Peace activist Jane Addams (Johnson, 1960) described symptoms of PTSD during World War I and ascribed the symptoms to the act of killing. In addition, there were a few early scholarly articles noting the distinction between passive victimization and active causing of the trauma before the American Psychiatric Association published the term and diagnostic criteria for PTSD in DSM-III in 1980.
Haley (1974) and Shatan (1978) separately pointed out that when the patient reports atrocities, therapists have more trouble listening. This could, of course, make patients less likely to report such events. If so, gaining knowledge of the psychological aftereffects of participating could be impaired.
Strayer and Ellenhorn (1975) found that participation in atrocities brought more symptoms in terms of withdrawal, hostility, and life-outcome maladjustment. Introversion accentuated the problems, but those with the authoritarian personality had the opposite reaction and had good life-outcome adjustment. Whether the latter finding has any validity in other samples has not been pursued.
Breslau and Davis (1987) commented that participation in atrocities and the cumulative exposure to combat stressors, each independently of the other, conferred a significant risk for PTSD. Hendin and Haas (1984) make a similar case, but from the opposite direction. They say, “we will discuss our study of combat veterans who have not developed posttraumatic stress. It is significant that none of the veterans in that group was involved in non-military violence” (p. 28).