You know, it shouldn’t exist. Human history and prehistory is crammed with all kind of mayhem and trauma: infant mortality, infanticide, genocidal fights with neighboring tribes.  You routinely lost family and routinely killed enemies. Childbirth hurts a lot.  What’s the adaptive strategy, in all of these situations? ? Get over it.

Although you can find academic papers talking about PTSD in the ancient world, they’re bullshit:  people coming out of the Legions after putting in their 25 were not famous for screaming in their sleep.  Neither were veterans of the American  Civil War: nobody worried whether veterans like Benjamin Harrison  or Garfield were damaged goods.  But although it was the bloodiest war in American history it was mainly a rifle war, not an artillery war. You rarely got your brain thumped.

But in WWI, we heard a lot about ‘shell shock’. Later, in WWII, ‘combat fatigue’ or ‘battle neurosis’. Artillery wars.  I would guess that what actually happened was a combination of people finding a way to avoid getting killed, and brain damage due to nearby explosions. After experience in Iraq and Afghanistan, plus football and boxing, people are thinking seriously about those explosions as a cause of PTSD.

Psychology in the 20th century looked for social/environmental causes of mental problems – toilet training, ‘refrigerator mothers’, ‘absent father/overprotective mother’, ‘double binds’. And of other social problems: school could make you smart or dumb,  kids were ‘depraved because they were deprived’, blah blah.

As far as I can tell they were entirely wrong.  Genetics and physical trauma ( which includes iodine shortages).  No real sign that they were right about those other problems either: certainly interesting that the programs designed to ameliorate those problems, based on the standard environmental assumptions, never, ever work.


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168 Responses to PTSD

  1. Hesse Kassel says:

    Should be easy enough to test. Lots of different military roles with different amounts of horror and explosions. No doubt the military keeps data on a lot of this stuff.

    • mtkennedy21 says:

      Lots of politics in the VA. A lot of anti-war protesters joined the VA late in and after the VN war, They then did their part by telling wounded vets they had been baby killers. Some of this is in Burkett’s “Stolen Valor.” Then, of course, we had Major Hassan telling Afghanistan vets they had been evil Muslim killers. Don’t rule out some politics in the PTSD story.

    • a-non says:

      One data point I read somewhere was that WWII bomber crews had rates of being disabled by “battle fatigue” comparable to those of front-line infantry under similar dangers. (From a review at the time, whose recommendation was to go for maximum stigmatisation in the hopes of keeping enough guys flying.)

      I don’t swear this is true of course, but it seems a likely place to find data: good records, high risk, no concussions. It would be interesting to know if there was a distinction between bomber crews (helplessly strapped into a box) and fighter pilots (single combat!).

      • Greying Wanderer says:

        flak fires explosive shells so i assume there would be pressure waves but i don’t know how they would compare to those on the ground

        • a-non says:

          The aim is to put enough shrapnel into the plane to break it, and I’m pretty sure that radius is a lot larger than the overpressure relevant for concussion. So I was figuring those guys didn’t get home. Whereas in a trench you can survive quite a big shell quite close by.

    • Kirk says:

      You would be surprised at just how little actual data is kept, or the utter lack of interest in the fine-grain details. If the VA wants to go back and corroborate details about when someone was injured, a lot of the time they have almost nothing to go by in the way of official documentation. I’ve seen Vietnam-era veterans who had to submit Freedom of Information Act requests to the National Archives in order to get access to things like unit morning reports and the Staff Duty Journals in order to attempt to support disability claims, because quite often, you simply can’t find a lot of the information in individual medical records.

  2. Julian says:

    Does anybody know of a report of someone being traumatised long-term by a rape before the 1930s?

    • J says:

      I don’t think ever read about it in Ancient literature. It is a mystery.

    • HumanHorn says:

      If rape isn’t all that traumatic – then what psychological factors made it to become a crime? Because it’s similar to theft maybe?

      • Frau Katze says:

        I’d say that if a stranger grabs someone from the street, definitely rape. Often these men kill the victims to stop them from talking. I would imagine it would be pretty traumatic, like a stranger breaking into your house. (Some of those guys will also add in rape if they can.)

        If they people know each other, the criteria to call it rape is hard to define. It often isn’t traumatic, to go by reports. But it’s hard to know, as being a rape victim gives you victim points to use in the current zeitgeist in the West. It’s distorting the statistics.

        • Rosenmops says:

          I think being grabbed off the street and raped by a stranger would be extremely traumatic. If some men think not, perhaps they could imagine themselves in a similar situation being anally rapped.

          • Frau Katze says:

            I think that violent attack by a stranger is fortunately not very common.

            Now there are these cases where the girl doesn’t go to the police but some parallel and different court situation at the university with some complaint about “date rape” (AFAIK we don’t have them in Canada).

            Mind you, I have heard of girls being drugged (powder dropped surreptitiously into her drink). That sounds bad.

            But that now-grown 12 year old victim of Roman Polanski was drugged now says she holds no resentment against him.

            Maybe Islam got some things right about teenagers.

    • Mycroft Jones says:

      Tess of the D’urbervilles, by Thomas Hardy.(published in 1891)

  3. Butler Schram says:

    Thank you. I’ve often thought that myself but could not put it so succinctly. Human history is a litany of horrors. Why the sudden surge in PTSD, not only in the military but in other walks of life…policing, firefighting…even jurors are claiming PTSD. One wonders if genes connected with resilience disappeared with the deaths on the battlefields of the 20th C wars.

    • gcochran9 says:

      ” Why the sudden surge in PTSD” – lawyers.

      • engleberg says:

        George MacDonald Fraser thought the surge in PTSD was a result of the surge in people paid to tell the troops to fret over their trauma until they went batty. Also, if you are middle class, you can have middle class genteel nerves if you want them. Most Americans think they are middle class, and most of us aren’t all that wrong. Also, actual mental illness is mostly a poor people’s problem, and being in the military puts you around poor people. Join the military, get out, join the middle class, use what you saw as a basis for your genteel nerves. Also, it’s not like actual war isn’t actually insanely horrible if you do it right.
        Moran’s Anatomy of Courage argument that you start with a finite amount of courage, and when it’s gone it’s gone, hasn’t been disproved.
        So it’s overdetermined, like everything real in social science.

      • Butler Schram says:

        Good point.

    • Karl Liebhardt says:

      Forgive the solipsism…I have sometimes wondered whether depression is similar, in the sense that our neural interface with reality was tempered over millions of years where seeing your relatives die from murder or starvation was often the norm. Most of us don’t live within such trauma now but it feels like there is a part of me that was made/reacts as if the world is still that sad and dangerous. Meanwhile, I go about my business, like most of us in the US, as if I’m from mayberry or part of the brady bunch. Bottom line feels like “evolution don’t care if your entire life was just a huge bowl of suffering so long as you procreated and your progeny, with heir attendant characteristics, can do the same.”

      • Frau Katze says:

        Religious beliefs might well have helped people enduring ghastly events. Consider this song about the Great Depression, that bad and all it was, wouldn’t have been nearly as bad as famine (Ireland, Ukraine in the 1930s),

        For fear the hearts of men are failing
        For these are latter days we know
        The Great Depression now is spreading
        God’s word declared it would be so
        I’m going where there’s no depression
        To the lovely land that’s free from care
        I’ll leave this world of toil and trouble
        My home’s in Heaven, I’m going there
        In that bright land, there’ll be no hunger
        No orphan children crying for bread
        No weeping widows, toil or struggle
        No shrouds, no coffins, and no death
        This dark hour of midnight nearing
        And tribulation time will come
        The storms will hurl in midnight fear
        And sweep lost millions to their doom

      • Greying Wanderer says:

        “I have sometimes wondered whether depression is similar, in the sense that our neural interface with reality was tempered over millions of years…”


  4. JayMan says:

    PTSD, as with everything else, is highly heritable, as seen in Vietnam vet twins:

    A classical twin study of PTSD symptoms and resilience: Evidence for a single spectrum of vulnerability to traumatic stress.

    Combat exposure moderates this:

    Combat Exposure Severity as a Moderator of Genetic and Environmental Liability to Posttraumatic Stress Disorder

    Compatible with the notion that heritable factors lead one to get brain injuries.

    For what both are worth (restricted sample, self-reported data).

    Cue CCR:

    • pyrrhus says:

      So Bad Moon Rising only for some, JayMan….For what it’s worth, military historian Martin van Creveld thinks that PTSD is largely a cultural phenomenon. Though I think he’s wrong with respect to powerful explosions, which were outside of human experience until recently, and therefore lacking evolutionary protection.

      • mtkennedy21 says:

        A French ammunition ship exploded in Halifax, Nova Scotia in 1918 and flattened the city. 3000 killed. It was largest explosion in human history until the atomic bomb.

