Talk:Combat stress reaction

Great
Great article! Throughly enjoyed reading this one. - Vaughan 07:53, 5 Oct 2004 (UTC)

I agree. This article needs an intro and at least a general description of the topic before delving into other areas of the matter. --Umma Kynes 03:03, 12 May 2006 (UTC)

Good article, but was what was defined as shell shock really the same thing as this? aren't there schools of thought that say it is more like PTSD? Shell shock seemed to be long term, and this is about a short term problem? The bit about Lebanon says men were able to return to action in 72 hours- WW1 shell shock affected the men long after they were back in civilian life. I'm no expert, would appreciate a response from someone who is. LouiseCooke —Preceding unsigned comment added by 195.195.71.206 (talk) 17:13, 9 January 2008 (UTC)


 * The article describes how CSR was called shell shock in WWI but that by the end of the war it was realised that it was not due to shocks by shells (commotional) but rather was emotional. Despite the British War Office producing a report on Shell Shock after the war (WWI), the term was by then deprecated.  --CloudSurfer (talk) 07:58, 5 March 2008 (UTC)

WWII info
Under the "Germans in WWII" section, it cites an increase of 5% of stress casualties over period 35 to 42. But the war had not begun in 35, so it is innaccurate to cite these numbers, I think.

Agreed. I was about to post something about this error too :P Talk User:Fissionfox 05:36, 1 April 2007 (UTC)


 * Don't forget the Germans fought in the Spanish Civil War, 1936-9, the figures might be counted from there (5 might be a typo for 6). Plus the conclusion at the end of the other psychiatrist, about the third of cases, could be wrong. The latter part of the war would have seen more movement, panic, and disarray as the German army was pushed back, together with a knowledge of impending defeat, which might well have an effect on the condition? Plus, if you know the war will end soon, wouldn't you try and report sick to avoid getting killed in the last few weeks when it all seems pointless? Tony Spencer 22:59, 13 September 2007 (UTC)

Merging Article
An arguement against merging this article with the PTSD article: PTSD is a medical ailment that is firmly within the realm of the medical community to deal with, whereas combat stress reaction can be argued to be in both the realm of the medical community and yet still maintains an element of leadership responsibility. By this, I mean that there are measures that can be taken by military leaders to mitigate or minimize the effects of combat stress, potentially preventing the development of long term problems like PTSD. I've added a reference that identifes some of the lessons the Canadian Forces has identified regrading this issue (someone can clean up the addition of the reference). --Milbuff101 14:23, 20 July 2006 (UTC)
 * Note that the ailments CSR and PTSD are not the same. The diagnostics for PTSD include duration of at least one month (I've heard six months after the event in oral presentations, but I can't link to a source for this), but not for CSR. Staffan S 09:14, 7 August 2006 (UTC)


 * opposed

The article would be too long and this subject goes furthur into detail about a specific form of PTSD as PTSD can come from many other things such as rape, witnessing a murder etc etc... Drew1369 17:38, 31 October 2006 (UTC) (Edited by Hyter -- fixed spelling)


 * opposed

CSR is generally treated with group therapy, but PTSD is usually a very personal things. Although they are similar, treatments and causes are VERY different. Hyter 17:44, 4 December 2006 (GMT -06:00 Central Time US & Canada)


 * Heavy Oppose Combat Stress Reaction is sufficiently large enough an article to stand on its own. Sharkface217 22:32, 16 December 2006 (UTC)


 * opposed CSR is a short-term military matter for leaders, medics, army doctors, fellow soldiers. It is part of the experience of major combat. PTSD extends to crime situations-- rape victims, hostages, domestic violence, etc. They're separate problems with separate solutions.

WW1
what about world war one shell shock?


 * One thing I'd like to see in this article is a reference to the extreme forms of CSR such as were experienced in WW1, including an almost total loss of control of the nervous system - men who couldn't stand up, for instance. A lot of footage of attempts to treat these men survives and it seems we don't see such severe CSR these days. I don't know enough about the medical side of it to include this. 60.240.225.21 16:11, 8 January 2007 (UTC)

Many years ago (circa 1975) when I worked for an engineering firm in London England, my boss used to recount his childhood experiences in Reading Berkshire. There was a psychiatric hospital in the town that specialized in "warehousing" the worst cases of shell shock from WW1. That kid would occasionally see these poor wretches being escorted on walks and he would run home screaming in terror. He could never articulate the exact expressions he read on their agonized faces but the fear of them went well near to driving him barking mad.

