Combat stress reaction

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Combat stress reaction
WW2 Marine after Eniwetok assault.jpg
A U.S. Marine, Pvt. Theodore J. Miller, exhibits a "thousand-yard stare", an unfocused, despondent and weary gaze which is a frequent manifestation of "combat fatigue"
Specialty Psychiatry

Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder.

Contents

Combat stress reaction is an acute reaction that includes a range of behaviors resulting from the stress of battle that decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and the inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction. The US Army uses the term/initialism COSR (combat stress reaction) in official medical reports. This term can be applied to any stress reaction in the military unit environment. Many reactions look like symptoms of mental illness (such as panic, extreme anxiety, depression, and hallucinations), but they are only transient reactions to the traumatic stress of combat and the cumulative stresses of military operations. [1]

In World War I, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The nature of trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was about 57%. [2] Whether a person with shell-shock was considered "wounded" or "sick" depended on the circumstances. Soldiers were personally faulted for their mental breakdown rather than their war experience. The large proportion of World War I veterans in the European population meant that the symptoms were common to the culture.

In World War II it was determined by the US Army that the time it took for a soldier to experience combat fatigue while fighting on the front lines was somewhere between 60 and 240 days, depending on the intensity and frequency of combat. This condition isn't new among the combat soldiers and was something that soldiers also experienced in World War I as mentioned above, but this time around the military medicine was gaining a better grasp and understanding of what exactly was causing it. What had been known in previous wars as "nostalgia", "old sergeant's disease", and "shell shock", became known as "combat fatigue". [3]

Signs and symptoms

Combat stress reaction symptoms align with the symptoms also found in psychological trauma, which is closely related to post-traumatic stress disorder (PTSD). CSR differs from PTSD (among other things) in that a PTSD diagnosis requires a duration of symptoms over one month,[ citation needed ] which CSR does not.

The most common stress reactions include:

  • The slowing of reaction time
  • Slowness of thought
  • Difficulty prioritizing tasks
  • Difficulty initiating routine tasks
  • Preoccupation with minor issues and familiar tasks
  • Indecision and lack of concentration
  • Loss of initiative with fatigue
  • Exhaustion

Autonomic nervous system – autonomic arousal

Battle casualty rates

The ratio of stress casualties to battle casualties varies with the intensity of the fighting. With intense fighting, it can be as high as 1:1. In low-level conflicts, it can drop to 1:10 (or less). Modern warfare embodies the principles of continuous operations with an expectation of higher combat stress casualties. [4]

The World War II European Army rate of stress casualties of 1 in 10 (101:1,000) troops per annum is skewed downward from both its norm and peak by data by low rates during the last years of the war. [5]

Diagnosis

The following PIE principles were in place for the "not yet diagnosed nervous" (NYDN) cases:

United States medical officer Thomas W. Salmon is often quoted as the originator of these PIE principles. However, his real strength came from going to Europe and learning from the Allies and then instituting the lessons. By the end of the war, Salmon had set up a complete system of units and procedures that was then the "world's best practice".[ citation needed ] After the war, he maintained his efforts in educating society and the military. He was awarded the Distinguished Service Medal for his contributions. [6]

Effectiveness of the PIE approach has not been confirmed by studies of CSR, and there is some evidence that it is not effective in preventing PTSD. [7]

US services now use the more recently developed BICEPS principles:

Between the wars

The British government produced a Report of the War Office Committee of Inquiry into "Shell-Shock", which was published in 1922. Recommendations from this included:

