They Are The Sameand They Are Different
Shell shock is a term originally coined in 1915 by Charles Myers to describe soldiers who were involuntarily shivering, crying, fearful, and had constant intrusions of memory. It is not a term used in psychiatric practice today but remains in everyday use.
In a previous post, a question was asked of me by a young veteran of the Iraq War about the difference between post-traumaticstress and shell shock. He wrote:
“… I experienced an abrupt, highly jarring event during my first tour of combat in Iraq that caused me thereafter, for a couple of years, to react bracingly to the sound of low-flying aircraft. This reaction, to me, was ‘shell shock.’
During my second tour, I was exposed to prolonged combat, a constant sense of hopelessness, and an environment characterized by above-average friendly casualties. Although I failed to admit to its occurrence initially, my reaction upon return from this tour was something I consider more akin to post-traumatic stress. For a few years, for example, I dove fairly heavily into alcohol consumption.Methods less detrimental to my health, such as writing and reading, have replaced alcohol presently. However, the cause for all of these activities is the samea desire for mental escape, which I relate to a prolonged state of reaction to my probable post-traumatic stress.”
Is shell shock the same as PTSD? This is an intriguing question one that I’ve been scratching my head over for the last couple of weeks.
The Dawn Of Modern Psychiatry
The psychiatrist Pinel is often depicted as freeing the insane from their chains in his treatise entitled Nosographie Philosophique , he described the case of the philosopher Pascal who almost drowned in the Seine when the horses drawing his carriage bolted. During the remaining eight years of his life, Pascal had recurring dreams of a precipice on his left side and would place a chair there to prevent falling off his bed. His personality changed, and he became more apprehensive, scrupulous, withdrawn, and depressive. From his experience with patients shocked by the events and wars of the French Revolution, Pinel wrote the first precise descriptions of war neuroses – which he called cardiorespiratory neurosis – and acute stuporous posttraumatic states – which he called idiotism.
What Should You Not Say To Someone With Ptsd
10 Things Not to Say to Someone With PTSD
- What not to say: It wasnt even life-threatening.
- What not to say: People have been through worse.
- What not to say: Stop over-reacting.
- What not to say: Youre faking it.
- What not to say: Ive been through something similar and I dont have PTSD, so you dont have it either.
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Shell Shock And Combat Fatigue
From aerial combat to poison gas, WWI introduced terrifying new combat technology on a previously unimaginable scale, and soldiers left the front shattered. Seemingly overnight, the field of war psychiatry emerged and a new termshell shockappeared to describe a range of mental injuries, from facial tics to an inability to speak. Hundreds of thousands of men on both sides left World War I with what would now be called PTSD, and while some received a rudimentary form of psychiatric treatment, they were vilified after the war. As historian Fiona Reid notes, shell-shock treatment was constantly entwined with discipline in militaries that had trouble aligning their beliefs in courage and heroism with the reality of men who bore invisible wounds.
By World War II, psychiatrists increasingly recognized that combat would have mental health ramificationsand concluded that too many men who were prone to anxiety or neurotic tendencies had been selected to serve in the previous war. But though six times as many American men were screened and rejected for service in the lead-up to the World War II, military service still took its toll. About twice as many American soldiers showed symptoms of PTSD during World War II than in World War I. This time their condition was called psychiatric collapse, combat fatigue, or war neurosis.
What Are The 5 Stages Of Ptsd
What Are the Stages of PTSD?
- Impact or Emergency Stage. This phase occurs immediately after the traumatic event.
- Denial Stage. Not everybody experiences denial when dealing with PTSD recovery.
- Short-term Recovery Stage. During this phase, immediate solutions to problems are addressed.
- Long-term Recovery Stage.
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Did Ww2 Soldiers Suffer From Ptsd
Among those who had previously sought psychiatric treatment, 37% of the World War II veterans and 80% of the Korean War veterans had current PTSD. Rosen et al found that 54% of a group of psychiatric patients who had been in combat during World War II met criteria for PTSD. The prevalence of current PTSD was 27%.
What Was The Role Of The British Army In World War 1
Under the terms of the Entente Cordiale, the British Armys role in a European war was to embark soldiers of the British Expeditionary Force , which consisted of six infantry divisions and five cavalry brigades that were arranged into two Army corps: I Corps, under the command of Douglas Haig, and II Corps,
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Why Was Ptsd Called Shellshock
At that time, some symptoms of present-day PTSD were known as shell shock because they were seen as a reaction to the explosion of artillery shells. Symptoms included panic and sleep problems, among others. Thinking changed when more soldiers who had not been near explosions had similar symptoms.
Broken Soldiers Long To Return Home
First battle of Villmergen in Switzerland, depicted by an unknown 18th century artist
Dr. Johannes Hofer, a Swiss physician, coins the term “nostalgia” to refer to cases of homesickness, a condition that afflicted Swiss troops stationed far from home.
