824:(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.
944:
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
567:
had proven his bravery in battle and was no longer with most of the fellow soldiers he trained with. Appel helped implement a 180-day limit for soldiers in active combat 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.
104:, 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.
40:
515:
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.
777:
667:... 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.
927:
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.
610:, 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
131:
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".
123:) and the total proportion of troops who became casualties (killed or wounded) was about 57%. 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
1535:
926:
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
589:
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
566:
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
514:
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
939:
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
882:
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
427:
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
943:
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
578:
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
493:
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,
434:
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
336:
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
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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
873:
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
680:
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
420:
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
95:
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
960:
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
956:
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
635:
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. In Normandy, "The infantry units engaged in the battle also experienced a rapid
413:
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
130:
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
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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
671:
However, as World War II progressed there was a profound rise in stress casualties from 1% of hospitalizations in 1935 to 6% in 1942. 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
362:
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
636:
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."
449:
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
626:
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.
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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.
621:
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
440:
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
481:
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
908:
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.
957:
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.
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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
435:
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.
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533:, 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.
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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.
340:
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.
76:) 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
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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.
2146:
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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
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treatment. 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.
1323:
1519:
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morale that jaded veterans quickly passed along to newcomers. After a few months, epidemics of combat fatigue would drastically reduce the efficiency of units.
1316:"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.'"
601:
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
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and combat stress reaction have very different causes yet result in similar neurologic symptoms, researchers emphasize the need for greater diagnostic care.
2145:
Pols, Hans. The Tunisian Campaign, War Neuroses, and the Reorientation of American Psychiatry During World War II. Harvard Review of Psychiatry pp 313-320
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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.
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procedures that was then the "world's best practice". After the war, he maintained his efforts in educating society and the military. He was awarded the
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1091:
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Stress exposure training or SET is a common component of most modern military training. There are three steps to an effective stress exposure program.
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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
370:
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.
486:. There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg."
1860:
Solomon, Z; Shklar, R; Mikulincer, M (December 2005). "Frontline treatment of combat stress reaction: a 20-year longitudinal evaluation study".
461:(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.
147:(PTSD). CSR differs from PTSD (among other things) in that a PTSD diagnosis requires a duration of symptoms over one month, which CSR does not.
2081:
982:
688:, several Finnish machine gun operators on the Karelian Isthmus theatre became mentally unstable after repelling several unsuccessful Soviet
1315:
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It is, however, considered that many of such cases could, after recovery, be usefully employed in some form of auxiliary military duty.
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Vossel G.; Laux L. (1978). "The Impact of Stress Experience on Heart Rate and Task Performance in the Presence of a Novel Stressor".
1721:
1221:
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forgotten, worry about themselves, are afraid of new assignments, have no sense of responsibility, and are hopeless about the future.
364:
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Inzana C. M., Driskell J. E.; et al. (1996). "Effects of Preparatory Information on Enhancing Performance Under Stress".
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said after the war, "It might have been wise to have had a nation-wide educational course in letter writing to soldiers", and
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unfit for further service of any kind with the forces in the field. This policy should be widely known throughout the Force.
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American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC:
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disorders. Soldiers with a "lower than average" sense of cohesion with their unit were more susceptible to stress illness.
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Many of the symptoms initially experienced by people with CSR are effects of an extended activation of the human body's
2034:
1529:
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Expectancy – ensure that everyone had the expectation of their return to the front after a rest and replenishment.
1605:
Driskell, James E.; Johnston, Joan H. (1998). "Stress exposure training.". In Cannon-Bowers, J. A.; Salas, E. (eds.).
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in their view, treatment should be brief, supportive, and could be provided by those without sophisticated training.
464:(2) If the breakdown is of such severity as to necessitate a long period of rest and treatment in the United Kingdom.
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1252:
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criticized "moms" (as opposed to mothers) who, after failing to "wean" their sons, damaged morale through letters.
1907:(7). Military Medicine . July 2007; 172(7):681–685. Available from: MEDLINE with Full Text, Ipswich, MA: 681–685.
