A historical narrative of mental health and war: from antiquity to the twenty-first century

Warfare has repeatedly reshaped psychiatry, compelling societies to confront the psychological, moral, and social consequences of organised violence. This review traces how ideas about war-related mental disorders have evolved from antiquity to today. Conditions once seen as moral weakness or imbalance (such as melancholia, nostalgia, and 'soldier's heart') were reinterpreted over time through medical and social change, leading to modern concepts like post-traumatic stress disorder (PTSD) and moral injury. While clinical attention historically centred on soldiers, modern conflicts demonstrate that civilians-particularly women, children, and displaced populations- bear disproportionate and enduring burdens, with high rates of depression, psychosis, substance misuse, and complex grief. Paradoxical patterns, including wartime declines in suicide linked to social cohesion, highlight the interplay between individual distress and collective purpose. The post-Vietnam recognition of PTSD advanced legitimacy and care but also exported a Western diagnostic lens that can obscure local expressions of suffering and structural determinants. Case studies from late twentieth- and twenty-first-century conflicts (e.g. the Balkans, Iraq-Afghanistan, Ukraine, Gaza) reveal persistent inequities in access to services, the politicisation of psychiatric categories, and the salience of community, faith, and meaning-making for recovery. Across eras, war psychiatry has oscillated between compassion and control, prevention and surveillance. Bridging historical insight with contemporary practice can better address the diverse and enduring psychological legacies of war, while foregrounding resilience and moral repair alongside symptom reduction.