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Biomedical subjects

Edgar Jones

Publications and source records attributed to Edgar Jones.

13 recordsLinked to original sources
PubMed2006

Shell shock: an outcome study of a First World War 'PIE' unit.

BACKGROUND: 'Forward psychiatry' was introduced by the French Army in 1915 to stem the loss of troops to base hospitals. Also known by the acronym PIE (proximity to the battle, immediacy of treatment and expectancy of recovery, including return to duty), it was subsequently used by the British and Americans in both World Wars. The US Army used PIE techniques in Korea and Vietnam. Although widely accepted as an effective intervention, forward psychiatry is not amenable to random-controlled trials and only one controlled outcome study has been conducted. METHOD: All 3580 soldiers with shell shock admitted to 4 Stationary Hospital between January and November 1917 were recorded. Unit details, military experience, length of stay and outcomes were analysed. Soldiers were categorized into combat, combat-support and non-combatant groups. Admissions were correlated with military operations to compare the impact of defensive and offensive phases of warfare. RESULTS: Rates of admission for shell shock rose significantly during offensives when physical casualties escalated. Combat troops were disproportionately represented. Over 50% of admissions had less than 9 months service in France and 21% broke down within 3 months of going overseas. Less than 20% returned directly to combat units, most going to other hospitals, convalescent depots or base duties. CONCLUSIONS: Forward psychiatry was not effective in returning combat troops to fighting units but, by allocating soldiers to support roles, it prevented discharge from the armed forces. Uncertainties remain about relapses, including other routes that servicemen used to escape from a combat zone.

France↗
PubMed2006

A paradigm shift in the conceptualization of psychological trauma in the 20th century.

The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm shift in the conceptualisation of post-trauma illness. Hitherto, a normal psychological reaction to a terrifying event was considered short-term and reversible. Long-term effects, characterized as "traumatic neurosis", were regarded as abnormal. Enduring symptoms were explained in terms of hereditary predisposition, early maladaptive experiences or a pre-existing psychiatric disorder. The event served merely as a trigger to something that existed or was waiting to emerge. Secondary gain, the benefits often but not solely financial that a person derived as a result of being ill, was considered the principal cause of any observed failure to recover. The recognition of PTSD reflected a diversion from the role of the group, in particular the "herd instinct", towards a greater appreciation of the individual's experience. From being the responsibility of the subject, traumatic illness became an external imposition and possibly a universal response to a terrifying and unexpected event. This shift from predisposition to the characteristics of the event itself reduced guilt and blame, while the undermining of secondary gain made it easier to award financial compensation.

Conflict, Psychological↗
PubMed2006

Historical approaches to post-combat disorders.

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.

Combat Disorders↗
PubMed2004

Hearts, guts and minds: somatisation in the military from 1900.

OBJECTIVES: To identify patterns of somatisation in army personnel diagnosed with postcombat syndromes from the Boer War to the Gulf conflict. METHODS: Using random samples of UK servicemen awarded war pensions, patterns of symptoms were compared and related to contemporary accounts. RESULTS: Somatic symptoms continued to be common during and after World War II, suggesting that their decline was not great as claimed. Although psychological presentations increased, they did not supplant conversion disorders. CONCLUSION: Somatoform disorders did not disappear from the military in a smooth progression as society's understanding of psychological issues advanced. Rather there was a change in physical focus from the heart to the gut as new medical priorities arose.

History, 19th Century↗
PubMed2003

"Forward psychiatry" in the military: its origins and effectiveness.

"Forward psychiatry" was devised in World War I for the treatment of shell shock and today is the standard intervention for combat stress reaction. It relied on three principles: proximity to battle, immediacy, and expectation of recovery, subsequently given the acronym "PIE." Both US and UK forces belatedly reintroduced PIE methods during World War II to return servicemen to active duty and made confident claims for its efficacy. Advanced treatment units also appeared to have minimized psychiatric battle casualties during Korean and Vietnamese Wars. Evaluations of its use by Israeli forces in the Lebanon conflict showed higher return-to-duty rates than at base hospitals. A reexamination of these examples suggests that reported outcomes tended to exaggerate its effectiveness both as a treatment for acute stress reaction and as a prophylaxis for chronic disorders such as PTSD. It remains uncertain who is being served by the intervention: whether it is the individual soldier or the needs of the military.

