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Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review.

OBJECTIVE: To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN: Literature review. SETTINGS: Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE: Mortality from wounds. RESULTS: During the fighting of war the number of people wounded is at least twice the number killed and may be 13 times as high; this ratio of the number wounded to the number killed results from the impact of a weapon system on human beings in the particular context of war. When firearms are used against people who are immobilised, in a confined space, or unable to defend themselves the wounded to killed ratio has been lower than 1 or even 0. CONCLUSIONS: Mortality from firearms depends not only on the technology of the weapon or its ammunition but also on the context in which it is used. The increased mortality resulting from the use of firearms in situations other than war requires a complex interaction of factors explicable in terms of wound ballistics and the psychology of the user. Understanding these factors has implications for recognition of war crimes. In addition, the lethality of conventional weapons may be increased if combatants are disabled by the new non-lethal weapons beforehand; this possibility requires careful legal examination within the framework of the Geneva Conventions.

Civil Disorders↗

From PTSD to voices in context: from an "experience-far" to an "experience-near" understanding of responses to war and atrocity across cultures.

This paper examines some of the difficulties of exporting the Western concept of Post Traumatic Stress Disorder (PTSD) to non-Western cultures. Using data drawn from Guatemala where I lived and worked among Quiché Mayan war widows, illustrates how culturally-specific understandings of events and reactions to them affect the well-being (or otherwise) of people exposed to extreme adverse events. The paper turns to the voices of the widows, who experienced and survived intense political conflict, explaining their experiences of violence within their particular context.

Cross-Cultural Comparison↗

Some problems associated with war experience in men of the Vietnam generation.

A national sample of men who were of military age during the Vietnam War (n = 1,342) was interviewed six to 15 years after veterans in the sample had left the service. Our findings showed that violent experiences in war were associated with a variety of behavioral and emotional problems. When preservice background factors were statistically controlled, combat exposure showed an association with arrests and convictions (generally for nonviolent offenses), with drinking, and with symptoms of traumatic stress. Participants in atrocities reported more stress symptoms and greater use of heroin and marijuana than did other veterans. Veterans who experienced no combat and did not take part in atrocities, however, did not differ appreciably from nonveterans. Not all men who experienced combat or took part in atrocities reported personal difficulties; almost three fourths of heavy-combat veterans were not arrested after the service. Tape recorded responses of the ten blacks and 18 whites who took part in atrocities suggested that soldiers' emotional responses may have been determined by their ability or inability to dehumanize the victims. Future research would benefit from a closer coordination of clinical and epidemiologic approaches.

Affective Symptoms↗