      • Frau Katze says:

        I wonder why I never of thought of it myself. These blasts must generate a very powerful shock wave. That could easily damage the brain.

        Especially now that we know about boxing and football problems.

      • JP says:

        I can think of one obvious way it could be “cultural”: we’re all soft. Even US soldiers in WW2 (presumably the softest soldiers in the war) would’ve grown up seeing animals slaughtered, getting into fist fights, beaten by parents. In Iraq, we took kids who grew up on pop tarts and Sega Genesis, raised in daycares, and threw them into paranoid urban combat in 120 degree heat. I could see how that experience would’ve been a greater discontinuity from the environment they were conditioned for, than say, the theaters US soldiers fought in in WW2.

    • anon says:

      lying is also heritable.

    • Greying Wanderer says:

      “PTSD, as with everything else, is highly heritable, as seen in Vietnam vet twins:”

      if there are different rates of PTSD by combat role and combat role is selected by the army aptitude test then twins might end up in the same combat arms.

  5. Audie Murphy reportedly suffered from severe PTSD, endured periods of suicidal depression, and slept with a forty five under his pillow. Dakota Meyer seems to have had a visitation of it recently. So it’s not cowardice.

  6. BB753 says:

    War trauma was in all likelihood mainly caused by constant shelling:

    • AppSocRes says:

      This is a great video but the point of it is precisely that many stressors OTHER than constant shelling.cause war trauma

  7. There could certainly be blast injuries resulting in behavioural deficits, but that would not argue against there being other causes. For example, compare active service soldiers with those who did body recovery duties in the aftermath. The latter could still show effects, though more likely depression than anxiety.

  8. Jon says:

    You haven’t read much about the Civil War if you think it was not an artillery war.

    • gcochran9 says:

      about 10% of casualties were caused by artillery in the Civil War: most were from small arms. In WWI, ~60% from artillery.

      And artillery was not so much killing by explosion in the Civil War: lots of solid shot & canister, fewer shells. Ammunition for a Union battery of 12-pounder Napoleons before going into battle: 288 shot, 96 shells, 288 spherical cases, and 96 canisters.

      I have probably read a bit more than you about the Civil war, but less than 100x as much.

      • mtkennedy21 says:

        Most Civil War deaths were from disease. It was WWI that saw more deaths from wounds than disease in human history. A Confederate physician said he did not know a soldier who had a formed stool the duration of the war.

        • gcochran9 says:

          You know, I think that disease was not the biggest killer in war in Classical times.

          • athEIst says:

            Could you amplify? I believed that it was WWI that saw more deaths from wounds than disease in human history.

          • Zimriel says:

            Might depend on where you define ‘classical’. The plague which struck Marcus Aurelius’ empire was contracted on campaign against Parthia IIRC.
            Also, the Romans endured numerous parasites in their urban areas and it would much surprise me if their camps were germ free. Not to mention that hygiene standards were not up to par with the standards of WW1.
            (They did know to use bronze surgical tools, which are better at combatting bacteria than are the steel tools our hospitals have been using. Otherwise…)

      • Jon says:

        The fact that most battlefield casualties in the Civil War were the result of small arms fire does not mean that there was not heavy use of artillery. The total number of deaths attributed to artillery in the Civil War is roughly equivalent to the number of American deaths in WW2 attributed to artillery fire. And surely a large number of Civil War soldiers who were not considered casualties had their bells rung by artillery fire (not to mention concussions among those manning the batteries). The artillery exchange on the 3rd day at Gettysburg was heard in Baltimore, sixty mies away.

        So much has been written about the Civil War that you may well have read more about it than I have. I don’t pretend to be a serious student of the War. But I have read a fair amount. In younger days I read the standard works and a lot more. These days I read 3-5 books about the Civil War every year, plus a few articles, and attend 2-4 lectures. I have walked all of the significant battlefields in Virginia, plus Antietam and Gettysburg. I estimate that I have read at least 150-200 books about the Civil War in my lifetime.

        On the subject of Civil War artillery, I strongly recommend Porter Alexander’s memoirs. He was probably the best Confederate artillerist.

        Incidentally, my great-grandfather was an artillery officer in the Army of Northern Virginia for a year. He got tired of it and managed to transfer to Stuart’s cavalry.

        • gcochran9 says:

          You’re wrong. I was trying to explain why not many Civil War veterans would have had brain damage due to explosions: most were never exposed to a close powerful explosion, because small arms supplied most of the fire, because most artillery was firing solid shot rather than shells, and because the charges in shells used in the typical battle were smaller and less powerful thn in later years ( black powder vs its succesors).

          In World War One, people were exposed to blast a lot. In the Civil War, hardly at all. I’ve heard of a guy in the Civil War getting his bell rung: he was leaning against a tree that was hit by a cannonball.

          • Jon says:

            What exactly have I written that is wrong? Your hypothesis that not many Civil War veterans would have had brain damage and thus PTSD due to explosions may or may not be correct. But when you say that the Civil War was not an artillery war and that in the Civil War people were exposed to blast “hardly at all” you overstate your case.

            • gcochran9 says:

              Tell me how you get “blast” from a 12-pounder cannonball, or shrapnel, or case shot, or grapeshot.

              The Civil War was not an artillery war. Maybe ~10% of casualties were due to artillery, while more like 60% of those in WWI were. And in the Civil War, mainly various kinds of solid shot: not much explosive.

              • Jon says:

                How much is “not much” explosive? I could be mistaken, but my reading indicates that in major Civil War battles the artillery on both sides fired more explosive shells than solid shot. At Gettysburg they were not lobbing solid cannonballs at each other in the artillery barrages.

                Lots of dud explosive shells are still found on battlefields. Sometimes they still kill people.

              • gcochran9 says:

                In the Union army, each ammunition chest had 12 shot, fixed: 12 spherical case shot: 4 shells: 4 canisters.

                So shells were 1/8th of ammunition available.

              • gcochran9 says:

                Gunpowder is a low explosive & was used in the Civil War. High explosives, things like TNT, were used in WWI and later wars. “Explosives are categorized as high-order explosives (HE) or low-order explosives (LE).
                HE produce a defining supersonic over-pressurization shock wave. Examples of HE include TNT, C-4, Semtex, nitroglycerin, dynamite, and ammonium nitrate fuel oil (ANFO). LE create a subsonic explosion and lack HE’s over-pressurization wave. Examples of LE include pipe bombs, gunpowder, and most pure petroleum-based bombs such as Molotov cocktails or aircraft improvised as guided missiles. HE and LE cause different injury patterns. “

              • Jon says:

                You might take a look at the tables in this article:

                They don’t seem consistent with “not much explosive.”

              • gcochran9 says:

                We’d use more rounds in one battle in WWI than in the entire Civil War: and those were high explosives, which generated blast waves, not black powder.

                ~10% of casualties in the Civil War were caused by artillery, more like 60% in WWI. And if you can’t understand that 60% >> 10%, the hell with you. Enough already.

  9. Lior says:

    Same for ‘Railway spine’
    “Erichsen observed that those most likely to be injured in a railway crash were those sitting with their backs to the acceleration. This is the same injury mechanism found in whiplash. As with automobile accidents, railway and airplane accidents are now known to cause posttraumatic stress disorder (PTSD) and other psychosomatic symptoms in addition to physical trauma.”

  10. AppSocRes says:

    John Keegan, in “The Face of Battle: A Study of Agincourt, Waterloo, and the Somme” (,notes that modern war is both quantitatively and qualitatively different than earlier forms of warfare. The geographic and temporal extent of battlefields has enlarged over time and this has increased levels of combat-induced stress. In classical and medieval times battlefields rarely covered more than a few acres, at most a square mile or two, and battles lasted an hour or two, never a full day. By the Napoleonic era the extent of battlefields had increased, but battles were over within the course of a day. The longest “Napoleonic” battle was probably Gettysburg, which lasted three days, and most of the troops in this extended battle were actually in combat for a day or less.

    Although Keegan doesn’t discuss this, a significant exception to this pattern was sieges. Contemporary observers often commented on the effects that sustained stress had on survivors of these, e.g., Caesar’s description of the aftermath of his circumvallation of Vercingetorix.

    In modern warfare battles can extend over hundreds of square miles and combat can last for weeks. Examples are most of the major battles in WW I, Guadalcanal and many other island battles in the Pacific theater during WW II, many of the battles on Germany’s and Russia’s front in that same war, the Battle of the Bulge, major battles in Korea, the two “sieges” of Dien Bien Phu and Khe San, extended LRPs in Vietnam, and the list goes on.

    A distant relative was never under direct bombardment in WW I but was close enough to the front that he sustained minor lung damage during a gas attack. It was common knowledge in the family that this man was “queer in the head” after the War. Care was taken to ensure that none of us children were ever left alone with him. My nephew was a combat engineer during the first Gulf War. Although he was never in a full-fledged battle, his unit was engaged with a fleeing enemy over the course of weeks. The stress took an obvious toll on him that lasted for years after.