In forward areas
No soldier should be allowed to think that loss of nervous or mental control provides an honorable avenue of escape from the battlefield, and every endeavor should be made to prevent slight cases leaving the battalion or divisional area, where treatment should be confined to provision of rest and comfort for those who need it and to heartening them for return to the front line.
In neurological centers
When cases are sufficiently severe to necessitate more scientific and elaborate treatment they should be sent to special Neurological Centers as near the front as possible, to be under the care of an expert in nervous disorders. No such case should, however, be so labelled on evacuation as to fix the idea of nervous breakdown in the patient's mind.
In base hospitals
When evacuation to the base hospital is necessary, cases should be treated in a separate hospital or separate sections of a hospital, and not with the ordinary sick and wounded patients. Only in exceptional circumstances should cases be sent to the United Kingdom, as, for instance, men likely to be unfit for further service of any kind with the forces in the field. This policy should be widely known throughout the Force.
Forms of treatment
The establishment of an atmosphere of cure is the basis of all successful treatment, the personality of the physician is, therefore, of the greatest importance. While recognizing that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority by the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided by such physical methods as baths, electricity and massage. Rest of mind and body is essential in all cases.
The committee are of opinion that the production of deep hypnotic sleep, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.
They do not recommend psycho-analysis in the Freudian sense.
In the state of convalescence, re-education and suitable occupation of an interesting nature are of great importance. If the patient is unfit for further military service, it is considered that every endeavor should be made to obtain for him suitable employment on his return to active life.
Return to the fighting line
Soldiers should not be returned to the fighting line under the following conditions:
(1) If the symptoms of neurosis are of such a character that the soldier cannot be treated overseas with a view to subsequent useful employment.
(2) If the breakdown is of such severity as to necessitate a long period of rest and treatment in the United Kingdom.
(3) If the disability is anxiety neurosis of a severe type.
(4) If the disability is a mental breakdown or psychosis requiring treatment in a mental hospital.
It is, however, considered that many of such cases could, after recovery, be usefully employed in some form of auxiliary military duty.

Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.

By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so were getting pensions for 'soldier's heart' or effort syndrome. There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg." [8]

War correspondent Philip Gibbs wrote:

Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening. [8]

One British writer between the wars wrote:

There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to compensation. This is hard saying. It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness. But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to 'shock' because they get something out of it. To give them this reward is not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state by implication that an unconscious cowardice or an unconscious dishonesty will be rewarded. [8]

World War II

American

At the outbreak of World War II, most in the United States military had forgotten the treatment lessons of World War I. Screening of applicants was initially rigorous, but experience eventually showed it to lack great predictive power.

The US entered the war in December 1941. Only in November 1943 was a psychiatrist added to the table of organization of each division, and this policy was not implemented in the Mediterranean Theater of Operations until March 1944. By 1943, the US Army was using the term "exhaustion" as the initial diagnosis of psychiatric cases, and the general principles of military psychiatry were being used. General Patton's slapping incident was in part the spur to institute forward treatment for the Italian invasion of September 1943. The importance of unit cohesion and membership of a group as a protective factor emerged.

John Appel found that the average American infantryman in Italy was "worn out" in 200 to 240 days and concluded that the American soldier "fights for his buddies or because his self respect won't let him quit". After several months in combat, the soldier lacked reasons to continue to fight because he had proven his bravery in battle and was no longer with most of the fellow soldiers he trained with. [9] Appel helped implement a 180-day limit for soldiers in active combat [10] and suggested that the war be made more meaningful, emphasizing their enemies' plans to conquer the United States, encouraging soldiers to fight to prevent what they had seen happen in other countries happen to their families. Other psychiatrists believed that letters from home discouraged soldiers by increasing nostalgia and needlessly mentioning problems soldiers could not solve. William Menninger said after the war, "It might have been wise to have had a nation-wide educational course in letter writing to soldiers", and Edward Strecker criticized "moms" (as opposed to mothers) who, after failing to "wean" their sons, damaged morale through letters. [9]

Airmen flew far more often in the Southwest Pacific than in Europe, and although rest time in Australia was scheduled, there was no fixed number of missions that would produce transfer out of combat, as was the case in Europe. Coupled with the monotonous, hot, sickly environment, the result was bad morale that jaded veterans quickly passed along to newcomers. After a few months, epidemics of combat fatigue would drastically reduce the efficiency of units. Flight surgeons reported that the men who had been at jungle airfields longest were in bad shape:

