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Battle stress reaction , in the past commonly known as shell shock or battle fatigue , is a military label used to categorize a range of behaviours resulting from the stress of battle which cut the combatant's fighting efficiency. The most common symptoms are fatigue, slower resistance times, indecision, disconnection from one's surroundings, and inability to prioritize. Combat accent reaction is generally short-term and should not be confused with acute anguish disorder, post-traumatic stress disorder, or other long-term disorders attributable to war stress although any of these may commence as a combat stress reaction.

The ratio of highlight casualties to battle casualties varies with the intensity of the fighting, but with impetuous fighting it can be as high as 1:1. In low-level conflicts it can drop to 1:10 (or less).

In People War I, shell shock was considered a psychiatric illness resulting from injury to the nerves during clash. The horrors of trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during Smashing War II) and the total proportion of troops who became casualties (killed or wounded) was 56%. Whether a outside-shock sufferer was considered "wounded" or "sick" depended on the circumstances. The large proportion of Creation War I veterans in the European population meant that the symptoms were common to the mores, although it may not have become popularly known in the US.

History

The history of Combat Importance Reactions (CSRs) has shown a remarkable variation and subvariation in the interest and knowledge of those whose tasks it has been to handle with them. Kardiner and Spiegel writing in 1947 stated:

During the American Non-military War two conditions, “soldier's heart” and “nostalgia”, were basically CSRs. Miscellaneous epidemics of psychological disorders (e.g. passengers with railway spine) were recognised in the 1800s.

The Russians in the Russo-Japanese War (1904-1905) were the outset to specifically diagnose mental disease as a result of war stress and try to treat it. It was not until Beget War I that the high level of cases with " shell shock " (also referred to as distressing war neurosis and neurasthenia) really surprised commanders and doctors.

The History Channel play Bible Battles makes the case that the scripture describing the Hebrew soldiers being required to wash themselves after the destruction of Jericho may be linked to CSRs.

World War I

In 1915 The British Army in France was instructed that:

In August 1916 Charles Myers was made Consulting Psychologist to the Army. He hammered residency the notion that it was necessary to create special centres near the line using treatment based on:

• Promptness of battle.
• Suitable environment.
• Psychotherapeutic measures.

He also used hypnosis with narrow success.

In December 1916 Gordon Holmes was put in charge of the northern, and more prominent, part of the western front. He had much more of the tough attitudes of the Army and suited the main military mindset and so his view prevailed. By June 1917 all British cases of “Cartridge-shock” were evacuated to a nearby neurological centre and were labelled as NYDN – Not Yet Diagnosed Fearful”. "But, because of the Adjutant-General’s distrust of doctors, no patient could away with that specialist attention until Form AF 3436 had been sent off to the man’s piece and filled in by his commanding officer." This created significant delays but demonstrated that between 4-10% of Fa-shock W cases were "commotional" (due to physical causes) and the rest were "emotional". This killed off cartridge-shock as a valid disease and it was abolished in September 1918.

During the war, 306 British soldiers were executed for faint-heartedness, many of them victims of shell shock. On 7 November 2006 the government of the United Kingdom gave them all a posthumous conditional indulgence.

Proximity by circumstance

Because of the delays AF 3436 was producing, medical officers started keeping their men in their units. This was conceivably the practical beginning of the concept of proximity. Col. Rogers, RMO 4/Black Watch wrote,

PIE principles

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

• P roximity - treat the casualties close to the front and within earshot of the fighting
• I mmediacy - treat them without delay and not wait till the wounded were all dealt with
• E xpectancy - certify that everyone had the expectation of their return to the front after a rest and replenishment

Coalesced States medical officer Thomas W. Salmon is often quoted as the originator of these PIE principles. No matter what, 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 perfect system of units and procedures that was then the “world’s best rehearsal”. After the war he maintained his efforts in educating society and the military. He was awarded the Honoured Service Medal for his contributions.

Effectiveness of PIE approach has not been confirmed by studies of CSR, and there is some manifest that it is not effective in preventing PTSD.

The US services now use the more recently developed BICEPS principles:

• Pithiness
• Immediacy
• Centrality or Contact
• Expectancy
• Proximity
• Simplicity

Between the World Wars

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

Go away of the concern was that many British veterans were receiving pensions and had desire-term disabilities.