    The inescapable levels of stress imposed by modern combat and the extended periods of such stress are so qualitatively different than the stresses imposed by most pre-WW I combat, that it’s not a slam dunk to rule such stresses out as a cause of shell shock, combat fatigue, PTSD, or whatever the current term is.

    • Erik Sieven says:

      I could imagine the majority off all humans who ever lived, experienced feuds between clans, neighbors, tribes or families. This means constant war, not in the battle ground but i your own home, where your family lives. Thus I think modern warfare has not really brought anything new.

    • Abelard Lindsey says:

      I find this very credible. One can be psyched up and full of adrenaline for the one to two hours of battle priot to industrial times and come out of it OK. Modern (industrial) warfare with its huge battle field, artillery, and going for days on end; would be highly nerve racking and eventually cause one to break. It is not physiologically possible to remain “psyched” for anywhere near this time. Shell shock, PTSD, whatever you call it clearly has to be real.

    • Frau Katze says:

      Very true about WW I being an unexpected horror. People were thinking back to the 1870 Prussian invasion of France. It lasted several months, with a series of battles and some sieges. But one doesn’t hear much about it.

      I guess all the European leaders were thinking of it, thinking they’d be home by Christmas.

  11. dearieme says:

    “I would guess that what actually happened was a combination of people finding a way to avoid getting killed, and brain damage due to nearby explosions.” I think the common British assumption is that shell-shock in WWI was well-named, and resulted from pretty much what you’ve described i.e. a combination of percussion and near-helpless terror.

    • dearieme says:

      I have heard a military opinion that an individual has a stock of courage, and once it’s exhausted even the brave man is no longer fit for action.

      • gcochran9 says:

        Somehow, that stock was a lot bigger for Germans and Russians than among the Brits and Americans.

        • Highlander says:

          And how high were John Basilone’s or Ernest E. Evans’ stock Greg?

          • gcochran9 says:

            I know and honor them – but somehow a tremendously larger fraction of Americans ended up out of the line due to combat fatigue than in the German or Russian armies, even though, for them, intense combat went on far longer. I don’t think American soldiers were very different – but I think we took psychiatrists and psychologists seriously, while they did not.

        • Kirk says:

          Well, while that’s possibly true, yet actually unknowable… Part of the problem is that the US military chose to recognize and treat, vs. what the Germans and Russians did, which was leave men in the line units until they died.

          You can do an easy compare/contrast between the German Luftwaffe and the US Army Air Force polices: In the US practice, it was 25 missions and then you were sent back to the training base to pass on what you’d learned to new pilots. German policy? LOL… You were on the line until you got yourself killed. If you were a good pilot, well… Then, you could rack up a really nice, high score against the Soviets and others.

          The US military generally took a very humane line on dealing with human fragility, which was why they seemed “softer”. The Germans did treat their battle fatigue cases somewhat differently, in that they were often kept in their units and allowed to recover gradually. This contrasted with the thousands of German soldiers summarily executed during the late war for “cowardice” and the like; the US has one lone example. one PVT Eddie Slovik.

          This is a very incomplete and highly inaccurate argument that you’re making. The Germans did some aspects of personnel management better than the US did, particularly when you start comparing the abysmal US replacement system to German practices. A former German wartime officer once commented to me that if he’d been caught doing replacement operations the way the US generally did things, he’d have been court-martialed and summarily shot out of hand. The Germans did some things very well, and the manner in which they integrated new troops to damaged units had considerable benefits. US practice, on the other hand, while optimized for “Big Picture” operations above the battalion/brigade, had horrid actual effects down at the lowest levels, that of the individual soldier and small unit.

          • gcochran9 says:

            We seemed softer because we were softer, and it didn’t work very well. Our methods of treatment didn’t work very well: they seldom got back in the line.

            We listened to psychologists: but they didn’t know anything. We have whole ‘disciplines’ with no predictive power that we pretend are sciences – but pretending doesn’t make it so.

            About the repple-depples: yes, our system was notoriously bad. McNair made some awful mistakes.

            • Frau Katze says:

              Don’t think the Germans in WW2 failed to notice how much “nicer” the Americans were. Individual units, at the end, were desperate not to have to surrender to the Red Army. I’m not sure if the English & their colonials were much different than the Americans. There might have some differences but they paled compared to the brutality of Stalin.

              Stalin saw no reason that the men shouldn’t be allowed to rape German women. It was sort of a reward for still being alive to get there.

              • gcochran9 says:

                The Germans knew what they had done in Russia, and what the Russians had done in their first forays into East Prussia. So they were scared, both soldiers and civilians. Nobody seems to have expected particularly harsh treatment from the Americans or Brits, and nor was there any.

                The Russians had plenty of reasons for wanting revenge against the Germans, and they were encouraged to do so by Soviet propagandists. For a while: then Stalin made it stop, because he plans for east Germany. In truth it didn’t make much sense in the first place: it permanently damaged relations with the Germans, and it’s not as if he was trying to get the frontovik vote.

              • Frau Katze says:

                @gcochran True. The Germans fought two different war styles. Hitler hated Slavs although I have read that even some Nazis couldn’t understand why.

              • gcochran9 says:

                “hated Slavs” – could be this.

            • Kirk says:

              Y’know… I think you don’t actually know what you’re talking about. At all.

              You rattle on about how “soft” the decadent US was, and yet… The US won. When it came down to the line, the US produced individual units like the First Special Service Force that easily trounced the “tougher” Germans in every engagement they took part in.

              The issues you’re ascribing to “softness” don’t actually stem from that; if anything, it’s a somewhat more realistic view of human nature and capability. The Germans were on a Nietzschean kick, thinking they were producing ubermensch with their policies. Only thing is, all they really produced was a brittle, fragile military force of aces and prima donna twats that lost the war. Nowhere in the German “superman military” did anyone bother to do the hard work of logistics; Rommel and most of his peers expected to be handed whatever they wanted, whenever they wanted it. The US, on the other hand? Carefully examined the disasters in procurement during WWI, and ensured that they wouldn’t repeat that set of errors. The Germans? Parvenus, all.

              There’s a valuable popular history out there that you obviously missed reading, or you’d likely not be making the claims you are: There’s a War to Be Won: The United States Army in World War II, by Geoffrey Perret. In it, he lays out the logical reasons that the US did things the way they did, and the background for the decisions that men like Marshall made.

              I really think you’re talking out your ass, with regards to this “softness” and “decadence” of the US. You’re echoing Nazi and Japanese Imperial propaganda of the war era, and we should note that the historical facts don’t support those. The Nazis and Imperial Japanese all came to rue taking on the US, particularly once they had gotten done giving them their finishing lessons in the initial battles. The stats speak for themselves: While individual German units occasionally achieved victory against US forces in Europe, the entire tale of war-making system against system left them destroyed. Similarly, all of the Japanese valor and barbarity came to naught, when their Banzai charges were stopped dead in their tracks by US support troops.

              Which is not to say that the US military of WWII was the acme of potential military performance; it was a citizen force, and reflected the nation that raised it. That force won the war, and that’s all that counts. You can criticize details of how they went about that, and the long tail of follow-on effects to the present day, but the essential fact remains that the German and Japanese “warrior races” both went down in flames before the racial mongrels produced here in the US.

              As a professional soldier, I have studied these issues in considerable depth, and I have to say that I’m not satisfied with what we are doing, in any way, shape, or form. But, you? You are on an entirely mistaken track, and one parallel to the racial superiority theorists of German and Japanese ilk. That fact ought to give you pause.

              • gcochran9 says:

                I’ve probably read more military history than you have – a lot more. And if you’re going to quote me as saying “decadence” wait till I actually say it, because I never did. Nor do I think that of America in 1942.

                I know that on the whole, German units were more effective than similar-sized US units ( by about 25%) : a combination of better infantry weapons, greater war experience, better officers, more effective doctrine. Overall German strategy was total lunacy, but their tactical execution of that lunacy was effective: better than the British, better than the Soviets, better than the US. One reason for inferior (western) Allied infantry is that they had to put a much larger fraction of their human capital into air and naval forces – had to, in order to secure the Atlantic shipping lanes ( and fight a naval war with Japan). The best soldiers tended to go into the Navy and Army Air Force, so the infantry suffered.
                As for ‘special ops’ units like the Devil’s Brigade or the SAS – every unusually talented guy in such units is one less such guy in a regular army unit. Eisenhower thought such elite units a mistake, and I tend to agree with him. Except for Skorzeny, of course, who was strategically effective.

