to be much more brutal. During modern warfare, with artillery, tanks, jet fighter planes, and scoped rifles, it’s extremely rare for regular troops to come face to face with the enemy. However, during ancient warfare where melee was the norm, there was no escaping coming intimately close to the enemy. The horrors of an entire battlefield riddled with thousands of eviscerated corpses cannot be put into words.

“Ancient soldiers facing the risk of injury and death must have been just as terrified of hardened and sharpened swords, showers of sling-stones or iron-hardened tips of arrows and fire arrows. The risk of death and the witnessing of the death of fellow soldiers appears to have been a major source of psychological trauma,” the paper reads. “Moreover, the chance of death from injuries, which can nowadays be surgically treated, must have been much greater in those days. All these factors contributed to post-traumatic or other psychiatric stress disorders resulting from the experience on the ancient battlefield.” 

Although PTSD is challenging (and sometimes impossible) to diagnose from text alone, these accounts show that trauma and distress haunted veterans likely since humans first waged war on one another. The Mesopotamians’ blend of supernatural and medical treatments offers a fascinating glimpse into the early efforts to alleviate the mental scars of battle.

This article originally appeared in 2022 and was updated with new information.