Book Review
| Pages | 286 |
| Publication year | 2021 |
86 CBJ 286. Book Review
Volume 86, No. 3, Pg. 286
September 2012
Barry R. Schaller, Potomac Books, 2012. 227 pages.
In his important and timely new book, Veterans on Trial: The Coming Court Battles Over PTSD, former state Supreme Court Justice Barry R. Schaller takes on the issue of Post Traumatic Stress Disorder ("PTSD") in returning war veterans and examines the impact of the disorder on the courts and society at large. In the book, Justice Schaller likens the mental health injuries sustained by returning veterans as "the first warning signs of a tidal wave of social, economic, and legal problems for American society."(fn1)
The book makes a forceful, compassionate, and even radical argument that our leaders must give greater weight to the negative human and societal costs when deciding to engage in military conflicts. Although psychiatric casualties of war have existed long before PTSD had a name, Justice Schaller vividly and meticulously outlines how combat trauma consistently has been overlooked, misunderstood, mismanaged, and stigmatized throughout warfare's lengthy history. The book delves deeply into the maddening lack of diagnostic clarity in diagnosing combat PTSD, even though the historical record from antiquity supports the prevalence of conflict-related stress.
Biblical, ancient Egyptian, and Greek sources all contain references to battle stress. The Romans developed a sophisticated system of records containing numerous accounts of stress-related injuries. The first appearance of an actual medical diagnosis of combat trauma used the term "nostalgia," supposedly induced by separation from homeland and hopelessness about returning home safely. In earlier wars, combat stress was dismissed as "combat fatigue," or "shell-shock." At the time of the Civil War, stress-related disorders were thought to result from medical deficiencies like "soldier's heart" and "railway spine," or were dismissed as "malingering." During the First World War the term "fright neurosis" was the reported cause of combat-related trauma. All of these terms, writes Justice Schaller, were examples of "the convenient practice of finding a name for psychiatric problems that avoids acknowledging the fact that war causes mental injury and illness."(fn2)
Efforts by military psychiatrists to diagnose symptoms related to combat stress historically have been complicated by conflicting, over-riding military goals. Diagnosis and treatment were compromised by the fear that military forces would be depleted if soldiers were allowed to plead "battle fatigue" in order to escape combat. Expeditiously returning the individual to the battlefield consequently took priority. During World War II, the preferred "forward" or frontline treatment option was to discourage soldiers from reporting symptoms at all, even though military psychiatrists were coming to the realization that those suffering psychiatric stress (up to 74 percent of ground soldiers) were exhibiting a "normal reaction of normal individuals exposed to the extraordinary stress of warfare."(fn3)
The Vietnam War and the five-year period following U.S. withdrawal represented a "watershed" in war psychiatry. Justice Schaller outlines the psychiatric dimensions of that war, which generated more cases of PTSD than any other war in American history. Following the end of American involvement in Vietnam, traumatic stress gradually began to be perceived as a public health problem that hampered the returning veterans' readjustment to civilian life. For the first time...
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