Psychiatric battle casualties: an intra- and interwar comparison

Background Psychiatric casualties are recognised as an important and inevit able feature of modern warfare. At the beginning of the 20th century they w ere scarcely acknowledged and still less treated,Today, as a result of less ons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied . Aims To discover more about the factors that cause psychiatric casualties a nd their relationship to total battle casualties. Method A survey of historical War Office reports and the papers of Royal Ar my Medical Corps psychiatrists has provided both statistics and treatment s trategies. Results Reported psychiatric casualties were low in the Beer War, influence d, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-s hock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers retu rned to fighting units. Conclusions A constant relationship exists between the incidence of the tot al killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved. Declaration of interest E.J. is supported by a grant from the US Department of Defense.