War correspondent Philip Gibbs wrote:

One British writer between the wars wrote:

Americans and the British in Times a deliver War II

At the outbreak of World War II most in the United States military had forgotten the treatment lessons of To the max War I. Screening of applicants was initially rigorous but experience eventually showed it to not have superior predictive power.

By 1943 the US Army was using the term "exhaustion" as the initial diagnosis of psychiatric cases and the usual principles of military psychiatry were being used. General Patton's slapping to-do was in part the spur to institute forward treatment for the Italian invasion of September 1943. The position of unit cohesion and membership of a group as a protective factor emerged.

Unlike the Americans, the lessons of Overjoyed War I were firmly in British Governmental minds. It was estimated aerial bombardment would assassinate up to 35,000 a day but the entire Blitz killed 40,000. The expected torrent of civilian crazy breakdown did not occur. The Government turned to the World War I doctors for advice on those who did maintain problems. The PIE principles were used generally.

However, in the British Army, since most of the Universe War I doctors were too old for the job, young, analytically trained psychiatrists were employed. Army doctors “appeared to possess no conception of breakdown in war and its treatment, though many of them had served in the 1914-1918 war.” The at the start Middle East Force psychiatric hospital was set up in 1942. With D-Day for the first month there was a conduct of holding casualties for only 48 hours before they were sent overdue renege over the Channel. This went firmly against the expectancy principle of PIE.

Germans in Happy War II

In a personal interview, Dr Rudolf Brickenstein stated that:

However as the war progressed there was a consummate rise in stress casualties from 1% of hospitalisations in 1935 to 6% in 1942. Another German psychiatrist reported after the war that during the closing two years, about a third of all hospitalisations at Ensen were due to war neurosis. It is probable that there was both less of a authentic problem and less perception of a problem.

German soldiers often became victims of shot shock in the Eastern front, as the Red Army's infamous BM-13 rocket system "were usually massed in very large numbers to create a shock effect on enemy forces." (reader was taken from this article)

Finns in World War II

The Finnish attitudes to "war neurosis" were specially tough. Psychiatrist Harry Federley, who was the head of the Military Medicine, considered fa shock as a sign of weak character and lack of moral fibre. His treatment for war neurosis was square: the patients were to be bullied and harassed as long as they were unwilling to carry back to front line service.

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

Developments since Happy War II

Simplicity was added to the PIE principles by the Israelis. This principle meant that treatment should be curtailed and supportive and could be provided by those without sophisticated training.

Peacekeeping stresses

Peacekeeping provides its own stresses with its prominence on rules of engagement providing a containment of the roles for which soldiers are trained. Causes tabulate witnessing or experiencing the following:

• Constant tension and threat of conflict.
• Threat of landmines and boobytraps.
• Close-fisted contact with dead people and the severely injured.
• Deliberate maltreatment and atrocities, perhaps involving civilians.
• Cultural issues, e.g. male dominant attitudes towards women in remarkable cultures.
• Separation and home issues.
• Risk of disease including HIV.
• Threat of disclosure to toxic agents.
• Mission problems.
• Return to service.

A notable case of CSR in peacekeeping operations is that of Canadian Prevalent Roméo Dallaire, commander of the UN-run operation in Rwanda, UNAMIR. Unable to intervene to prevent the ensuing Rwandan Genocide, Biggest-General Dallaire was forced to watch as almost a million Tutsis were brutally killed. On replacement to Canada, feeling that he had not done enough to halt the genocide, and haunted by the images of dismembered victims, Dallaire contemplated suicide; in June 2000 he was set in a public park near Ottawa's Rideau Canal, drunk and overdosing from anti-depressant medication. This decidedly public incident highlighted the impact of difficult sub-combat operations on soldiers and awoke the business's awareness to CSR (or, as it is often referred to by the public, Post-Traumatic Stress Disorder).

Symptoms and signs of Contend Stress Reaction

Combat stress reaction symptoms align with the symptoms also base in psychological trauma, which is highly related to Post-Traumatic Stress Fray, PTSD. CSR differs from PTSD (among other things) in that a PTSD diagnosis requires a duration of symptoms at an end one month, which CSR does not.

