Shell shock is a term that originated during World War I to describe symptoms similar to those of combat stress reaction and post-traumatic stress disorder (PTSD), which many soldiers suffered during the war. Before PTSD was officially recognized, the phrase was often used colloquially to refer to a combination of distressing symptoms some experience as a reaction to the intensity of battle. This set of symptoms typically include a feeling of dread or helplessness that may coincide with panic, fear, flight, or an inability to reason, sleep, walk, or talk. During the war, the concept of shell shock was poorly defined. Cases of "shell shock" could be interpreted as either a physical or psychological injury. Although the United States Department of Veterans Affairs still uses the term to describe certain aspects of PTSD, it is mostly a historical term, and is often considered to be the signature injury of the war. In World War II and beyond, the diagnosis of "shell shock" was replaced by that of combat stress reaction, which is a similar but not identical response to the trauma of warfare and bombardment. Despite medical alerts, long-term trouble was disregarded as a cowardice and weakness of mind by military leadership. In recent decades and following the 2003 invasion of Iraq, shell shock has been linked to biological brain damages, such as concussions and micro-tearing of the brain tissues. There are terms that exist that describe similar characteristics of shell shock, like the thousand-yard stare, which both come from the stresses of war.
Origin That day [in February 1918] the Germans gave us a terrible shelling. Lieutenant Lewis [of a machine gun platoon] and I were sitting in my dugout and Lewis was so nervous he could not sit still. It developed that this was his first day at the Front. I tried to calm him down but it did no good. Finally a shell landed on top of the dugout and blew the whole roof off so that we could see daylight through the hole above. Lewis went entirely to pieces, fell on the floor and tried to dig in the floor with his hands. He finally went entirely limp and we were unable to rouse him or get him to speak although his eyes were open and he apparently was not hurt. Finally we had to send him back on a stretcher. This was the only real case of shell shock that I saw. During the early stages of World War I, in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise. While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds. By December 1914, as many as 10% of British officers and 4% of enlisted men were experiencing "nervous and mental shock". The term "shell shock" was coined during the Battle of Loos in 1915 to reflect an assumed link between the symptoms and the effects of explosions from artillery shells. The term was first published in 1915 in an article in The Lancet by Charles Myers. Some 60–80% of shell-shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of conversion disorder, including mutism and fugue. The number of shell-shock cases grew during 1915 and 1916; however, it remained poorly understood medically and psychologically. Some physicians held the view that it was a result of hidden physical damage to the brain, with the shock waves from bursting shells creating a cerebral lesion that caused the symptoms and could potentially prove fatal. Another explanation was that shell shock resulted from poisoning by the carbon monoxide formed by explosions. At the same time, an alternative view developed describing shell shock as an emotional, rather than a physical, injury. Evidence for this point of view was provided by the fact that an increasing proportion of men with shell-shock symptoms had not been exposed to artillery fire. Since the symptoms appeared in men who had no proximity to an exploding shell, the physical explanation was clearly unsatisfactory. In spite of this evidence, the British Army continued to try to differentiate those whose symptoms followed explosive exposure from others. In 1915, the British Army in France was instructed that: "'Shell-shock and shell concussion cases should have the letter W prefixed to the report of the casualty, if it was due to the enemy: in that case the patient would be entitled to rank as "wounded" and to wear on his arm a "wound stripe".' If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy'; and he was to [be] labelled 'Shell-shock, S' (for sickness) and was not entitled to a wound stripe or a pension." However, it often proved difficult to identify which cases were which, as the information on whether a casualty had been close to a shell explosion or not was rarely provided.
Cowardice
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