No wonder Achilles sometimes wet the bed …
Post-traumatic stress disorder (PTSD) is now a well-accepted aspect of modern soldiering, and it seems to be now recognized that earlier disorders of soldiers such as shell shock that might once have been described as cowardice or weakness were in fact manifestations of the same condition. I did not know, however, that there are accounts from ancient times of this phenomenon occurring amongst soldiers from very different types of warfare, and it isn’t the case that PTSD is a function only of modern warfare. Today I discovered an article describing symptoms of PTSD in Assyrian warriors, from Iraq between 1300 and 600 BC, which were taken from cuneiform tablets. Apparently the Assyrians had a form of military service, with military age males spending one of every three years of their service in combat, and the Assyrians kept extensive documentation of both their campaigns and their medical practice. The article, published in the journal Early Science and Medicine, reports on symptoms of PTSD (especially seeing ghosts and nightmares) taken from some of these tablets. It also gives a bit of detail about Assyrian medical practice, and the importance of diagnosis to Assyrian doctors. The article is a bit jumbled up and confusing, but it makes the case that PTSD is not just associated with modern, extremely lethal soldiering, but is associated in the case of these ancient warriors with fear of death, the sight of colleagues dying, and also the fear of slow death from injury.
The findings themselves aren’t groundbreaking, but I am interested in the general finding of PTSD in ancient soldiers and its documentation. As role-players, we often play warriors engaged in quite brutal old-fashioned combat, often engaged with horrible things from beyond the grave, but in the older games there is no mechanism for the gradual erosion of confidence and strength that constant terror of this kind might cause – indeed, the classic model of gaining XP from experience suggests that our soldiers only gain in strength from continued exposure to slaughter and near death (or, in many cases, death and resurrection!) Of course some of the more modern games have mechanisms for insanity and humanity loss, but these are generally primarily triggered by exposure to sinister magic and beasts from beyond, not from the “mundane” horrors of seeing your friends dismembered, clubbed to death, burnt alive or eaten by zombies. Upon reflection it seems obvious that this would tend to wear one down, and it appears that published accounts from people who did a lot of stabbing, smashing and clubbing to death support the idea that it is a disturbing and sometimes enervating experience.
Some of the symptoms are also quite profound: blindness or deafness, sudden weakness, and loss of sleep. It’s easy to imagine that in a classic D&D setting the inability to sleep would be crippling for a wizard. Inserting some kind of simple mechanic for PTSD from continued battlefield exposure – perhaps ramping it up for multiple back to back battles – would lead to a quite interesting change in play style and get people rethinking battlefield strategies, especially if even “mundane” combat could bring it about, and if it was related more to the length of exposure than the intensity. Players would reconsider frontal assault tactics if there was the possibility that their wizard would suddenly freak out and decide to blow himself up … or their cleric became a shivering wreck incapable of healing them.
I guess we have a tendency to think about psychological health of our characters only in terms of their exposure to hideous dark secrets from beyond the veil. We imagine ourselves as heroes whose basic psychology and morality can only be tempered with by the gods and dark magics. Apparently, and not really surprisingly, the reality is rather different. It would be interesting to see how the tone and style of classic fantasy play would change if it were modified to make the psychology, as well as physiology, of its heroes vulnerable to the slings and arrows of their horde of enemies…
Compromise and Conceit 
January 26, 2015 at 8:28 am
It can go both ways, though. A lot of very effective ancient and medieval armies had cores of veterans who had been through scores of battles – aged up to 60. For these guys, killing was just a day’s work. Maybe for the same reason, urban insurrections were often led by butchers, who slept soundly after a day in the shambles and had no qualms about cutting down a bodyguard.
PTSD is also a very wide diagnosis. Shell-shock is increasingly seen as down to neurological damage. Ancient warriors, battered by slings and clubs, may well have had the same problems. Of course, the brain can repair itself, given rest and time….
January 26, 2015 at 2:45 pm
Some time ago I read an article about modern soldiers and the stress of war, I think it may have been about the popular image of Vietnam vets as broken souls, in which the author described how many men found combat to be an empowering experience, and recall their experience of war in a positive light. I guess part of the purpose of research on PTSD is to understand who is affected and why – it does seem to be very random, not just in who it strikes but in when. I wonder if it was more predictable in ancient battles because you were more likely to have direct control over your own death – not cut down by an IED or a bullet fired from 2km away that you didn’t even see, but only harmed through your own failings in personal combat.
The D&D model of adventuring only allows people to benefit psychologically from combat, whereas a more nuanced model would occasionally break PCs. I like the Warhammer 3 approach to this – too much stress and fatigue just immediately puts you at risk of insanity, which is a very real and direct measure of the psychological risk of combat. But then, it is a grim and perilous world …
Regarding brain injury and shock, when I was training kickboxing at a high rate and doing a lot of sparring a few years back I did notice that I would sometimes behave irrationally after sparring sessions, and I realized the reason was simple brain injury. Not concussion or anything serious, but being repeatedly hit in the head leaves you both exhausted and somewhat moody afterwards, and not from fear – I would leave sparring classes elated and happy, but then become irrational an hour later. I think this phenomenon has been observed in IED survivors who often have hidden brain injury. One would think it would be very prevalent in ancient soldiers, especially the armoured variety …
January 26, 2015 at 5:43 pm
In RPGs, the PTSD effects should be expected to be (at least partially) offset by magic (especially at the medium and high levels). That’s just a feature of a setting where magic gets to interact with the mechanics of the game (unless you specifically say that PTSD can’t be magic’d).
The other downside of putting in mechanics for PTSD is that logically, if you can heal it you should be able to inflict it. In may games, inflicting a mental effect on a PC is regarded as as bad (or worse) than killing the PC because it reduces the control of the player over the character. Just look at how Domination and Confusionspells have been nerfed across D&D editions.
Allowing PTSD style effects (or any insanity effects) would be strongly frowned upon by many players if the mechanics had any teeth. This probably reflects the wish fulfillment nature of basic RPGs – no one plays a game to pretend to be a powerless twerk who has no say in the direction of the game. That’s what real life is for…
January 28, 2015 at 11:41 pm
I think you’re right that this reflects the different genres and associated expectations. Anyone who played WFRP2 for a long time has to be a masochist, whereas the majority of people playing classic RPGs just want to be heroes, not the powerless people we are in real life. I guess that’s why the WFRP 3 insanity mechanic was really just a mild disability with a role-playing hook (until you accrue lots of insanity and need to be put down like a dog). I guess balance is really hard to find when you’re trying to describe the effect of creeping horrors from beyond space and time without reducing the game to “I’ll hide quivering in the closet.” But maybe classic combat PTSD could be mild enough to make accrued combat a pain without being completely destructive …?
February 18, 2015 at 3:49 pm
I just came across an ad for a game that may actually provide a PTSD like mechanic: https://www.humblebundle.com/store/p/darkestdungeon_storefront
Specific selling points that look relevant are:
– The Affliction System – battle not only monsters, but stress! Contend with paranoia, masochism, fear, irrationality, and a host of gameplay-meaningful quirks!
– Rest your weary, shell-shocked characters in town at the Tavern or the Abbey to keep their stress in check.
I’d say such mechanisms are easier to play in a PC game as 1) it’s tracked automatically for you 2) there is (frequently) a save and reload mechanism if you hate the outcome and 3) I find I have a lower connection to PC game characters (as much as I love some of them).
July 5, 2016 at 5:21 pm
Battlefield 1 Download PC
Post Traumatic Stress Disorder in Ancient Warriors | Compromise and Conceit