Is Shell Shock the Same as PTSD?

Shell shock is a term originally coined in 1915 by Charles Myers to describe soldiers who were involuntarily shivering, crying, fearful, and had constant intrusions of memory. It is not a term used in psychiatric practice today but remains in everyday use.

In a previous post, a question was asked of me by a young veteran of the Iraq War about the difference between post-traumatic stress and shell shock. He wrote:

"... I experienced an abrupt, highly jarring event during my first tour of combat in Iraq that caused me thereafter, for a couple of years, to react bracingly to the sound of low-flying aircraft. This reaction, to me, was 'shell shock.'

During my second tour, I was exposed to prolonged combat, a constant sense of hopelessness, and an environment characterized by above-average friendly casualties. Although I failed to admit to its occurrence initially, my reaction upon return from this tour was (and, perhaps, continues to be) something I consider more akin to post-traumatic stress. For a few years, for example, I dove fairly heavily into alcohol consumption. Methods less detrimental to my health, such as writing and reading, have replaced alcohol presently. However, the cause for all of these activities is the same—a desire for mental escape, which I relate to a prolonged state of reaction to my probable post-traumatic stress."

Is shell shock the same as PTSD? This is an intriguing question; one that I've been scratching my head over for the last couple of weeks.

The answer I've come up with is that PTSD and shell shock are the same. And they are different.

They are the same because shell shock was an intellectual forerunner to PTSD. PTSD was influenced by the experiences of psychiatrists working with veterans returning from Vietnam. As such, the two ideas set out to do pretty much the same thing.

The difference, however, is that shell shock was specific to the experiences of combat whereas the concept of PTSD has developed to be more wide-ranging. DSM-IV lists 17 symptoms. But not all of the symptoms have to be present for a diagnosis to be made. At least one of the five re-experiencing symptoms (B1-B5), at least three of the seven avoidance symptoms (C1-C7) and at least two of the five arousal symptoms (D1-D5), have to be present for the diagnosis to be made.

The implication is that two cases of PTSD may be different in how they present. For example, to fulfill the criteria for re-experiencing and arousal one person may present with physiological reactivity (B5), hypervigilance (D4) and an exaggerated startle response (D5) whereas another person may present with intrusive and distressing recollections (B1), difficulty sleeping (D1) and concentrating (D3).

Both would receive the same diagnosis of PTSD. But the first description seems much more resonant with the idea of shell shock and fear conditioning whereas the second seems to be more of a depressive reaction. These two forms of PTSD would indeed seem to be, psychologically, very different experiences.

The question may have been about shell shock but what it also illustrates is that the diagnostic criteria for PTSD pull together a range of human experience under one umbrella, which is just too big.

Find out more about my work here.