From "Shell Shock" to PTSD – A History
By LtCol Richard Beil USMC(Ret.)

It has long been recognized that the trauma of combat can result in psychological problems. Military members and veterans today have been led to believe that what is now called PTSD constitutes a mental disorder. They don't believe they are mentally ill, but this is how the civilian mental health community has termed the condition. Consequently, many refuse to seek treatment. By learning the actual history of the condition, those military members and veterans may get a better understanding of what has happened and why. It is believed that this knowledge may actually help them cope with and overcome this condition.

What are the classic symptoms of PTSD? To what extent are these symptoms novel, and to what extent is PTSD simply a restatement of earlier concepts of shell shock or combat fatigue? If PTSD is largely a restatement, why did psychiatric reformers in the 1970s demand with great urgency that it be recognized as a new concept in psychopathology, necessary to respond to the "unique" problems of returning Vietnam veterans? Were those problems truly unique? What is the relationship between military and civilian psychiatry? Why is it that the prevailing methods of describing mental illness seem to shift every twenty to thirty years, as old concepts are jettisoned in favor of new ideas, from "shell shock" and "combat fatigue" to "PTSD", or from "neurasthenia" and "hysteria" in the 19th century, to the "neuroses" and "psychoses" of the 20th which, in turn, were abandoned by the psychiatric profession in the 1990s?

This paper provides a glimpse into the actions taken by the civilian psychiatric industry to create a new mental disorder, which could then be diagnosed with increasing frequency, generating income for practitioners.

Background

Psychological casualties are as old as war itself, but historians and sociologists note that the high-profile involvement of civilian psychiatrists in the wake of the Vietnam War set those returning soldiers apart. "The suggestion or outright assertion was that Vietnam veterans have been unique in American history for their psychiatric problems," writes the historian Eric T. Dean Jr. in Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. As the image of the psychologically injured veteran took root in the national conscience, the psychiatric profession debated the wisdom of giving him his own diagnosis.

During the Civil War, some soldiers were said to suffer "irritable heart" or "Da Costa's Syndrome"—a condition marked by shortness of breath, chest discomfort and pounding palpitations that doctors could not attribute to a medical cause. In World War I, the condition became known as "shell shock" and the inability to cope was believed to reflect personal weakness—an underlying genetic or psychological vulnerability. Combat itself, no matter how intense, was deemed little more than a precipitating factor. Otherwise, well-adjusted individuals were believed to be at small risk of suffering more than a transient stress reaction once they were removed from the front.

From 1918 to 1979, no matter what name was given to what is now called PTSD, the condition was never considered a mental disorder or illness. It was considered something that any normal individual could experience when exposed to combat. And, it was seen as a temporary condition that would disappear with counseling and understanding. If it did not, there was some other pathology, not related to combat, that should be treated. This all changed in 1980 with publication of the 3rd edition of the Diagnostic and Statistical Manual (DSM-III) of the American Psychiatric Association.

However, unlike true scientific disciplines like Chemistry and Physics, Psychology is a "theoretical" discipline that can never provide "proof", as do the others. The sciences follow specific methodologies. To be termed scientific, a method of inquiry must be based on empirical or measurable evidence, subject to specific principles of reasoning. The scientific method involves developing hypotheses and then carrying out experiments based on those predictions. A scientific hypothesis must be falsifiable. It must be possible to identify a possible outcome of an experiment that conflicts with predictions deduced from the hypothesis. Otherwise, the hypothesis cannot be meaningfully tested.

Veterans and the general public have been led to believe that there is some scientific basis to substantiate the mental illness label that PTSD now bestows.

The entire field of Psychoanalysis is based on theories that seek to explain human behavior. First there was Freud, who put forward the theory that sex underlies everything humans do - that all psychic energy is generated by the libido. Then came Behavior theorists like John B. Watson and B. F. Skinner, who came up with the theory that any person could potentially be trained to perform any task, regardless of things like genetic background, personality traits, and internal thoughts. All it takes is the right conditioning. Behavior Theory was predominant from the 1920s to the 1950s in America.

Then, we had Erik Erikson's theory of Psychosocial Development, Carl Jung's theory of "Archetypes", and Henry Murray's theory of Psychogenic Needs, suggesting that our personalities are a reflection of behaviors controlled by needs.

