The origins of the concept of Posttraumatic Stress Disorder (PTSD) are to be found in studies of combat veterans. In World War I, the term “shell shock” was used to describe the phenomenon, and it was essentially thought to be a physical problem. In World War II, it was called “battle fatigue” or “combat fatigue, ” and it was finally admitted to be psychological in origin. An even older term for it is “soldier's heart.” All these terms are imprecise, which reflected the level of understanding people had at the time.
Since it was first officially defined, thousands of articles and many books have come out dealing with various aspects of PTSD. Much of the vast amounts of amassed literature has focused on people who had a trauma inflicted upon them by outside forces. In most cases, they were passive victims. In other cases, they were rescue workers or emergency personnel—people who help such victims. What of those who were active in traumatic circumstances, and helped bring them about? Does a situation that is traumatic enough to cause these symptoms require a lack of control? Does the element of control keep the situation from being a trauma? Alternatively, is it just as bad since the graphic and horrifying nature of the situation is the same, and these are the most important elements? As yet another possibility, the symptoms could actually be more severe: active participation accentuates the trauma.
Very little of the literature has considered PTSD symptomatology among perpetrators. Most of this scant literature has analyzed participation in “atroci-