combat disorder

This page has been archived and is no longer being updated regularly. During World War I, some people saw shell shock as cowardice or malingering, but Charles S. Myers convinced the British military to take it seriously and developed approaches that still guide treatment today. By the winter of 1914–15, "shell shock" had become a pressing medical and military problem. Not only did it affect increasing numbers of frontline troops serving in World War I, British Army doctors were struggling to understand and treat the disorder. The term "shell shock" was coined by the soldiers themselves. Symptoms included fatigue, tremor, confusion, nightmares and impaired sight and hearing. It was often diagnosed when a soldier was unable to function and no obvious cause could be identified. Because many of the symptoms were physical, it bore little overt resemblance to the modern diagnosis of posttraumatic stress disorder . Shell shock took the British Army by surprise. In an effort to better understand and treat the condition, the Army appointed Charles S. Myers, a medically trained psychologist, as consulting psychologist to the British Expeditionary Force to offer opinions on cases of shell shock and gather data for a policy to address the burgeoning issue of psychiatric battle casualties. The first cases Myers described exhibited a range of perceptual abnormalities, such as loss of or impaired hearing, sight and sensation, along with other common physical symptoms, such as tremor, loss of balance, headache and fatigue. He concluded that these were psychological rather than physical casualties, and believed that the symptoms were overt manifestations of repressed trauma. Along with William McDougall, another psychologist with a medical background, Myers argued that shell shock could be cured through cognitive and affective reintegration. The shell-shocked soldier, they thought, had attempted to manage a traumatic experience by repressing or splitting off any memory of a traumatic event. Symptoms, such as tremor or contracture, were the product of an unconscious process designed to maintain the dissociation. Myers and McDougall believed a patient could only be cured if his memory were revived and integrated within his consciousness, a process that might require a number of sessions. While Myers believed that he could treat individual patients, the greater problem was how to manage the mass psychiatric casualties that followed major offensives. Drawing on ideas developed by French military neuropsychiatrists, Myers identified three essentials in the treatment of shell shock: "promptness of action, suitable environment and psychotherapeutic measures," though those measures were often limited to encouragement and reassurance. Myers argued that the military should set up specialist units "as remote from the sounds of warfare as is compatible with the preservation of the ‘atmosphere' of the front." The army took his advice and allowed him to set up four specialist units in December 1916. They were designed to manage acute or mild cases, while chronic and severe cases were referred to base hospitals for more intensive therapy. During 1917, the battles of Arras, Messines and Passchendaele produced a flood of shell-shock cases, overwhelming the four units. Inevitably, Myers was criticized by those who believed that shell shock was simply cowardice or malingering. Some thought the condition would be better addressed by military discipline. Myers became increasingly demoralized and requested a posting back to the United Kingdom. In October 1917, the War Office in London held an emergency conference to discuss ways to improve the treatment of shell shock as large numbers of patients were being discharged from general hospitals as invalids incapable of regular employment, because physicians lacked expertise and understanding. Myers proposed a system by which doctors would refer severe cases of shell shock directly from the base hospitals in Fra