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describes some of the emotional effects of World War I on German troops, and refers to a phrase he attributes to
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for the first month there was a policy of holding casualties for only 48 hours before they were sent back over
144:
101:
89:
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contains the roles for which soldiers are trained. Causes include witnessing or experiencing the following:
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Recall – give the individual the chance to recall and discuss the experiences that have led to the reaction
478:
Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.
17:
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Rehabilitation – improve the physical and mental health of the patient until they no longer show symptoms
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where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening.
2255:
2250:
2152:
1831:"The Tunisian Campaign, War Neuroses, and the Reorientation of American Psychiatry During World War II"
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Driskell J. E.; Johnston J. H.; Salas E. (2001). "Does Stress Training Generalize to Novel Settings?".
789:
2235:
1445:
2209:
2180:
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785:
556:
2204:
1708:
Thyer B. A.; et al. (1981). "In Vivo Distraction – Coping in the Treatment of Test Anxiety".
470:(4) If the disability is a mental breakdown or psychosis requiring treatment in a mental hospital.
51:": an unfocused, despondent and weary gaze which is a frequent manifestation of "combat fatigue".
2123:, The Army Lessons Learned Centre, Canadian Forces Base Kingston, Vol. 10, No. 1, February 2004.
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added to the table of organization of each division, and this policy was not implemented in the
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977:
355:
Immediacy – treat them without delay and not wait until the wounded were all dealt with.
348:
The following PIE principles were in place for the "not yet diagnosed nervous" (NYDN) cases:
97:
77:
1936:
Bhattacharjee Yudhijit (2008). "Shell Shock Revisited: Solving the Puzzle of Blast Trauma".
238:
140:
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prioritize. Combat stress reaction is generally short-term and should not be confused with
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Proximity – treat the casualties close to the front and within sound of the fighting.
8:
987:
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545:
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48:
1963:
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probable that there was both less of a true problem and less perception of a problem.
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1967:
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1938:
1918:
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997:
689:
568:
503:
296:
56:
1830:
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808:, facilitate immediate physical reactions associated with a preparation for violent
657:
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Soldiers should not be returned to the fighting line under the following conditions:
39:
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Dispatches: Lessons learned for Soldiers; Stress Injury and Operational Deployments
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1992:
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meant that about 10% of the fighting soldiers were killed (compared to 4.5% during
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reported that the men who had been at jungle airfields longest were in bad shape:
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comfort for those who need it and to heartening them for return to the front line.
2185:
1951:
1873:
1437:
1016:
1009:
615:
580:
572:
483:
301:
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Lamprecht, Friedhelm and Sack, Martin, "Posttraumatic Stress Disorder Revisited"
2007:
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2199:
2002:
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G. Fontenot, "Fear God and Dreadnought: Preparing a Unit for Confronting Fear"
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in the European population meant that the symptoms were common to the culture.
116:
112:
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1913:
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Battle Exhaustion. Soldiers and Psychiatrists in the Canadian Army, 1939–1945
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Reassurance – inform them that their reaction is normal and they will recover
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Recognition – identify that the individual has an Operational Stress Reaction
805:
797:
560:
549:
2106:
1722:
10.1002/1097-4679(198110)37:4<754::aid-jclp2270370412>3.0.co;2-g
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Making decisions under stress: Implications for individual and team training
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The British Army treated Operational Stress Reaction according to the 7 Rs:
1988:
1959:
1922:
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The process whereby the human body responds to extended stress is known as
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291:
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120:
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Vanguard of Nazism: the Free Corps Movement in Post-war Germany, 1918–1923
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and prepares the body to fight or run from the threat causing the stress.
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1764:
1570:
1123:
992:
623:
108:
85:
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Grinker RR, Spiegel JP. Men Under Stress. Philadelphia Blakiston, 1945.
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2018:
801:
731:
685:
81:
61:
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Combat stress reaction symptoms align with the symptoms also found in
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enemy dead, is also effective at reducing the chance of a breakdown.
