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December 11, 2003 (Ira Pilgrim)

Shell Shock

Insanity is often the logic of an accurate mind overtaxed.

Oliver Wendell Holmes (1809-1894)

The term "shell shock" originated during World War I when the theory was proposed that the symptoms of insanity were due to blast injury to the brain. This was nonsense, but the term stuck until W.W.II when the diagnosis was changed to "combat fatigue," and much later to "post traumatic stress disorder."

When I was with a general hospital in France during World War II, I remember a large ward full of beds filled with sleeping men. The treatment for combat fatigue was keeping the men in a drugged sleep(barbiturates) for a period of time, with them being awakened just to eat and eliminate. I don't know whether it did any good, but it didn't seem to do any harm.

My first actual contact with a soldier with combat fatigue happened during my first night as a medic with the infantry. It was at night, after a truck ride under fire, when I was dumped at an aid station of the 328th Infantry regiment. I introduced myself and was told that I was now "In charge of the aid station," and everyone immediately disappeared. A soldier came in who was completely bewildered. He asked me where he was. I told him that this was an aid station. "What aid station?" he asked. I answered with all I knew, "Red aid station." He asked, "Who's red?" Then he said, "I have to go." He left. Before long, he returned and said "They sent me back." I suggested that he give me his rifle and that he lie down and go to sleep. He did. He had combat fatigue. He was, to use a medical term, nuttier than a fruitcake. To use a more modern term, he had "freaked out."

A martinet like Gen. George Patton (Old Blood and Guts) figured that a soldier with combat fatigue was simply a coward. During W.W.I, some soldiers were shot by their officers when they didn't charge when ordered to do so.

The ostensible purpose of the medical profession is to cure or help ill people. The purpose of military medicine is very different; it is "To preserve the fighting strength." In other words, what is good for the military supersedes what is good for the patient. This can put a conscientious physician in a bit of a bind. He may know that the best thing for his patient is to send him home, but his orders are to send him back to the front lines. I am surprised that more psychiatrists don't develop non-combat fatigue.

I would guess that any psychiatrist would be aware of what the soldier's problem was. It results from a conflict between what a soldier believes is his duty to his comrades and country and an overwhelming desire to go on living. If a professional sky diver came to a psychiatrist with those symptoms, the most effective treatment would consist of convincing his patient to change his occupation to something less hazardous. A military psychiatrist doesn't have that option. His business is to send that soldier back to the line.

If you think, from what I have written, that I don't think much of the military, you would be absolutely correct. If you also conclude that I am a coward, and that I am not ashamed of it, you would also be correct. I might risk my life for my wife, but that's about it. The military think that it is dishonorable to want to go on living. I was brave once, but now I have grown up. It is no accident that the vast majority of combat troops are young. Words like courage and bravery are words that only the young believe in enough to die for. And some do just that.

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