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Arthur Hurst was a British First World War physician, best known for his films of shell shock, 'War Neuroses'. He has often been portrayed an innovative pioneer of somewhat mysterious 'suggestion' techniques for functional motor disorders but also as an ambitious clinician who exaggerated the effectiveness of his treatments and failed to address psychological factors. His use of suggestion, persuasion and re-education together with occupational therapy, for chronic or severe cases of shell shock stirred controversy at the time because of the dramatic nature of some of his treatment responses and lack of outcome data. In part, this was a turf war between neurologists and psychiatrists for a dominant therapeutic model. A re-evaluation of his publications and new research into soldiers treated at Seale Hayne in Devon show that Hurst pioneered multidisciplinary and empathetic treatments for functional motor disorders with good short-term outcomes, though insufficient data survives to assess longer term outcomes., Competing Interests: No conflict of interests declared

The First World War was a global war, beginning on 28 July 1914, until 11 November 1918. Soon after the beginning of the war, there was an "epidemic" of neurological conversion symptoms. Soldiers on both sides started to present in large numbers with neurological symptoms, such as dizziness, tremor, paraplegia, tinnitus, amnesia, weakness, headache and mutism of psychosomatic origin. This condition was known as shell shock, or "war neurosis". Because medically unexplained symptoms remain a major challenge, and considering the close relationship of symptoms described in shell shock with clinical neurology, we should study their history in order to improve future care.

World War I was the archetype of an industrial conflict and its consequences have been million dead, some heavily disabling physical traumatisms beside serious neurological/psychological suffering. Some of the sequels had been noticed during previous wars such as Crimea War, Civil War, Franco-Prussian War, and were labeled as shellshock. In literature (Céline, Virginia Woolf, William, March, Gughenno and so on) some situations or characters evoked disorders, which have been described later as post-traumatic syndrome.

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain's leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient's military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

During the First World War soldiers suffered from a wide range of debilitating nervous complaints as a result of the stresses and strains of modern warfare. These complaints--widely known as shell shock--were the subject of much medical-military debate during the war and became emblematic of the war and its sufferings afterwards. One hundred years after the war the diagnosis of PTSD has not resolved the issues initially raised by First World War shell shock. The stigma of mental illness remains strong and it is still difficult to commemorate and remember the mental wounds of war in a culture which tend to glory or glamorise military heroes., (Copyright © 2014. Published by Elsevier Ltd.)

The First World War was a turning point in the cultural history of death and bereavement in Australia. The mass deaths of some 60,000 soldiers overseas led to communal rituals of mourning for the war dead and minimal public expressions of private grief. The mass slaughter of so many young men and the interminable grief of so many families devalued the deaths of civilians at home and helped to create a new cultural model of suppressed and privatised grieving which deeply constrained the next two generations. Emotional and expressive grieving became less common, mourning ritual was minimised and sorrow became a private matter., (Copyright © 2014. Published by Elsevier Ltd.)

This article reviews the treatment of functional neurological symptoms during World War I by Lewis Yealland at the National Hospital for the Paralysed and Epileptic in London. Yealland was among the first doctors in Britain to incorporate electricity in the systematic treatment of shell shock. Our analysis is based on the original case records of his treatment of 196 soldiers with functional motor and sensory symptoms, functional seizures and somatoform disorders. Yealland's treatment approach integrated peripheral and central electrical stimulation with a variety of other--psychological and physical--interventions. A combination of electrical stimulation of affected muscles with suggestion of imminent improvement was the hallmark of his approach. Although his reported success rates were high, Yealland conducted no formal follow-up. Many of the principles of his treatment, including the emphasis on suggestion, demonstration of preserved function and the communication of a physiological illness model, are encountered in current therapeutic approaches to functional motor and sensory symptoms. Yealland has been attacked for his use of electrical stimulation and harsh disciplinary procedures in popular and scientific literature during and after World War I. This criticism reflects changing views on patient autonomy and the social role of doctors and directly impacts on current debates on ethical justification of suggestive therapies. We argue that knowledge of the historical approaches to diagnosis and management of functional neurological syndromes can inform both aetiological models and treatment concepts for these challenging conditions.

