Years of war in Iraq and Afghanistan have meant multiple tours of duty for many U.S. combat troops - and plans under discussion would appear to make additional tours likely. What might the added time, stress and combat experience mean for the psychological condition of soldiers? That would not have been a concern before World War I (1914-18), and views have changed over the years since, according to medical historian Mark Micale (mih-KAL-ee), an expert in the history of psychological illness and author of "Hysterical Men: The Hidden History of Male Nervous Illness." Micale was interviewed by News Bureau social sciences editor Craig Chamberlain.
War has been a constant in human history, so what happened in World War I that brought an awareness of, and concern about, psychological disorders resulting from combat?
Probably a number of things, but above all a difference in weaponry. The First World War is often called "the first modern war" because it deployed a new class of industrial weapons. The machine gun, chemical gas, the armored and motorized tank, and more accurate and powerful artillery were the most important. The sheer killing power of this mechanized war technology was much greater than the swords, bayonets, catapults, and cannons of earlier times, and much greater than anyone had anticipated before the war. Not surprisingly, these weapons generated unprecedented levels of fear and anxiety among the masses of fighting men in the trenches. And incidentally, the distinctive phenomenon of trench warfare as a type of combat, which became stalemated for months at a time, most likely added to the excruciating levels of stress.
The main suspect in the Fort Hood shootings on Nov. 5 is a psychiatrist who had counseled soldiers returning from Iraq and Afghanistan. Is it common for those who counsel soldiers to be affected themselves, even if not necessarily in a way that would drive them to violence?
Yes it is, and we can pretty easily understand why. They're spending many hours listening to stories of individual suffering that are extremely sad and tragic. So it's not difficult to understand how they might eventually, after dwelling in that emotional environment for a long period of time, take on some of that freight. In fact, there have been famous cases of major physicians who have studied PTSD and its precursors, and who have collapsed under pressure. Easily the most famous of these is William Rivers, a founding figure in this research, who successfully treated scores of shell-shocked British soldiers at the Craiglockhart Hospital outside Edinburgh, Scotland, during World War I. At one point during the war, Rivers began to develop a stutter and a slight shake in one of his hands, and to have very bad dreams and difficulty sleeping. He did brilliant work, but threw himself into it so much that it took a psychic toll on him and he developed the identical symptoms of his shell-shocked soldiers.
So were these disorders just less likely before World War I, or did we just choose to ignore them?
Both. At the same time that new instruments of war had been engineered for the First World War, the medical profession had changed. The specialty of psychiatry was emerging, and physicians were beginning to develop a good sense of the corrosive effects that anxiety and terror, especially when experienced over a long period of time in a helpless situation, could exert on the human psyche and nervous system. This realization created such new concepts and diagnoses as "shell shock," "war neurosis," and "soldier's traumatic hysteria," which hadn't existed earlier.
What has changed in terms of attitudes, prevention and treatment through the wars since?
Well, an understanding of what American psychiatrists by 1980 officially labeled "post-traumatic stress disorder" has emerged bit by bit. Each conflict brought more cases of nervous breakdown among soldiers and therefore more new clinical observations, theories, and treatments. Part of this growing medical knowledge was a greater understanding of PTSD-like reactions on the part of society, families, and governments, as well as by the suffering individuals themselves. This has been an important human advance.
Have we learned any specifics about what factors, or types of combat, are more likely to produce PTSD?
This question is now being asked by many clinical investigators, with inconclusive results. Some people have the idea that different wars cause different types of post-traumatic outbreaks. It is certainly true that World War I doctors emphasized quasi-neurological symptoms in their soldier-patients, like paralyses, gait disorders, facial tics, and loss of voice. In contrast, we hear much more among Vietnam vets about psychological problems such as flashbacks, nightmares, insomnia, and troubles with concentration. It is a fascinating pattern, but interpreting it is difficult.
How directly have attitudes about masculinity affected our views, over time, about these disorders?
Quite directly. One reason that people in earlier times didn't recognize war-induced psychological trauma was a tendency to view it as a sign of weakness and cowardice. In ancient martial societies like Sparta or the Roman Empire, soldiers were supposed to be the strongest specimens of manhood. The specter of large numbers of them breaking down emotionally in the face of the fear of death would not have been acceptable or regarded with compassion. Likewise with attitudes toward manliness in the late Victorian period of the late 1800s. The ideal adult man was then characterized by a kind of stoical strength and a lack of emotional expression. In America today, however, we seem to be in a time and place that recognizes the possible vulnerabilities of men, including in males who are supposed to be the toughest, such as Marines. In fact, any individual, of either sex, can probably collapse psychologically if confronted with the right type and degree and duration of stress. So ultimately, this more recent view of masculine human nature is more accurate, honest, and humane.