Combat neurosisis a special type of traumatic or transient neurosis. It has been called by several names, including combat fatigue, operational fatigue, and shell shock. It is delineated more by the special circumstances under which it occurs than by any unique and specific symptoms.
In combat neurosis the individual, prior to the development of his neurosis, has often undergone prolonged, violent emotional experiences. He has been excessively fatigued. He has lacked emotional supports to relieve pent-up feelings. He has a general feeling of helplessness, a feeling that he has no control over what will happen to him. Also, he has been in an ego-thwarting situation for a good many weeks. He has had to lay aside his personal plans, and his own style of living.
Even in such conditions, most military personnel and civilians in a war zone do not become psychiatric casualties. U.S. Army experience in World War II was that only an estimated 10% of men in combat developed combat neurosis. Those who do develop symptoms do not break down because of a single battle episode. Their neurosis is a consequence of the special factors associated with the combat zone over a period of time, plus a critical incident.
The symptoms of combat neurosis are extremely varied: some patients lose all feelings in a limb, while others may display hysterical paralysis, hysterical blindness, or hysterical deafness. Some patients become mute and appear to be in a stupor. Others are agitated and unable to be still. Some seem depressed, but others appear to be overexcited. The symptom picture is so varied that it is not possible to diagnose combat fatigue on the basis of the symptoms presented by the patient. The diagnosis is made after consideration of the suddenness of the onset of the disorder, the special circumstances under which the individual had been existing, and certain secondary character changes more or less common to all patients who exhibit the disorder. Almost all of these patients have terrifying battle dreams. Most patients also exhibit decreased control as manifested by irritability, oversensitivity to noise or to being startled by any means, and over-reaction to minor irritations. They also show inability to concentrate and a restriction of interest.
Experience during World War II demonstrated that best results in treating combat neurosis occur if the patient is treated as close to the combat zone as possible and within a few days of the terrifying critical incident. Many men were able to return to combat duty after two or three days of rest and psychotherapy. When men who had had slight combat experience prior to the breakdown were treated close to the combat zone, approximately 90% recovered and returned to duty; but only 35% of those who had undergone prolonged combat experience recovered and returned to combat duty. When men were treated several hundred miles from the combat zone, only 10% recovered and were returned to combat duty. Thus, a delay in treatment and the removal of the men from the combat zone appeared to fixate the symptoms.