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More than 30 centuries ago, long before even the written word Homer talked about combat stress in his epic poems on the Trojan War. 

During the Civil War soldiers were removed from the front and considered for disability and pensions for Soldiers Heart or “nostalgia”, but in reality combat stress during that time was considered a form of insanity.

By 1914, at the outbreak of World War I, combat stress and its civilian counterpart, “railway spine” had actually risen to the position of being considered physical ailments that deserved medical treatment. 

By the summer of 1916, the brutal trench warfare on the Western Front had produced an epidemic of shell shock among French and British troops, and “nervenshock” among Germans troops which was draining the treasuries and manpower pools on both sides. To address this crisis, Kaiser Wilhelm directed the German Association of Psychiatry to convene a special War Congress.

 After briefly discussing the evidence, these leading psychiatrists of their day settled the debate by declaring –“Persistent distress or functional impairment following exposure to a traumatic stressor could only occur in individuals already afflicted with the pre-existing personality weakness that they termed hysteria”.

Subsequently, the German government was relieved of its responsibility to pay disability pensions to veterans sufferingfrom combat stress, while commanders in the field were no longer obligated to evacuate stress casualties from the front.

The term “hysteria” was never intended to be a neutral label. It was chosen to be intentionally stigmatizing, especially when applied to male service members who understood it to be a feminizing term. 

The French and English and later the Americans also adopted the doctrine. The term shell shock was dropped and there was a drastic reduction in the evacuation of stress casualties along with the responsibilities of paying compensation fees.  

As a result of these new tenets the rates of wartime psychiatric evacuations during the 20th century fell to approximately 10% in WWII, 3.7% in the Korean War and barely 1.2% in Vietnam.