What all this actually means is that the entire field of Psychology is made up of individuals who try and come up with a new way to explain human behavior, either to get published and become famous, or to create a new diagnosis that can be used to make money. If they'd ever actually PROVEN anything, there wouldn't be a need for new theories.

They count on their curriculum vitae, all the letters behind their names, to impress the general public that what they are talking about is actually factual. They say, "We're making great strides in understanding the human mind". In fact, their "great strides" are nothing but new theories, which are then explained to others in the profession in language only they can understand. They publish their "research" in professional journals, where it is vetted only by others within the field. It then becomes the "revealed wisdom" that is accepted by the general public. "Gee, they went to college. They MUST know what they're talking about, right"?

Despite claims to the contrary, Psychology cannot prove or disprove anything about the workings of the human mind. The rigors of the scientific method, requiring a testable and falsifiable hypothesis, cannot be used. Therefore, whatever else it is, it is NOT science. In fact, there are some psychologists who themselves argue that Psychology should not be considered a science at all; that there are alternatives to empiricism, such as rational research, argument, and belief.

One alternative is the Humanistic approach which values private, subjective conscious experience and argues for the rejection of science. The leading psychologists in this field were Carl Rogers, Rollo May, and Abraham Maslow. The humanistic approach argues that objective reality is less important than a person's subjective perception and subjective understanding of the world.

A person's subjective experience of the world is an important and influential factor on their behavior. Only by seeing the world from the individual's point of view can we really understand why they act the way they do. The humanistic approach does not have an orderly set of theories and is not interested in prediction and controlling people's behavior – the individuals themselves are the only ones who can and should do that.

This approach is fully recognized as valid. In 1971, Humanistic Psychology, as a field, was recognized by the American Psychological Association (APA) and granted its own division (Division 32) within the APA.

However, it is the clinical, rather than the humanistic, approach that prevails in the U.S. Department of Veteran Affairs. It is for this reason that many veterans simply refuse treatment at these facilities.

World War I - Shell Shock

During World War I, some people saw shell shock as cowardice or malingering, but Charles S. Myers convinced the British military to take it seriously and developed approaches that still guide treatment today.

By the winter of 1914–15, shell shock had become a pressing medical and military problem. Not only did it affect increasing numbers of frontline troops serving in World War I, British Army doctors were struggling to understand and treat the condition.

The term "shell shock" was coined by the soldiers themselves. Symptoms included fatigue, tremor, confusion, nightmares and impaired sight and hearing. It was often diagnosed when a soldier was unable to function and no obvious cause could be identified. Early in the war, doctors adopted the medical theory that exploding artillery shells sent off invisible shock waves that caused these symptoms among soldiers. When soldiers not exposed to artillery fire experienced the same symptoms, doctors realized shell shock was a psychological problem caused by the stress of war.

Shell shock took the British Army by surprise. In an effort to better understand and treat the condition, the Army appointed Charles S. Myers, a medically trained psychologist, as consulting psychologist to the British Expeditionary Force to offer opinions on cases of shell shock and to gather data for a policy to address the burgeoning issue of psychiatric battle casualties.

The first cases Myers described exhibited a range of perceptual abnormalities, such as loss of or impaired hearing, sight and sensation, along with other common physical symptoms, such as tremor, loss of balance, headache and fatigue. He concluded that these were psychological rather than physical casualties, and believed that the symptoms were overt manifestations of repressed trauma.

Drawing on ideas developed by French military neuropsychiatrists, Myers identified three essentials in the treatment of shell shock: "promptness of action, suitable environment and psychotherapeutic measures," though those measures were often limited to encouragement and reassurance. Myers argued that the military should set up specialist units "as remote from the sounds of warfare as is compatible with the preservation of the ‘atmosphere' of the front."

Inevitably, Myers was criticized by those who believed that shell shock was simply cowardice or malingering. Some thought the condition would be better addressed by military discipline. Myers became increasingly demoralized and requested a posting back to the United Kingdom.

Only in 1940, with Britain again at war, did he write his memoirs, which detailed his theories about shell shock and its treatment. His account was not well received by the military reviewer in the Journal of the Royal Army Medical Corps, who argued that the book revealed a "lack of understanding and conviction." Written at a time when the U.K. faced the threat of invasion, the author may have felt that Myers's criticisms of the army's medical services were unpatriotic and defeatist. In truth, they revealed the inability of a mass, hierarchical organization to accommodate the nuanced policy recommendations of an innovative clinician.