The long Iraq and Afghanistan conflicts have thrust Combat Related Post-Traumatic Stress Disorder (CR-PTSD) into the public consciousness and promoted national dialogue on the incidence and results of war related psychological trauma. In the first of a two part series we outline our contemporary understanding of CR-PTSD, the evolution of the diagnosis throughout the history of modern warfare, its impact on the mind and body, and its treatment. PTSD has become the mental health issue of our time.

This article deals with a little known episode that occurred near the end of the Great War in a military reserve hospital located in the small town of Pasewalk, part of the distant region of Pomerania in northern Poland. The story is centered around the transient visual loss of a 29-year-old Austrian messenger of the 16th Bavarian Infantry Regiment. His name: Adolf Hitler.

We find that Union Army veterans of the American Civil War who faced greater wartime stress (as measured by higher battlefield mortality rates) experienced higher mortality rates at older ages, but that men who were from more cohesive companies were statistically significantly less likely to be affected by wartime stress. Our results hold for overall mortality, mortality from ischemic heart disease and stroke, and new diagnoses of arteriosclerosis. Our findings represent one of the first long-run health follow-ups of the interaction between stress and social networks in a human population in which both stress and social networks are arguably exogenous.

Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future.

After World War II, the confidence of American psychiatrists was at an all-time high as a result of their successful participation in the war. When the incidence of mental breakdown in the American armed forces rose to unprecedented heights, new and effective psychotherapeutic methods were developed to treat the traumatic effects of the extraordinary stresses of warfare. At the same time, social scientists concluded that breakdown incidence was inversely related to morale, which led to the development of preventive measures aimed at specific groups. Both initiatives stimulated a number of psychiatrists to plan projects of social engineering after the war. They first focused on aiding the reintegration of returning veterans. Later, they addressed the poor mental health of the American population as a whole, which they considered to be the consequence of faulty child-rearing methods.

The paper deals with a form of functional heart disorder that caused substantial disability among men in military service. By viewing the condition through the dual lenses of history and modern medical knowledge we can analyse the syndrome and trace the changing medical and social attitudes to it. The disorder is still now present after harrowing events, including natural disasters, assault of individuals, episods of mass violence and combat. A historical review of the syndrome is also useful in extending our understanding of the natural history of stress reactions, their prognostic indicators and the way in which we can intervene to reduce the effects of trauma.

During World War I, military officers encountered a new and puzzling phenomenon: soldiers emerged from the trenches stuttering, crying, trembling and at times were even paralysed and blind. Those in charge were convinced these soldiers were cowards or malingerers who deserved stern discipline or to be court-martialled. A number of physicians, by contrast, initially assumed that these alarming symptoms resulted from close exposure to explosions and called it shell shock. Later, they realized that it was a psychological reaction and came up with psychotherapeutic treatments. But it was only in World War II that military psychiatrists, particularly those in the USA, began to implement treatment methods for this phenomenon in a systematic way. Their thinking and the treatments they devised had significant consequences for the future of American psychiatry, which in turn influenced the development of psychiatry and military psychiatry world-wide.

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.

Although posttraumatic stress disorder has only recently been admitted into the international classification systems, psychological reactions to traumatic incidents have been frequently described for well over a hundred years. This article provides an overview of mental reactions to a trauma in different historical situations. It discusses the "railway spine injuries" of the 19th century, victims of accidents in which third party liability could be established, and the psychological consequences of the catastrophes that characterised the 20th century: World War I, the rule of National Socialism, World War II, the expulsion and persecution of political opponents in the former GDR. The analysis suggests that the different psychological reactions do not describe an identical disorder. It seems that reactions to injuries are mainly influenced by the historical and social background.

Preventive intervention after exposure to traumatic events is a subject of increasing interest among mental health professionals. Psychological debriefing, which aims to reduce the risk of posttraumatic stress disorder and other psychopathological sequelae of traumatic experiences, is an example of such an intervention. The authors review the history of psychological debriefing and examine its efficacy. They conclude that psychological debriefing might be an effective intervention after extreme stress, although more support from controlled studies is required.