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The application of psychiatry to war and terrorism is highly topical and a source of intense media interest. Shell Shock to PTSD explores the central issues involved in maintaining the mental health of the armed forces and treating those who succumb to the intense stress of combat. Drawing on historical records, recent findings and interviews with veterans and psychiatrists, Edgar Jones and Simon Wessely present a comprehensive analysis of the evolution of military psychiatry. The psychological disorders suffered by servicemen and women from 1900 to the present are discussed and related to contemporary medical priorities and health concerns. This book provides a thought-provoking evaluation of the history and practice of military psychiatry, and places its findings in the context of advancing medical knowledge and the developing technology of warfare. It will be of interest to practicing military psychiatrists and those studying psychiatry, military history, war studies or medical history. Introduction. Part 1: Pre-1914 British Military Psychiatry. Wind Contusions, Nostalgia and Other Early War Syndromes. Irritable Heart and the Crimea. Disordered Action of the Heart. The Lunatic House, Chatham. 'D Block', Royal Victoria Hospital, Netley. The Boer War: DAH and Rheumatism. Railway Spine. Traumatic Neurastenia. The Russo-Japanese War. Balkan Wars (1912-13). Discussion. Part 2: Shell Shock and War Neuroses. Organisation of British Military Psychiatry. The Problem of Shell Shock. French Neurological Centres. British Forward Psychiatry. Psychiatry in the American Expeditionary Force. Base Hospitals. Psychical Treatments. DAH: The Continuing Problem. Gas Hysteria. Chemical Warfare: US Experience. Discussion. Part 3: Military Psychiatry in the Interwar Period. Psychiatrists in the Aftermath of World War One. Southborough Report. The Impact of the Military on Civilian Psychiatry. The Doldrums: Military Psychiatry in the 1920s and 1930s. Shell Shock in the Twenties and Thirties. Ex-Services Mental Welfare Society. Preparing for War. Discussion. Part 4: Recruitment of Psychiatrists. Dunkirk. No. 41 General (Neuropathic) Hospital. Belmont Hospital, Sutton: Slater and Sargant. Mill Hill EMS Hospital: Lewis and Jones. Directorate of Army Psychiatry: Management and Organisation. The Western Desert: The Rediscovery of PIE. No. 78 Neuropathic Hospital. Italy. D-Day and Northwest Europe. US Forward Psychiatry. Post-War Evaluation. Treatment in the UK: Hollymoor Military (P) Hospital, Northfield. Innovation in Treatment. 'Lack of Moral Fibre'. Discussion. Part 5: Screening and Selection. Experimental Phase. Screening World War Two. United Kingdom. Outcomes Screening: United States. Outcomes Screening: United Kingdom. Why Did Screening Fail in World War Two? Korean War. Post-1953. Post-Traumatic Stress Disorder. Discussion. Part 6: Post-1945: Korea, Vietnam and the Falklands. Restructuring for Peace. Post-War Re-evaluation: US Forces. Korean War. Medical Organisation. Psychiatric Casulties. Combat Exhaustion. Somatisation and Cold Injury. Vietnam: The Early Years. The Veterans Come Home. The Epidemiological Evidence. Vietnam: Conclusions. Falklands. Discussion. Part 7: War Pensions and Veterans' Pressure Groups. The Royal Hospital, Chelsea. The Boer War (1899-1902). World War One: Ministry of Pensions and Shell Shock. Veterans' Pressure Groups. The British Legion. Curtailment of Pensions. The Horder Conference. Impact of War. Comrades Associations. US Veterans Groups and the Vietnam War. Glossary of Technical Terms. 'This book is a comprehensive analysis of the history and development of military psychiatry... it provides a fascinating insight to the attempts made to manage and treat war personnel and veterans. It will be of interest to those interested in the classification and development of psychological disorders. The book would be a useful addition to any psychiatric library.' - Joseph Curran, Mental Health Practice, July 2005

\"They called it Shell Shock provides a new perspective on the psychological reactions to the traumatic experiences of combat. In the Great War, soldiers were incapacitated by traumatic disorders at an epidemic scale that surpassed anything known from previous armed conflicts. Drawing upon individual histories from British and German servicemen, this book illustrates the universal suffering of soldiers involved in this conflict and its often devastating consequences for their mental health. Dr Stefanie Linden explains how shell shock challenged the fabric of pre-war society, including its beliefs about gender (superiority of the male character), class (superiority of the officer class) and scientific progress. She argues that the shell shock epidemic had enduring consequences for the understanding of the human mind and the power that it can exert over the body.\"