                I think that listening to psychologists about combat fatigue and shell shock was a mistake, because they didn’t know what they were talking about. Psychology wasn’t a science: they couldn’t predict, they couldn’t cure.
                Most of the what they said was ridiculous crap. Still the case today, as when the CIA paid two contract psychologists $80 million to develop new and better means of torture – psychologists that knew nothing about torture, or war, or the Middle East.

                I think many things the US Army did in WWII were just wonderful – throwing candy at kids is better and more effective than German Schrecklichkeit.

                But, in my opinion, the way we dealt with combat fatigue was based on a “wrong theory of human nature”, and was the least effective such policy in the war – considerably worse than the British policies.

                As for the Japanese Army, unusually fanatical, but basically incompetent. No real understanding of modern warfare, contempt for logistics, etc.

  12. JMcG says:

    I had a friend, now dead, who was on the Franklin when it was struck by two Japanese bombs off Okinawa. He was one of the 700 who remained on board and saved the ship. At one point he was in an ammunition magazine tying ropes to 5” rockets so they could be thrown overboard before they cooked off.
    When he was in his mid seventies he had a cataract removed. A few weeks later I asked when he planned to have the other eye done. “Never” was his reply.
    He told me that the anesthesia had affected him such that he was experiencing horrifyingly vivid flashbacks to the war. He spent his nights driving around the town where we lived, afraid to lie awake in bed.
    He was a Bosun’s mate, assigned to a 20mm ammunition locker for his battle station, so he’d have been exposed to plenty of cannon fire.

    • JP says:

      Modern warfare turns the soldier into an insect in a swarm, just waiting for a blast of bug spray. It’s a lot less about heroism and skill, than in, say, the days of boasting Germanic barbarians or Homeric duels. This is apparently why the general or the sniper has largely taken over the propagandistic icon role, they’re the only ones who can survive long enough to repeatedly display their skill and form a legend.

  13. greifer says:

    Doesn’t being extremely sensitive to a small noise, and reponding with heightened fight or flight, seem a good adaptation? I get the “just so” ness of such a armchair theory, but perhaps there wasn’t a need for a damper on such a mechanism?

    It’s generally held that our ears work on base 10 log systems–that’s why we measure in decibels. I don’t know if more recent work has shown variation in this; the advantage is it’s still linear at the quiet end of the scale. But how often did our genes work on the top end of that spectrum? Perhaps not everyone’s ear/brain is properly using that scale, after all.

  14. Highlander says:

    I dunno Greg. I was a combat engineer fifty years ago and speaking from anecdotal and purely personal experience I went through four separate events over a ten month period each of which resulted in concussions which knocked me out cold. Two Chicom anti-tank mines exploding prior to any attempt to de-activate them sent me flying through the air; a self induced high amperage 400 volt live wiring mishap that I contived while unwisely sitting in a pool of sweat on a 40,000 gallon steel water tank left me unconscious for an unknown length of time one afternoon; and finally a direct hit by a 122mm Soviet rocket on a bunker I was sleeping in left me with a double skull fracture that put me on light duty for the remaining two months of my tour.

    On arriving back in the States I had an annoying tick in my left eye and an intermittent palsy like shake in my right arm. After two months in the Camp Pendleton Naval Hospital receiving dope like drugs for the amelioration of the tick and doing daily physical therapy to get my right hand grip back under control I was given a Marine Corps disability rating of 10% for concussive brain damage, $1600 total compensation, and a medical discharge under honorable conditions.

    Some 30 tears on I was repeatedly encouraged to go and tell the VA my well documented story, the result of which I was awarded a 40% TBI disability rating PLUS another 40% for PTSD!!! (which didn’t even exist back in the day and had to be explained to me.) I did have to pay back the 1969 $1600 in nominal year 2000 dollars. LOL! I also get free dental too (a not inconsiderable benefit to any septuagenarian.)

    Given your churlish comments I take great pleasure in contemplating the fact that my financial windfall may have increased your total federal taxes by at least the amount of a cup of double cappuccino or one time reduction in any money however small the amount available to you to contribute to your grand children’s college fund.

    I would say that loud noises do induce a bit of a startle reaction in me but would also note that none of my siblings seem to suffer any permanent symptoms of undo stress over and above what one suffers from ordinary life experience.

    • Space Ghost says:

      Given your churlish comments I take great pleasure in contemplating the fact that my financial windfall may have increased your total federal taxes by at least the amount of a cup of double cappuccino or one time reduction in any money however small the amount available to you to contribute to your grand children’s college fund.

      You realize that he’s not saying your symptoms are fake, right? He’s saying that they are due to the physical act of concussive brain trauma you experienced, not any sort of emotional response to the hazards of war.

    • Abelard Lindsey says:

      I find this very credible. One can be psyched up and full of adrenaline for the one to two hours of battle priot to industrial times and come out of it OK. Modern (industrial) warfare with its huge battle field, artillery, and going for days on end; would be highly nerve racking and eventually cause one to break. It is not physiologically possible to remain “psyched” for anywhere near this time. Shell shock, PTSD, whatever you call it clearly has to be real.

  15. US says:

    Remembering vividly situations where you almost died seems potentially highly adaptive, as heightened awareness of precipitating factors would be expected to minimize the risk of recurrence. Similarly, to take an example rape basically equals an experienced loss of control pertaining to partner selection (females want to limit partner choice to potential high-(genetic) quality mates, and forced copulations by undesirable males are highly undesirable outcomes… Also the sort of thing an organism reproducing sexually would benefit from minimizing, e.g. by developing vivid memories in targets/victims to preclude recurrences.

    Modern human warfare’s weird, humans did not evolve to handle the constant firing of M60s, but being able to vividly recall undesirable events in order to avoid their recurrences is not weird at all; you’d expect to observe such mechanisms in fitness-optimizing species.

    I’m pretty sure I’ve read about this stuff in the evolutionary biology literature I’ve read in the past, but I’m too lazy to try to dig up links.

    • Cloveoil says:

      “Modern human warfare’s weird, humans did not evolve to handle the constant firing of M60s, but being able to vividly recall undesirable events in order to avoid their recurrences is not weird at all; you’d expect to observe such mechanisms in fitness-optimizing species.”

      Is mental illness about a sick person or a sick society? More properly modern society – and in this case tech – creates social situations we didn’t evolve to face, and healthy mechanisms are mistaken for dysfunctional.

      • RD Laing has long since been debunked at this point. You seem determined to believe the fads of previous decades about mental illness. I don’t know what your agenda is, but I have to suspect you have some reason for not wanting to some particular answer to be true.

        • Cloveoil says:

          If psychiatry has advanced scientifically or ethically, its by abandoning the mental illness paradigm than conflated philosophy of mind with medical science. But still there are a ton of philosophical problems; some with relevance to mental health issues. PTSD is as postnatal depression – its real but you can’t say its a disease if the physiology was under positive selection, and it wouldn’t happen without ‘un-natural’ or suboptimal situations.

        • Cloveoil says:

          Laing was wrong about biopsychiatry, but correct that the diagnosis of mental illness does not follow a traditional medical model – see the vagueness of psychiaric manuals. That said one does not have to reject biopsychiatry to realise that if mental illness often affects people’s social interactions, the social context must still cultivate the symptoms and inner experiences somewhat,

          This does not depend on Laing’s flaws nor Laing himself who I don’t really hold in high regards. Szasz had more useful things to say but he didn’t respond to positive changes in psychiatry by admitting there were improvements. Disease can only mean something people “have”, while behavior is what people “do” – cognitive vs behavioural. To some degree psych still blurs this: the classic example must be ASPD.

          • Cloveoil says:

            Mental disorders are not purely natural processes whose detection is untarnished by cultural interpretation. Most trick-cyclists hold that the mental disorder/illness may have an objective basis but there is enough unscientific fuzziness they can’t be precisely defined as a physical illnesses would.

            According to location psychiatrists will interpret behaviours such as finger biting as evidence of illness, proving the errant conflation of the cognitive and the behavioural as well as the external pressure from cultural assumptions upon both patient and clinician.

            Here is an example of such rubbish:

            “Conduct disorder is specifically confined to children and adolescents, and some psychiatrists believe it is a precursor of schizophrenia. According to DSM-IV, ‘The essential feature of Conduct Disorder is a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated.’ Staying out late at night despite parental prohibitions is one of the signs. The text-book recommendation for treating this kind of waywardness is dosing with haloperidol, a high-strength neuroleptic drug used for treating schizophrenia.”

            “Simple schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic ‘negative’ symptoms of residual schizophrenia without any history of hallucinations, delusions, or other manifestations of an earlier psychotic episode, and with significant changes in personal behaviour, manifest as a marked loss of interest, idleness, and social withdrawal over a period of a least one year.”

            In other words ‘simple schizophrenia’ could never have construct validity – other causes such as (obviously) depression could underlie the schizophreniform symptoms – which are merely describing the onset of an affective disorder.