Many have chronic dysentery or other disease, and almost all show chronic fatigue states. ... They appear listless, unkempt, careless, and apathetic with almost mask-like facial expression. Speech is slow, thought content is poor, they complain of chronic headaches, insomnia, memory defect, feel forgotten, worry about themselves, are afraid of new assignments, have no sense of responsibility, and are hopeless about the future. [11]

British

Unlike the Americans, the British leaders firmly held the lessons of World War I. It was estimated that aerial bombardment would kill up to 35,000 a day, but the Blitz killed only 40,000 in total. The expected torrent of civilian mental breakdown did not occur. The Government turned to World War I doctors for advice on those who did have problems. The PIE principles were generally used. However, in the British Army, since most of the World War I doctors were too old for the job, young, analytically trained psychiatrists were employed. Army doctors "appeared to have no conception of breakdown in war and its treatment, though many of them had served in the 1914–1918 war." The first Middle East Force psychiatric hospital was set up in 1942. With D-Day for the first month there was a policy of holding casualties for only 48 hours before they were sent back over the Channel. This went firmly against the expectancy principle of PIE. [8]

Appel believed that British soldiers were able to continue to fight almost twice as long as their American counterparts because the British had better rotation schedules and because they, unlike the Americans, "fight for survival" – for the British soldiers, the threat from the Axis powers was much more real, given Britain's proximity to mainland Europe, and the fact that Germany was concurrently conducting air raids and bombarding British industrial cities. Like the Americans, British doctors believed that letters from home often needlessly damaged soldiers' morale. [9]

Canadian

The Canadian Army recognized combat stress reaction as "Battle Exhaustion" during the Second World War and classified it as a separate type of combat wound. Historian Terry Copp has written extensively on the subject. [12] In Normandy, "The infantry units engaged in the battle also experienced a rapid rise in the number of battle exhaustion cases with several hundred men evacuated due to the stress of combat. Regimental Medical Officers were learning that neither elaborate selection methods nor extensive training could prevent a considerable number of combat soldiers from breaking down." [13]

Germans

In his history of the pre-Nazi Freikorps paramilitary organizations, Vanguard of Nazism, historian Robert G. L. Waite describes some of the emotional effects of World War I on German troops, and refers to a phrase he attributes to Göring: men who could not become "de-brutalized". [14]

In an interview, Dr Rudolf Brickenstein stated that:

... he believed that there were no important problems due to stress breakdown since it was prevented by the high quality of leadership. But, he added, that if a soldier did break down and could not continue fighting, it was a leadership problem, not one for medical personnel or psychiatrists. Breakdown (he said) usually took the form of unwillingness to fight or cowardice. [15]

However, as World War II progressed there was a profound rise in stress casualties from 1% of hospitalizations in 1935 to 6% in 1942.[ citation needed ] Another German psychiatrist reported after the war that during the last two years, about a third of all hospitalizations at Ensen were due to war neurosis. It is probable that there was both less of a true problem and less perception of a problem. [15]

Finns

The Finnish attitudes to "war neurosis" were especially tough. Psychiatrist Harry Federley, who was the head of the Military Medicine, considered shell shock as a sign of weak character and lack of moral fibre. His treatment for war neurosis was simple: the patients were to be bullied and harassed until they returned to front line service.[ citation needed ]

Earlier, during the Winter War, several Finnish machine gun operators on the Karelian Isthmus theatre became mentally unstable after repelling several unsuccessful Soviet human wave assaults on fortified Finnish positions.

Post-World War II developments

Simplicity was added to the PIE principles by the Israelis: in their view, treatment should be brief, supportive, and could be provided by those without sophisticated training.

Peacekeeping stresses

Peacekeeping provides its own stresses because its emphasis on rules of engagement contains the roles for which soldiers are trained. Causes include witnessing or experiencing the following:

  • Constant tension and threat of conflict.
  • Threat of land mines and booby traps.
  • Close contact with severely injured and dead people.
  • Deliberate maltreatment and atrocities, possibly involving civilians.
  • Cultural issues.
  • Separation and home issues.
  • Risk of disease including HIV.
  • Threat of exposure to toxic agents.
  • Mission problems.
  • Return to service. [16]

Pathophysiology

SNS activation

A U.S. Long Range Reconnaissance Patrol leader in Vietnam, 1968. Long-range patrolling.jpg
A U.S. Long Range Reconnaissance Patrol leader in Vietnam, 1968.

