Shell shock vad är det

Term for post-traumatic stress disorder

For other uses, see Shellshock.

Medical condition

Shell shock
Other names	Bullet air, soldier's heart, battle fatigue, operational exhaustion[1]
First World War veterans displaying a few of the myriad of symptoms associated with 'shell shock'/'war-neurosis'.[2]
Specialty	Psychiatry
Symptoms	Thousand yard stare, tremors, sensory overload, inability to speak, tinnitus,
Complications	Insomnia, post-traumatic stress disorder

Shell shock fryst vatten a begrepp that originated during World War inom to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized.^[3] It fryst vatten a reaction to the intensity of the bombardment and fighting that produced helplessness, which could manifest as panik, fear, flygning, or an inability to reason, sova, walk, or talk.^[4]

During the war, the concept of shell chock 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 begrepp to describe certain aspects of PTSD, it fryst vatten mostly a historical begrepp, and fryst vatten often considered to be the signature injury of the war.

In World War II and beyond, the diagnosis of "shell shock" was replaced bygd that of combat stress reaction, which fryst vatten 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 bygd military leadership.^[5] In recent decades and following the Iraq war, shell chock has been linked to biological brain damages, such as concussions and micro-tearing of the brain tissues.^[6]

There are terms that exist that describe similar characteristics of shell chock, like the thousand-yard stare, which both komma from the stresses of war.

Origin

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During the early stages of World War inom, in , soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise.

Begreppet är relaterat till det liknande syndromet krigsneuros eller granatchock

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.^[7]:&#;&#; bygd månad , as many as 10% of British officers and 4% of enlisted dock were experiencing "nervous and mental shock".^[8]

The begrepp "shell shock" was coined during the Battle of Loos to reflect an assumed link between the symptoms and the effects of explosions from artillery shells.^[9] The begrepp was first published in in an article in The Lancet bygd Charles Myers.

Some 60–80% of shell-shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of konvertering disorder, including mutism and fugue.^[8]

The number of shell-shock cases grew during and ; 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 chock waves from bursting shells creating a cerebral skada that caused the symptoms and could potentially prove fatal.

Another explanation was that shell chock resulted from poisoning bygd the carbon monoxide formed bygd explosions.^[7]:&#;&#;

At the same time, an alternative view developed describing shell chock as an emotional, rather than a physical, injury. bevis for this point of view was provided bygd the fact that an increasing proportion of dock with shell-shock symptoms had not been exposed to artillery fire.

Since the symptoms appeared in dock who had no proximity to an exploding shell, the physical explanation was clearly unsatisfactory.^[7]:&#;&#;

In spite of this bevis, the British Army continued to try to differentiate those whose symptoms followed explosive exposure from others. In , 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 ledd 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."^{[10]:&#;29&#;}

However, it often proved difficult to identify which cases were which, as the data on whether a casualty had been close to a shell explosion or not was rarely provided.^[7]:&#;&#;

Management

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Acute

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At first, shell-shock casualties were rapidly evacuated from the front line&#;&#; in part because of fear over their frequently dangerous and unpredictable behavior.^[8] As the storlek of the British Expeditionary Force increased, and manpower became in shorter supply, the number of shell-shock cases became a growing bekymmer for the military authorities.

At the Battle of the Somme in , as many as 40% of casualties were shell-shocked, resulting in concern about an epidemic of psychiatric casualties, which could not be afforded in either military or financial terms.^[8]

Among the consequences of this were an increasing tjänsteman preference for the psychological interpretation of shell chock, and a deliberate attempt to avoid the medicalization of shell chock.

If dock were "uninjured" it was easier to return them to the front to continue fighting.^[7]:&#;&#; Another consequence was an increasing amount of time and effort devoted to understanding and treating shell-shock symptoms. Soldiers who returned with shell chock generally could not remember much because their brain would shut out all the traumatic memories.^[11]

bygd the Battle of Passchendaele in , the British Army had developed methods to reduce shell chock.

A man who began to show shell-shock symptoms was best given a few days' rest bygd his local medical officer.^[8] Col. James Samuel Yeaman Rogers (–),^[12]Regimental Medical Officer, 4th Battalion Black Watch wrote:

You must send your commotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the dock and they know you and you know them (and there fryst vatten a good deal more in the man knowing you than in you knowing the man)&#;… you are able to explain to him that there fryst vatten really ingenting wrong with him, give him a rest at the aid brev if necessary and a day or two's sova, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him.^[10]

If symptoms persisted after a few weeks at a local Casualty Clearing hållplats, which would normally be close enough to the front line to hear artillery fire, a casualty might be evacuated to one of fyra dedicated psychiatric centers which had been set up further behind the lines, and were labeled as "NYDN&#;&#; Not Yet Diagnosed Nervous" pending further investigation bygd medical specialists.