Around the same time, German and French doctors also diagnosed the condition as homesickness , as they believed the symptoms came from a soldier’s longing to return home. Spanish doctors called it “estar roto,” literally, “to be broken.”
“Nostalgia” remained a common mental illness for the next 200 years.
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When Germany Called Its Soldiers Hysterical
After WWI, German psychiatrists diagnosed traumatized soldiers as having hysteria, othering the men to somewhat disastrous effect.
For many soldiers who returned from World War I, the terror of combat never abated. Though the statistics are still fuzzy, at least one historian estimates that upwards of twenty percent of all soldiers suffered from shell shock, the early twentieth-century name for combat PTSD. But in Germany, shell shock was not considered an acceptable diagnosis. Instead, writes historian Paul Lerner, men who came back from the war with psychological trauma were dubbed hystericalwith disastrous consequences.
Male hysteria was not new in Germany. Lerner writes that the first mass instances of traumatic neurosis recorded in Germany happened among industrial workers who survived gruesome railroad and mining accidents. At first, these workers were compensated through pensions. Over the years, however, the public began believing that these accident victims only pretended to be sick in order to seek pension benefits.
Weekly Digest
What Was The Population Of France During World War 1
The French Empire of the First World War. The population of Metropolitan France during 1914 was 39,000,000. The French colonies had a population of roughly 50,000,000 which meant the total population for the French Empire of 89,000,000, however, similar to the British Empire, the majority of troops were drawn from the metropolitan population.
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A Shock To The System
In the early years of World War One, shell shock was believed to be the result of a physical injury to the nerves and being exposed to heavy bombardment.
Shell shock victims often couldn’t eat or sleep, whilst others continued to suffer physical symptoms.
| Shell Shock – The symptoms |
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Many soldiers found themselves re-living their experiences of combat long after the war had ended.
Officers suffered some of the worst symptoms because they were called upon to repress their emotions to set an example for their men.
War neurosis was four times higher among officers than among the regular soldiers.
The war poet Siegfried Sassoon, himself a victim, describes the psychological pain of shell shock in his poem Survivors.
He writes of soldiers with “dreams that drip with murder” and their “stammering, disconnected talk”.
Development Of The Ptsd Diagnosis
In 1952, the American Psychiatric Association produced the first Diagnostic and Statistical Manual of Mental Disorders , which included “gross stress reaction.” This diagnosis was proposed for people who were relatively normal, but had symptoms from traumatic events such as disaster or combat. A problem was that this diagnosis assumed that reactions to trauma would resolve relatively quickly. If symptoms were still present after six months, another diagnosis had to be made.
Despite growing evidence that trauma exposure was associated with psychiatric problems, this diagnosis was eliminated in the second edition of DSM . DSM-II included “adjustment reaction to adult life” which was clearly insufficient to capture a PTSD-like condition. This diagnosis was limited to three examples of trauma: unwanted pregnancy with suicidal thoughts, fear linked to military combat, and Ganser syndrome in prisoners who face a death sentence.
In 1980, APA added PTSD to DSM-III, which stemmed from research involving returning Vietnam War Veterans, Holocaust survivors, sexual trauma victims, and others. Links between the trauma of war and post-military civilian life were established.
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Ptsd In Epics And Classics
Long before the dawn of modern psychiatry, people and situations depicting PTSD may have been recorded in early works of literature.
For example, in the Epic of Gilgamesh, the earliest surviving major work of literature , the main character Gilgamesh witnesses the death of his closest friend, Enkidu. Gilgamesh is tormented by the trauma of Enkidus death, experiencing recurrent and intrusive recollections and nightmares related to the event.
Later, in a 440-B.C. account of the battle of Marathon, Greek historian Herodotus describes how an Athenian named Epizelus was suddenly stricken with blindness while in the heat of battle after seeing his comrade killed in combat. This blindness, brought on by fright and not a physical wound, persisted over many years.
Other ancient works, such as those by Hippocrates, describe soldiers who experienced frightening battle dreams. And outside of Greco-Latin classics, similar recurrent nightmares also show up in Icelandic literature, such as Gísli Súrsson Saga.
In the Indian epic poem Ramayana, likely composed around 2,500 years ago, the demon Marrich experiences PTSD-like symptoms, including hyper-arousal, reliving trauma, and avoidance behavior, after nearly being killed by an arrow. Marrich also gave up his natural duty of harassing monks and became a meditating recluse.
Nostalgia Soldier’s Heart And Railway Spine
Prior to U.S. military efforts, Austrian physician Josef Leopold wrote about “nostalgia” among soldiers. Among those who were exposed to military trauma, some reported missing home, feeling sad, sleep problems, and anxiety. This description of PTSD-like symptoms was a model of psychological injury that existed into the Civil War.
A second model of this condition suggested a physical injury as the cause of symptoms. “Soldier’s heart” or “irritable heart” was marked by a rapid pulse, anxiety, and trouble breathing. U.S. doctor Jacob Mendez Da Costa studied Civil War soldiers with these “cardiac” symptoms and described it as overstimulation of the heart’s nervous system, or “Da Costa’s Syndrome.” Soldiers were often returned to battle after receiving drugs to control symptoms.
