'Pitiless psychology': the role of prevention in British military psychiatry in the Second World War

Shephard, Ben

doi:10.1177/0957154x9901004005

Cited by 44 publications

(35 citation statements)

References 1 publication

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“…The report left the core dilemma unsolved: how to compensate the truly deserving (courageous men traumatized by combat) without rewarding those for whom psychological injury merely offered an escape from military duty (Shephard 1999). Its publication represented a high-water mark in the history of shell shock and henceforth the term disappeared from official medical and military vocabularies.…”

Section: History Of Post-combat Disorders E Jones 537mentioning

confidence: 99%

Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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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.

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Section: History Of Post-combat Disorders E Jones 537mentioning

confidence: 99%

Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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“…Further, the modern situation has forgotten lessons of the world wars (Shephard, 1999). Rather than self-consciously avoiding the effects of medical diagnoses, we have given adversity-linked distress its own terminology: Posttraumatic Stress Disorder.…”

Section: Emergence Of Ptsd In the Dsmmentioning

confidence: 99%

“…Again, the key was to prevent these morbid psychological symptoms from forming (Spiegel, 2000). Shephard (1999) has characterized treatment approaches emerging from the world wars as "Pitiless Psychology," wherein adopted policies where characterized by "deterrence" strategies that included avoidance of diagnostic terms, rest with an expectation of return to battle, and elimination of pensions for war neuroses.…”

Section: Lessons From the World Warsmentioning

confidence: 99%

“First Do No Harm:” Emerging Guidelines for the Treatment of Posttraumatic Reactions

Herbert

Sageman

2004

Posttraumatic Stress Disorder

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“…This distinction was invoked in making decisions about the grounds for determining disability both during and after combat, and it was also significant for determining criteria for awarding pensions. 6,10,11 Veterans from World War I were eligible for pensions as a consequence of suffering from shell shock, but concerns were raised about the large number of recipients and the possibility of malingering. As World War II loomed in the future and then occurred, British policy created strict criteria for recognizing and awarding disabilities secondary to shell shock/stress/neurastheniaall in the direction of minimizing or eliminating any rewards for disabilities considered to be psychogenic.…”

mentioning

confidence: 99%

“…As World War II loomed in the future and then occurred, British policy created strict criteria for recognizing and awarding disabilities secondary to shell shock/stress/neurastheniaall in the direction of minimizing or eliminating any rewards for disabilities considered to be psychogenic. 10 After the end of World War II, American psychiatry decided to create a standard nomenclature that would be used by all psychiatrists; the impetus came initially from the Veterans' Administration and was influenced by the World War II experience, which required that psychiatrists from across the United States and from diverse training backgrounds develop a common language for discussing psychopathology, making diagnoses, and determining disability. This led to the formulation of a diagnostic category called Gross Stress Reaction, which appeared in the first Diagnostic and Statistical Manual (DSM-I), published in 1952.…”

mentioning

confidence: 99%

What is Posttraumatic Stress Disorder?

Shalev

2001

PsycEXTRA Dataset

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Although post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are categorized as separate and discrete disorders, the boundary between them is sometimes indistinct. Their separation is based on the assumption that PTSD results primarily from psychological stress, while TBI is the consequence of an identifiable injury to the brain. This distinction is based on an antiquated polarity between mind and brain, and the separation of the two disorders often becomes arbitrary in day-to-day psychiatric practice and research.This issue of Dialogues in Clinical Neuroscience is titled "Trauma, Brain Injury, and Post-traumatic Stress Disorder." The articles between its covers address both post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). As the combination of these articles indicates, the various recent wars in the Middle East have awakened an old controversy about the relative impact of physical and psychological stress in causing neuropsychiatric disorders. Although the term TBI suggests the occurrence of some type of physical lesion, while PTSD suggests a disorder occurring as a consequence of psychological stress, the boundary between the two is often unclear and sometimes permeable or overlapping. The first systematic discussion of the relationship between physical and psychological stress dates back to World War I. The history of that discussion provides an informative context for current controversies concerning PTSD and TBI. 1 Combat techniques in World War I introduced new types of combat stress that had not existed during previous wars. Soldiers engaged in trench warfare were relatively immobile and therefore more vulnerable. They were also chronically exposed to new and perversely lethal threats, such as poison gas, machine gun fire, mortar attacks, land mines, and tanks. Casualties were devastating, and fatality rates were frightening. Men watched their friends die beside them, and they confronted the possibility of their own demise on a daily basis. Alternatively they might be maimed and consigned to a life of chronic disability. As the war progressed, the high casualty rate made it clear that Britain and continental European countries were losing many of an entire generation of young men-a social loss from which they would be slow to recover. In this context of brutal bloodshed and omnipresent fear, a new and somewhat unfamiliar type of disability emerged that had not been described in previous wars: a syndrome characterized by confusion, memory impairment, headache, difficulty concen- 240 G u e s t e d i t o r i a l

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'Pitiless psychology': the role of prevention in British military psychiatry in the Second World War

Cited by 44 publications

References 1 publication

Historical approaches to post-combat disorders

Historical approaches to post-combat disorders

“First Do No Harm:” Emerging Guidelines for the Treatment of Posttraumatic Reactions

What is Posttraumatic Stress Disorder?

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