Blast Injury: What We Have Learned Since the Days of "Shell Shock"
Dr. Perl describes how what we know about blast injury has changed since the early days of 'shell shock' in World War I and in subsequent conflicts.
The issue of blast injury started with World
War One. In World War One was the first significant
battle in which high explosives were used in warfare. And this was the trench warfare and on the
Western Front, the Battle of Verdun and things like that that we’re now celebrating 100-year-anniversaries
of and things like that where individual were in trenches and were exposed on a daily basis
to literally hundreds of explosions. And soon after this an entity was seen that
was referred to as “shell shock,” or sometimes neurasthenia, that has many of the features
of what we see today in our returning service members. The headaches, the difficulty concentrating,
the behavioral and manifestations that we talked about. It was called “shell shock,” it was not
well defined, nobody really knew quite what to do with it or how to treat it, and there
was in those days, 100 years ago, a debate in the literature as well as in academic circles
as to whether this was actual physical damage to the brain or whether this was a mental
health problem. And at the end of World War One, a commission
was put together by the British government and they looked into it and they decided that
this, that “shell shock” was really not a proper clinical entity, the term should
not be used and that they didn’t feel there was evidence of damage to the brain, that
this was all a mental health problem. And that has continued until this day. We couldn’t use “shell shock” in World
War Two so we called it “combat fatigue” or “battle fatigue.” When we got to Vietnam psychiatrists involved
in dealing with this problem in Vietnam introduced the term of post-traumatic stress disorder,
PTSD, and we’ve continued to use that to this day. But really over the hundred years of history
of this specifically military problem, nobody had actually looked at the brains to see whether
there was any evidence to solve this debate until we stepped in and did our work. This is a very difficult problem because the
patients that are affected by it have both these neurologic problems, they have severe
intractable headaches, they’ve got severe sleep disorder, they’re not sleeping at
night, they have problems concentrating, they have problems with vision, and they have these
behavioral issues in terms of mood swings, in terms of ability to plan, in terms of recognizing
the consequences of one’s actions. These are all things that are controlled by
the frontal lobes of the brain, which are as severely incidentally by the scarring problem
at any rate. And so dealing with society has always been
a problem for these patients. I mean, this goes back to “shell shock”
really, the “shell shock” victims could not go back really to be productive members
of society, they couldn’t work. This was a difficult problem in terms of readjusting
to society. And we see this to this day. This disrupts family life. Many of these families end up in divorce. Child abuse, spousal abuse. I mean, this is a very complex problem that
has just been implanted in our society in virtually every corner of the United States
with these returning deployed, post-deployed service members.
Posted on BrainLine December 13, 2017.
Dr. Perl is a Professor of Pathology at USUHS and Director of the CNRM's Brain Tissue Repository, where he has established a state-of-the-art neuropathology laboratory dedicated to research on the acute and long-term effects of traumatic brain injury among military personnel.