The thought that physical injury led to PTSD-like symptoms was supported by European reports of “railway spine.” As rail travel became more common, so did railway accidents. Injured passengers who died had autopsies that suggested injury to the central nervous system. Of note, Charles Dickens was involved in a rail accident in 1865 and wrote about symptoms of sleeplessness and anxiety as a result of the trauma.
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World War Ii Years 1939
A Disease Called Nostalgia Torments Soldiers
Austrian physician Josef Leopold Auenbrugger describes the plight of trauma-stricken soldiers, in his book “Inventum Novum.”
“When young men who are still growing are forced to enter military service and thus lose all hope of returning safe and sound to their beloved homeland, they become sad, taciturn, listless, solitary, musing, full of sighs and moans. Finally, these cease to pay attention and become indifferent to everything which the maintenance of life requires of them. This disease is called nostalgia. Neither medicaments, nor arguments, nor promises, nor threats of punishment are able to produce any improvement.”
Josef Leopold Auenbrugger, a noted Austrian physician, in an undated portrait.
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Shell Shock And History
There was much medical commentary on shell shock during and immediately after the war yet historians paid little attention to its history until the late 1970s when Eric Leed argued that shell shock was a soldiers flight from intolerable reality and that neurosis provided men with a legitimate if temporary respite from the rigours of warfare. This was the first of numerous studies into military medicine and ethics. The recognition of Post-Traumatic Stress Disorder in 1980 prompted historians and medical experts to situate modern trauma in its historical context. This attention to the history of war neuroses was matched by a growth in the longer-term histories of shell-shocked men and their families, many of whom had to deal with the emotional impact of the war for years, or even decades, after the armistice.
A number of historians have recently incorporated the psychologically wounded into the wider medical history of the First World War, yet there has been no European survey of the history of shell shock. In response, this article offers a brief synthesis of combatant trauma throughout Europe. The focus is on the soldiers of the primary combatant nations on the western front because although men were traumatised in all areas, the conditions on the western front were unique, being characterised by highly industrial, intensive and static trench warfare. In consequence, the type of “mental cases” seen on the western front were not replicated in all sectors.
World War Ii: Long Deployments Cause Battle Fatigue
A Marine returns after two days of battle on the beaches of the Marshall Islands in February 1944.
British and American physicians use the terms “battle fatigue,” “combat fatigue,” and “gross stress reaction” to describe traumatic responses to combat during World War II. As the terms imply, the military believed that the condition was partly related to long deployments.
Historian Ben Shephard describes one British soldier’s emotional breakdown. The soldier collapsed and lost the ability to speak after he saw his best friend’s body blown apart by a landmine. He was transferred to a psychiatric hospital in Cairo, where a general described him as “tremulous, dazed, tearful, show the startle reflex.” Many of his fellow patients “had severe battle dreams and were restless and inclined to scream in their sleep.” The soldier returned to active duty 49 days later. After the war ended, his wife told a doctor that her husband was “well employed but inclined to rush out of doors when the children are noisy.”
“I sometimes get in a mood that I want to kill myself or somebody who has said something I dislike. It has only been since I came back from the front line. My life before I came into the army was uneventful but full of childish dreams,” recounted one British soldier after being evacuated to a psychiatric hospital.
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What Was Ptsd Called In Vietnam
Combat FatigueThe psychological effects of this war were seen in returning veterans as involuntary tics and shaking uncontrollably and named Shell Shock or War Neuroses. The term was replaced by Combat Fatigue and later, Combat Stress Reaction during WWII due to the longer tours and extensive time soldiers spent on the battlefields.
And Looking Back To My Left Coming Towards Me Was A Tram And It Was About 100
The First World War was the first time that the psychological trauma of warfare was formally recognised both by doctors and society at large. The condition became known as shell shock. While moving up to the trenches during his first time on the Western Front, NCO Frederick Holmes witnessed someone suffering from it.
We stayed the night in a building without a roof, there were four walls. And there I saw my first shell shock case, a fellow lying, crying and shaking like an aspen. It was pitiful really. I asked somebody what was his trouble and they said hes a shell shock case and he was just waiting to be transported down, home. It was a terrible thing, I didnt realise it was as bad as that. I thought it was pretty terrible but at the time I was still had that adventurous spirit and I wasnt afraid.
Shell shock could manifest itself in a variety of ways. Clifford Lane, of the Hertfordshire Regiment, remembered one example.
An inability to stop shaking and trembling was one common symptom of the condition. Alfred Griffin of the Kings Royal Rifle Corps remembered an instance of this.
Stretcher-bearer James Brady found that speechlessness was another way in which a man could be affected.
George Jameson thought the main reason that men suffered from shell shock was the Germans use of trench mortars, known as minenwerfers.
Some men were really shaken by a near miss. Stan Small of the Devonshire Regiment described an instance of this.
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