Objective To identify the impact of the first world war on the lifespan of participating military personnel (including in veterans who survived the war).Design Comparison of two cohorts of military personnel, followed to death.Setting Military personnel leaving New Zealand to participate in the first world war.Participants From a dataset of the New Zealand Expeditionary Forces, we randomly selected participants who embarked on troopships in 1914 and a comparison non-combat cohort who departed on troopships in late 1918 (350 in each group).Main outcome measures Lifespan based on dates of birth and death from a range of sources (such as individual military files and an official database of birth and death records).Results A quarter of the 1914 cohort died during the war, with deaths from injury predominating (94%) over deaths from disease (6%). This cohort had a significantly shorter lifespan than the late 1918 “non-combat” cohort, with median ages of death being 65.9 versus 74.2, respectively (a difference of 8.3 years shown also in Kaplan-Meier survival curves, log rank P<0.001). The difference for the lifespan of veterans in the postwar period was more modest, with median ages of death being 72.6 versus 74.3, respectively (a difference of 1.7 years, log rank P=0.043). There was no evidence for differences between the cohorts in terms of occupational class, based on occupation at enlistment.Conclusions Military personnel going to the first world war in 1914 from New Zealand lost around eight years of life (relative to a comparable military cohort). In the postwar period they continued to have an increased risk of premature death.

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the efficacy of forward psychiatry were inflated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance—not as an opportunity for self-congratulation.

Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of ‘psychopathic constitution’ or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

During the First World War, thousands of soldiers were treated for \"shell shock,\" a condition which encompassed a range of physical and psychological symptoms. Shell shock has most often been located within a \"genealogy of trauma,\" and identified as an important marker in the gradual recognition of the psychological afflictions caused by combat. In recent years, shell shock has increasingly been viewed as a powerful emblem of the suffering of war. This article, which focuses on Britain, extends scholarly analyses which question characterizations of shell shock as an early form of post-traumatic stress disorder. It also considers some of the methodological problems raised by recasting shell shock as a wartime medical construction rather than an essentially timeless manifestation of trauma. It argues that shell shock must be analyzed as a diagnosis shaped by a specific set of contemporary concerns, knowledges, and practices. Such an analysis challenges accepted understandings of what shell shock \"meant\" in the First World War, and also offers new perspectives on the role of shell shock in shaping the emergence of psychology and psychiatry in the early part of the twentieth century. The article also considers what relation, if any, might exist between intellectual and other histories, literary approaches, and perceptions of trauma as timeless and unchanging.

According to the Roll‐of‐Honour dataset for New Zealand military forces in the First World War, the last New Zealand soldiers “killed in action” in this war died on 7 November 1918, one hundred years ago this year of writing. They were Frank Gardner, Donald Stewart Kennedy, and Andrew Mather, who were all killed at Le Quesnoy in France. They died four days before the war officially ended and are buried at Cross Roads Cemetery, Fontaine‐au‐Bois, Nord, France. The centenary of these deaths and this war’s end seems an appropriate time to review its health impacts along with what might remain to be discovered about these impacts. To do this, we examined key official New Zealand history resources (NZ History, and Te Ara) and conducted PubMed searches. Search terms for the latter included combinations of: “world war”, “Zealand”, “ANZAC”, “Australasia”, “Gallipoli” and “pandemic influenza”. Searches were conducted on 19 January 2018.

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain’s leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient’s military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

Herodotus' account of the Athenian spear carrier Epizelus' psychogenic mutism following the Marathon Wars is usually cited as the first documented account of post-traumatic stress disorders in historical literature. This paper describes much earlier accounts of post combat disorders that were recorded as occurring in Mesopotamia (present day Iraq) during the Assyrian dynasty (1300-609 bc). The descriptions in this paper include many symptoms of what we would now identify in current diagnostic classification systems as post-traumatic stress disorders, including flashbacks, sleep disturbance and low mood. The Mesopotamians explain the disorder in terms of spirit affliction; the spirit of those enemies whom the patient had killed during battle causing the symptoms.