The Psychophysical Effects of Combat from the Ancient times to Modern Day
Posted on June 19th, 2010

Dr Ruwan M Jayatunge M.D.

The psychophysical effects of combat have been recorded since the early days of Human civilization. From the time of Homer’s ancient story of the battle between the Trojans and the Greeks, (1200 BC) military personnel have been confronted by the trauma of war.

According to the historians, Saul the King of Israel (11 Century BC) had abnormal behavior with inclination towards violence. On one occasion, he went in to a brutal rage and tried to kill his son Jonathan.

 Alexander the Great (356 BC “”…” 323 BC)who had conquered a large portion of the known world at that era suffered from combat fatigue. When his forces came near the Indo river Alexander’s forces were exhausted and refused to march further.

 The Emperor Ashoka (304 BC- 232 BC) of India experienced a depressive reaction soon after the Kalinga War after witnessing deaths and destruction. He felt disheartened for his military actions and completely renounced violence and embraced Buddhism.

 The Roman Empire, which lasted from 27 BC to 1453, was filled with battle stress. A countless numbers of soldiers and civilians experienced a great deal of combat related stresses during this time period. Once archeologists discovered an ancient bunker from the Britannic Islands, which was used by the Roman Soldiers. They found frescos that portrayed the isolation, nostalgia, uncertainty, and fear experienced by the soldiers.

 The Great Oriental Conqueror Tamerlane (1336- 1405) was highly affected by the war stress demonstrated aggressive and sadistic behavior. He was fond of building pyramids of human skulls. Once he made a giant pyramid after a war which contained some 40, 000 skulls.

 The prophet Nostradamus named Napoleon Bonaparte as an Anti Christ.Napoleon’s forces invaded many parts in Europe and North Africa.   His Moscow invasion in 1812 caused heavy damage to the French forces. The French Army had to face cold Russian winter, famine and General Kutuzov’s cannon fire. After his disastrous retreat, Napoleon was sent in exile. He escaped from the island of Elba and engaged in so called the Hundred Days of War.  Finally, Napoleon Bonaparte was defeated by the Duke of Wellington “”…” the Leopard of England. Napoleon went in to post combat depression and died in the island of St Helena in 1821 while in exile.

 During the US Civil War Dr Mendez Da Costa evaluated 300 soldiers referred to him for a syndrome that he called Irritable Heart. This syndrome was characterized by shortness of breath, palpitations, burning chest pain, fatigability, headache, diarrhea, dizziness and disturbed sleep.  This condition was later called Da Costa Syndrome.(a syndrome is a group of symptoms that occur together and that are characteristic of a disease or condition)

 At the beginning of the World War one  the Effort Syndrome was frequently attributed to cardiac hypertrophy caused by heavy marching , packs compressing the chest. The Effort syndrome was considered to be a  Psychoneurosis and not a medical disease. In 1938 Soley and Shock claimed that hyperventilation was responsible for the symptoms of Effort Syndrome.

 Until the World War 1 (1914-1918) psychological consequence of war trauma  were considered merely manifestations of poor discipline and cowardice and often the victims were severely punished. Some military records of the WW1 indicate that a considerable number of Shell Shocked soldiers were given the FP -1 or the Field Punishment Number One.  FP -1 involved that the offender being attached to a fixed object for up to two hours a day and for a period up to three months, often put in a place within range of enemy shellfire. Dr Charles Myer suspected the psychological factors associated with Shell Shock.

 The Nobel Prize Laureate Ernest Hemingway served in the Lincoln Brigade during the Spanish Civil War that erupted in 1936.  Hemingway saw the horrendous war trauma in Spain and that inspired him to write his famous novel Farewell to Arms.  Anyhow, in later years Ernest Hemingway experienced depression and took his own life. According to the Military Psychiatrist Dr William Pike half of the Spanish Civil War veterans suffered from severe combat related stress. At one point, Dr William Pike treated 28 shell-shocked men who were hiding in a wine caller.

 During the World War 2 (1939-1945) battle stress were classified as Operational Fatigue or War Neurosis.  Chronic Fatigue Syndrome was evident in during the World War 2 and most of the symptoms had somatic nature. It has been estimated that 10% of US servicemen developed combat exhaustion in WW2.  The military authorities were not very empathetic towards war stressed sufferers and on one occasion General George S Patton slapped and verbally abused Pvt Paul G. Bennet and Pvt Charles H. Kuhl, who experienced battle fatigue.

 The term Section Eight was used to identify the victims of psychological effects of war trauma in the Korean War, which continued from 1950 to 1953. Psychiatric evacuations were considerably reduced during the Korean War due to the praiseworthy work of Dr Albert Glass.

However in a recent study done by Dr Malcolm Sim and colleagues of Centre for Occupational and Environmental Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria found that anxiety, post-traumatic stress disorder and depression in Korean War veterans 50 years after the war.

