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Introduction: The decrease in the rate of mortality due to brain damage during the First World War resulted in a large number of veterans with neurological or neuropsychological sequelae. This situation, which was unknown up until then, called for the development of new therapeutic approaches to help them reach acceptable levels of autonomy., Development: This article reviews the relationship between neuropsychological rehabilitation and warfare, and describes the contributions made by different professionals in this field in the two great conflicts of the 20th century. The First World War was to mark the beginning of neuropsychological rehabilitation as we know it today. Some of the most outstanding contributions in that period were those made by Goldstein and Popplereuter in Germany or Franz in the United States. The Second World War was to consolidate this healthcare discipline, the leading figures at that time being Zangwill in England and Luria in the Soviet Union. Despite being of less importance, geopolitically speaking, the study also includes the Yom Kippur War, which exemplifies how warfare can stimulate the development of neuropsychological intervention programmes., Conclusions: Today's neuropsychological rehabilitation programmes are closely linked to the interventions used in wartime by Goldstein, Zangwill or Luria. The means employed may have changed, but the aims are still the same, i.e. to help people with brain damage manage to adapt to their new lives.

In World War I, an unprecedented number of soldiers were suffering from nervous disturbances, known as war psychoneuroses. Mechanisms of commotion, emotion, and suggestion were defined in order to explain these disturbances. In France, emphasis was placed on the mechanism of suggestion, based on pithiatism, introduced by Joseph Babinski (1857-1932) before the war to highlight the concept of suggestion and its hazy border with simulation. As a result, many soldiers suffering from war neuroses became considered as simulators or malingerers who were merely attempting to escape the front. A medical-military collusion ensued with the aim of sending as many of these nervous cases back to the front as possible through the use of painful or experimental therapies. Aggressive therapies flourished including torpillage, a particularly painful form of electrotherapy developed by Clovis Vincent (1879-1947) and subsequently by Gustave Roussy (1874-1948). At the end of the war, some psychiatrists, such as Paul Sollier (1861-1933), Georges Dumas (1866-1946), and Paul Voivenel (1880-1975), developed a more psychological approach. In Great Britain, where Charles Myers (1873-1946) coined the term shell shock in 1915 to describe these cases, psychological theories were more successful. In Germany, aggressive therapies developed by Fritz Kaufmann (1875-1941) emerged in the second part of the war. In Austria, the future Nobel Prize winner Julius Wagner-Jauregg (1857-1940) was accused of performing violent therapies on patients with war neuroses. These methods, which now seem barbarian or inhuman, were largely accepted at the time in the medical community and today should be judged with caution given the cultural, patriotic, and medical background of the Great War.

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.

'Trauma' tends to exceed human understanding. It disrespects boundaries, interrupts all kinds of units and makes them blend, it disturbs bodily and psychic organisms and upsets social and historical organization. Some characteristics of the history of trauma have their origin in this situation. One of them is the gradual extension for instance of the notion of 'trauma' which makes the surgical 'wound' (greek: trauma) evolve into a bio-psycho-social phenomenon. Other characteristics of the history of trauma are its association with questions of endogenous versus exogenous causes of suffering and with the issue of guilt and its recurrent falling into oblivion. The paper traces the history of traumatogenic illness from the simple wound to forensically important damages like the 'railway-injuries' entitling to claims for damages, to 'traumatic-' and 'war-neuroses' and finally to the more or less endemic 'posttraumatic stress syndrome' of present time.

The accidental separation of PTSD and the dissociative disorders, based on the unfortunate fact that the PTSD and the dissociative disorder workgroups of the DSM-III never met to compare data, and the lack of knowledge within the workgroups of existing research connecting these disorders, will continue in the DSM-IV. That separation, however, is slowly being eroded by a solid body of research that shows that these conditions rarely occur independently. Thus, contemporary research is beginning to show that the original concept of "hysteria," formulated 150 years ago to capture a group of patients who have complex psychological and somatic problems and whose problems often elude intervention from the medical and psychological professions, is alive and well among patients on the verge of the twenty-first century. Although the DSM process has attempted to create cleaner diagnostic categories, 100 years of research on traumatized patients consistently shows that these patients defy easy classification, and that they seem to have symptoms that represent somatic, social, symbolic, and intrapsychic adaptations to having experienced overwhelming terror. Thus, what the DSM split when it abolished hysteria as a diagnosis, has once again been found to constitute a syndrome, a conglomeration of symptoms, first defined by Briquet and Janet more than 100 years ago, which is the result of severe and prolonged interpersonal abuse, usually starting in childhood. One hundred years of research has shown us that patients often cannot remember and, instead, re-enact their dramas. The professions ministering to these patients have had similar problems with remembering the past, and thrice in this century have forgotten the hard-earned lessons from our patients. It is not likely that these amnesias and dissociations will be a thing of the past; they are likely to continue as long as physicians and psychologists are faced, helplessly, with man's inhumanity to man.