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Deliberate maltreatment and atrocities, possibly involving civilians.
727:
645:
602:
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The US entered the war in December 1941. Only in November 1943 was a
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Psychological Support to ADF Operations: A Decade of Transformation
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405:, which was published in 1922. Recommendations from this included:
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US services now use the more recently developed BICEPS principles:
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Blindfold and Alone: British Military Executions in the Great War
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124:
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resulting from injury to the nerves during combat. The nature of
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Miss Yourlovin: GIs, Gender, and Domesticity during World War II
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A U.S. Long Range Reconnaissance Patrol leader in Vietnam, 1968.
403:
Report of the War Office Committee of Inquiry into "Shell-Shock"
1222:"Treating Survivors in the Acute Aftermath of Traumatic Events"
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217:
207:
186:
1224:. United States Department of Veterans Affairs. Archived from
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Respite – provide a short period of relief from the front line
611:
212:
1637:
618:. This went firmly against the expectancy principle of PIE.
555:
was in part the spur to institute forward treatment for the
444:
They do not recommend psycho-analysis in the Freudian sense.
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467:(3) If the disability is anxiety neurosis of a severe type.
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Wine J (1971). "Test Anxiety and Direction of Attention".
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and membership of a group as a protective factor emerged.
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Mortar attacks becoming routine for troops in Afghanistan
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1609:. American Psychological Association. pp. 191–217.
1894:
1859:
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1935:
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Medical support of the Army Air Forces in World War II
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A War of Nerves: Soldiers and Psychiatrists, 1914–1994
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In an interview, Dr Rudolf Brickenstein stated that:
2162:
1557:
Plesset M. R. (1946). "Psycho-neurotics in Combat".
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Confidence building through application and practice
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Close contact with severely injured and dead people.
421:
the idea of nervous breakdown in the patient's mind.
47:
A U.S. Marine, Pvt. Theodore J. Miller, exhibits a "
1897:"Psychiatric medications for deployment: an update"
1521:
What's the Good of Counselling & Psychotherapy?
961:substance abuse rate among former people with CSR.
2205:DCoE National Center for Telehealth and Technology
2086:
2022:
2006:
859:Return – allow the soldier to return to their unit
788:. The fight-or-flight response involves a general
715:provides its own stresses because its emphasis on
700:Simplicity was added to the PIE principles by the
187:Autonomic nervous system – autonomic arousal
172:Preoccupation with minor issues and familiar tasks
2216:A Matter of Duty: The Continuing War Against PTSD
1110:
1108:
695:
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1742:
1604:
1118:Combat Stress Control in a Theater of Operations
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1163:"Thomas W. Salmon: Advocate of Mental Hygiene"
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1313:
983:Eye movement desensitization and reprocessing
895:Providing knowledge of the stress environment
2087:Corns, Cathryn; Hughes-Wilson, John (2005).
1471:"Stress and the General Adaptation Syndrome"
1055:"World War I - Killed, wounded, and missing"
863:
660:: men who could not become "de-brutalized".
2055:
1707:
1160:
681:until they returned to front line service.
510:One British writer between the wars wrote:
150:
1895:Benedek D, Schneider B, Bradley J (2007).
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1269:
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155:The most common stress reactions include:
1912:
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1409:Contemporary Studies in Combat Psychiatry
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948:, compared with 14% of control veterans.
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775:
723:Constant tension and threat of conflict.
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331:
1997:. Garden City, NY: Garden City Pub. Co.
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498:alternating with a restless desire for
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2017:
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1344:Mae Mills Link and Hubert A. Coleman,
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1088:The National WWII Museum | New Orleans
489:War correspondent Philip Gibbs wrote:
2001:
792:discharge in reaction to a perceived
134:
2069:
1987:
1828:
1393:, (Harvard University Press, 1969),
1273:
494:and queer tempers, fits of profound
175:Indecision and lack of concentration
2082:A Review on the Disarm Doctumentary
1841:from the original on April 17, 2024
756:Threat of exposure to toxic agents.