Nevertheless, the principles of forward psychiatry that Myers identified — prompt treatment as close to the fighting as is safe, with an expectation of recovery and return to unit — were widely adopted during World War II by both the U.S. and U.K. military, and they continue to be practiced by Western armed forces today in Afghanistan and Iraq.


World War II - Battle Fatigue

Spurred by the experience of World War I, whereby it was thought that an emotional weakness in a soldier predisposed him to "shell shock," policy makers were already making plans in 1940, prior to the outbreak of World War II, to weed out the weak. Based on a plan created by psychoanalyst Henry Stack Sullivan in 1940, the Selective Service program required psychiatric screenings for the young American men who would be fighting the war. This screening process rejected 1,600,000 potential recruits who were deemed psychologically unfit for duty.

These initial screenings were supposed to eliminate soldier collapse; therefore, combat fatigue was not taken seriously early in the war. A soldier who broke down emotionally was given the bare minimum of care in a battlefield hospital. Military leaders were unprepared for the large number of men who suffered from war neurosis; estimates are that it was double the number of World War I cases. This is to be expected, as there were far more Americans deployed and fighting in World War II.

Following the Normandy invasion, two psychologists, Drs. Roy Swank and Walter Marchand, conducted what became a landmark study of the effects of prolonged exposure to combat. Of U.S. Army combatants on the beaches of Normandy, the study found that after 60 days of continuous combat, 98% of the surviving soldiers had become psychiatric casualties to some degree. The remaining 2% were identified as "aggressive psychopathic personalities."

Screening for mental defect before enlistment was abolished by General George Marshall in 1944, since the process had not reduced the incidence of nervous exhaustion among the World War II warriors. The Army's slogan then became "every man has his breaking point" and the terminology utilized to describe psychological injury was Battle or Combat Fatigue.

Regardless of the comprehension of the breaking point of the combat soldier, many with battle fatigue were sent back to the front lines after a period of rest away from combat, unless the soldier remained nonfunctional. In the 1940s the assumption was that once a soldier was removed from combat, his trauma would disappear. The preferred treatment was to have the traumatized soldier treated close to the war zone in order to facilitate a quick return to the front. More severe cases were taken out of action and often discharged and sent home.

More than forty percent of medical discharges during the World War II years were for psychiatric reasons, the common diagnoses being psychoneurotic disorder and/or personality defects. The large number of discharges for neuropsychiatric reasons belies the common assumption that the World War II soldier did not suffer the same degree of war trauma as those of later wars. Only the most severely affected were discharged; so the actual rate of combat/battle fatigue may have been underreported in World War II.

Korea - Combat Stress Reaction

There were far fewer cases of battle fatigue in the Korean War than in World War II. The psychiatric prescreening process that failed in World War II was abandoned; instead, new recruits were evaluated on a case-by-case basis. This new evaluation process proved to be more effective. In order to prevent battle fatigue, the Army implemented a troop rotation policy after the first year of the war. This policy ensured soldiers spent no more than nine months serving in combat. This rotation policy dramatically reduced the rate of battle fatigue cases to less than half of the rate experienced in World War II.

During the Korean War, the approach to combat stress became even more pragmatic. Due to the work of Albert Glass (1945), individual breakdowns in combat effectiveness were dealt with in a very situational manner. Clinicians provided immediate onsite treatment to affected individuals, always with the expectation that the combatant would return to duty as soon as possible. The results were gratifying. During World War II, 23 percent of the evacuations were for psychiatric reasons. But in Korea, psychiatric evacuations dropped to only 6 percent. It finally became clear that the situational stresses of the combatant were the primary factors leading to psychological casualty.

Coincident with the conflict in Korea, and following the publication of a diagnostic manual by the Veterans Administration, the American Psychiatric Association published its first Diagnostic and Statistical Manual (DSM-I) in 1952.

This manual included a category called gross stress reaction. It was defined as a stress syndrome that is a response to an exceptional physical or mental stress, such as a natural catastrophe or battle; it occurs in people who are otherwise normal, and it must subside in days to weeks. If it persisted, another diagnosis should be made.

DSM-I specified that gross stress reaction should only be diagnosed in individuals who were normal prior to experiencing the stress. If they had another psychiatric disorder, such as depression, the stress reaction would be treated as secondary to that and would not be given an independent diagnosis. Implicitly, this approach suggested that gross stress reaction was a diagnosis that should not confer any stigma. It implied that people who developed it were normal, healthy individuals who had simply been temporarily overcome by a stress that was overwhelming.