Many of the symptoms initially experienced by people with CSR are effects of an extended activation of the human body's fight-or-flight response. The fight-or-flight response involves a general sympathetic nervous system discharge in reaction to a perceived stressor and prepares the body to fight or run from the threat causing the stress. Catecholamine hormones, such as adrenaline or noradrenaline, facilitate immediate physical reactions associated with a preparation for violent muscular action. Although the flight-or-fight-response normally ends with the removal of the threat, the constant mortal danger in combat zones likewise constantly and acutely stresses soldiers. [17]

General adaptation syndrome

The process whereby the human body responds to extended stress is known as general adaptation syndrome (GAS). After the initial fight-or-flight response, the body becomes more resistant to stress in an attempt to dampen the sympathetic nervous response and return to homeostasis. During this period of resistance, physical and mental symptoms of CSR may be drastically reduced as the body attempts to cope with the stress. Long combat involvement, however, may keep the body from homeostasis and thereby deplete its resources and render it unable to normally function, sending it into the third stage of GAS: exhaustion. Sympathetic nervous activation remains in the exhaustion phase and reactions to stress are markedly sensitized as fight-or-flight symptoms return. If the body remains in a state of stress, then such more severe symptoms of CSR as cardiovascular and digestive involvement may present themselves. Extended exhaustion can permanently damage the body. [18]

Treatment

7 Rs

The British Army treated Operational Stress Reaction according to the 7 Rs: [19]

Predeployment preparation

Screening

Historically, screening programs that have attempted to preclude soldiers exhibiting personality traits thought to predispose them to CSR have been a total failure. Part of this failure stems from the inability to base CSR morbidity on one or two personality traits. Full psychological work-ups are expensive and inconclusive, while pen and paper tests are ineffective and easily faked. In addition, studies conducted following WWII screening programs showed that psychological disorders present during military training did not accurately predict stress disorders during combat. [20]

Cohesion

While it is difficult to measure the effectiveness of such a subjective term, soldiers who reported in a WWII study that they had a "higher than average" sense of camaraderie and pride in their unit were more likely to report themselves ready for combat and less likely to develop CSR or other stress disorders. Soldiers with a "lower than average" sense of cohesion with their unit were more susceptible to stress illness. [21]

Training

Stress exposure training or SET is a common component of most modern military training. There are three steps to an effective stress exposure program. [22]

  • Providing knowledge of the stress environment

Soldiers with a knowledge of both the emotional and physical signs and symptoms of CSR are much less likely to have a critical event that reduces them below fighting capability. Instrumental information, such as breathing exercises that can reduce stress and suggestions not to look at the faces of enemy dead, is also effective at reducing the chance of a breakdown. [23]

  • Skills acquisition

Cognitive control strategies can be taught to soldiers to help them recognize stressful and situationally detrimental thoughts and repress those thoughts in combat situations. Such skills have been shown to reduce anxiety and improve task performance. [24] [25]

  • Confidence building through application and practice

Soldiers who feel confident in their own abilities and those of their squad are far less likely to develop combat stress reaction. Training in stressful conditions that mimic those of an actual combat situation builds confidence in the abilities of themselves and the squad. As this training can actually induce some of the stress symptoms it seeks to prevent, stress levels should be increased incrementally as to allow the soldiers time to adapt. [26] [27]

Narcosynthesis

A technique that was used to treat PTSD disorders during World War II by using sodium pentothal was created by psychiatrists Roy Grinker and John Spiegel. During the treatment, they offered soldiers an opportunity to abreact their trauma by re-experiencing it in a hospital environment in the presence of supportive, protective, and understanding therapists. The therapists induced a dream state or twilight sleep by injecting sodium pentothal, after which most soldiers spontaneously started to express their anxiety. While the psychiatrist fulfilled the soldier's need for protection, the soldier's ego was nurtured, and the soldier was encouraged to abreact his trauma. [28]

