"Shell shock," the psychological scourge of World War I, occurred after "a man has been buried, lifted, or otherwise subjected to the physical effects of a bursting shell or other similar explosive." So wrote Charles Myers, an officer in the British army's medical corps, in his 1940 book, Shell Shock in France, 1914-18. Additionally, he noted, shell shock could result even "when the soldier is remote from the exploding missile, provided that he be subject to an emotional disturbance or mental strain sufficiently severe." Of course, Myers warned, the effects of shell shock could also appear in those "who have never been near any such exploding missile... or indeed have never come under fire at all."
Shell shock without the shells or the shock? What in the world did that mean? What did it say about war and those called upon to fight in them?
War-related psychiatric conditions have long been a slippery subject. Soldier's heart, Da Costa syndrome, trench neurosis, shell shock, war neurosis, acute combat stress reaction, battle fatigue, post-traumatic stress disorder (PTSD) -- each of these maladies has been a product of its time and each has been all too real, painful, and debilitating to the men and women who have suffered from them.
In his 1919 text, Shell-Shock and Other Neuropsychiatric Problems, Elmer Southard -- an Army veteran, Harvard Medical School professor, and former director of a unit of the U.S. Army's Neuropsychiatric Training School -- profiled a Russian officer who became afflicted by tremors, was incapacitated by fear that "the Germans were going to break through and capture him [and] shells were about to burst over his head," and started suffering "hallucinations of shots and the voices of soldiers" that he was unable to distinguish from reality. In February 1915, this officer was medically evacuated, but not from the front lines. He had, Southard explained, never served there nor even "had occasion to visit the line or the trenches."
In fact, a study of a group of British soldiers suffering from war psychoses during World War I found that just 20% had been under fire. Late in World War II, a study of Australian psychiatric casualties concluded that 60% had had no contact with the enemy. Given all of this, it isn't surprising that TomDispatch regular Jeremiah Goulka's brief tour in Iraq has continued to affect him years later despite the fact that "he hardly saw a thing."
According to the Department of Veterans Affairs, almost 30% of the post-9/11 veterans -- close to 250,000 men and women -- treated at V.A. hospitals and clinics have been diagnosed with post-traumatic stress disorder. To that total, you would have to add American civilian advisors and contractors like Goulka, State Department officials, CIA agents, mercenaries, aid workers, reporters, and others who also bear the psychic scars of America's recent wars. And then consider all those Iraqis and Afghans, millions of them, combatants and noncombatants -- without a veterans' administration in sight, benefits of any sort, or even the possibility of psychiatric counseling. Consider all those inhabitants of American war zones who have had no choice but to spend not a few weeks, several tours of duty, or even the length of a world war under such stress, but often a decade or more in countries wracked by violence, privation, and distress. Perhaps we need yet another diagnosis to accurately capture the essence of what war has done to them. Neither shell shock nor PTSD seems remotely sufficient. Nick Turse
It Doesn't Take Much
On Almost Getting PTSD in Iraq
By Jeremiah Goulka
I was one nightmare short of PTSD.
It didn't take much, that's what surprised me. No battles. No dead bodies. I spent just three and a half weeks as a contractor in Iraq, when the war there was at its height, rarely leaving the security of American military bases.
For several years now, Americans have become increasingly aware that a large number of veterans have gotten post-traumatic stress disorder (PTSD) in Iraq and Afghanistan. Studies estimate that at least 1 in 5 returning vets -- possibly as many as 1 in 3 -- have it. Less notice has been given to the huge numbers of veterans who suffer some PTSD symptoms but not quite enough to be diagnosed as having the disorder. Civilian employees of the U.S. government, contractors, and of course the inhabitants of the countries caught up in America's wars have gotten even less notice.
The thing is: It doesn't take much to develop the symptoms of PTSD. Our idea of what used to be called "shell shock" tends to be limited to terrible battles, not just the daily stress of living in a war zone or surviving a couple of close calls.
This is a story of how little it can take. I hardly saw a thing.
My first day in Iraq ended with an explosion.