542:Mediterranean Theater of Operations
396:
169:Difficulty initiating routine tasks
24:
1981:
1862:The American Journal of Psychiatry
1538:from the original on 17 April 2024
766:
557:Italian invasion of September 1943
401:The British government produced a
25:
2267:
2221:Maine Public Broadcasting Network
2158:
1167:American Journal of Public Health
1024:that subtly addresses the subject
1012:that subtly addresses the subject
1008:– a film written and directed by
771:
326:Extreme feeling of losing control
1360:. Terry Copp and Bill McAndrew.
1259:. London: Jonathan Cape, 2000.
692:on fortified Finnish positions.
38:
1929:
1888:
1822:
1779:
1736:
1701:
1666:
1631:
1598:
1595:(July–August, 1995), pp. 13–24.
1585:
1550:
1511:
1462:
1414:
1384:
1371:
1351:
1338:
1326:from the original on 2016-03-03
1296:from the original on 2013-09-26
1203:from the original on 2008-10-12
1094:from the original on 2024-03-30
1065:from the original on 2023-10-15
644:In his history of the pre-Nazi
519:
178:Loss of initiative with fatigue
111:, shell shock was considered a
84:. It is historically linked to
1710:Journal of Clinical Psychology
1559:American Journal of Psychiatry
1381:(Stackpole Books, 2007) p. 47
1214:
1154:
1076:
1047:
1038:
1000:– among returning war veterans
951:
847:Rest – allow rest and recovery
696:Post-World War II developments
145:post-traumatic stress disorder
143:, which is closely related to
102:post-traumatic stress disorder
90:post-traumatic stress disorder
13:
1:
1640:Journal of Applied Psychology
1282:. Columbia University Press.
1028:
502:. Many were easily moved to
166:Difficulty prioritizing tasks
2219:Documentary produced by the
1952:10.1126/science.319.5862.406
1874:10.1176/appi.ajp.162.12.2309
1829:Pols, Hans (December 2011).
1757:10.1016/0301-0511(78)90021-2
1314:Carroll, Erin (2000-07-13).
1274:Pfau, Ann Elizabeth (2008).
1084:"WWII Post Traumatic Stress"
930:
868:
827:
648:paramilitary organizations,
343:
160:The slowing of reaction time
7:
971:
886:
877:
822:general adaptation syndrome
816:General adaptation syndrome
746:Separation and home issues.
630:
524:
453:Return to the fighting line
365:Distinguished Service Medal
88:and can sometimes precurse
10:
2272:
1800:10.1518/001872001775992471
1652:10.1037/0021-9010.81.4.429
1524:. Sage. pp. 231–232.
1446:W. W. Norton & Company
790:sympathetic nervous system
749:Risk of disease including
639:
596:
283:Heightened sense of threat
2166:
1994:The Return of the Soldier
1517:
1151:Ed. Gabriel, R.A., (1986)
864:Predeployment preparation
55:
46:
37:
32:
2200:Glossary of Traumatology
2129:Madness and the Military
2127:Tyquin, Michael (2020).
1914:10.7205/milmed.172.7.681
1423:, Murphy, P.J. et al.
1179:10.2105/AJPH.2006.095794
786:fight-or-flight response
675:
151:Fatigue-related symptoms
1973:(subscription required)
1518:Feltham, Colin (2002).
1487:10.1136/bmj.1.4667.1383
1475:British Medical Journal
1436:, Alan J. Fridlund and
1059:Encyclopedia Britannica
832:
417:In neurological centers
367:for his contributions.
1675:Psychological Bulletin
1276:"1: Fighting for Home"
1173:(10). Ajph.org: 1741.
966:traumatic brain injury
781:
669:
517:
508:
476:
70:Combat stress reaction
33:Combat stress reaction
1745:Biological Psychology
1320:Philadelphia Inquirer
978:Acute stress disorder
779:
708:Peacekeeping stresses
665:
512:
491:
407:
383:Centrality or contact
332:Battle casualty rates
98:acute stress disorder
78:acute stress reaction
2246:Psychological stress
2051:. (Channel 4 Books).
