Chapter Five
WORLD WAR I
It is difficult today to comprehend the enthusiasm with which the belligerent populations of both sides greeted the outset of World War I. The notion of war was both glamorous and desirable; it was to be the test of both national and individual toughness, character, and worth. Military doctrine on both sides called for a war of maneuver guided by the "spirit of the offensive" that would be both brief and glorious. The short period of maneuver ended weeks after the initial German offensive on the West. It was followed by the deadlock on the Marne and the "race for sea," which ended with the prolonged stalemate of trench warfare. The means of war were ultimately much different from those hypothesized at its outbreak.
SHELL SHOCK
It is of interest to note that the extraordinary living conditions of trench warfare were seldom evoked as contributory to shell shock. Mud, hunger, fatigue, chronic sicknesses, often continual damp, lice, and rats were seldom mentioned as possible contributors to the soldiers’ state. Even so astute an observer and therapist as Rivers (1918) preferred an essentially psychological model of causality, deriving the symptoms of war neurosis from the degree of immobility demanded of the soldier in his combat task. A fuller appreciation of the roles that might be played in symptom generation by environmental factors in the combat zone was not to come until World War II.
As a cultural phenomenon during World War I, the legitimacy of the symptoms that called for withdrawal of the soldier from the trenches or the combat zone would then, for most, be questionable if physical symptoms were not a part of the expression of the disorder.
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." http://www.gulflink.osd.mil/library/randrep/marlowe_paper/mr1018_11_ch5.html
I've seen bodies ripped to pieces by bullets, blown into millions of scraps by bombs, and pierced by booby traps. I’ve smelled the stench of bodies burned. I’ve heard the air sound like it was boiling from rounds flying back and forth. I’ve lived an insanity others should never live..."
-- Dennis Tenety, Fire in the Hole
●-Michael C.C. Adams, The Best War Ever: America and World War II About 25-30 percent of WWII casualties were psychological cases; under very severe conditions that number could reach as high as 70-80percent. In Italy, mental problems accounted for 56 percent of total casualties. On Okinawa, where fighting conditions were particularly horrific, 7,613 Americans died, 31,807 sustained physical wounds, and 26, 221 were mental casualties.-Adams, 95Trying to repress feelings, they drank, gambled suffered paralyzing depression, and becameinarticulately violent. A paratrooper’s wife would “sit for
hours and just hold him when he shook. Afterward, he started beating her and the children: “He became a
brute.” And they divorced —-Adams, 150
Battle Continues Over Vietnam PTSD Numbers
08.23.07, 12:00 AM ET
http://www.medicinenet.com/script/main/art.asp?articlek...THURSDAY, Aug. 23 (HealthDay News) --
-
In the years following the end of U.S. involvement in Vietnam, the actual number of veteran 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.
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"The most important results have been underemphasized, and that is the dose/response relationship, and that's about as close as you can come to a causal relationship," he said.
"The other thing is the rate of 1-in-5 war-related onset of PTSD and 1-in-10 still current after the war of impairing PTSD. That
is far from trivial. This is a heavy cost by any count.
FIELD MANUAL NO. 22-51
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.
a. Battle fatigue can also be present in soldiers who have been physically wounded or who have nonbattle injuries or diseases caused by stressors in the combat area. It may be necessary to treat both the battle fatigue and the other problems.
b. Battle fatigue may coexist with misconduct stress behaviors. However, battle fatigue itself, by definition, does not warrant legal or disciplinary action.
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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, 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).
NOTE
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 vacuation 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.
All Soldiers Fade AwayJustin HudallPosted November 11, 2007 | 06:39 PM (EST)
http://www.huffingtonpost.com/justin-hudnall/all-soldie..."Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home, while 12% per year were diagnosed with a mental health problem. Against this grim backdrop is an issue that has ignited debate among veterans, government officials and civilians in the healthcare industry: how the Veterans Affairs Department could improve access to healthcare services for rural veterans, who account for about 40% of the VA's patient population." There are 21 states with higher than the national average of veterans within their populations. Eighteen of these are rural states.
Because of advances in body armor and medical technology, this war will produce a higher proportion of seriously wounded, traumatized, and brain-damaged veterans than any other.Compounding this is an expected baby boom among military personnel, meaning that the next generation, growing up in the shadow of the Iraq war, will be significantly affected as well.
PTSD and Murder Among Newest VeteransJon Soltz | Posted January 14, 2008 | Politics
This weekend, while the 24-hour primary coverage raged on, the New York Times published a very well researched and stunning report on the number of Iraq and Afghanistan Veterans involved in killings, here in America. They found at least 121 cases, now, where a veteran was charged with involvement in a homicide.
The trend of our newest veterans being involved in killings on the homefront can be largely attributed to four letters -- PTSD. Our failure to properly screen for and treat this mental injury is the source of so many problems our newest veterans face -- from drug and alcohol abuse, to homelessness, to joblessness, to spousal abuse, to suicide, and now, to murders.http://www.huffingtonpost.com/jon-soltz/ptsd-and-murder...HEALTH-US: Iraq Vets Left in Physical and Mental Agony
By Aaron Glantz
The group Veterans for America, formerly the Vietnam Veterans of America Foundation, estimates that 10,000 veterans of Iraq and Afghanistan are now living on the street.
"What's unique about the men and women coming back from Iraq and Afghanistan is that they're not able to integrate with their family," Feldstein said. "They've seen horrible things. They've been in horrible places and their family can't relate. And so you become homeless in the last place you lived."
A recent study by Harvard's Kennedy School of Government found that by the time the Iraq and Afghanistan wars end, there will be at least two and a half million vets.
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Pentagon studies show that 12 percent of soldiers who have served in Iraq suffer from post-traumatic stress disorder. The group Veterans for America, formerly the Vietnam Veterans of America Foundation, estimates 70,000 Iraq war veterans have gone to the VA for mental health care.
http://www.ipsnews.net/news.asp?idnews=36056This article originally appeared in the July 2007 volume of the Zero To Three
Journal on Coping With Separation and Loss.
The Young Military Child
Our Modern Telemachus
Stephen J. Cozza
Uniformed Services University of the Health Sciences
Alicia F. Lieberman
University of California, San Francisco
-A combat mindset or what has been referred to as Battlemind can lead to misdirected irritability or aggression that can impact on small children. Irritability, emotional rage, jumpiness, hypervigilance, or overreactivity can all lead to family conflict and misunderstanding on the part of the young child. Social withdrawal or reduced communication because of anxiety about sharing upsetting war-related experiences may cause further withdrawal from family members and lead to a child’s confusion about the meaning of such parental nonavailability.—Postdeployment emotional and behavioral responses can range from more typical short-term distress responses, such as change in sleep, decreased sense of safety, or social isolation, to the development of more serious psychiatric conditions, such as post traumatic stress disorder (PTSD) or depression.
Studies conducted by Hoge and colleagues (Hoge et al., 2004; Hoge, Auchterlonie, & Milliken, (2005) at the Walter Reed Army Institute of Research have demonstrated significant postdeployment distress in populations of combat exposed soldiers and marines returning from Iraq. When screened 12 months after return from combat deployment, nearly 20% of service members endorsed symptoms consistent with a mental
disorder, most often PTSD or depression.
—Studies have demonstrated that the children of parents with depression (Beardslee, Versage, & Gladstone, 1998) evidence significant problems in a wide range of functional areas. Children of Vietnam veterans with PTSD are more likely to evidence symptoms similar to those of their combat-exposed fathers (Rosenheck & Nathan, 1985; Rosenheck & Thompson, 1986).
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