I'm quite surprised to see all of the instructions by the British in WW1, I always thought it was an unrecognised condition. Certainly many soldiers, hundreds, were court martialed and executed for cowardice, desertion or refusal to obey orders for this illness. Many relatives were still trying to obtain pardons for their relative's actions, when in November 2006 the UK government did an about face, and pardoned all, rather than face a Judicial Enquiry.
 * http://www.shotatdawn.org.uk/
 * http://www.bbc.co.uk/history/british/britain_wwone/shot_at_dawn_07.shtml
 * http://www.clarkehome58.freeserve.co.uk/
 * http://news.bbc.co.uk/2/hi/asia-pacific/475718.stm

The following is a series of stories about the lead case of Harry Farr in chronological order
 * http://news.bbc.co.uk/2/hi/uk_news/england/4552301.stm
 * http://news.bbc.co.uk/2/hi/uk_news/england/london/4847504.stm
 * http://news.bbc.co.uk/2/hi/uk_news/england/london/4796313.stm
 * http://news.bbc.co.uk/2/hi/uk_news/politics/6127832.stm - this one includes the announcemnet that the pardon measure as part of the Armed Forces Act gained Royal Assent
 * http://news.bbc.co.uk/2/hi/uk_news/england/6372763.stm - service and picture of Harry Farr's and another soldier's name added to the war memorial

Tony Spencer 22:54, 13 September 2007 (UTC)

Context in the Introduction
I have just rewritten the introduction in an attempt to increase the context and accuracy. The previous introduction was:


 * Combat stress reaction, commonly known as shell shock, is a term used to categorize the long-term results of stress in war conditions during World War I and World War II, and sometimes the Vietnam War.


 * The most common symptom is fatigue: slower reaction times, indecision, disconnection from one's surroundings, and inability to prioritize. The ratio of stress casualties to battle casualties varies with the intensity of the fighting, but with intense fighting it can be as high as 1:1. In low-level conflicts it can drop to 1:10 (or less).


 * In WWI, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The horrors of WWI trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was 56%. Whether a shell-shock sufferer was considered "wounded" or "sick" depended on the circumstances. The large proportion of WWI veterans in the European population meant that the symptoms were common to the culture, although it may not have become popularly known in the US.


 * In current understanding, the long-term effects that some war veterans develop from the stress of combat are seen as a subset of Post-Traumatic Stress Disorder.

My current edit is:


 * Combat stress reaction, in the past commonly known as shell shock or battle fatigue, is a military term used to categorize a range of behaviours resulting from the stress of battle which decrease the combatant's fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from one's surroundings, and inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, posttraumatic stress disorder, or other long-term disorders attributable to combat stress although any of these may commence as a combat stress reaction.


 * The ratio of stress casualties to battle casualties varies with the intensity of the fighting, but with intense fighting it can be as high as 1:1. In low-level conflicts it can drop to 1:10 (or less).


 * In WWI, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The horrors of WWI trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was 56%. Whether a shell-shock sufferer was considered "wounded" or "sick" depended on the circumstances. The large proportion of WWI veterans in the European population meant that the symptoms were common to the culture, although it may not have become popularly known in the US.

The mention of the three wars is misleading. Firstly, the term CSR was not used in WWI or WW2. It is a term that has a recent origin. CSR is also not confined to particular wars but can occur in any battle scenario. Secondly, CSR describes a short-term reaction with other disorders being diagnosed if the problems persist.

Does this provide adequate context in the introduction? Can the header be removed? What is the process of having it removed?--CloudSurfer 18:15, 6 August 2007 (UTC)


 * I have looked back and the context header was added at a time when the original introduction had been deleted completely! Now that there is an introduction that gives context, as there has been for some time, I have deleted the header. --CloudSurfer 18:25, 6 August 2007 (UTC)

Great Article, Indeed
I don't have neither the knowledge background or the time to properly research and edit this page myself, but if I could, I think it would be very pertinent to address to combat stress issue and how it is dealt with in current Iraq. In this war, American GIs are kept on field far beyond their assignments ends. Many of them are enlisted to homeland security and diverted as reinforcements to regular troops on the battlefield, without the proper training or combat experience regulars have. This lack of refreshment of new soldiers certainly leads to fatigue and a new paragraph would be of interest on Medicine, Psychology and political consequences, in case someone writes it.

Kapella 11:11, 13 April 2008 (UTC)

Why
is it called shell shock?

Shouldn't this be mentioned in the article?

I'd nominate it for at least good, otherwise.