Vietnam - Post-Vietnam Syndrome

The story of PTSD starts with the Vietnam War. In the late 1960s, a band of self-described antiwar psychiatrists—led by Chaim Shatan and Robert Jay Lifton, who was well known for his work on the psychological damage wrought by Hiroshima—formulated a new diagnostic concept to describe the psychological wounds that the veterans sustained in the war. They called it "Post-Vietnam Syndrome," a disorder marked by "growing apathy, cynicism, alienation, depression, mistrust, and expectation of betrayal, as well as an inability to concentrate, insomnia, nightmares, restlessness, uprootedness, and impatience with almost any job or course of study." Messrs. Shatan and Lifton said the symptoms did not emerge until months or years after the veterans returned home.

But, there was a definite political component to this argument. In past wars, the principal function of psychiatry was to return soldiers to their units, to meet the manpower needs of the military. A critical goal of the anti-war movement was to change this paradigm. Since the war was viewed as unjust, it was the duty of the psychology industry to cease being the "tool of the military". By creating the image of the troubled Vietnam veteran, the military became the "enemy". Psychiatry must now protect the common soldier from being used as a tool of the military-industrial complex. What better way than to describe the natural reactions to combat stress as somehow unique – a new "disorder" never before seen in American history?

This vision inspired portrayals of the Vietnam veteran as the kind of "walking time bomb" immortalized in films such as "Taxi Driver" and "Rambo." In the summer of 1972, the New York Times ran a front-page story on Post-Vietnam Syndrome. It reported that 50% of all Vietnam veterans—not just combat veterans—needed professional help to readjust, and contained phrases such as "psychiatric casualty," "emotionally disturbed" and "men with damaged brains." By contrast, veterans of World War II were heralded as heroes. They fought in a popular war, a vital distinction in understanding how veterans and the public give meaning to their wartime hardships and sacrifice.

Since the rotation policy used in the Korean War had seemed to reduce battle fatigue casualties, military planners believed that rotating soldiers individually would improve the morale of soldiers while maximizing the fighting ability of the unit. This plan seemed like a good idea, but actually made combat stress a greater problem because of the absence of unit cohesion. This lack of cohesion created a hostile environment, and leadership was not trusted by the average soldier.

Vietnam was also the first counter-insurgency war in which America had participated since the "Banana Wars" in Latin America in the early 1900s. Counterinsurgency warfare, as contrasted with conventional warfare, is characterized by an absence of front lines and an inability to distinguish friend from foe. The enemy used "guerilla" or irregular war tactics, in which small groups of combatants, such as armed civilians or irregulars, use tactics such as ambushes, sabotage, raids, hit-and-run, and mobility to fight a larger and less mobile, traditional force. The Vietnam War seemed to produce PTSD cases at an alarming rate.

Soldiers experienced a loss of community because of the individual rotation policy. Unlike after WW II and Korea, he did not come back slowly aboard a troop ship with his comrades, allowing time to "decompress" and assimilate his experiences. Instead, a soldier would leave his unit in the field and, within two days, he was back in the United States. Once home again and trying to deal with the shocking transition, he was either totally ignored by the civilian population or, worse, spit upon and blamed for losing an unpopular war.

Having already lost the community of their fellow soldiers, returning veterans needed to be accepted and honored by society, but instead Vietnam veterans were systematically harassed and ridiculed by anti-war protesters. Already alone, Vietnam veterans quietly suffered as Americans rejected and dishonored them. Vietnam veterans experienced unimaginable rejection, which in the end, seemed to produce an unprecedented number of psychological casualties.

By the time PTSD was incorporated into the official psychiatric lexicon, it bore a hybrid legacy—part political artifact of the antiwar movement, part legitimate diagnosis. While the major symptoms of PTSD are fairly straightforward—re-experiencing, anxiety and avoidance—what counted as a traumatic experience turned out to be a moving target in subsequent editions of the DSM.

The first revision of this manual, DSM-II, was published in 1968. Without any explanation, the diagnosis of gross stress reaction that had been included in 1952 was omitted. The most plausible explanation for the omission is that the concept was closely linked to warfare and combat, and DSM-II was written in a relatively peaceful era, at least for the authors themselves. In neither Korea nor Vietnam was the general public, and particularly researchers and clinicians, even inconvenienced by war. Consequently, between 1968 and 1980 no official diagnosis for stress disorders was available.

