Shell Shock / Combat Stress Reaction (CSR) / Post-Traumatic Stress Disorder (PTSD)

World War I Australian dressing station in France. Wounded warrior in lower left of image is thought to have the dazed look of a soldier suffering shell shock.

US Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury

In many cases, a military medic can take one look at a wounded warrior and determine exactly what’s hurt and how to fix it. The military is rife with procedures and standards of operation that govern all predictable scenarios, such as wounded soldiers, although there are really few predictable events during times of war. The soldiers with obvious wounds are handled by the book, or close to it. It’s the warriors suffering invisible emotional wounds that pose the biggest questions.

How does one truly and accurately assess the mental state of another? Do these assessment measures ring true during times of peace as well as during times of war? How accurate can these psychiatric assessments be during the heat of battle? Is the soldier really sick or deliberately faking mental distress? Is this one just not emotionally equipped to be a combat soldier or is emotional and/or neurological damage truly evident? Can this soldier be returned to battle after a rest or does he need more intensive therapy elsewhere? These are the questions every military medic must grapple with. They’re the questions military medics have been grappling with forever.

Medical terminologies change over time just as war and military terminologies do. In the earliest part of the 20th century, the emotional trauma associated with war was called shell shock and it was thought to be directly related to battle. Because of that battlefield connection, it was also known as battle fatigue. Neither term is in official use at this time.

Emotional trauma, or combat stress reaction (CSR), as it’s called today, isn’t always associated with physical injury. The very carnage of war, the lights, the noises, the fear, and the awareness that comrades are getting hurt and killed all around contribute mightily to a soldier’s ability to think clearly during and after the actual battle itself. Even those who seem to come through the battle relatively unscathed can be affected by the emotional trauma of killing.

As a general rule in today’s military, combat stress reaction is a short-term response to recent combat. It’s awful for a while but symptoms pass relatively quickly. Most soldiers suffering a spell of combat stress reaction can return to battle once symptoms subside. They may be even better equipped emotionally to deal with the realities of war after confronting it on such an in-depth personal and intellectual level.

When CSR lingers too long or creates an emotional chasm too deep to cross with battles still raging nearby, the combat medic may need to diagnose post-traumatic stress disorder, or PTSD. The best treatment for PTSD is removal from the military field hospital environment and the assurance that no more battle will be seen by this soldier.

The military has long honored soldiers suffering physical wounds during combat but emotional wounds have not been so openly embraced. Emotional wounds are difficult for others to understand – no casts to sign, no scars to show off, no gruesome personal war stories – so they’ve been kept out of the military limelight as much as possible.

Fortunately for today’s soldier, these very real effects of war are being discussed openly. New regulations and standards of military and medical procedure are being developed to better respond to emotional wounds of war.

Today’s military medic may diagnose emotional wounds more often now than in times past because he or she is confident the diagnosis will withstand military scrutiny. Maybe it’s due to more confidence in treatment options. And maybe it’s because emotionally wounded soldiers don’t fell the stigma of emotional trauma as sharply these days as they likely did in times past so they’re more inclined to discuss their feelings with their field doctor.