Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war.

Modern warfare embodies the principles of continuous operations with an expectation of higher combat stress casualties.

[7] US services now use the more recently developed BICEPS principles: The British government produced a Report of the War Office Committee of Inquiry into "Shell-Shock", which was published in 1922.

They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914.

They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure.

[8]One British writer between the wars wrote: There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to compensation.

It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness.

Only in November 1943 was a psychiatrist added to the table of organization of each division, and this policy was not implemented in the Mediterranean Theater of Operations until March 1944.

General Patton's slapping incident was in part the spur to institute forward treatment for the Italian invasion of September 1943.

Coupled with the monotonous, hot, sickly environment, the result was bad morale that jaded veterans quickly passed along to newcomers.

Flight surgeons reported that the men who had been at jungle airfields longest were in bad shape: Unlike the Americans, the British leaders firmly held the lessons of World War I.

Regimental Medical Officers were learning that neither elaborate selection methods nor extensive training could prevent a considerable number of combat soldiers from breaking down.

"[13] In his history of the pre-Nazi Freikorps paramilitary organizations, Vanguard of Nazism, historian Robert G. L. Waite describes some of the emotional effects of World War I on German troops, and refers to a phrase he attributes to Göring: men who could not become "de-brutalized".

[14] In an interview, Dr Rudolf Brickenstein stated that: ... he believed that there were no important problems due to stress breakdown since it was prevented by the high quality of leadership.

Psychiatrist Harry Federley, who was the head of the Military Medicine, considered shell shock as a sign of weak character and lack of moral fibre.

The fight-or-flight response involves a general sympathetic nervous system discharge in reaction to a perceived stressor and prepares the body to fight or run from the threat causing the stress.

Catecholamine hormones, such as adrenaline or noradrenaline, facilitate immediate physical reactions associated with a preparation for violent muscular action.

During this period of resistance, physical and mental symptoms of CSR may be drastically reduced as the body attempts to cope with the stress.

Long combat involvement, however, may keep the body from homeostasis and thereby deplete its resources and render it unable to normally function, sending it into the third stage of GAS: exhaustion.

Sympathetic nervous activation remains in the exhaustion phase and reactions to stress are markedly sensitized as fight-or-flight symptoms return.

[18] The British Army treated Operational Stress Reaction according to the 7 Rs:[19] Historically, screening programs that have attempted to preclude soldiers exhibiting personality traits thought to predispose them to CSR have been a total failure.

[22] Soldiers with a knowledge of both the emotional and physical signs and symptoms of CSR are much less likely to have a critical event that reduces them below fighting capability.

Training in stressful conditions that mimic those of an actual combat situation builds confidence in the abilities of themselves and the squad.

[26][27] Narcosynthesis A technique that was used to treat PTSD disorders during World War II by using sodium pentothal was created by psychiatrists Roy Grinker and John Spiegel.

During the treatment, they offered soldiers an opportunity to abreact their trauma by re-experiencing it in a hospital environment in the presence of supportive, protective, and understanding therapists.

The therapists induced a dream state or twilight sleep by injecting sodium pentothal, after which most soldiers spontaneously started to express their anxiety.

research has caused an increasing number of scientists to believe that there may be a physical (i.e., neurocerebral damage) rather than psychological basis for blast trauma.

As traumatic brain injury and combat stress reaction have very different causes yet result in similar neurologic symptoms, researchers emphasize the need for greater diagnostic care.