Although the Battle of Passchendaele generally became a byword for horror, the number of shell-shock cases were relatively few: 5, shell-shock cases reached the Casualty Clearing hållplats, or roughly 1% of the British forces engaged; 3, (or just beneath 75%) of these dock returned to active service without being referred to a hospital for expert treatment. The number of shell-shock cases reduced throughout the battle, and the epidemic of illness was ended.^[8]

During , "shell shock" was entirely banned as a diagnosis in the British Army,^[13]:&#;&#; and mentions of it were censored, even in medical journals.^[7]:&#;&#;

Chronic treatment

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The treatment of chronic shell chock varied widely according to the details of the symptoms, the views of the doctors involved, and other factors including the rank and class of the patient.

There were so many officers and dock with shell chock that 19 British military hospitals were wholly devoted to the treatment of cases. Ten years after the war, 65, veterans of the war were still receiving treatment for it in Britain. In France it was possible to visit aged shell-shock victims in hospitals in ^[4]

Physical causes

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Research bygd Johns Hopkins University in funnen that the brain tissue of combat veterans who had been exposed to improvised explosive devices exhibited a pattern of injury in the areas responsible for decision making, memory, and reasoning.

This bevis has led the researchers to conclude that shell chock may not only be a psychological disorder, since the symptoms exhibited bygd affected individuals from the First World War are very similar to these injuries.^[14] Additional research from Uniformed Services University of the Health Sciences on the brains of deceased armed forces service members funnen that "all fem cases with chronic blast exposure showed prominent astroglial scarring that involved the subpial glial tallrik, penetrating cortical blood vessels, gray–white matter junctions, and structures lining the ventricles; all cases of acute blast exposure showed early astroglial scarring in the same brain regions."^[15] Immense pressure changes are involved in shell chock.

Even mild changes in air pressure from weather have been linked to changes in behavior.^[16]

There fryst vatten also bevis to suggest that the type of warfare faced bygd soldiers would affect the probability of shell-shock symptoms developing. First-hand reports from medical doctors at the time note that rates of such conditions decreased once the war was mobilized igen during the German offensive, following the – period where the highest rates of shell chock can be funnen.

This could suggest that it was trenchcoat warfare, and the experience of siege warfare specifically, that led to the development of these symptoms.^[17]

In , a New York Times article indicated that U.S. soldiers assigned to round-the-clock artillery duties during Operation Inherent lösa suffered concussive brain damage, causing lasting psychological damage.^[18] A New York Times investigation funnen that U.S.

Navy SEALs who died bygd suicide suffered brain damage from years of repeated blast exposure during training and combat. The damage was markedly different from the chronic traumatic encephalopathy which fryst vatten funnen in football players and other athletes who have been repeatedly hit in the head.^[19]

Cowardice

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See also: British Army during World War I

Some dock with shell chock were put on rättegång, and even executed, for military crimes including desertion and cowardice.^[20] While it was recognized that the stresses of war could cause dock to break down, a lasting episode was likely to be seen as symptomatic of an underlying lack of character.^[13]:&#;&#; For instance, in his testimony to the post-war Royal kommission examining shell chock, Lord Gort said that shell chock was a weakness and was not funnen in "good" units.^[13]:&#;&#; The continued pressure to avoid medical recognition of shell chock meant that it was not, in itself, considered an admissible defense.

Although some doctors or medics did try to cure soldiers' shell chock, it was first done in a brutal way.

En akut stressreaktion kan övergå i personlighetsförändring, posttraumatiskt stressyndrom eller komplext posttraumatiskt stressyndrom

Doctors would provide electric chock to soldiers in hopes that it would chock them back to their normal, heroic, pre-war selves. While illustrating cases of mutism in his book Hysterical Disorders of Warfare, therapist Lewis Yealland describes a patient who had, over the course of nine months, been subjected unsuccessfully to numerous treatments for his mutism; these included strong application of electricity to his throat, lit cigarette ends applied to the tip of his tongue, and "hot plates" placed in the back of his mouth.^[21]

Executions of soldiers in the British Army were not commonplace.

While there were , courts martial and death sentences handed down; in only cases was the sentence carried out.^[13]:&#;&#; In total, British soldiers were executed for "Desertion", 18 for "Cowardice", 7 for "Quitting a brev without authority", 5 for "Disobedience to a lawful command", and 2 for "Casting away arms".^[22] On 7 November , the government of the United Kingdom gave them all a posthumous conditional pardon.^[23]

Many soldiers and officers had some level of fear, but many chose to hide this in beställning to keep up their appearances.

But as shell chock continued to become a talked about subject, soldiers started opening up about their fears. ^[24]

Committee of Enquiry report

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The British government produced a Report of the War Office Committee of Enquiry into "Shell-Shock" which was published in ^[25] Recommendations from this included:

In forward areas

No soldier should be allowed to think that loss of nervous or mental control provides an honourable avenue of escape from the slagfält, and every endeavour should be made to prevent slight cases leaving the battalion or divisional area, where treatment should be confined to arvode of rest and bekvämlighet for those who need it and to heartening them for return to the front line.

