" In no circumstances whatever will the expression 'shell-shock' be used verbally or be recorded in any regimental or other casualty report,or in any hospital or other medical document."
British army General Routine Order No. 2384, issued on 7 June 1917 issued in France.
Reevaluating Society's Perception of Shell Shock: A Comparative Study
Between Great Britain and the United States”
By Annessa Cathleen Stagner
West Texas State University
The large number of soldiers affected by shell shock continues to engage World War I historians even today. "The heightened code of masculinity that dominated in wartime was intolerable to surprisingly large numbers of men." <4> Nearly 80,000 men in Britain were diagnosed with shell shock during the War, and the number of cases continued to rise after the War ended. Some estimates, including undiagnosed soldiers, claim 800,000 British cases and 15,000 American cases. <5> Shell shock was not just a disease of the common soldier either. Myra Schock acknowledged "historians have generally taken it for granted that officers experienced shell shock in far greater numbers than soldiers of other ranks." <6> Inevitably numerous soldiers from all ranks were diagnosed with shell shock, thus having a tremendous impact on all of society.
During World War I, the British government's primary focus was to keep as many men available for service and in the field as possible. Shell-shocked soldiers directly hindered the army's ability to successfully wage war because their inability to fight decreased the army's number of active troops.
—The British government clearly put pressure on doctors and officials to treat shell shock harshly, not as a disease, but as a form of malingering.
Other historians have argued the government became more sympathetic when it became evident that those affected were experienced soldiers and officers. Joanna Bourke stated, "society as a whole acknowledged that of those affected, some had war medals for valiant behavior under fire." <9> They were not cowards, but some of the best fighting men Britain had. Instead of acknowledging the disease's legitimacy among the troops, however, the government still discredited many of its victims. Attempts were made to "protect" officers of high status by classifying them as victims of "anxiety neurosis" or "neurasthenia," while common soldiers were classified as victims of "hysteria neurosis," a purely feminine disease. <10> The differing titles reflected the British government's willingness to make a clear distinction between the legitimate illness of its officers and the unfounded appeals of its psychologically weak common soldiers.
http://www.wfa-usa.org/new/shellshock.htm”The punishment for the exhibition of essentially psychological symptoms was often in the earlier years of World War I, summary and massive. Men whom we would today classify as combat-stress casualties were shot for "cowardice." Ferguson (1999) indicates that a significant proportion of the 346 British soldiers executed were shot for cowardice, many of whom were suffering from shell shock. Babington (1997) illustrates this cogently with four cases of soldiers previously seen as suffering from shell shock who were subsequently executed for cowardice. In Britain, "cowardice" was punishable by death until 1930.”
http://www.gulflink.osd.mil/library/randrep/marlowe_paper/mr1018_11_ch5.htmlhttp://health.usnews.com/usnews/health/healthday/070823/battle-continues-over-vietnam-ptsd-numbers.htmBattle Continues Over Vietnam PTSD Numbers
By Amanda Gardner
HealthDay Reporter
http://www.medicinenet.com/script/main/art.asp?articlekey=83448THURSDAY, Aug. 23 (HealthDay News) -- Decades after the last U.S. troops departed Vietnam, the debate still rages on how many veterans of that conflict suffered or still suffer from post-traumatic stress disorder.
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In the years following the end of U.S. involvement in Vietnam, the actual number of veterans psychologically scarred by what they had encountered in the war became the subject of heated controversy.
A 1988 study, conducted by the U.S. Centers for Disease Control and Prevention, estimated a relatively low lifetime rate of PTSD among veterans of 14.7 percent.
But a second government study -- the National Vietnam Veterans Readjustment Study (NVVRS) -- calculated a much higher lifetime figure of 30.9 percent and a current figure of 15.2 percent. Both studies relied heavily on veterans' self-reports of PTSD symptoms and exposure to wartime trauma, and both drew heavy criticism.
FIELD MANUAL HEADQUARTERS DEPARTMENT OF THE ARMY
Washington, DC, 29 September 1994
CHAPTER 5
BATTLE FATIGUE FM 22-51
5-1. Introduction
Battle fatigue is the approved US Army term (AR 40-216) for combat stress symptoms and reactions which --
* Feel unpleasant.
* Interfere with mission performance.
* Are best treated with reassurance, rest, replenishment of physical needs, and activities which restore confidence.
b. Battle fatigue may coexist with misconduct stress behaviors. However, battle fatigue itself, by definition, does not warrant legal or disciplinary action.
5-5. Severity of Symptoms and Response to Treatment
b. Leader and medical personnel in forward areas should expect as many or more soldiers to present with duty or rest battle fatigue as there will be hold and refer cases. It is essential that the former not become casualties by unnecessarily evacuating or holding them for treatment.
c. In general, the more intense the combat, especially with indirect fire and mass destruction, the more cases become heavy and need holding or referral, and the harder it is for them to recover quickly and return to duty.
d. Fifty to eighty-five percent of battle fatigue casualties (hold and refer) returned to duty following 1 to 3 days of restoration treatment, provided they are kept in the vicinity of their units (for example, within the division).
NOTEe
Premature evacuation of battle fatigue soldiers out of the combat zone must be prevented as it often results in permanent psychiatric disability. If the tactical situation permits, the evacuation policy in the corps should be extended from 7 to 14 days for the reconditioning program, as this will substantially improve the returned to duty rate and decrease subsequent chronic disability.
http://www.globalsecurity.org/military/library/policy/army/fm/22-51/22-51_e.htmUnsurprisingly, the stress of combat commonly produces psychotropic if not psychopathic effects. Psychiatric casualties have been more common in all major modern conflicts than physical injuries. (A modern military no longer court-martials or executes such "shell-shocked" soldiers for cowardice, nor excuses them, but "treats" these psychosomatic rebellions against fighting with encouragement to return to fighting as soon as possible.)
Since WWII the US military has had information that it only takes 60 days of continuous combat for 98 percent of survivors to become psychiatric casualties, and the remaining two percent will already have shown aggressive psychopathic characteristics before combat. <7> In other words, war makes everyone crazy who isn't already nuts. Maybe we should just be surprised that it takes as long as 60 days for the insanity of combat to finish the job.
http://www.promethea.org/Misc_Compositions/FightingFutureWar/TheEffectsofWar.html#PsychologicalSymptoms