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Shell shock patients: from cowards to victims

BMJ 1998; 317 doi: (Published 14 November 1998) Cite this as: BMJ 1998;317:1394
  1. Derek Summerfield, psychiatrist
  1. Medical Foundation for Caring for Victims of Torture, London

    In 1980 I was a rural government medical officer in southeastern Zimbabwe when the civil war ended and Robert Mugabe's guerrillas could show themselves and seek treatment. One of these lay unmoving but alert in his soiled bedclothes day after day on my ward, without wounds or obvious pathology. As my concern about an atypical encephalopathy subsided, I came to see him as a case of some sort of combat stress and eventually talked him back into life.

    An admirable three part television series on shell shock started this week with the first world war (Shell Shock, Channel 4, Sundays 8 00 pm). In fact, a better place might have been the American civil war, where military doctors were perplexed that men could die not just of wounds or disease but also of what they called “nostalgia”—a contagious condition associated with morbid homesickness. “Nostalgia” became an epidemic as the war dragged on, accounting for more cases than dysentery.

    During the first world war, there were 13 …

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