Cultural shift in mental illness: a comparison of stress responses in World War I and the Vietnam War

OBJECTIVES: Post-traumatic stress disorder is an established diagnostic category. In particular, over the past 20 years, there has been an interest in culture as a fundamental factor in post-traumatic stress disorder symptom manifestation. However, only a very limited portion of this literature studies the historical variability of post-traumatic stress within a particular culture. DESIGN: Therefore, this study examines whether stress responses to violence associated with armed conflicts have been a culturally stable reaction in Western troops. SETTING: We have compared historical records from World War I to those of the Vietnam War. Reference is also made to observations of combat trauma reactions in pre-World War I conflicts, World War II, the Korean War, the Falklands War, and the First Gulf War. PARTICIPANTS: The data set consisted of literature that was published during and after these armed conflicts. MAIN OUTCOME MEASURES: Accounts of World War I Shell Shock that describe symptom presentation, incidence (both acute and delayed), and prognosis were compared to the observations made of Vietnam War post-traumatic stress disorder victims. RESULTS: Results suggest that the conditions observed in Vietnam veterans were not the same as those which were observed in World War I trauma victims. CONCLUSIONS: The paper argues that the concept of post-traumatic stress disorder cannot be stretched to cover the typical battle trauma reactions of World War I. It is suggested that relatively subtle changes in culture, over little more than a generation, have had a profound effect on how mental illness forms, manifests itself, and is effectively treated. We add new evidence to the argument that post-traumatic stress disorder in its current conceptualisation does not adequately account, not only for ethnocultural variation but also for historical variation in stress responses within the same culture.