  16. jimeo722 says:

    Reminds me of a George Carlin routine. Google it if you’re curious. He doesn’t address this point.

    Raises another question. Was Patton right to slap that guy?

  17. Caribbe Mont Pi says:

    Gulf War Syndrome is an example of Shell Shock updated, more “modern” and “scientific,” specific toxins alleged as causes of what is just a psychogenic condition.

    The way that loss of a child and rape seem to permanently screw people up seems evolutionarily irrational. You’d want, for instance, in the case of a child, for a parent to do anything possible to preserve its life and go on to reproduce, but after the child is dead, the trauma is not accomplishing anything. I’ve always thought that the answer may be that some of these adaptations may have developed when lives were very short, so lifelong trauma was not as much of a problem.

    And I wonder if childbirth has always been so painful, or if natural selection for women with big pelvises and baby chutes has broken in modern times with modern medicine, and women who, evolutionarily, have no business having babies with their tiny equipment have been able to proliferate.

    • Erik Sieven says:

      I thought almost all women who ever lived had children anyway?

    • mtkennedy21 says:

      I think this is a big factor in the incidence of type I diabetes.

    • Rosenmops says:

      Childbirth has always been painful. The worst pain comes from the contractions of the uterus. These contractions feel sort of like very severe intestinal contractions. They go on for many hours, getting more and more powerful, lasing longer and coming closer together. The actual birth itself is usually quite short and not nearly as painful as the hours of contractions that proceed it. This is based on my experience of giving birth naturally 3 times. Women tend to forget about the pain when they hold the baby.

      Women with very narrow hips would probably get a C section. In the old they they might have died in childbirth.

      • crew says:

        Chinese women seem to have narrow hips compared to Caucasian women (perhaps you have heard of Hong Kong Hips), and yet they have been able to give birth to babies for a long time.

        I know of one who gave birth 9 or 10 time, all natural and others who have given birth multiple times naturally. I also know of Caucasian women who have had C sections, but I hear that that is widely regarded these days to be so it was more convenient for the doctor.

        I dunno.

        • mtkennedy21 says:

          The highest incidence of C section for years was Brazil, not the US,

        • Rosenmops says:

          Maybe the Chinese babies are proportionately smaller.

          • crew says:

            Have you seen many Chinese babies?

            They tend to have big heads compared to some other groups.

            I know of a small Chinese woman who had an 8lb+ baby and a 9lb+ baby. No C sections.

        • Phille says:

          Chinese women don’t just have narrower hips, their hips are somehow formed differently too. I can tell a Chinese women from quite a distance, without seeing her hair or face, just from the way they walk. Maybe that difference compensates for having narrower hips/being smaller.

  18. Cloveoil says:

    Something rings true about this, but PTSD can result from severe abuse, but only sever abuse – not one rape or a bit of bullying.

    • Rosenmops says:

      I’m going to assume you are a man. (forgive me if I am wrong). Imagime, say, walking along the sidewalk towards home. Suddenly a large, powerful man (much stronger than you) jumps out of the bushes and pulls you back into the bushes and pulls you down. Suppose he has a knife or gun and threatens you to keep quiet. Now suppose he anally rapes you. After he finished you are lucky–he doesn’t kill you. He just melts into the bush, leaving you lying there.

      Is this “server abuse”?

  19. Jim says:

    It’s amazing that all the Freudian-Jungian whatever crap was widely accepted by so many educated people without any empirical evidence whatsoever. It shows how little influence the scientific worldview has had even in European civilization where it originated.

    • Cloveoil says:

      Nah. It looks scientific – don’t forget any science is ‘woo’ to most people, even other scientists who can’t understand it. Cultural science is not the same as real science by any means.

  20. Recusant says:


    I don’t know what data you have on PTSD in the US, but here in the UK the research on PTSD sufferers from Afghanistan has been unexpected. Basically, those serving in theatre, but in support, not combat, roles were 3x as likely to suffer from PTSD than those in the front line.

  21. This flick

    is being shown to high-school faculties around the country at the low, low price of $2k per showing. Faculty members are getting increasingly frustrated with today’s youth; this film helps them understand the snowflakes’ unique trauma. My wife just joked to me we should make a rejoinder flick calked “Get Over It.”

  22. Wanda says:

    Some people may be confusing PTSD with the after-effects of mild traumatic brain injury. Granted, the two are often intertwined, but a person may suffer from PTSD without having experienced TBI and vice versa.
    About 10 years ago during my first deployment to AFG, I was riding in a vehicle that was struck by an EFP IED and sustained mTBI, from which I seem to have largely recovered.
    I was diagnosed with PCS, but nontheless had little trouble completing OCS and returning for a second deployment. Since then, I’ve completed rigorous training programs, gotten an advanced degree and become a mommy. I’ve been diagnosed with PPCS but not PTSD.
    I’m not by any means saying those who suffer from PTSD are malingerers. But Jayman is right to point out the genetic factors in susceptibility to the disorder. There has been some progress made in developing tests to predict who may be vulnerable to it.
    Also, I don’t think life experience factors can be discounted. For example, lots of people are severely stressed out by OCS — it’s designed to do that — but I was not bothered by it. As a service brat whose dad conducted weekly RLP inspections and generally treated us kids as if we were slacker recruits who needed toughening the GDF up, actual service life was a breeze.
    As far as PTSD sufferers in the past, they may well have just not been recognized. Eg., ISTR there were a vast number of tramps in the years after the Civil War, even a so-called “Tramp Scare.” Could a significant number of these men have been suffering from PTSD and MTBI?
    Also, the past was more of a “root hog, or die” world. To survive, you had to, as those who have seen the elephant say today, suck it up, shut up and drive on.

    • jb says:

      Um, I don’t suppose you could provide us with an acronym glossary? 🙂

      • Rosenmops says:

        I looked some of the acronyms up. I guess most people know the more common ones.:

        TBI traumatic brain injury

        EFP Explosively formed penetrator

        IED improvised explosive device

        mTBI mild traumatic brain injury

        PCS Post-concussion syndrome

        OCS Officer Candidate School

        PPCS this one is a mystery. Probably related to PCS

        RLP Room . Locker, Personel
        In the Room Locker Personnel (RLP) phase of OCS Training, students learn attention to detail through routine inspections of their uniform and living quarters. Strict room cleanliness and uniform appearance are stressed in RLP to help candidates become detail-oriented officers and more effective leaders.

        GDF ? God damned fuck ?

        ISTR I seem to remember ?

        • Wanda says:

          PPCS = Persistent Post-Concussion Syndrome.
          Sorry to make you look up all that, but thanks. I should have defined those terms. (^_^)
          Thinking about this subject, it definitely seems that the symptoms of mTBI, in which an explosive over-pressure wave propagates through the brain, creating characteristic cell damage, are being confused with those of PTSD, a reaction to emotional stress.
          In the World War I-era poem “Strange Meeting,” Wilfred Owen writes that “Foreheads of men have bled where no wounds were.” This could describe either mTBI or PTSD, though I think that in the context of the poem, it is more likely to be PTSD.
          In “Into the Valley,” a description of small-unit combat on Guadalcanal by John Hersey in which he describes a Marine patrol descending into a river ravine, attempting a crossing and being prevented by intense mortar and artillery fire, then retreating back up the way they came carrying their wounded, Hersey seems mystified by men collapsing and dying who have no visible wounds. The concept of damage not only to the brain but other organs by over-pressure waves is foreign to him and he does not have the vocabulary to describe it succinctly.
          As far as how common claims of PTSD have become in recent years, I suppose it is another example of rewarding a behavior and getting more of it. In the past, the world told us laugh and the world laughs with you, cry and you cry alone. Today, if you laugh, society’s scolds tell you nothing is funny, and if you cry, you’ll get a research grant paying you to describe in elaborate academic bafflegab just exactly who made you cry.

    • mtkennedy21 says:

      There was no VA or equivalent after the Civil War. Many veterans worked on the railroad west and Mother Bickerdyke, a hero of the war that no one has ever heard of, and Sherman set up some living quarters in Kansas for some of them.

  23. Stephen says:

    Re American Civil War: see for something that looks rather like PTSD.

    But for modern prevalence: I remember a discussion with much older family members (ex-8th Army antitank gunner, ex-Japanese POW, ex-Arctic Convoys plus surviving ship torpedoed elsewhere) who agreed that yes, it’s real, but by modern US standards half the population of Europe and Asia should have been suffering from it by 1945.

    • Jim says:

      Speaking of being a prisoner of war I remember when I was in school in Guam one of our teachers was a Catholic priest who had arrived on Guam just before the Japanese invasion and spent the war in Japan as a prisoner of war. He had some pretty horrific stories about his experience but seemed quite stable and cheerful.