1571:10.1176/ajp.103.1.87
1161:Manon Perry (2006).
1126:on December 30, 2005
1120:US Army Publication"
684:Earlier, during the
559:. The importance of
306:Loss of adaptability
239:Urinary incontinence
141:psychological trauma
2241:Military psychiatry
2091:. London: Cassell.
1481:(4667): 1383–1392.
1469:Hans Selye (1950).
1149:Military Psychiatry
988:Lack of Moral Fibre
717:rules of engagement
690:human wave assaults
546:military psychiatry
529:At the outbreak of
337:stress casualties.
315:Disruptive behavior
163:Slowness of thought
113:psychiatric illness
49:thousand-yard stare
2057:Grabenhorst, Georg
1395:Robert G. L. Waite
904:Skills acquisition
800:hormones, such as
782:
762:Return to service.
654:Robert G. L. Waite
650:Vanguard of Nazism
431:Forms of treatment
318:Mistrust of others
229:Abdominal distress
203:Inability to relax
135:Signs and symptoms
2256:Anxiety disorders
2251:Military medicine
2195:
2194:
2138:978-1-925984-46-0
2098:978-0-304-36696-5
1946:(5862): 406–408.
1901:Military Medicine
1868:(12): 2309–2314.
1615:10.1037/10278-007
1455:978-0-393-97767-7
998:Social alienation
935:Figures from the
759:Mission problems.
569:William Menninger
553:slapping incident
548:were being used.
424:In base hospitals
275:Excessive startle
80:used in civilian
67:
66:
27:Medical condition
16:(Redirected from
2263:
2236:Aftermath of war
2164:
2163:
2142:
2110:
2078:
2066:
2052:
2040:
2028:
2014:
2012:
1998:
1975:
1974:
1971:
1933:
1927:
1926:
1916:
1892:
1886:
1885:
1857:
1851:
1850:
1848:
1846:
1835:researchgate.net
1826:
1820:
1819:
1783:
1777:
1776:
1740:
1734:
1733:
1705:
1699:
1698:
1687:10.1037/h0031332
1670:
1664:
1663:
1635:
1629:
1628:
1602:
1596:
1589:
1583:
1582:
1554:
1548:
1547:
1545:
1543:
1515:
1509:
1508:
1498:
1466:
1460:
1459:
1430:
1424:
1418:
1412:
1406:
1397:
1388:
1382:
1375:
1369:
1355:
1349:
1342:
1336:
1335:
1333:
1331:
1311:
1305:
1304:
1302:
1301:
1271:
1260:
1250:
1237:
1236:
1234:
1233:
1218:
1212:
1211:
1209:
1208:
1190:
1158:
1152:
1146:
1137:
1135:
1133:
1131:
1122:. Archived from
1112:
1103:
1102:
1100:
1099:
1080:
1074:
1073:
1071:
1070:
1051:
1045:
1042:
937:1982 Lebanon war
743:Cultural issues.