Prognosis

Figures from the 1982 Lebanon war showed that with proximal treatment, 90% of CSR casualties returned to their unit, usually within 72 hours. With rearward treatment, only 40% returned to their unit. It was also found that treatment efficacy went up with the application of a variety of front line treatment principles versus just one treatment. [5] In Korea, similar statistics were seen, with 85% of US battle fatigue casualties returned to duty within three days and 10% returned to limited duties after several weeks. [4]

Though these numbers seem to promote the claims that proximal PIE or BICEPS treatment is generally effective at reducing the effects of combat stress reaction, other data suggests that long term PTSD effects may result from the hasty return of affected individuals to combat. Both PIE and BICEPS are meant to return as many soldiers as possible to combat, and may actually have adverse effects on the long-term health of service members who are rapidly returned to the front-line after combat stress control treatment. Although the PIE principles were used extensively in the Vietnam War, the post traumatic stress disorder lifetime rate for Vietnam veterans was 30% in a 1989 US study and 21% in a 1996 Australian study. In a study of Israeli Veterans of the 1973 Yom Kippur War, 37% of veterans diagnosed with CSR during combat were later diagnosed with PTSD, compared with 14% of control veterans. [29]

Controversy

There is significant controversy with the PIE and BICEPS principles. Throughout a number of wars, but notably during the Vietnam War, there has been a conflict among doctors about sending distressed soldiers back to combat. During the Vietnam War this reached a peak with much discussion about the ethics of this process. Proponents of the PIE and BICEPS principles argue that it leads to a reduction of long-term disability but opponents argue that combat stress reactions lead to long-term problems such as post-traumatic stress disorder.

The use of psychiatric drugs to treat people with CSR has also attracted criticism, as some military psychiatrists have come to question the efficacy of such drugs on the long-term health of veterans. Concerns have been expressed as to the effect of pharmaceutical treatment on an already elevated substance abuse rate among former people with CSR. [30]

Recent research has caused an increasing number of scientists to believe that there may be a physical (i.e., neurocerebral damage) rather than psychological basis for blast trauma. As traumatic brain injury and combat stress reaction have very different causes yet result in similar neurologic symptoms, researchers emphasize the need for greater diagnostic care. [31]

See also

Related Research Articles

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Neurasthenia is a term that was first used as early as 1829 for a mechanical weakness of the nerves. It became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist George Miller Beard reintroduced the concept in 1869.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. The aim of military psychiatry is to keep as many serving personnel as possible fit for duty and to treat those disabled by psychiatric conditions. Military psychiatry encompasses counseling individuals and families on a variety of life issues, often from the standpoint of life strategy counseling, as well as counseling for mental health issues, substance abuse prevention and substance abuse treatment; and where called for, medical treatment for biologically based mental illness, among other elements.

Jonathan Shay is an American doctor and clinical psychiatrist. He holds a B.A. from Harvard (1963), and an M.D. (1971) and a Ph.D. (1972) from the University of Pennsylvania. He is best known for his publications comparing the experiences of Vietnam veterans with the descriptions of war and homecoming in Homer's Iliad and Odyssey.

Combat Stress is a registered charity in the United Kingdom offering therapeutic and clinical community and residential treatment to former members of the British Armed Forces who are suffering from a range of mental health conditions; including post traumatic stress disorder (PTSD). Combat Stress makes available treatment for all Veterans who are suffering with mental illness free of charge.

Shell shock is a term that originated during World War I to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized. It is a reaction to the intensity of the bombardment and fighting that produced helplessness, which could manifest as panic, fear, flight, or an inability to reason, sleep, walk, or talk.