--Hawkian (talk) 17:45, 30 June 2008 (UTC)


 * It was originally termed shell shock because it's effects were first observed on troops who had undergone extensive artillery barrages and who had developed a nervous reaction that made them non-functional as fighting soldiers. During some of the many offensives on the Western Front the attacks by both sides were preceded by massive artillery bombardments that sometimes went on for days at a time. Soldiers sheltering in trenches under this bombardment were therefore placed in a situation where for prolonged periods they could be killed or maimed instantly and completely randomly with no self-determination over their own survival. This affected the human body's fight or flight mechanism and in essence made the victims into what used to be termed 'nervous wrecks'.


 * So, the original term shell 'shock was an apt description for the syndrome as it was encountered by doctors at the time. — Preceding unsigned comment added by 80.4.57.101 (talk) 13:55, 1 October 2011 (UTC)

Suicide controversy
The controversy section says that more US servicemen killed themselves after their experiences in Vietnam than died in combat. Is that really true? Rather than remove it, I have tagged it with. If no one comments here or we can't confirm it in a while, it should be removed. Enviroboy TalkCs 05:42, 1 November 2008 (UTC)
 * I did a little research and I found out that the actual numbers are highly contested. I have removed the sentence. Enviroboy TalkCs 20:45, 3 November 2008 (UTC)

Shellshock and acute stress disorder are the same
The DSM-IV-TR definition is the same as shellshock, they are the same. —Preceding unsigned comment added by Tivaelydoc (talk • contribs) 05:34, 18 November 2008 (UTC)

Germans in WWII
This line doesn't make sense to me:

"It is probable that there was both less of a true problem and less perception of a problem." 

Can anyone clarify this for me, and if need be, rephrase it in the article so that it is more understandable? Nytewing07 (talk) 18:11, 4 August 2009 (UTC)

Afghanistan Section Removal
Look, I'm removing the following original research section from the page until I can find the time to edit and collect citations for it. Right now it's just not encyclopedic. Therealhazel (talk) 05:04, 12 February 2010 (UTC)

"Looking into the conflict in Afghanistan there is a lot of concern from the soldiers, and their built up stress.The frequency of mortar fire put some soldiers on edge while others just get used to the idea. There are bunkers at almost all bases in Afghanistan and the soldiers are well trained to drop everything and get to these bunkers in the case of an attack. Many times, however, its not mortar attacks but landmines being set off that trigger the knee jerk, trained, reaction from soldiers. The job of many trained soldiers is to go out and search for and disarm landmines, a mentally and physically taxing assignment for all those involved. Landmines are a constant threat and a cause of many military and civilian deaths. Many soldiers report jumping out of bed and fleeing to a nearby bunker, when in fact it was only an animal setting off a nearby landmine. The mental wear down these situations have on soldiers is a current problem in Afghanistan with troop morale and mental stability. Many of the newly arriving soldiers experience a shell shock in their first couple weeks of these events and must find a way to cope or their condition will worsen."

"Nostalgia"
So what exactly was nostalgia? 213.122.34.43 (talk) 15:42, 8 June 2010 (UTC)

Image
The image currently being used in the article to illustrate the "thousand-yard-stare" (a common "sign" of CSR) is, I think, a poor choice, given the alternatives available. The soldier being referenced is not the focus of the image. He is also smiling, which is not usually what someone will do. I think this image, used on the thousand-yard stare article, is a much better way of "illustrating" CSR (if that's actually possible) or at least the 'stare', which is what most think of when hearing about someone who is "shell shocked".

http://en.wikipedia.org/wiki/File:WW2_Marine_after_Eniwetok_assault.jpg

If not that photograph, then this illustration, which was created to depict the 'stare'.

http://en.wikipedia.org/wiki/File:Tom_Lea_-_2000_Yard_Stare.jpg

TaintedMustard (talk) 20:29, 13 December 2011 (UTC)