550:General Patton's
410:In forward areas
397:Between the wars
250:Hyperventilation
226:Loss of appetite
42:
30:
29:
21:
2271:
2270:
2266:
2265:
2264:
2262:
2261:
2260:
2226:
2225:
2196:
2191:
2190:
2175:
2161:
2139:
2099:
2037:
2003:Woolf, Virginia
1984:
1982:Further reading
1979:
1978:
1972:
1934:
1930:
1893:
1889:
1858:
1854:
1844:
1842:
1827:
1823:
1784:
1780:
1741:
1737:
1706:
1702:
1671:
1667:
1636:
1632:
1625:
1603:
1599:
1593:Military Review
1590:
1586:
1555:
1551:
1541:
1539:
1532:
1516:
1512:
1467:
1463:
1456:
1438:Daniel Reisberg
1431:
1427:
1419:
1415:
1407:
1400:
1389:
1385:
1376:
1372:
1356:
1352:
1343:
1339:
1329:
1327:
1312:
1308:
1299:
1297:
1290:
1272:
1263:
1251:
1240:
1231:
1229:
1220:
1219:
1215:
1206:
1204:
1159:
1155:
1147:
1140:
1129:
1127:
1114:
1113:
1106:
1097:
1095:
1082:
1081:
1077:
1068:
1066:
1053:
1052:
1048:
1043:
1039:
1031:
1010:Gerald McMorrow
974:
954:
933:
889:
880:
871:
866:
835:
830:
818:
774:
769:
767:Pathophysiology
710:
698:
678:
642:
633:
599:
581:Flight surgeons
573:Edward Strecker
527:
522:
484:effort syndrome
399:
346:
334:
329:
302:Substance abuse
272:Excessive sleep
189:
184:
153:
137:
28:
23:
22:
15:
12:
11:
5:
2269:
2259:
2258:
2253:
2248:
2243:
2238:
2224:
2223:
2212:
2207:
2202:
2193:
2192:
2189:
2188:
2176:
2171:
2170:
2168:
2167:Classification
2160:
2159:External links
2157:
2156:
2155:
2149:
2143:
2137:
2124:
2116:
2111:
2097:
2084:
2079:
2067:
2053:
2041:
2036:978-0525934271
2035:
2015:
1999:
1983:
1980:
1977:
1976:
1928:
1887:
1852:
1821:
1778:
1751:(3): 193–201.
1735:
1716:(4): 754–764.
1700:
1665:
1646:(4): 429–435.
1630:
1623:
1597:
1584:
1549:
1531:978-1847871251
1530:
1510:
1461:
1454:
1444:(6 ed.).
1434:Henry Gleitman
1425:
1413:
1398:
1383:
1370:
1366:978-0773507746
1350:
1348:(1955) p. 851
1337:
1306:
1289:978-0231135528
1288:
1261:
1238:
1213:
1153:
1138:
1104:
1090:. 2020-06-27.
1075:
1046:
1036:
1035:
1030:
1027:
1026:
1025:
1013:
1001:
995:
990:
985:
980:
973:
970:
953:
950:
932:
929:
922:Narcosynthesis
915:
914:
906:
905:
897:
896:
888:
885:
879:
876:
870:
867:
865:
862:
861:
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857:
854:
851:
848:
845:
842:
834:
831:
829:
826:
817:
814:
773:
772:SNS activation
770:
768:
765:
764:
763:
760:
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747:
744:
741:
738:
735:
724:
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641:
638:
632:
629:
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593:
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526:
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475:
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468:
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458:
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333:
330:
328:
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324:
319:
316:
313:
307:
304:
299:
294:
289:
284:
281:
279:Hypervigilance
276:
273:
270:
269:Restless sleep
267:
262:
257:
252:
247:
241:
236:
230:
227:
224:
215:
210:
204:
201:
196:
190:
188:
185:
183:
182:
179:
176:
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167:
164:
161:
157:
152:
149:
136:
133:
117:trench warfare
65:
64:
59:
53:
52:
44:
43:
35:
34:
26:
9:
6:
4:
3:
2:
2268:
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2201:
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2178:
2177:
2174:
2169:
2165:
2154:
2150:
2148:
2144:
2140:
2134:
2130:
2125:
2122:
2121:
2117:
2115:
2112:
2108:
2104:
2100:
2094:
2090:
2085:
2083:
2080:
2076:
2075:Die Rebellion
2072:
2068:
2064:
2063:
2058:
2054:
2050:
2046:
2045:Holden, Wendy
2042:
2038:
2032:
2027:
2026:
2020:
2016:
2011:
2010:
2004:
2000:
1996:
1995:
1990:
1989:West, Rebecca
1986:
1985:
1969:
1965:
1961:
1957:
1953:
1949:
1945:
1941:
1940:
1932:
1924:
1920:
1915:
1910:
1906:
1902:
1898:
1891:
1883:
1879:
1875:
1871:
1867:
1863:
1856:
1840:
1836:
1832:
1825:
1817:
1813:
1809:
1805:
1801:
1797:
1794:(1): 99–110.