  24. Jamie_NYC says:

    Shell-shock, maybe. I read that Israeli Defense Forces didn’t have any cases of PTSD in their early wars, when Israel was fighting for survival (up to 1973). They started seeing PTSD related to their ‘campaigns’ in Lebanon and Gaza – in other words, the wars of choice, where men wonder ‘what are we doing here’ rather than fighting to protect their homes and families.

  25. sfw says:

    I was a firefighter for 25 years and another 5 as a police officer, did the usual stuff, lots of unpleasant experiences. I only worked with one person who claimed to have PTSD and that was after a particularly bad job, but nobody else who was there had a problem. He was always a bit flaky and soft and I always wondered why he was in the job, not suited to it. It wasn’t the incident that did it for him he would have struggled anywhere. Funny how after he got a payout and pension he managed to live a normal life without problems.

  26. TB says:

    I see PTSD in patient pre-existing conditions lists fairly often, most commonly in younger (under 40) females, although occasionally Vietnam-era males. May be observer bias, but it seems to show up along with diagnoses of depression, anxiety, loads of ‘allergies’ to common drugs, long histories of frequent in-patient admissions for a wide variety of odd ailments.
    In other words, they seem just like all my other patients with histories of mental illness.

  27. Warren Notes says:

    How about Nazi concentration camp survivors, did they exhibit any signs of PTSD? Horrific conditions there, but without the shells exploding. Of course, incredible malnutrition. I have only read accounts focusing on individuals rather than populations – have any studies looked at psychiatric conditions of any kind of representative sample?

  28. The Z Blog says:

    As far as I know, humans never had to defend against attacks from above. Predators, animal or human, all exist in 2D space. Shells, choppers, drones, jets, missiles all come from above the battle field, Just having an A-10 fly over under normal conditions is unnerving.

    Maybe it is not the explosions that are the cause, but the fact that death from above is particularly terrifying to humans. We’re not built to fight in three dimensions.

  29. info says:

    Tribal societies have purification rituals for war:

    That’s how they dealt with PTSD. Also I recommend this book:
    On Killing: The Psychological Cost of Learning to Kill in War and Society

  30. Zenit says:

    Starvation, malnutrition and nutrient deficiency was normal for all history and prehistory, therefore humans shall evolve to withstand them without any lasting effects, shouldn’t they?

    • gcochran9 says:

      You can solve a traumatic memory by simply forgetting it: you can’t wish away starvation.

      • Zenit says:

        If you survive starvation and find yourself again in good times with enough food, you can solve any trauma just by gorging yourself enough and regenerating all bodily damage – or you could if evolution worked to make man a perfectly calibrated machine, and not Ruby Goldberg style collection of kludges.

  31. Rich Rostrom says:

    You’ve overlooked siege warfare, which was very common in all eras. A siege might last for weeks or months. That includes “active” sieges in the gunpowder era, where the attackers continually bombarded the defenders.

    Also, “firefight” battles in the gunpowder age could last for days. And in the Napoleonic period, there were cases of units under continual sporadic fire for hours.

  32. Aldo says:

    Have you considered that the ancient soldiers were more used to death? Higher levels of warfare, disease, childbirth deaths, crime, butchering animals themselves instead of heading to a supermarket.

    • +1

      We are maladapted to our environment in all kids of ways, see the low fertility, depression, obesity, ect. Maybe if you experience a lot of trauma in childhood, you learn to get over it, but this doesn’t happen if you’re raised in an unnaturally low-trauma environment and are suddenly thrust into the high-trauma environment of war.

  33. Eugine Nier says:

    One interesting question to ask is what about the Germans and Russians during the two world wars? This seems like a good way to distinguish the “modern warfare” hypothesis from the “culture-bound syndrome” hypothesis.

    • Zenit says:

      Do not know about WW2, but PTSD was definitely there in the later wars, search for “Afghan syndrome” or “Chechen syndrome”. There was no reason for making things up – Russia in 80’s and especially 90’s was not land of sensitive “snowflakes”, and veterans of Afghanistan and Chechnya had to care for themselves, there were no benefits for them (or anyone else).

    • Warren Notes says:

      Russians? By WWII, Stalin had inflicted a great deal of mental trauma on his own.

  34. Coagulopath says:

    Could PTSD = adaptive overreach? “That was a maladaptive experience, here’s a bad feeling so you don’t do it again!” works so well for 95% of the population that it doesn’t matter that it manifests as a debilitating illness in the remaining 5%?

  35. Peter Gerdes says:

    Some of PTSD symptoms are simply the result of behaviors/heuristics that benefit survival in a highly dangerous, violent and unpredictable environment being executed in an (evolutionarily unusually) high trust, low risk environment that requires people to spend long hours focusing on reading, writing, screens and other passive activities as well as constant friendly interaction with strangers.

    For instance, in a highly dangerous environment like a war zone it’s dangerous to let oneself become fully absorbed and miss threats. Thus a system which enhances survival in such an environment might well interfere with the levels of concentration and focus we expect in western society. Similar points can be made about extreme watchfulness, paranoia and violent dreams etc.. etc..

    These weren’t an issue with the ancient Romans because the society they came back to was still quite violent, dangerous and low trust.

  36. Pingback: Weekend Link Love — Edition 517 -

  37. Larry, San Francisco says:

    MY dad was a navigator who flew 26 missions over Germany between September 1943 and April 1944 when he was shot down (his plane made it to Sweden where he sat out the rest of the war). Right before he died he told me that he thought he had PTSD because he would often wake up terrified, sweating and extremely anxious from a horrible dream he could never quite remember.I often think that being on a plane that is going straight into a flak field would be terrifying.

    • Greying Wanderer says:

      i think flak fires explosive shells but i don’t know if the pressure wave from that was weaker or stronger than on the surface – no obstacles in the way i guess but would lower air density be better or worse? lack of helmets?

  38. David Chamberlin says:

    I wish I could get ahold of Dr Dave Hanrahan, a psychiatrist who works full time for the military treating people with severe PTSD to respond in his words why he disagrees with Greg. But I lost track of him. Anyway I really don’t think it would work for him to announce to his patients that all they have to do is toughen up. War is hell and it fucks up everybody that is in it. Why does it screw up more people today?

    People in the past lived vastly different lives, death, violence, and human misery were on a completely scale so of course they responded by being a lot tougher. People today can’t handle what they put up with in the past. If one of these soft folks of the present was to go back in the past and bitch and moan about his troubles he would be laughed out of the room. It’s all a matter of scale. Throw soft people into a war and they get diagnosed with PTSD. Tough guys come home from the war and move on with their lives, but they are scarred.

  39. mtkennedy21 says:

    When I was a little kid, I knew a few Air Corps veterans, several of whom had been shot down. They seemed to get on with their lives quite well. My mother stayed in touch with several couples that met at parties my parents had for the guys when they came home in 1946. I never heard of any troubles after with any of them. One cousin, who I idolized and insisted that my father get a army cot so I could sleep next to him in our home, had no nightmares or outward signs of trauma even though he was a bombardier and was wounded.

  40. Wanda says:

    I put together this little visual to help explain that blast mTBI is a real thing, different from other types of brain injury, and its connection to battlefield PTSD:

  41. jb says:

    Are we certain that PTSD is limited to human beings? I’ve read articles and seen TV shows about shelter dogs that had been seriously mistreated, and they don’t necessarily just “get over it” — in fact many seem to be permanently traumatized, even after they’ve physically recovered. Could that be a canine PTSD analogue?

    “Getting over it” might be the optimal adaptive strategy in a general hand-waving sense, but perhaps there are reasons why this optimum isn’t always realizable.

  42. Greying Wanderer says:

    i can imagine multiple kinds of trauma but a specific blast/shock/concussion type of brain damage being one of them makes a lot of sense imo

    • Greying Wanderer says:

      and the thing about that is it might be possible to design helmets which prevent or reduce it

    • Highlander says:

      Blast waves are bad but it is the “shrapnel” that is a real bitch. Airbursts from a 155mm fragmentation round:

      • Greying Wanderer says:

        out in the open for sure but what if you’re in a trench, bunker, shell scrape etc?

        • Highlander says:

          Those airbursts in the video are designed to rain down a hail of fragments into trenches. The crew sets the fuses to explode at the optimal distance from the target depending on the mission.

          Those bursts of black smoke you see in war movies are designed to send metallic fragments into the targeted aircraft. The proximity fuses in the nose of ant-aircraft artillery rounds have had little radar sets in them since WWII.

  43. James James says:

    “Although you can find academic papers talking about PTSD in the ancient world, they’re bullshit: people coming out of the Legions after putting in their 25 were not famous for screaming in their sleep.”