<span class="mw-page-title-main">Simon Wessely</span> British psychiatrist

Sir Simon Charles Wessely is a British psychiatrist. He is Regius Professor of Psychiatry at the Institute of Psychiatry, King's College London and head of its department of psychological medicine, vice dean for academic psychiatry, teaching and training at the Institute of Psychiatry, as well as Director of the King's Centre for Military Health Research. He is also honorary consultant psychiatrist at King's College Hospital and the Maudsley Hospital, as well as civilian consultant advisor in psychiatry to the British Army. He was knighted in the 2013 New Year Honours for services to military healthcare and to psychological medicine. From 2014 to 2017, he was the elected president of the Royal College of Psychiatrists.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Perpetrator trauma, also known as perpetration- or participation-induced traumatic stress , occurs when the symptoms of posttraumatic stress disorder (PTSD) are caused by an act or acts of killing or similar horrific violence.

A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

In the nineteenth and early twentieth century, hysteria was a common psychiatric diagnosis made primarily in women. The existence and nature of a purported male hysteria was a debated topic around the turn of the century. It was originally believed that men could not suffer from hysteria because of their lack of uterus. This belief was discarded in the 17th century when discourse identified the brain or mind, and not reproductive organs, as the root cause of hysteria. During World War I, hysterical men were diagnosed with shell shock or war neurosis, which later went on to shape modern theories on PTSD. The notion of male hysteria was initially connected to the post-traumatic disorder known as railway spine; later, it became associated with war neurosis.

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.

Disaster psychiatry is a field of psychiatry which focuses on responding to natural disasters, climate change, school shootings, large accidents, public health emergencies, and their associated community-wide disruptions and mental health implications. All disasters, regardless of exact type, are characterized by disruption: disruption of family and community support structures, threats to personal safety, and an overwhelming of available support resources. Disaster psychiatry is a crucial component of disaster preparedness, aiming to mitigate both immediate and prolonged psychiatric challenges. Its primary objective is to diminish acute symptoms and long-term psychiatric morbidity by minimizing exposure to stressors, offering education to normalize responses to trauma, and identifying individuals vulnerable to future psychiatric illness.

<span class="mw-page-title-main">Post-traumatic stress disorder after World War II</span>

WWII lasted from September 1st, 1939 until September 2nd, 1945. The death toll during WWII has been estimated to be between 35,000,000 and 60,000,000. However, the exact number is unknown. With all those fatalities, it should not be surprising that it left so many lasting effects on the survivors. There have been many terms for these lasting effects over the decades. These terms include, but are not limited to, shell sock and combat fatigue. In 1980, the diagnosis of PTSD was added to the newly published DSM 3.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

