War pensions (1900–1945): changing models of psychological understanding

Jones, Edgar; Palmer, Ian; Wessely, Simon

doi:10.1192/bjp.180.4.374

Cited by 73 publications

(27 citation statements)

References 16 publications

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“…An analysis of over 6200 cases of Chelsea Hospital pensions dating from the late 1880s showed that 37 (0.6%) were for melancholia or mania, while no cases of nostalgia were recorded ( Jones et al 2002a). …”

Section: Early War Syndromesmentioning

confidence: 99%

Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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Almost every major war in the last century involving western nations has seen combatants diagnosed with a form of post-combat disorder. Some took a psychological form (exhaustion, combat fatigue, combat stress reaction and post-traumatic stress disorder), while others were characterized by medically unexplained symptoms (soldier's heart, effort syndrome, shell shock, non-ulcer dyspepsia, effects of Agent Orange and Gulf War Syndrome). Although many of these disorders have common symptoms, the explanations attached to them showed considerable diversity often reflected in the labels themselves. These causal hypotheses ranged from the effects of climate, compressive forces released by shell explosions, side effects of vaccinations, changes in diet, toxic effects of organophosphates, oil-well fires or depleted-uranium munitions. Military history suggests that these disorders, which coexisted in the civilian population, reflected popular health fears and emerged in the gaps left by the advance of medical science. While the current Iraq conflict has yet to produce a syndrome typified by medically unexplained symptoms, it is unlikely that we have seen the last of post-combat disorders as past experience suggests that they have the capacity to catch both military planners and doctors by surprise.

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Section: Early War Syndromesmentioning

confidence: 99%

Historical approaches to post-combat disorders

Jones¹

2006

Phil. Trans. R. Soc. B

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“…Whereas the PTSD definition requires exposure to a life-threatening event (criterion A, [54]), an anticipated or feared traumatic experience was sufficient to trigger a functional disorder. This phenomenon had also been observed in British servicemen awarded a war pension for a psychological disorder [20]. …”

Section: Discussionmentioning

confidence: 57%

The neurological manifestations of trauma: lessons from World War I

Linden

Hess

Jones

2011

Eur Arch Psychiatry Clin Neurosci

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Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of ‘psychopathic constitution’ or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

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“…They are potentially iatrogenic at the level of the individual veteran, and also probably distort the empirical database and limit our ability to accurately understand posttraumatic reactions and evaluate effective treatments for them Jones et al 2002;Mossman 1996;. All of this is especially unfortunate because there is solid evidence to indicate that PTSD is often not a permanent condition and is highly treatable.…”

Section: Forensic Implicationsmentioning

confidence: 95%

The Future of Posttraumatic Stress Disorder in the DSM

Frueh

Elhai

Acierno

2010

Psychol. Inj. and Law

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Posttraumatic stress disorder (PTSD), added to the DSM nosology in 1980, has become a widely used and studied psychiatric diagnosis-though it has also been the subject of much criticism and controversy. In this paper, we review and discuss a number of issues related to the future of PTSD within the DSM, including the conceptual basis of the disorder, summary of proposed changes to DSM-V, the empirical basis for or against specific disorder criteria, forensic implications, and conclusions and recommendations regarding the future of the disorder in DSM. Overall, the current proposed changes for DSM-V represent a modest improvement over DSM-IV criteria, though they are incremental and relatively minor in nature. As such, they are unlikely to have a meaningful impact on prevalence rates, treatment approaches, or forensic applications of the disorder-and the disorder, as defined, remains problematic in many ways. The empirical data on latent structure of responses to traumatic and general life stressors seem to indicate that perhaps PTSD should be replaced by a dimensional general stress response disorder within the DSM system.

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War pensions (1900–1945): changing models of psychological understanding

Abstract: The acceptance of psychological disorders was a response to cultural shifts, advances in psychiatric knowledge and the exigencies of war. Changing explanations were both a consequence of these forces and themselves agents of change.

Cited by 73 publications

References 16 publications

Historical approaches to post-combat disorders

Historical approaches to post-combat disorders

The neurological manifestations of trauma: lessons from World War I

The Future of Posttraumatic Stress Disorder in the DSM

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