    This guy discusses people in the ancient world seeing ghosts, but caused by dishonourable behavior on the battlefield:

  44. Lee says:

    I had the misfortune of experiencing just how fragile the human brain can be. About a year ago I ended up hitting my head on the ground from a fall off a bicycle, lost consciousness for a few seconds but did not get so much as a bruise/swelling. MRI soon after came back as normal. However, I have had ‘post-concussion syndrome’, which I’m convinced at this point is little more than a euphemism for mild brain damage, ever since.

    Before this I had never been to a hospital for a medical condition and my once-every-few-years visits to the GP have been for antibiotics – what surprised me most about this whole experience is the reactions I’ve had from physicians. I had a neurologist at a ‘concussion clinic’ tell me that he doesn’t believe PCS (or mild brain damage not visible on standard imaging modalities) exists and that my symptoms are caused by an anxiety disorder.

    Apparently anxiety can give you 5 months of unremitting daily headaches (even if you’ve never had issues with headaches before in your life), various visual dysfunctions (e.g. eye-tracking impairment as you now skip a word every other sentence and even slowly moving objects are blurred), cognitive issues (recall and ability to encode new memories aren’t a fraction of what they used to be) and fatigue so severe that you feel like you haven’t slept for a few days after what used to be an average working day.

    Brain injury whether from physical trauma or blast exposure is much more serious than I thought. At least for people who are genetically susceptible to them, anyway. For the same reason why some boxers are relatively lucid in their 50s and beyond (George Foreman) while others are slurring their speech in their 20s I suspect some of us can handle multiple concussions or frequent blast exposure without becoming symptomatic while others are unfortunate enough to develop serious problems after a single such exposure.

  45. HelenaHandbasket says:

    Even by the exalted standards of this page, this is one of the dumbest questions Greg has ever raised. “Why didnt we have mental illness in the olden days?” FFS Because folk with those sorts of problems were ignored, locked in attics, shoved to the margins of society, or locked away in institutions where their screams couldnt be heard.
    And why do we have it now? Because sometimes the process of dehumanising enemies doesnt completely take and a bit of humnaity leaks through. How sad. Lets hope we do better in future
    I realize that “compassion” may sound like one of those fancy new fangled things, but, given that neither you, nor your generation, nor most of the posters to this site have ever seen anything remotely approaching combat (let alone trauma) in their entire lives, maybe they’d be well-advised to keep their assinine opinions to themselves?
    Alternatively–read this


    • gcochran9 says:

      I’ve read the Iliad. And I know something about the history of warfare, which you don’t. Including war before civilization: the indications are that tribes have been beating on each other, often exterminating neighbors, since before we were human. Psychological trauma, unlike a cracked skull or an arrow between the ribs, is potentially completely fixable by good old-fashioned forgetting. And apparently, most people did indeed ‘ get over it’. Most people lost children: they got over it. Most participated in warfare: warfare killed a considerably greater fraction than in any modern state. They got over it. There’s no indication that any significant fraction of people in the past were permanently traumatized, woke up screaming, because of hard lives.

      In 20th century wars there was a lot of talk about “shell shock” and ‘combat fatigue’. Shell shock I’m willing to believe: blast is a new kind of trauma, and with MRI and CAt scans, there’s lots of evidence that it causes brain damage. Which caused us to look hard at boxing and football, even heading the ball in soccer. Having your head thumped is bad for you.

      Most cases of ‘combat fatigue” must be something else – it was much more common in some armies than others. It certainly looks as if it was only common when it was tolerated – and it was an excellent way of avoiding combat. Wanting to avoid highly dangerous combat is not an ev-psych mystery.

      It’s interesting how evolutionary psychology gives strong hints about the explanations for a number of current issues, while actual evolutionary psychologists often neglect those hints – because, all too often, the wrong people go into evolutionary psychology. Roughly the same kind of wrong people that go into subjects like sociology and anthropology. Not as bad, but in the same direction.

      • Gary Anders says:

        It’s interesting how evolutionary psychology gives strong hints about the explanations for a number of current issues…

        Give some examples, pls.

      • athEIst says:

        Previous entry question.

        You know, I think that disease was not the biggest killer in war in Classical times.

        So what was?

  46. Scott Harrington says:

    Find fault with the ‘explanation’ of PTSD. Had an Uncle that used to wake up yelling from the Korean War. Knew a hardass Vietnam Officer, had a tank crew member splattered by a rpg, who’s wife told me about his ‘difficulties’ (something he would never tell me.) My father tells a story of a Marine Sgt. having an ‘episode’ in barracks. It’s real.

    Now you brought up the American Civil War. Three categories – Slackers, Shell fever, and “Soldier’s heart.” Here’s the link to an 1863 manual to help distinguish between the three.

    Slackers – Had a friend who knew a guy stationed in Germany who after every hard work detail would rush over to the showers, turn up the heat and get a good rash going. Then report his condition – soon no hard work details…..

    Shell fever – an author friend told me about General Duryea at Antietam, carnage all around him, a quote from a letter – “I must tell you then after falling back from the voluntary charge over shot and shell and holding the line till help came towards the Smoketown Road we came up to where General Duryea was dismounted and demoralized.”

    PTSD, always changing names, soldier’s heart, irritable heart, and such. Here’s a link to the National Civil War Museum of Medicine about the condition. Here’s a link to the National Civil War Museum of Medicine about the condition.

    In a strange example, there are tales during the Civil War of “Jonas” (bad luck) – individuals that had lost it – following their regiment along in combat but not in the ranks.

    And off the field we have the account of Christine “Chris” Costner Sizemore, of “Three Faces of Eve” (book and movie followed) who according to Wikipedia “developed multiple personalities as a result of her witnessing two deaths and a horrifying accident within three months as a small child.”

    The mind responds in strange ways to trauma, whether on the field of combat or in just ordinary life. Some handle it well and some partition the experience in ways to protect themselves.

    Audie Murphy, Medal of Honor recipient for his bravery in World War II, suffered PTSD. From his memorial website – – we get:
    “Audie suffered from what is now known as Post Traumatic Stress Disorder (PTSD)and was plagued by insomnia and depression. During the mid-60’s he became dependent for a time on doctor prescribed sleeping pills called Placidyl. When he recognized that he had become addicted to this prescription drug, he locked himself in a motel room, stopped taking the sleeping pills and went through withdrawal symptoms for a week.

    Always an advocate for the needs of veterans, he broke the taboo about discussing war related mental problems after this experience. In a effort to draw attention to the problems of returning Korean and Vietnam War veterans, Audie Murphy spoke-out candidly about his personal problems with PTSD, then known as “Battle Fatigue”. He publicly called for United States government to give more consideration and study to the emotional impact war has on veterans and to extend health care benefits to address PTSD and other mental health problems of returning war vets.”

    Often only hinted about, lasting effects of trauma – battle and otherwise has recently come out into the open, Of course, just like the 1863 manual above showed, many fake it. Audie Murphy, a war hero and a terrible pilot (had an instructor fly with him) certainly was not a weak man and did not fake it.

    • Wanda says:

      I thought someone would post John Huston’s 1948 US Army Signal Corps film, “Let There Be Light,” about psychiatric casualties, 20 percent of the total. But since no one has, here it is. For anyone interested in this subject, it’s well worth watching.

      • Wanda says:

        The 20 percent figure above refers to US casualties in WW2. A restored version of the film with much better quality:

      • gcochran9 says:

        The US Army in WWII had far more psychiatric casualties than any major power. Why?

        • donald j tingle says:

          From Recusant above:

          I don’t know what data you have on PTSD in the US, but here in the UK the research on PTSD sufferers from Afghanistan has been unexpected. Basically, those serving in theatre, but in support, not combat, roles were 3x as likely to suffer from PTSD than those in the front line.

          Few USA soldiers saw combat?

          • Wanda says:

            Few USA soldiers saw combat?

            …Turns head, spits…
            Back in 2009, when Col. Michael Killion was G-3 of the 2nd Marine Expeditionary Brigade in AFG he had a meeting with Hugh Powell, CMG, and Lord God of all the Earth, as well as the British government’s senior representative in Helmand. The British had been a disaster in Helmand, infuriating the Afghanis while accomplishing absolutely nothing. The Marines had to be sent in to try to fix things.
            Powell was not pleased at being pushed aside, and he told Col. Killion in that inimitable snooty upper class British way that everything was under control and perfectly fine in Helmand.
            Insert laugh track.
            Col. Killion kept his cool, at least by USMC standards, and told Powell that the Marines had come to defeat the enemy and not sit around on their asses and take casualties like the self-licking British.
            The only reason the Marines were there was because Helmand’s governor, Gulab Mangal was furious with the British and wanted them out. British troops were abusing and insulting the civilian population, refusing to eat with Afghani troops they patrolled with…all the usual British crap — and still not driving out the enemy, who operated with impunity within a few hundred yards of the main British base.
            The British could never acknowledge that the Americans knew what they were doing, had generations of combat experience that the British totally lacked — and yakking on endlessly about northern Ireland and how you did things there only emphasized that fact.
            Maybe knowing that you are led by arrogant incompetents who have not got clue one might lead to lots of PTSD in those sad-sacks.