In DSM-II, the stressor was defined relatively narrowly, as so severe and outside the range of normal human experience that it would produce significant symptoms in almost anyone. It could be physical or psychological or both. In recognition that a stress syndrome is a final common pathway, with many entry points reflecting the variety of stressors that can produce it, there was no specific "post-Vietnam syndrome." Instead the new diagnosis was given the very general name of "post-traumatic stress disorder." For the stressed, there was no requirement of preexisting normality. This decision was based on the recognition that individuals vary in vulnerability and resilience.

PTSD "Evolves"

By 1980, 22 years had elapsed with very little notice of the absence of a diagnosis for stress disorders associated with combat. The absence of an "official" diagnosis for combat stress did not preclude their study by researchers. Consequently, there was a great deal of evidence claiming that stress disorders were common, that they had characteristic symptoms, and that they were a final common pathway, reached by experiencing a variety of different types of stressors: combat, death camps, industrial accidents, natural disasters, mass catastrophes, and violent acts against individuals. The issue was simply how to incorporate all this evidence into the definition and description of the condition.

The reemergence of a diagnostic category for stress syndromes, after 22 years of absence, clearly filled a niche. The diagnosis soon became widely used clinically, and it also became the object of many research studies. The rapid and widespread acceptance also led to some unintended consequences. Despite the narrow definition of the stressor specified in the diagnostic criteria, the concept was steadily broadened by clinicians (and also researchers) to include milder stressors that were not intended for inclusion (e.g., auto accidents, childhood abuse). As a consequence, dissociative syndromes after "childhood abuse" (broadly defined and sometimes poorly documented) were reported with increasing frequency. The diagnosis, assumed to be relatively rare in peacetime, became much more common.

In 1987, the DSM was revised to expand the definition of a traumatic experience still further. The concept of stressor now included a secondhand experience. In the fourth edition in 1994, the range of "traumatic" events was again expanded to include hearing about the unexpected death of a loved one or receiving a fatal diagnosis such as terminal cancer. No longer did one need to experience a life-threatening situation directly or be a close witness to a ghastly accident or atrocity. Experiencing "intense fear, helplessness, or horror" after watching the Sept. 11 terrorist attacks on television, for example, could qualify an individual for PTSD.

Today, the DSM is commonly used as a checklist of behaviors and symptoms, but is not founded in medicine or science. Indeed, according to an international poll of mental health experts conducted in England in 2001, DSM-IV (fourth edition) was voted one of the 10 worst psychiatric papers of the millennium. It was criticized for reducing psychiatry to a checklist. "If you are not in the DSM-IV, you are not ill. It has become a monster, out of control."

PTSD has become "stretched and blurred," says Tana Dineen, Ph.D., author of Manufacturing Victims: What the Psychology Industry is Doing to People. It can be applied to "psychiatrists in training, those exposed to toxic substances, potential AIDS patients, and those who have survived a heart attack…the application of PTSD has resulted in everything being pathologized, until the only way to be is to be 'abnormal,'".

There is pitched debate among trauma experts as to whether a stressor should be defined as whatever traumatizes a person. True, a person might feel "traumatized" by, say, a minor car accident—but to say that a fender-bender counts as trauma alongside such horrors as concentration camps, rape, or the Bataan Death March is to dilute the concept. "A great deal rides on how we define the concept of traumatic stressor", says Harvard psychologist Richard J. McNally, author of Remembering Trauma. In the civilian realm, Mr. McNally says, "the more we broaden the category of traumatic stressors, the less credibly we can assign causal significance to a given stressor itself and the more weight we must place on personal vulnerability."

For some non-combat servicemen and women, anticipatory fear of being in harm's way can turn into a crippling stress reaction. But how often symptoms fail to dissipate after separation from the military and subsequently morph into a lasting disability is unknown.

In 2010, the Secretary of Veterans Affairs said the mental injuries of war "can be as debilitating as any physical battlefield trauma." The occasion for his remark was a new VA rule allowing veterans to receive disability benefits for PTSD if, as non-combatants, they had good reason to fear hostile activity, such as firefights or explosions. In other words, veterans can now file a benefits claim for being traumatized by events they did not actually experience.