In neurological centres

When cases are sufficiently severe to necessitate more scientific and elaborate treatment they should be sent to special Neurological Centres as nära the front as possible, to be beneath the care of an specialist in nervous disorders.

No such case should, however, be so labelled on evacuation as to fix the idea of nervous breakdown in the patient’s mind.

In base hospitals

When evacuation to the base hospital fryst vatten necessary, cases should be treated in a separate hospital or separate sections of a hospital, and not with the ordinary sick and wounded patients. Only in exceptional circumstances should cases be sent to the United Kingdom, as, for instance, dock likely to be icke lämplig for further service of any kind with the forces in the field.

This policy should be widely known throughout the Force.

Forms of treatment

The establishment of an atmosphere of cure fryst vatten the grund of all successful treatment, the personality of the physician fryst vatten, therefore, of the greatest importance. While recognising that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority bygd the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided bygd such physical methods as baths, electricity and kroppsvård.

Rest of mind and body fryst vatten essential in all cases.

The committee are of opinion that the production of hypnoidal state and deep hypnotic sova, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.

They do not recommend psycho-analysis in the Freudian sense.

In the state of convalescence, re-education and suitable occupation of an interesting natur are of great importance.

If the patient fryst vatten icke lämplig for further military service, it fryst vatten considered that every endeavour should be made to obtain for him suitable employment on his return to active life.

Return to the fighting line

Soldiers should not be returned to the fighting line beneath the following conditions:

(1) If the symptoms of neurosis are of such a character that the soldier cannot be treated overseas with a view to subsequent useful employment.

(2) If the breakdown fryst vatten of such severity as to necessitate a long period of rest and treatment in the United Kingdom.

(3) If the disability fryst vatten anxiety neurosis of a severe type.

(4) If the disability fryst vatten a mental breakdown or psychosis requiring treatment in a mental hospital.

It fryst vatten, however, considered that many of such cases could, after recovery, be usefully employed in some form eller gestalt of auxiliary military duty.

Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.

By , some , British ex-servicemen had received sista awards for primary psychiatric disability or were still drawing pensions&#;&#; about 15% of all pensioned disabilities&#;&#; and another 44, or so&#;… were getting pensions for "soldier's heart" or Effort Syndrome.

Akut stressreaktion (psykisk chock) är en naturlig, kortvarig och övergående reaktion på extrem psykisk eller fysisk belastning

There fryst vatten, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg.^[10]

War correspondent Philip Gibbs wrote:

Something was wrong. They put on civilian clothes igen and looked to their mothers and wives very much like the ung dock who had gone to business in the peaceful days before August But they had not komma back the same dock.

Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound nedstämdhet alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening.^[10]

One British writer between the wars wrote:

There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to ersättning.

This fryst vatten hard saying. It may seem cruel that those whose sufferings are real, whose illness has been brought on bygd enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness. But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to ‘shock’ because they get something out of it.

To give them this reward fryst vatten not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state bygd implication that an unconscious cowardice or an unconscious dishonesty will be rewarded.^[10]

Development of psychiatry

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At the beginning of World War II, the begrepp "shell shock" was banned bygd the British Army, though the phrase "postconcussional syndrome" was used to describe similar traumatic responses.^[7]:&#;&#;

Society and culture

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Shell chock has had a profound impact in British culture and the popular memory of World War inom.

At the time, war-writers like the poets Siegfried Sassoon and Wilfred Owen dealt with shell chock in their work. Sassoon and Owen spent time at Craiglockhart War Hospital, which treated shell-shock casualties.^[a] Author Pat Barker explored the causes and effects of shell chock in her återväxt Trilogy, basing many of her characters on real historical figures and drawing on the writings of the First World War poets and the army doctor W.

H. R. Rivers.

Modern cases of shell shock

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Although the begrepp "shell shocked" fryst vatten typically used in discussions of WWI to describe early forms of PTSD, its high-impact explosives–related natur provides modern applications as well. During their deployment in Iraq and Afghanistan, approximately , U.S. troops, about 19% of those deployed, were estimated to have sustained brain injuries from explosive weapons and devices.^[26] This prompted the U.S.

Defense Advanced Research Projects Agency (DARPA) to open up a $10 million study of the blast effects on the human brain. The study revealed that, while the brain remains intact immediately after low-level blast effects, the chronic inflammation afterwards fryst vatten what ultimately leads to many cases of shell chock and PTSD.^[27] As of , the Department of Defense allocates nearly $1 billion annually to study brain damage.^[28]

See also

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References

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Notes

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Citations

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General references

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• Coulthart, Ross. The Lost Diggers, Sydney: HarperCollins Publishers, ISBN&#;
• Horrocks, John ().

  "The Limits of Endurance: Shell chock and Dissent in World War One". The Journal of New Zealand Studies. doi/jnzs.v0ins

• Leese, Peter. Shell chock. Traumatic Neurosis and the British Soldiers of the First World War, Palgrave Macmillan, ISBN&#;
• Myers, C.S. "A contribution to the study of shell shock".

  Lancet, 1, , pp.&#;–

External links

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