Combat-Related Mental Health Issues from World War I to Today

Published: 20 June 2024

By Lindsay Denton 
Special to the Doughboy Foundation website

A soldier walking near the front lines.

Denton 1

Trauma has always been an inseparable part of war.

Throughout history, countless soldiers have developed mental health disorders directly linked to their wartime experiences. However, until the 20th century, few documented and categorized this mental health issue. It gained significant attention during World War I, the largest and most devastating conflict known to humanity at that time that continues to astonish us with its sheer scale and devastation. Many soldiers, including the US Army men who joined the war in 1917, suffered from what was then called “shell shock,” characterized by severe anxiety, flashbacks, nightmares, insomnia, and anger. This condition later evolved into what we now know as PTSD. Join us here as we explore the history of combat-related mental health issues from World War I to today.

WWI and shell shock

Before combat stress reaction and PTSD (post-traumatic stress disorder), there was shell shock. According to Psychology Today, the term was coined in 1915 by Charles Myers, an English psychologist, to describe soldiers experiencing involuntary shivering, crying, fearfulness, and constant intrusive memories. Many WWI soldiers experienced it due to the intense bombardments and large-scale battles never seen before in human history.

This condition led to helplessness, manifesting as panic, fear, flight, and an inability to reason, sleep, walk, or talk. At the time, during and shortly after the war, shell shock was poorly defined and could be seen as either a physical or psychological injury. Although the term is now mostly historical, it remains a significant marker of the psychological impact of World War I on soldiers. However, as something of a WWI legacy, the United States Department of Veterans Affairs continues to use the term shell shock to describe specific aspects of PTSD.

How many WWI soldiers were shell-shocked?

Probably over 250,000 men suffered from shell shock as a result of the First World War. To illustrate the scope of the issue, by December 1914 – just four months into the war for Britain – around 10% of British officers and 4% of enlisted men were experiencing “nervous and mental shock.”

A devastated WWI landscape.

World War I was, at the time, the most devastating conflict in human history.

WWII and combat stress reaction

Combat stress reaction (CSR), often referred to as combat fatigue or battle neurosis, emerged as the successor to shell shock during World War II. This condition is an acute behavioral disorganization directly resulting from the trauma of war. While the experience of combat fatigue was nothing new – as we highlighted above, soldiers had faced similar issues in World War I and even earlier – military medicine during WWII began to better understand its causes. Initially known by terms such as nostalgia and old sergeant’s disease, this condition came to be more systematically identified as combat fatigue.

New policies

The US military initially forgot many of the psychiatric lessons from World War I, and rigorous screening procedures proved ineffective. By 1943, however, the importance of treating psychiatric cases with a forward treatment approach became clear, partly spurred by high-profile incidents such as General Patton’s slapping incident, where he slapped two soldiers he mistook for cowards in a hospital for combat fatigue. It was found that the average American infantryman could endure between 200 to 240 days of front-line combat before experiencing a significant psychological breakdown. This realization led to the implementation of policies like the 180-day limit on active combat duty.

Bridging the gap

Airmen in the Southwest Pacific faced similar challenges, with the high frequency of missions and harsh conditions leading to severe morale issues and widespread combat fatigue. Unlike in Europe, the lack of a fixed number of missions for rotation out of combat worsened these problems. Veterans in these environments often displayed chronic fatigue states, characterized by symptoms like dysentery, insomnia, memory defects, and a general sense of hopelessness. This deeper understanding of combat fatigue laid the groundwork for modern approaches to treating combat-related mental health issues, bridging the gap between early notions of shell shock and contemporary concepts of PTSD.

A group of WWII soldiers next to a flame.

WWII “bridged the gap” between shell shock and PTSD

Post-Vietnam and PTSD

While it might seem intuitive that soldiers have always experienced PTSD, the formal recognition of this condition is relatively recent. The term post-traumatic stress disorder (PTSD) was officially introduced in 1980 when it appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published by the American Psychiatric Association. This diagnosis emerged in the collective consciousness largely due to the profound impact of the Vietnam War.

A need for more comprehensive approaches

The unique and intense nature of the Vietnam conflict, combined with the political and social turbulence of the era (late 60s and early 70s), highlighted the need for a more comprehensive and compassionate approach to understanding and treating war-induced psychological conditions. These approaches have been modernized and are now widely implemented in treatment centers across the country. As a result, We Level Up Treatment Centers, a network of rehab and mental health facilities spanning several states in the US, provide an excellent Veterans Program. They offer specialized support for military veterans dealing with mental health problems, substance abuse issues, or both, keeping the unique challenges of their service in mind.

Vietnam Veterans – PTSD “pioneers”

PTSD is characterized by flashbacks, upsetting memories, and severe anxiety following a traumatic event. Although these symptoms have been observed and documented for centuries, it wasn’t until the aftermath of the Vietnam War that they were formally categorized under the term PTSD. Vietnam Veterans were among the first to have this term applied to their experiences, and the condition’s recognition provided a framework for understanding the long-term psychological effects of war.

A Vietnam War memorial site.

Only after the Vietnam War was the term PTSD coined.

In 1983, Congress mandated the VA to conduct the National Vietnam Veterans Readjustment Study (NVVRS) to assess the prevalence of PTSD and other postwar psychological issues among Vietnam Veterans. This groundbreaking study found that as many as 15% of Vietnam Veterans had PTSD, drawing significant attention to the condition and prompting further research and development of treatment strategies. The NVVRS underscored the chronic nature of PTSD for many veterans, emphasizing the importance of ongoing support and care.

Final Thoughts on Combat-Related Mental Health Issues

From the pioneering investigations of shell shock to the recognition of combat stress reactions and PTSD, there has been a significant advancement in treating combat-related mental health issues. These developments have provided critical tools for understanding and addressing the profound psychological wounds caused by warfare. Over time, this understanding has continued to evolve, offering hope and healing to countless veterans and others affected by traumatic events. As we reflect on the journey from early diagnoses to modern treatments, it becomes clear that the path forward involves ongoing research, compassionate care, active listening to the stories of people who were in combat, and a commitment to supporting those who have sacrificed so much in service.

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