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EDITORIALS: R J Ursano, D M Benedek, and C C Engel Mental illness in deployed soldiers BMJ 2007; 335: 571-572 [Full text]

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War neurosis or PTSD

Jim E Hefford   (21 September 2007)

Spiritual issues and mental health

Wouter Havinga   (28 September 2007)

War neurosis or PTSD 21 September 2007
Jim E Hefford, retired family physician home -56 Highbury Rd Wellington 6012 Send response to journal: Re: War neurosis or PTSD	When my older brother returned to Medical School after five years in the army he wrote a Public Health thesis on "War Neurosis" (as shell shock, now post traumatic stress disorder, was called) He told me that the problem was as common amongst the base wallahs as among the front line troops and that everything depended on morale. World War 2 is generally agreed to have been necessary,inevitable, and worthwhile so morale was generally high. The same cannot be said about any of the wars since then,and no one knows this better than those who took part in such enterprises as the Vietnam War. This would apply whether the soldiers were conscripts, such as the Americans and Australians, or volunteers, such as the New Zealanders. If what I have suggested is true then I would expect the incidence of PTSD to be much higher in current conflicts than in those of the earlier twentieth century. Jim Hefford, Retired GP, New Zealand Competing interests: None declared
Spiritual issues and mental health 28 September 2007
Wouter Havinga, GP locum GL6 6JL Send response to journal: Re: Spiritual issues and mental health	Ursano, Benedek and Engel advise to measure relevant exposures in real battle front time, to protect the health of soldiers. 1  Roberto et all found an association between duration of deployment and mental health that might be explained by exposure to combat. 2  An 11 year follow-up study in Croatia recorded that soldiers showed a significant increase in psychosomatic complaints with time, whereas refugees showed a decrease and contrary to these findings, civilians showed relatively low level of psychosomatic complaints and did not show any significant changes with time. 3  The soldier’s struggle around the meaning of specific actions can be read in the narratives of soldiers, for example in the national press. 4  Both the BMJ editorial and article did not go into specifics as to what kind of experiences on the battle ground are causing mental health problems for the soldiers. Talking specifically about killing another human being and the impact on mental health seems to be a taboo in this context. However, since Kübler-Ross the medical world does not deny the issues around death anymore. This is an area where the concept of spirituality has been developed. The importance of taking spiritual elements into account is also recognised by NICE guidelines. 5  Spirituality could be defined as a search for existential or transcendental meaning, wrestling with and creating meaning in one's life and feeling connected to others. Furthermore, psychiatrist Marc Galanter writes in his book ‘Spirituality and the healthy mind’ that people's spiritual beliefs are strong motivational factors in the recovery process. He admits that spirituality is difficult to define because it is subjective and introspective, where as the biomedical approach is externally validated through measuring behaviour.  Soldiers continue to feel responsible for what they are ordered to do. In this light, “providing continuity of care across time and space is a challenge for providers and health systems.” 1  Ursano RJ, Benedek DM, Engel CC. Mental illness in deployed soldiers. BMJ  2007;335:571-572  Rona RJ, Fear NT, Hull L, Greenberg N, Earnshaw M, Hotopf M, et al. Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study. BMJ  2007;335:603  Proroković A, Cavka M, Cubela Adorić V. Psychosomatic and depressive symptoms in civilians, refugees, and soldiers: 1993-2004 longitudinal study in Croatia. Croat Med J. 2005 Apr;46(2):275-81 Philp C. The bloody passage to manhood for the PlayStation generation. The Times, 22 September 2007 http://www.timesonline.co.uk/tol/news/world/asia/article2507973.ece Supportive and palliative care http://guidance.nice.org.uk/csgsp   Competing interests: None declared