Historical approaches to post-combat disorders

Abstract

Almost every major war in the last century involving western nations has seen combatants diagnosed with a form of post-combat disorder. Some took a psychological form (exhaustion, combat fatigue, combat stress reaction and post-traumatic stress disorder), while others were characterized by medically unexplained symptoms (soldier's heart, effort syndrome, shell shock, non-ulcer dyspepsia, effects of Agent Orange and Gulf War Syndrome). Although many of these disorders have common symptoms, the explanations attached to them showed considerable diversity often reflected in the labels themselves. These causal hypotheses ranged from the effects of climate, compressive forces released by shell explosions, side effects of vaccinations, changes in diet, toxic effects of organophosphates, oil-well fires or depleted-uranium munitions. Military history suggests that these disorders, which coexisted in the civilian population, reflected popular health fears and emerged in the gaps left by the advance of medical science. While the current Iraq conflict has yet to produce a syndrome typified by medically unexplained symptoms, it is unlikely that we have seen the last of post-combat disorders as past experience suggests that they have the capacity to catch both military planners and doctors by surprise.

Compensation and wellness: a conflict for veterans' health

“…A cluster analysis of symptoms showed that there was no difference in the patterning of symptoms between the two groups and that three groups of symptoms had predominated consistently in war syndromes throughout the 20th century: debility cluster (n = 847); somatic cluster (n = 434) and neuropsychiatric cluster (n = 575). 8 Australian research into Gulf War Syndrome yielded similar results. Australian Gulf War veterans reported symptoms more frequently and more severely when compared with matched military personnel who did not deploy to this conflict.…”

Managing future Gulf War Syndromes: international lessons and new models of care

“…In addition to clinical and epidemiological research, the Gulf War Syndrome controversy has prompted medical historians to rediscover an extensive international literature on poorly understood war-related symptom syndromes (for a detailed discussion, see Jones 2006). Controversial syndromes have occurred during and after virtually every major war dating back at least as far as the Crimean War of the 1850s and the US Civil War (Hyams et al 1996;Jones et al 2002).…”

Long-Term Military Work Outcomes in Soldiers Who Become Mental Health Casualties When Deployed on Operations

“…The role of the military mental health practitioners who work in FMHTs is to provide clinical, educational, and advisory support to operational commanders. In discharging their clinical function, the FMHT makes use of "Forward Psychiatry," a term which refers to a set of treatment principles that were first articulated in 1916 (Jones, 2006). These principles are described using the acronym "PIE," which refers to treatment delivery being proximal to the combat zone, being delivered immediately to those that need it, and delivered with the expectation of occupational recovery.…”