Problems with the article
A summary of a few problems with the article: The above was added as part of the WWI editathon taking place today, based on the comments of Simon Wessely, co-author of 'Shell Shock to PTSD (2005). Carcharoth (talk) 11:58, 16 June 2012 (UTC)
 * (1) Shell shock redirects here when it should probably be a separate article.
 * (2) This article (combat stress reaction) makes the incorrect assumption that shell shock and CSR are the same.
 * (3) Care should be taken not to assume that the various labels used such as shell shock, CSR, PTSD are referring to the same thing. Shell shock was a 1914 term that was abandoned by the military by the end of the war, with a different entity (now called CSR). This article should make clear that the psychological reactions to extreme stress are influenced by the nature of war, culture, society, and the views of the self, and that this has changed over time.
 * (4) The picture used may not suitable for showing shell shock
 * More notes: Shell shock isn't the same as PTSD, which was defined after the Vietnam War in 1980. For instance, flashbacks are missing from World War I descriptions of psychologically damaged service personnel (termed shell shock) - whereas flashbacks are present in PTSD - which emphasises the impact of culture on psychological reactions. Psychological response to trauma, as well as the definition of trauma, have changed over time. Need to clarify whether "shell shock" was a physical or psychological reaction; there were many interpretations at the time, ranging from physical contusion of the brain in respoonse to the shell, the pscyhological trauma, or social - a way of dealing with war service. All three views werre held, often simultaneously. At the end of the War there was a committee of inquiry (the Shell Shock Commission of 1922) which attempted to resolve these conflicts, but didn't though it did rule out the physical. In 1917 shell shock was as a medical term by the Adjutant-General and fell into disrepute as a medical label, but at the same time became gradually established in literature, culture and language. The Land (talk) 13:52, 16 June 2012 (UTC)
 * I have just forked out Shell Shock - leaving things in a slightly messy state, but I'll come back to it. :-) The Land (talk) 14:04, 16 June 2012 (UTC)


 * CSR/shell shock/battle fatigue and PTSD are not the same thing. CSR is an acute illness triggered by combat experience. PTSD is a chronic illness that can be triggered by any psychological trauma, ranging from combat to witnessing a crime. With prompt, effective care, the CSR victim can be returned to normal mental status relatively quickly (days to weeks, typically), whereas the PTSD victim requires far longer and extensive treatment. That's why I sent soldiers to the rear ASAP when they began showing early signs of CSR, explaining to them why and that they'd be back after a little rest and that EVERYONE can get to that point and need the same care. They returned typically within a few days and were quite well. I've met with some, many years later, they're still OK, no signs of PTSD.Wzrd1 (talk) 21:31, 14 August 2012 (UTC)

Sentence
I cannot make much sense of this sentence:

Peacekeeping provides its own stresses because its emphasis on rules of engagement contains the roles for which soldiers are trained.

The sentence was recently copyedited, and the original sentence was: Peacekeeping provides its own stresses with its emphasis on rules of engagement providing a containment of the roles for which soldiers are trained.

I don't know if the problem is my lack of language skills, or the sentence in itself. Can anybody help? Lova Falk    talk   13:31, 17 October 2013 (UTC)


 * I think that the latter is the most accurate, though it would require further explanation. Soldiers are trained to engage an armed enemy. In peacekeeping, they have rules of engagement that frequently prevent them from engaging forces that they are observing commit violent acts, even war crimes. There are many instances where UN peacekeepers actually received enemy fire upon their compound, but were prohibited from returning fire. Those are things that go directly against their training, as well as instincts. That creates an additional stress that has previously been unknown.Wzrd1 (talk) 14:21, 17 October 2013 (UTC)

Nonvalid Source Citation
A number of the sources cited on this article are inaccessible without paying a fee. This renders the article unverifiable by the general public. 32.209.67.97 (talk) 00:11, 14 July 2017 (UTC)

External links modified
Hello fellow Wikipedians,

I have just modified 2 external links on Combat stress reaction. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
 * Added archive https://web.archive.org/web/20060824003028/http://armyapp.dnd.ca/ALLC/Downloads/dispatch/Vol_10/dispatchesvol10no1_eng.pdf to http://armyapp.dnd.ca/ALLC/Downloads/dispatch/Vol_10/dispatchesvol10no1_eng.pdf
 * Added archive https://web.archive.org/web/20160307155307/http://www.mpbn.net/Television/LocalTelevisionPrograms/AMatterofDuty.aspx to http://www.mpbn.net/Television/LocalTelevisionPrograms/AMatterofDuty.aspx

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

Cheers.— InternetArchiveBot  (Report bug) 03:59, 11 August 2017 (UTC)

Terrible image
''Image from World War I taken in an Australian dressing station near Ypres in 1917. The wounded soldier in the lower left of the photo has a dazed thousand-yard stare, a frequent manifestation of "shell-shock".''

No. No, he does not. He's smiling and looking at something off-camera. See the talk page on thousand-yard stare which also once featured this image. I'm changing the image to another one from that article. 108.34.201.56 (talk) 06:23, 19 August 2017 (UTC)

Wiki Education assignment: Foundations of Clinical Trauma Psychology Fall Quarter2022
— Assignment last updated by Nbaldwin13 02:06, 18 October 2022 (UTC)