The term “shell shock” was used during the First World War to describe the acute stress reactions displayed by many soldiers in the battlefield. When unaddressed, short term combat stress reactions can lead to more prolonged problems, like post-traumatic stress disorder (PTSD). The study of combat stress reactions has advanced significantly since the First World War, when soldiers with shell shock were commonly treated as malingerers who were attempting to get out of the fighting.
A number of slang terms have been used to refer to combat stress reactions, including soldier's heart, war neurosis, and battle fatigue. Many of these terms, like shell shock, came with pejorative implications where were meant to suggest that soldiers who suffered from these conditions were cowards, rather than people experiencing genuine psychological and physical strain. Negative attitudes about the effects of battle stress led to a lack of treatment options for soldiers suffering from acute stress reactions.
Several things are signs of shell shock. Most commonly, soldiers seem disoriented and unable to focus. They may also experience a number of autonomic nervous system reactions like shaking, nightmares, twitching, headaches, fatigue, insomnia, dizziness, anxiety, and irritability, among others. The rate of combat stress reactions tends to go up as the rate of injuries and deaths increases. In the trenches of the First World War, the 10% casualty rate was devastating, and rates of combat stress reactions were extremely high.
Doctors treating soldiers during the First World War at first believed that shell shock and its infamously associated “thousand yard stare” was a result of physical trauma to the brain caused by the close proximity of exploding shells. Doctors tended to prescribe rest away from the front for officers who suffered from shell shock, while enlisted men were often accused of being cowards and sent right back out to the battlefield. Some were shot for cowardice, or punished in a variety of creative ways which undoubtedly added to their emotional distress.
Modern armies recognize that so-called “shell shock” in a genuine and complex condition. A variety of techniques are used to reduce the risk of shell shock among soldiers, including morale building exercises and the provision of ample food, shelter, and rest. In combat situations where a stress reaction may be likely, soldiers are offered counseling and psychiatric support in addition to physical measures. Treatment for combat stress reactions is often offered close to the battlefield, allowing soldiers to return when they are pronounced fit for duty. Some people believe that the policy of returning soldiers to war after experiencing a combat stress reaction could be dangerous, as it may set soldiers up for long-term PTSD.