            • gcochran9 says:

              “British could never acknowledge that the Americans knew what they were doing”

              We didn’t, and don’t. Which isn’t to say that the Brits did either.

  47. donald j tingle says:

    I professionally was well versed in the supposed symptoms of PTSD, and did not believe in it…until I experienced first hand the near death (at the time I thought the actual death) of a loved one (whom I may have saved by my own actions), and I woke up two years later to realize I had been in a mild way having the subjective experiences described in the literature as PTSD. I may just not be a tough guy, but I did what I had to in the crunch, and it is not surprising to me that the experience changed me. I rationalize it as just coming to a realization of how inimical to humankind the universe is. For your sake, you should hope you never find out.

  48. Scott Harrington says:

    The US Army in WWII had far more psychiatric casualties than any major power. Why?
    1) The Magic of numbers. God runs a subroutine called the bell curve when he’s not talking thru burning bushes. More numbers, much more psychiatric casualties. We fought over two very large oceans with lots of people.
    2) The Magic of numbers. When you are dead, PTSD is not a worry. We killed many of the other side.
    3) The Magic of names. When you identify things, suddenly you find more of it. Hey, some people write with their left hand! Hey, some people write with both hands. Hey, some people can’t sleep after avoiding death.
    4) The Magic of home field. Defending your home country is easier to take than crossing big oceans to countries that speak a different language.
    5) The Magic of fear. Capture by the Allied forces was a cakewalk. My mother tells of doing her part for the war effort by sticking her tongue out at the German POW’s led to the movie theater when they weren’t working in the fields and eating real well. Tell that to the survivors of the Bataan Death March or the Great Escape (“76 men who escaped, 3 made it home to the UK. 23 were recaptured and sent back to Sagan. Hitler personally ordered the execution of the other 50 men.”) Thank God for nuclear fission in saving Prisoners of War held by the Japanese.
    6) The Magic of training. Read Lt. Col. Rigg’s “Realistic Combat Training (1955) to see stress inoculation. Read Grossman’s “On Killing” and how closer approach to the death scene increases the mental trauma. (He pushes Marshall’s recap of reluctance to shoot – I agree slightly, but a reluctant to shoot is also a reluctance to put yourself in a position to shoot where you may be SHOT by return fire.
    7) The Magic of time. I remember a graph of military readiness studied. Military efficiencies start at 80% (you learn not to stick your head up over a rock quickly from the example of your dead file partner) to peak 100% then steadily decrease over time due to casualties (dead and wounded) then extreme stress. Gets down to 2% who are having a great time. We call them psychopaths today.
    8) The Magic of caring. The US actually (usually) takes care of its soldiers. In the “Psychology for the Fighting Man” (1943) it states, “The body has defense mechanisms. So has the mind.” Solutions were listed to alleviate excessive trauma (War is trauma.)
    9) The Magic of Numbers again. 3 to 1. That’s the ratio to take a defended position. Whether the Allied bombers getting shot out of the air, the line soldiers rolling to the Rhine, or dodging Kamikaze attacks, attacking (unless a surprise) is never easy.
    10) The Magic of disease. Pulling large amount of men and women into military service means some will be less than perfect. The physical is easily culled. The mental is a bit more difficult. And sometimes you don’t want to cull some of those (see psychopaths above.) Also, I believe that visiting a foreign country is by its very nature detrimental to physical and mental health. GC – you have talked about how infectious diseases may cause detrimental mental health. Just imagine what strange, unknown agents abound that the natives have resistance too or overcame when they were young. Just seeing some of those massive sand spiders in the tent over there would give me PTSD. Now imagine smaller bugs…..
    11) The Magic of Bad Stuff In combat, you will see things commonly that are rarely seen in civilian life. Paramedics, Police, Firefighter personnel are the filter. Now imagine seeing that daily, happening to friends, nearly happening to you, and certainly happening to the enemy (that’s why soldiers are there.) I keep this quote in my office that I read from a Medal of Honor recipient who said, “In war, if it happens, it happens, and that’s a feeling only a few people know.”

  49. Kirk says:

    Interesting discussion, overall. Some points I agree with, some not so much.

    I am a 25-year career professional soldier in the combat arms of the US Army. I mention that to make it clear that I have some slight knowledge of the issues here, and to make it clear I’m not “talking out of my ass”.

    The biggest thing with the PTSD issue is that the US military does an absolutely abysmal job of preparing men for the actual act of killing other human beings in combat. This fact contributes greatly to the development of some forms of PTSD, because what you’re basically doing is taking a civilized human being and asking them to ignore a lifetime’s conditioning not to kill others, and you’re doing it with a casual insouciance that is borderline criminal. Not all PTSD could be remedied by better preparation, but a lot of the problems which result in PTSD stem from things like PFC Smith finding himself in a situation where he’s got no choice but to empty a belt of 7.62 NATO into a vehicle that is mimicking the profile of a VBIED–And, then discovering that it was actually a particularly stupid Iraqi family man, driving the wife and kids off to some social affair. That’s the stuff of nightmares, and it’s also precisely the sort of thing that isn’t covered in pre-deployment training at all. Nobody wants to talk about the act of killing, or that you’re probably going to make mistakes and unintentionally kill non-combatants who act like they’re combatants, and that blue-on-blue happens. Instead, we sent men to war unfamiliar with these facts, these things happen, and then they come home without ever really having had closure with the whole “I did everything right, but I still killed a bunch of people who shouldn’t have died…”.

    You’d think we’d have a code of conduct and a training program for this stuff, but… We don’t. The current Code of Conduct covers what to do if you’re captured, and is utterly silent on what to do when you screw up and kill a van full of civilians that looked like they were making an attack on your convoy. Likewise, it’s silent on what to do when the psychopath the Army put into a leadership position over you starts talking about killing civilians for grins and giggles (Maiwand). You want to reduce PTSD, then things like all this need to be addressed, discussed, and actually integrated into training.

    You want a good model, the place to go looking at is the Israeli Defense Forces, and their “Purity of Arms” stuff. That is excruciatingly detailed about how to conduct yourself as a soldier defending Israel, and is actually integrated into training on a routine basis. Their training scenarios always include a moral component, and they have guys who are roleplaying “doing the wrong thing” to show the troops what not to do, and give them an opportunity to make reports and respond to the moral issues raised in the scenario.

    It’s also a factor that the IDF enforces this stuff seriously. There are former IDF officers that are still serving time in prison for things that the US Army would look at and go “Hmmm… Oh, well… Things happen in war…”, and then not even prosecute. You do not, I repeat, do not want to be an IDF officer who has one of their men kill a non-combatant with a negligent discharge of their weapon. You will go to jail, and your life will be ruined. US forces? LOL… Ain’t nobody got time, for that.

    Which all contributes to the IDF’s lower rate of PTSD, in my opinion. The troops know they’re on a solid moral base, and having to think about what they did afterwards does not fill them with self-recrimination.

    Some PTSD is unavoidable; you go to pull the charred and still screaming bodies of your friends out of a vehicle, that’s going to stick with everyone but the truly sociopathic. Especially when you remember the parts of their bodies falling off as you try desperately to get them out, and later wish you’d simply put them out of their misery, instead of prolonging their lives in agony.

    One of the other things we’re doing wrong, aside from poorly preparing the men we send to war, is that we’re selecting the wrong ones in the first place. Every single case of unrecoverable PTSD that I know personally, the guys who committed suicide or committed really heinous self-destructive acts were guys who all shared similar background issues: Broken homes, lack of childhood structure/discipline, drug use, prescription of psychotropics for things like ADHD, alcohol abuse, and all the rest of the usual markers. Guys who recovered from PTSD? Strong, supportive family backgrounds, stable childhoods, no drug/alcohol abuse histories, and were not prescribed psychotropics growing up. The things that contribute to the sort of PTSD that culminates in self-destruction are, I honestly believe, knowable. We could be screening for these risk factors, and instead of tracking people who have them into the military, we could be doing the same thing you’d do with radiation exposure and putting people who’ve been exposed in jobs that don’t have a radiation hazard.

    Not to mention, we need to be doing a better job of tracking trauma, and treating it like a radiation badge. Have this much TBI? Well, Sergeant Smith, you’re gonna get put into a low-combat probable position until you’ve fully recovered, and if it turns out you don’t…? We’ll put you somewhere you won’t be dealing with blast injuries. Even out of the military, if need be, and with full pension benefits earned to date.

    We could be doing a lot more, but we aren’t. Which flatly pisses me off.

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