Something happens to the human brain after long-term exposure to the stress and horrors of war–something on top of the conscious stabs of regret and anger, or the black-humored fatalism that feeds on young soldiers’ idealism. It is something people have recognized for thousands of years but are only now beginning to understand.
Societies have spoken of the changes in men returning from battle since the days of epic Greece when Homer told of Oddysseus’ epic struggles to go back home after the Trojan War, even though it is part of war left out of history books. It has gone by a host of different names: “nostalgia” in eighteenth-century Europe; “war excitement,” “exposure,” or “soldiers’ heart.” in the Civil War; “war neurosis” or “shell shock” in World War I; and “battle fatigue” in World WarII.
Today, it is widely known as “post traumatic stress disorder,” PTSD, or even “post traumatic stress syndrome,” PTSS.
We tend to think of PTSD as a modern disorder, but it is only a modern label. It is neither a new phenomenon, or one present only in some wars. the widely-held view, for example, that World War II did not produce significant psychological casualties is simply false. In 1943, for example, a total of 435,000 troops were discharged from the the army for psychiatric reasons–eclipsing the total number enlisted that year.
“I hear Viet Nam veterans say they are suffering from flashbacks and I think, ‘Hey, I’ve been having them since 1944, I have seniority.” Edward Babe Heffron, an infantry private from the original Band of Brothers of World War II wrote in his 2007 memoir, Brothers In Battle, Best of Friends. “Any soldier who lived through combat, whether it ws 1776, 1861, 1918, 1944, any war, will never be entirely free of the war we fought. Some are just able to brush it off better than others.”
After the Civil War thousands of soldiers filled mental asylums and prisons. After World War I, the British discharged at least 200,000 soldiers stricken by shell shock and had to commandeer public hospitals, spas, and resorts to treat the casualties. At the onset of World War Ii the U.S. military decided that screening for mental and moral defects in recruits could nip the problem in the bud. The army rejected 94 men per thousand for not meeting the standards, a total of 1.6 million. Even so, vast numbers of soldiers broke down in combat. By the end of the war in 1946, 454,699 veterans of World War II were receiving disability benefits for neuropsychiatric diseases.
In addition in the mid-1940s , veterans hospitals still housed an estimated 33,000 psychiatric patients from World War I.
These casualties are a long-term and costly aspect of waging war. Studies suggest the total number of PTSD cases from Viet Nam is around 479,000. As of 2009 nearly 390,000 veterans were receiving Veteran Administration benefits for PTSD, making it the fourth-most prevalent service disability.
Technology has evolved. But the human threshold for horror has not, and without taking into account the widespread casualties it produces, no accurate tally of the cost of war can be produced. Just as prevalent and long-lived are the suspicion by commanders are the suspicions that these invisible injuries aren’t real. It is hard to fke a broken leg or a gunshot wound. It is reasonably easy to fake a psychological wound, so commanders have always been faced with the conundrum of determining who is really injured.and who just wants out of the fight.
In the first years of the Civil War and World War I, many soldiers stricken by psychological breakdowns from the bombardment were treated as deserters were treated as deserters and were jailed or shot. It was only after years of conflict and mounting psychological casualties from both wars that the military learned to treat soldiers, offering them rest, an often morphine, to ease their nerves.
For a hundred years, the formula for treating soldiers on the battlefield was mainly the same. Soldiers were offered a break from combat, good food, and sometimes narcotics. They were usually not allowed to go home. Instead, they were kept close to the front lines and encouraged to return to battle in three to ten days. Those who would not return were given menial, distasteful jobs like digging latrines. Using this approach, the Army found that it could get up to 90 percent of the soldiers to return to duty.
This is first in a two-part article about the rigors of combat, and the hellish nature of psychological injuries men receive when placed on the front lines of battle. The above is largely from David Philipps’ Lethal Warriors, what Kirkus Review called a “searing expose” of the dangers men in uniform face every day. The book was published by Palgrave Macmillan of New York in 2010.