1793:
1789:
1788:Human Factors
1782:
1774:
1770:
1766:
1762:
1758:
1754:
1750:
1746:
1739:
1731:
1727:
1723:
1719:
1715:
1711:
1704:
1696:
1692:
1688:
1684:
1681:(2): 92–104.
1680:
1676:
1669:
1661:
1657:
1653:
1649:
1645:
1641:
1634:
1626:
1624:1-55798-525-1
1620:
1616:
1612:
1608:
1601:
1594:
1588:
1580:
1576:
1572:
1568:
1564:
1560:
1553:
1537:
1533:
1527:
1523:
1522:
1514:
1506:
1502:
1497:
1492:
1488:
1484:
1480:
1476:
1472:
1465:
1457:
1451:
1447:
1443:
1439:
1435:
1429:
1422:
1417:
1410:
1405:
1403:
1396:
1392:
1387:
1380:
1374:
1367:
1363:
1359:
1354:
1347:
1341:
1325:
1321:
1317:
1310:
1295:
1291:
1285:
1281:
1277:
1270:
1268:
1266:
1258:
1254:
1253:Shephard, Ben
1249:
1247:
1245:
1243:
1228:on 2006-12-09
1227:
1223:
1217:
1202:
1198:
1194:
1189:
1184:
1180:
1176:
1172:
1168:
1164:
1157:
1150:
1145:
1143:
1130:September 26,
1125:
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1011:
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994:
991:
989:
986:
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976:
975:
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962:
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949:
947:
941:
938:
928:
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923:
919:
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911:
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903:
902:
901:
894:
893:
892:
884:
875:
858:
855:
852:
849:
846:
843:
840:
839:
838:
825:
823:
813:
811:
807:
806:noradrenaline
803:
799:
798:Catecholamine
795:
791:
787:
778:
761:
758:
755:
752:
748:
745:
742:
739:
736:
733:
729:
725:
722:
721:
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714:
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703:
693:
691:
687:
682:
673:
668:
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659:
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651:
647:
637:
628:
625:
619:
617:
613:
609:
604:
588:
587:
586:
585:
584:
582:
576:
574:
570:
564:
562:
561:unit cohesion
558:
554:
551:
547:
543:
539:
534:
532:
516:
511:
507:
505:
501:
497:
490:
487:
485:
479:
472:
469:
466:
463:
460:
459:
455:
452:
448:
447:
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433:
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416:
412:
409:
408:
406:
404:
391:
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271:
268:
266:
263:
261:
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248:
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242:
240:
237:
235:
232:Frequency of
231:
228:
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216:
214:
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209:
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200:
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99:
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83:
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71:
63:
60:
58:
54:
50:
45:
41:
36:
31:
19:
2215:
2179:
2128:
2119:
2088:
2074:
2071:Roth, Joseph
2061:
2048:
2025:Regeneration
2024:
2009:Mrs Dalloway
2008:
1993:
1943:
1937:
1931:
1904:
1900:
1890:
1865:
1861:
1855:
1843:. Retrieved
1834:
1824:
1791:
1787:
1781:
1748:
1744:
1738:
1713:
1709:
1703:
1678:
1674:
1668:
1643:
1639:
1633:
1606:
1600:
1592:
1587:
1562:
1558:
1552:
1540:. Retrieved
1520:
1513:
1478:
1474:
1464:
1441:
1428:
1420:
1416:
1408:
1390:
1386:
1378:
1377:Copp, Terry
1373:
1357:
1353:
1345:
1340:
1330:21 September
1328:. Retrieved
1319:
1309:
1298:. Retrieved
1279:
1256:
1230:. Retrieved
1226:the original
1216:
1205:. Retrieved
1170:
1166:
1156:
1148:
1128:. Retrieved
1124:the original
1117:
1096:. Retrieved
1087:
1078:
1067:. Retrieved
1058:
1049:
1040:
1032:
1022:Dito Montiel
1020:– a film by
1015:
1003:
963:
959:
955:
942:
934:
925:
921:
920:
916:
907:
898:
890:
881:
872:
836:
819:
783:
713:Peacekeeping
711:
699:
683:
679:
670:
666:
662:
652:, historian
649:
643:
634:
620:
608:British Army
600:
577:
565:
538:psychiatrist
535:
531:World War II
528:
520:World War II
513:
509:
492:
488:
480:
477:
402:
400:
372:
369:
361:
347:
339:
335:
292:Irritability
245:palpitations
206:Shaking and
154:
138:
129:
121:World War II
106:
94:
73:
69:
68:
18:War neurosis
2049:Shell Shock
2019:Barker, Pat
1379:The Brigade
993:Shell shock
952:Controversy
732:booby traps
624:Axis powers
616:the Channel
109:World War I
86:shell shock
2230:Categories
2029:. Dutton.
