Concept

Shell shock

Summary
Shell shock is a word that originated during World War I to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized. It is a reaction to the intensity of the bombardment and fighting that produced a helplessness, which could manifest as 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 shell shock 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. 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 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 but it remained poorly understood medically and psychologically.
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