Blast from the past

New Scientist covers the debate on the causes of the non-specific emotional and cognitive symptoms that are appearing at an alarming rate in US soldiers who have been caught up in blasts while on service.

The controversy centres on whether the symptoms of ‘post concussional syndrome’ (which can include depression, irritability, concentration difficulties, headaches and reduced memory function) are caused by damage to the brain or from shock waves of the explosion, or are largely triggered by an emotional reaction to the stress of war.

It’s an interesting debate, not least because it’s almost 100 years since almost exactly the same debate raged over shell shock.

This is from an excellent article by medical historian Edgar Jones and colleagues who discuss the similarities between the ‘shell shock’ debates, and the current controversy:

Frederick Mott, then Britain‚Äôs leading neuropathologist, who was recruited by the War Office to discover the etiology of the disorder, argued that in extreme cases shell shock could be fatal if intense commotion affected “the delicate colloidal structures of the living tissues of the brain and spinal cord,” arresting “the functions of the vital centers in the medulla”. It was also speculated that the disorder resulted from damage to the CNS from carbon monoxide released by the partial detonation of a shell or mortar. In other words, shell shock was formulated as an organic problem even though the pathology remained unclear.

However, research conducted in 1915 and 1916 by Myers, consultant psychologist to the British Expeditionary Force, led to a new hypothesis. Based on his own observations, an increasing appreciation of the stress of trench warfare, and the finding that many shell-shocked soldiers had been nowhere near an explosion but had identical symptoms to those who had, Myers suggested a psychological explanation. For these cases, the term “emotional,” rather than “commotional,” shock was proposed. The psychological explanation gained ground over the neurological in part because it offered the British Army an opportunity to return shell-shocked soldiers to active duty.

As mentioned by the NewSci two big studies have recently found strikingly similar results: many soldier who have the symptoms of ‘post concussional syndrome’ were never actually in an explosion.

Extreme stress and trauma, of whatever type, seems to predict the likelihood of someone having the symptoms better than actually being caught up in an explosion.

The more things change, the more they stay the same.

Link to NewSci ‘Brain shock: The new Gulf War syndrome’.
Link to ‘Shell Shock and Mild Traumatic Brain Injury: A Historical Review’.

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