Fatigue related symptoms

The most common burden reactions include:

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

Autonomic arousal

• Headaches
• Repudiate pains
• Inability to relax
• Shaking and tremors
• Sweating
• Nausea and vomiting
• Privation of appetite
• Abdominal distress
• Frequency of urination
• Urinary incontinence
• Heart palpitations
• Hyperventilation
• Dizziness
• Insomnia
• Nightmares
• Worked up sleep
• Excessive sleep
• Excessive startle
• Hypervigilance
• Heightened sense of menace
• Anxiety
• Irritability
• Depression
• Substance abuse
• Loss of adaptability
• Suicidality
• Disruptive manners
• Mistrust of others
• Confusion
• Extreme feeling of losing control

Battle fatalities rates

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

The World War II European Army rate of lay stress casualties of 101:1,000 troops per annum is biased by data from the last years of the war where the rates were low.

Therapy

In the military, therapy starts with balking by training and providing good morale and support. Simple procedures like providing ample rest, food and shelter are important. Relaxation exercises have a role as does sensitive event debriefing.

Once a service member has deteriorated beyond this they are large relieved of duty and given support, dry clothes, food and rest. When germane they are given supportive counselling aimed at their speedy recovery. Some are prescribed psychotropic medications and entirely discharged.

Treatment results

Figures from the 1982 Lebanon war showed that with proximal treatment 90% of CSR casualties returned to their module, usually within 72 hours. With rearward treatment only 40% returned to their constituent.

In Korea 85% of US battle fatigue casualties returned to duty within three days and 10% returned to reduced duties after several weeks.

Although the PIE principles were used extensively in the Vietnam War the role traumatic stress disorder lifetime rate for Vietnam veterans was 30% in a 1989 US think over and 21% in a 1996 Australian study.

Controversy

There is significant controversy with the PIE principles. All over wars but notably during the Vietnam War there has been a conflict amongst doctors hither sending distressed soldiers back to combat. During the Vietnam War this reached a top out with much discussion about the ethics of this process. Proponents of the PIE principles contend persuade that it leads to a reduction of long-term disability but opponents argue that spar stress reactions lead to long-term problems such as post-shocking stress disorder.

Recent research has caused an increasing number of scientist to swear by that there may be a physical rather than psychological basis for blast trauma.

See also

• Promulgate-traumatic stress disorder
• Acute stress disorder
• Psychological trauma
• Eye Workings Desensitization and Reprocessing (modern treatment)
• Combat Stress (Ex Services Mental Well-being Welfare Service)

Notes and references

1. ^ ^{a b c d e f g} Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914-1994 . London, Jonathan Headland, 2000.
2. ^ Taylor-Whiffen, Peter (2002-03-01). "Shot at Dawn: Cowards, Traitors or Victims?" . http://www.bbc.co.uk/relation/british/britain_wwone/shot_at_dawn_01.shtml .  
3. ^ "War Pardons receives Stately Assent". ShotAtDawn.org.uk . http://www.shotatdawn.org.uk/ .  
4. ^ http://www.ajph.org/cgi/glad/full/96/10/1741
5. ^ United States Department of Veterans Affairs. "Treating Survivors in the Clever Aftermath of Traumatic Events".
6. ^ ^{a b} Contemporary Studies in Combat Psychiatry , (1987)
7. ^ Psychological Foundation to ADF Operations: A Decade of Transformation , Murphy, P.J. et al.
8. ^ ^{a b} Combat Stress Control in a Theater of Operations US Army Semi-monthly.
9. ^ ^{a b} Military Psychiatry Ed. Gabriel, R.A., (1986)
10. ^ Shell Shock Revisited: Solving the Puzzle of Denounce Trauma. Science 25 January 2008

• Lamprecht, Friedhelm and Sack, Martin, 'Posttraumatic Emphasis on Disorder Revisited'
• Dispatches: Lessons learned for Soldiers; Stress Abuse and Operational Deployments , The Army Lessons Learned Centre, Canadian Forces Establish Kingston, Vol 10, No.1, February 2004.
• Tyquin, M. Madness and the Military: Australia's Incident in the Great War . AMHP, Sydney, 2006.
• Flashbacks, Paul Burns, Counselling at Work 2007

What is more reading

• West, Rebecca (1918). The Return of the Soldier .  
• Woolf, Virginia (1925). Mrs Dalloway .  
• Barker, Pat (1991). Regeneration .  
• Grabenhorst, Georg (1928). Zero Hour .  
• Roth, Joeph (1924). Die Insurrection .  

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