1442:Psychology
1411:, (1987)
1300:2013-09-21
1232:2012-10-23
1207:2012-10-23
1098:2024-03-30
1069:2021-09-28
1029:References
802:adrenaline
728:land mines
726:Threat of
686:Winter War
496:depression
392:Simplicity
386:Expectancy
309:Attempted
297:Depression
265:Nightmares
199:Back pains
181:Exhaustion
82:psychiatry
62:Psychiatry
2131:. Arden.
2062:Zero Hour
1968:206578848
1845:March 30,
1565:: 87–88.
1542:12 August
931:Prognosis
869:Screening
828:Treatment
702:Israelis:
646:Freikorps
603:the Blitz
389:Proximity
380:Immediacy
344:Diagnosis
322:Confusion
255:Dizziness
234:urination
194:Headaches
57:Specialty
2107:58052897
2073:(1924).
2059:(1928).
2047:(1998).
2021:(1991).
2005:(1925).
1991:(1918).
1960:18218877
1923:17691678
1882:16330595
1839:Archived
1808:11474766
1773:33000532
1579:20996374
1536:Archived
1505:15426759
1440:(2004).
1324:Archived
1294:Archived
1201:Archived
1197:17008565
1092:Archived
1063:Archived
1017:Man Down
1005:Franklyn
972:See also
887:Training
878:Cohesion
810:muscular
794:stressor
631:Canadian
525:American
500:pleasure
311:suicides
260:Insomnia
222:vomiting
213:Sweating
125:veterans
2186:D003130
1939:Science
1816:8056746
1730:7309864
1695:4937878
1660:8751456
1496:2038162
1188:1586146
640:Germans
597:British
504:passion
377:Brevity
287:Anxiety
208:tremors
2153:online
2147:online
2135:
2105:
2095:
2033:
1966:
1958:
1921:
1880:
1814:
1806:
1771:
1765:667242
1763:
1728:
1693:
1658:
1621:
1577:
1528:
1503:
1493:
1452:
1364:
1286:
1195:
1185:
658:Göring
243:Heart
218:Nausea
1964:S2CID
1812:S2CID
1769:S2CID
676:Finns
612:D-Day
450:life.
441:time.
2181:MeSH
2133:ISBN
2103:OCLC
2093:ISBN
2031:ISBN
1956:PMID
1919:PMID
1878:PMID
1847:2024
1804:PMID
1761:PMID
1726:PMID
1691:PMID
1656:PMID
1619:ISBN
1575:PMID
1544:2019
1526:ISBN
1501:PMID
1450:ISBN
1362:ISBN
1332:2013
1284:ISBN
1193:PMID
1132:2004
946:PTSD
833:7 Rs
730:and
220:and
1948:doi
1944:319
1909:doi
1905:172
1870:doi
1866:162
1796:doi
1753:doi
1718:doi
1683:doi
1648:doi
1611:doi
1567:doi
1563:103
1491:PMC
1483:doi
1183:PMC
1175:doi
804:or
751:HIV
107:In
74:CSR
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