One historian estimates at least 20 percent of men developed shell-shock, though the figures are murky due to physician reluctance at the time to brand veterans with a psychological diagnosis that could affect disability compensation.
Soldiers were archetypically heroic and strong. When they came home unable to speak, walk or remember, with no physical reason for those shortcomings, the only possible explanation was personal weakness. Treatment methods were based on the idea that the soldier who had entered into war as a hero was now behaving as a coward and needed to be snapped out of it. Yealland then applied an electric shock to the throat so strong that it sent the patient reeling backwards, unhooking the battery from the machine.
Yealland reported this encounter triumphantly — the breakthrough meant his theory was correct and his method worked. Shell-shock was a disease of manhood rather than an illness that came from witnessing, being subjected to and partaking in incredible violence.
The next wave of the study of trauma came when the Second World War saw another influx of soldiers dealing with similar symptoms. Longitudinal studies showed that symptoms could persist anywhere from six to 20 years , if they disappeared at all. These studies returned some legitimacy to the concept of combat trauma that had been stripped away after the First World War.
Vietnam was another watershed moment for combat-related PTSD because veterans began to advocate for themselves in an unprecedented way. Beginning with a small march in New York in the summer of , veterans themselves began to become activists for their own mental health care. Public understanding of war itself had begun to shift, too, as the widely televised accounts of the My Lai massacre brought the horror of war into American living rooms for the first time. This tendency to agnosticism about the physiology of PTSD is also reflected in contemporary evidence-based approaches to medicine.
Modern medicine focuses on using clinical trials to demonstrate that a therapy works, but is skeptical about attempts to link treatment effectiveness to the biology underlying a disease. People can develop PTSD for a number of different reasons, not just in combat. Sexual assault, a traumatic loss, a terrible accident — each might lead to PTSD.
At first shell shock was thought to be caused by soldiers being exposed to exploding shells but eventually doctors and nurses began to realise that the causes were deeper.
Doctors soon found that many men suffering the symptoms of shell shock without having even been in the front lines. Shell shock victims often couldn't eat or sleep, whilst others continued to suffer physical symptoms.
Many soldiers found themselves re-living their experiences of combat long after the war had ended. At the time there was little sympathy for shell shock victims with the condition generally seen as a sign of emotional weakness. Many soldiers suffering from the condition were charged with desertion, cowardice, or insubordination. Heartbreakingly some suffering soldiers were shot dead by their own side after being branded cowards. At the end of the war over 80, cases of shell shock had passed through British Army medical facilities.
The huge number was completely unexpected and as early as there was a shortage of hospital beds for sufferers. Many asylums, private mental institutions and disused spas were taken over and designated as hospitals for mental diseases and war neurosis. In the Department of Defense established the Center for Neuroscience and Regenerative Medicine Brain Tissue Repository, under the direction of Perl, to pursue postmortem study of brains at the tissue level. The eight brain specimens his team studied represented chronic cases, in which the person had lived at least six months after the blast event, as well as acute cases, in which death had followed within 60 days.
And these early signs—these early scars—are in the right places, form the right pattern. Blast waves seem to cause damage at the boundaries of different structures, such as between brain matter and cerebrospinal fluids and between gray and white brain matter. More starkly revealing than any words are the brain images that illustrate what Perl describes.
Panels show brain tissue, as delicate as butterfly wings, spatter-marked as if with buckshot, bearing outright tears surrounded by broken tendrils of scarring or dark clouds of damage looming from the folds and furrows.
This blast damage reaches its spider legs into different regions of the brain: the frontal lobe, which controls attention span and emotional control; the hypothalamus, which regulates sleep; the hippocampus, responsible for the formation of memories. The symptoms resulting from damage to these areas are exactly the kinds of symptoms often attributed to PTSD.
Emerging from the welter of medical data are details about the lives of the men who make up the research study.
They had all been exposed to bombs, IEDs, and high explosives, and they had lived from as long as nine years after blast exposure to as little as four days. They ranged in age from 26 to 45 at the time of death.
They had endured headaches, anxiety, depression, insomnia, memory and concentration problems, seizures, and chronic pain. One was a Navy SEAL who conducted explosives training exercises and lost his coherence of thought; he began to jumble his speech and became overwhelmed by such routine tasks as driving or even packing a car. Three of the men had acute brain injury and died shortly after exposure to the explosion, suffering burns, fractures, and hemorrhage.
Four of the remaining five men who had chronic blast-induced brain injury died by suicide or from drug overdoses. The cause of death of the eighth service member was not determined. The new paper may add to mounting evidence that destructive behaviors, including suicide, are outcomes directed by damaged regions of the brain—as symptomatic of blast damage as such common conditions as sleeplessness and ringing in the ears. A century ago, in February , the Lancet, the parent journal of the Lancet Neurology, published the first medical case study of shell shock in World War I.
These mostly young veterans suffered through their lives in the belief that they had lost their nerve on the field of battle—in short, that they had failed. From the British government Ministry of Pensions files we can catch occasional glimpses of their postwar fates. Beyond the specifically medical questions, the finding raises a number of issues, such as care costs many years into the future and whether those diagnosed with TBI should be awarded the Purple Heart.
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