 In 1965, United States sent troops to South Vietnam to help fight communist guerrillas. US troops fought in hostile territory facing sudden ambushes and booby trap mines. US forces faced defeat and forced to withdraw from Vietnam in 1975. During the Vietnam War, 2.8 million US servicemen served in the Southeast Asia mainly in Vietnam and almost one million were exposed to active combat. By the end of the War over 50,000 Vietnam veterans were diagnosed with combat related post-traumatic Stress Disorder. PTSD has been found in 15% of 500,000 men who were in Vietnam.  It is said 20,000 veterans committed suicide in the war of the aftermath.

 In 1979 December 25th the Soviet Union sent forces to Afghanistan. By 1986, about 118,000 Soviet troops and 50,000 Afghan Government troops were facing perhaps 130,000 Mujahideen guerrillas. Following the conflict over one million Afghans died and the Soviet army lost 14,427 combatants. When Mikhail Gorbachev became the Soviet leader in 1985, he was keen to getting Soviet troops out of Afghanistan. The Soviet withdrawal was completed in February 1989.  Although the Soviet health authorities did not comment on psychological casualties of the Afghan war, there were significant numbers of PTSD victims in the Red Army who fought in Afghanistan. Since PTSD was not recognized in the Soviet Union at that era, the Afghan veterans did not receive proper psychological and psychiatric treatment. Many veterans are still hounded by the war intrusions.

 The Persian Gulf War (2 August 1990 “”…” 28 February 1991), also known as the first Gulf War was conducted by the Coalition Forces to free Kuwait from Iraqi forces led by Saddam Hussein. The number of coalition wounded in combat seems to have been 776, including 458 Americans. Iraq sustained between 20,000 and 35,000 fatalities. The Gulf War Syndrome was evident during the Persian Gulf War and many returning coalition solders reported illnesses such as headaches, memory loss, fatigue, sleep disorders, intestinal ailments, and unusual loss of hearing. Nearly 150,000 veterans have showed symptoms of Gulf War illness.

 According to Toomey R and  Kang HK, Karlinsky  ( “Mental health of US Gulf War veterans 10 years after the war”  British Journal of Psychiatry 2007)  found that deployment in the Gulf War was associated with increased levels of mental disorders, psychological symptoms, and a lower quality of life – beginning during the war and persisting at a lower rate 10 years later. Around 700,000 US military personnel were deployed to the Middle East during the 1991 Persian Gulf War. These veterans reported greater psychological symptoms immediately after the war than veterans who were not sent to the Gulf. 10 years later, these cases of depression and non-PTSD anxiety disorders remained significantly more prevalent among deployed compared with non-deployed veterans. PTSD was over 3 times more prevalent among deployed veterans. The prevalence of PTSD among Gulf War veterans is estimated at 10% (Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM:

Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like illness among Gulf War Veterans: A population-based survey of 30,000 veterans. Am. J. Epidemiol. 157:141-148. Jan 2003. )

 The War in Afghanistan is an ongoing armed conflict which began on October 7, 2001 and the Second Gulf War also known as the Iraq War also an ongoing military campaign, which began on March 20, 2003 with the invasion of Iraq by a multinational force led by troops from the United States and the United Kingdom  are massive military campaigns in the present day. These conflicts have produced a large number of psychological casualties. The researchers say nearly 20 percent of military service members who have returned from Iraq and Afghanistan 300,000 in all report symptoms of PTSD or major depression. According to a 2005 VA study of 168,528 Iraqi veterans, 20 percent were diagnosed with psychological disorders, including 1,641 with PTSD.

 German soldiers are coming back from Afghanistan more and more traumatized. In 2006, 55 soldiers were diagnosed with post-traumatic stress disorder, or PTSD. By 2008, the figure had risen to 226. The Ministry of Defence record that of all illnesses reported by Gulf war veterans from the last decade 35% were psychological (M.O.D., 2001).

The prevalence of PTSD in Iraq and Afghanistan veterans is 17% (Hoge:Combat duty in Iraqand Afghanistan, mental health problems, and barriers to care. N Engl J Med. 351:13-22. 2004. )

 The Sri Lankan conflict, which lasted for nearly three decades, had generated a large number of combatants, members of the LTTE and civilians affected by war trauma especially PTSD.

 Combat Relate PTSD among the Sri Lnkan Combatants study was done by Dr Neil fernando / Dr Ruwan M Jayatunge  of the Sri Lanka Army with face-to-face psychological examinations. This study was  conducted between 2002 Aug “”…” 2005 March paticipation of 824 Sri Lankan combatants who were on active duty and referred to the Psychiatric unit of the Military Hspital Colombo for various behavioural and psychophysiological  ailments. PTSD was  diagnosed using structural clinical interviews, and standard questionnaires assessed psychological symptoms based on DSM 4  citeria. Diagnoses of post-traumatic stress disorder (PTSD) were made with the Clinician Administered PTSD Scale (based on Mississippi scale ), a structured interview yielding PTSD diagnoses according to DSM””…”IV criteria (American Psychiatric Association 1994 )and ICD 10 guidelines. They found 56 combatants with full-blown symptoms of PTSD and 6 combatants with Partial PTSD.

 Most of these war stressors were not diagnosed sufficiently, and they are not receiving adequate treatment.  Therefore, war stress can affect the Sri Lankan society for a long time. To minimize the psychological damage to the society, effective measures must be implemented.

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