  1. ↑ Department of the Army (2009). Field Manual No. 6-22.5. Combat and Operational Stress Control Manual for Leaders and Soldiers. Department of the Army Headquarters, Washington, DC, 18 March 2009. p 12.
  2. ↑ "World War I - Killed, wounded, and missing". Encyclopedia Britannica. Archived from the original on 2023-10-15. Retrieved 2021-09-28.
  3. ↑ "WWII Post Traumatic Stress". The National WWII Museum | New Orleans. 2020-06-27. Archived from the original on 2024-03-30. Retrieved 2024-03-30.
  4. 1 2 "Combat Stress Control in a Theater of Operations US Army Publication". Archived from the original on December 30, 2005. Retrieved September 26, 2004..
  5. 1 2 Military Psychiatry Ed. Gabriel, R.A., (1986)
  6. ↑ Manon Perry (2006). "Thomas W. Salmon: Advocate of Mental Hygiene". American Journal of Public Health. 96 (10). Ajph.org: 1741. doi:10.2105/AJPH.2006.095794. PMC   1586146 . PMID   17008565. Archived from the original on 2008-10-12. Retrieved 2012-10-23.
  7. ↑ "Treating Survivors in the Acute Aftermath of Traumatic Events". United States Department of Veterans Affairs. Archived from the original on 2006-12-09. Retrieved 2012-10-23.
  8. 1 2 3 4 Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914–1994. London: Jonathan Cape, 2000. [ ISBN missing ][ page needed ]
  9. 1 2 3 Pfau, Ann Elizabeth (2008). "1: Fighting for Home". Miss Yourlovin: GIs, Gender, and Domesticity during World War II. Columbia University Press. ISBN   978-0231135528. Archived from the original on 2013-09-26. Retrieved 2013-09-21.
  10. ↑ Carroll, Erin (2000-07-13). "Psychiatrist, 89, Is No Couch Potato John Appel Is Still Practicing And Still Writing Books. He Describes His Latest As A 'How-to ... For Staying Sane.'". Philadelphia Inquirer. Archived from the original on 2016-03-03. Retrieved 21 September 2013.
  11. ↑ Mae Mills Link and Hubert A. Coleman, Medical support of the Army Air Forces in World War II (1955) p. 851 [ ISBN missing ]
  12. ↑ Battle Exhaustion. Soldiers and Psychiatrists in the Canadian Army, 1939–1945. Terry Copp and Bill McAndrew. ISBN   978-0773507746 [ page needed ].
  13. ↑ Copp, Terry The Brigade (Stackpole Books, 2007) p. 47 [ ISBN missing ]
  14. ↑ Vanguard of Nazism: the Free Corps Movement in Post-war Germany, 1918–1923, (Harvard University Press, 1969), Robert G. L. Waite [ ISBN missing ][ page needed ]
  15. 1 2 Contemporary Studies in Combat Psychiatry, (1987) [ page needed ][ ISBN missing ]
  16. ↑ Psychological Support to ADF Operations: A Decade of Transformation, Murphy, P.J. et al. [ ISBN missing ][ page needed ]
  17. ↑ Henry Gleitman, Alan J. Fridlund and Daniel Reisberg (2004). Psychology (6 ed.). W. W. Norton & Company. ISBN   978-0-393-97767-7.
  18. ↑ Hans Selye (1950). "Stress and the General Adaptation Syndrome". British Medical Journal. 1 (4667): 1383–1392. doi:10.1136/bmj.1.4667.1383. PMC   2038162 . PMID   15426759.
  19. ↑ Feltham, Colin (2002). What's the Good of Counselling & Psychotherapy?. Sage. pp. 231–232. ISBN   978-1847871251. Archived from the original on 17 April 2024. Retrieved 12 August 2019.
  20. ↑ Plesset M. R. (1946). "Psycho-neurotics in Combat". American Journal of Psychiatry. 103: 87–88. doi:10.1176/ajp.103.1.87. PMID   20996374.
  21. ↑ G. Fontenot, "Fear God and Dreadnought: Preparing a Unit for Confronting Fear" Military Review (July–August, 1995), pp. 13–24.
  22. ↑ Driskell, James E.; Johnston, Joan H. (1998). "Stress exposure training.". In Cannon-Bowers, J. A.; Salas, E. (eds.). Making decisions under stress: Implications for individual and team training. American Psychological Association. pp. 191–217. doi:10.1037/10278-007. ISBN   1-55798-525-1.
  23. ↑ Inzana C. M., Driskell J. E.; et al. (1996). "Effects of Preparatory Information on Enhancing Performance Under Stress". Journal of Applied Psychology. 81 (4): 429–435. doi:10.1037/0021-9010.81.4.429. PMID   8751456.
  24. ↑ Wine J (1971). "Test Anxiety and Direction of Attention". Psychological Bulletin. 76 (2): 92–104. doi:10.1037/h0031332. PMID   4937878.
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  26. ↑ Vossel G.; Laux L. (1978). "The Impact of Stress Experience on Heart Rate and Task Performance in the Presence of a Novel Stressor". Biological Psychology. 6 (3): 193–201. doi:10.1016/0301-0511(78)90021-2. PMID   667242. S2CID   33000532.
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  28. ↑ Pols, Hans (December 2011). "The Tunisian Campaign, War Neuroses, and the Reorientation of American Psychiatry During World War II". researchgate.net. Archived from the original on April 17, 2024. Retrieved March 30, 2024.
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  31. ↑ Bhattacharjee Yudhijit (2008). "Shell Shock Revisited: Solving the Puzzle of Blast Trauma". Science . 319 (5862): 406–408. doi:10.1126/science.319.5862.406. PMID   18218877. S2CID   206578848.(subscription required)

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