Combat Disorders↗
PubMed2003

Unexplained symptoms after terrorism and war: an expert consensus statement.

Twelve years of concern regarding a possible "Gulf War syndrome" has now given way to societal concerns of a "World Trade Center syndrome" and efforts to prevent unexplained symptoms following the most recent war in Iraq. These events serve to remind us that unexplained symptoms frequently occur after war and are likely after terrorist attacks. An important social priority is to recognize, define, prevent, and care for individuals with unexplained symptoms after war and related events (eg, terrorism, natural or industrial disasters). An international, multidisciplinary, and multiinstitutional consensus project was completed to summarize current knowledge on unexplained symptoms after terrorism and war.

Causality↗
PubMed2003

Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis.

BACKGROUND: It has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as 'railway spine' and 'shellshock'. Others have suggested that PTSD is a novel presentation that has resulted from a modern interaction between trauma and culture. AIMS: To test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat. METHOD: Random selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations. RESULTS: The incidence of flashbacks was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars. CONCLUSIONS: Although this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesis that some of the characteristics of PTSD are culture-bound. Earlier conflicts showed a greater emphasis on somatic symptoms.

Dissociative Disorders↗
PubMed2003

Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I.

This study seeks to investigate the mortality rates of U.K. servicemen with postcombat syndromes following the Boer War and World War I. Random samples of veterans awarded war pensions for either disordered action of the heart (DAH) or neurasthenia/shellshock were compared with gunshot wounded ex-servicemen as controls. The destruction of pension records has led to reliance on groups of the longest lived veterans, which diminishes their representative qualities. Study groups were matched by rank and level of disability. With the exception of DAH cases in World War I, no statistically significant difference in mortality rates was found using Cox proportional hazards. The same DAH subjects were then compared with gunshot wound controls whose disability had been assessed 20% higher, and no statistically significant difference was seen. The reason why World War I veterans with DAH had a reduced life expectancy remains unclear, although it is possible that physician bias in assessment and the termination by the Ministry of Pensions of awards granted to healthy cases may have been factors. Postcombat disorders suffered by U.K. servicemen after the Boer War and World War I were not generally associated with an increased mortality.

Europe↗
PubMed2002

Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution.

OBJECTIVES: To discover whether post-combat syndromes have existed after modern wars and what relation they bear to each other. DESIGN: Review of medical and military records of servicemen and cluster analysis of symptoms. DATA SOURCES: Records for 1856 veterans randomly selected from war pension files awarded from 1872 and from the Medical Assessment Programme for Gulf war veterans. MAIN OUTCOME MEASURES: Characteristic patterns of symptom clusters and their relation to dependent variables including war, diagnosis, predisposing physical illness, and exposure to combat; and servicemen's changing attributions for post-combat disorders. RESULTS: Three varieties of post-combat disorder were identified-a debility syndrome (associated with the 19th and early 20th centuries), somatic syndrome (related primarily to the first world war), and a neuropsychiatric syndrome (associated with the second world war and the Gulf conflict). The era in which the war occurred was overwhelmingly the best predictor of cluster membership. CONCLUSIONS: All modern wars have been associated with a syndrome characterised by unexplained medical symptoms. The form that these assume, the terms used to describe them, and the explanations offered by servicemen and doctors seem to be influenced by advances in medical science, changes in the nature of warfare, and underlying cultural forces.

Cluster Analysis↗
PubMed2002

War pensions (1900-1945): changing models of psychological understanding.

BACKGROUND: War pensions are used to examine different models of psychological understanding. The First World War is said to have been the first conflict for which pensions were widely granted for psychological disorders as distinct from functional, somatic syndromes. In 1939 official attitudes hardened and it is commonly stated that few pensions were awarded for post-combat syndromes. AIMS: To re-evaluate the recognition of psychiatric disorders by the war pension authorities. METHOD: Official statistics were compared with samples of war pension files from the Boer War and the First and Second World Wars. RESULTS: Official reports tended to overestimate the number of awards. Although government figures suggested that the proportion of neurological and psychiatric pensions was higher after the Second World War, our analysis suggests that the rates may not have been significantly different. CONCLUSIONS: The acceptance of psychological disorders was a response to cultural shifts, advances in psychiatric knowledge and the exigencies of war. Changing explanations were both a consequence of these forces and themselves agents of change.

Attitude to Health↗