This has caused some criticism from those who actually served in combat, asserting that such non-combatants are somehow seeking to "cheat the system". Such criticism fails to take into account the very characteristics of the counter-insurgency battlefield. Non-combatants are equally as likely to be killed by a roadside IED or a mortar round in the latrine as those who are in combat specialties. In such an environment, nowhere in the war zone is safe. The continuous and cumulative stress of living under such conditions can be equally debilitating, in the same way law enforcement officers succumb to the stress of that profession. However, there are those veterans whose attitude is, "The government did this to me. I'm going to make them pay". The salient question then becomes, "pay for what"? Pay for your becoming mentally ill, when the very diagnosis of mental illness was done for political/financial, rather than medical, reasons?

As Tana Dineen stated, "Do you ever wonder when we began to accept as fact that we can't cope with death or violence without the services of a therapist? Or why we decided that a stranger with a graduate degree in psychology is better equipped than anyone else we know to help us 'properly' deal with and 'heal' from a shocking or violent incident?"

Richard Gist, a psychologist who assists the fire department in Kansas City, states, "Mental health professionals sometimes undermine the traditional sources of support for those experiencing grief: talking to friends, family, clergy and others." "Maybe what we need to do is give people tea and sympathy and let them talk to their Aunt Tilly. But we should not try to dress Aunt Tilly in a white lab coat and have her talk in psychobabble."

There is no comparison between the funded mechanisms of a sterile and ineffective mental health system, and the truly caring compassion, understanding, support, and spiritual boost that comes from one's family, friends, the clergy, and other concerned citizens like other veterans. These inherent and positive qualities in our communities should be our main focus as we recover from recent events, not the reinforcing and expanding of already incompetent psychiatric or psychological systems.

From early childhood, the American education system "programs" individuals to show deference and respect to those assumed to be better educated. Psychology textbooks use language that presents students theoretical constructs as if they were proven facts. A student who dares argue with this "revealed wisdom" risks a failing grade. This has led veterans to place their trust and reliance on those in the civilian mental health system who write the rules. But, in a recent study (Nov. 2014), the Rand Corporation found that, among civilian psychiatrists, psychologists, and clinical social workers, only 13% met the study's criteria for "cultural competence", meaning they understood military mores, language and background, and delivered appropriate care for illnesses unique to the military, such as combat-related post-traumatic stress disorder and depression.

Conclusions

The entire system of American slavery was based on the best "science" of its time. In the 17th, 18th, and 19th centuries, the prevailing wisdom of the best scientific minds in the world was that the Negro was inferior, in all respects, to Caucasians. We now recognize that this was "pseudo-science". What if no one had questioned it?

The history of psychiatry has been the story of a frustrating (and continuing) attempt to understand the nature of mental illness. The continuing lack of consensus within the professions of psychiatry and psychology regarding the conceptualization and treatment of mental pathology are a testament to the difficulty of the issues involved. Psychiatry is concerned with the most complex medico-physiological problem, that of the body-mind relationship, which remains unresolved to this day.

Born in an era of vehement anti-war sentiment, PTSD cast its net widely over many aspects of human behavior that had never before been considered a "mental illness". Dreams, flashbacks, and low-level feelings of depression, anxiety, and guilt, even when not disabling, were now considered to be a mental illness or a "syndrome". Mental health "reformers" (advocates of the recognition of PTSD as a disorder) thus created the impression that Vietnam was unique because large numbers of veterans from that war suddenly seemed to be mentally ill. The truth of the matter was that expanding categories of "disease" were including more and more people who would have been considered "normal" in the past. This did not come about through any new "breakthrough" in understanding the workings of the human brain. It came about due to politics.

Americans are deeply moved by the men and women who fight our wars. We have an incalculable moral debt, as Abraham Lincoln said, "to care for him who shall have borne the battle." Yet, rather than broaden the definition of PTSD, it would do our veterans better to discard that label entirely. Otherwise, how can we assess their prospects for meaningful recovery no matter their diagnosis?

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Source: militaryhistoryonline.com
LtCol Richard Beil USMC(Ret.)

Published online: 04/30/2017

Written by LtCol Richard Beil USMC (Ret.). If you have questions or comments on this article, please contact Richard Beil at: iwojimajoe1775@gmail.com.

About the author:
LtCol Rich Beil served 30 years in the Marine Corps, as an enlisted Infantryman and as an Artillery officer. Following his retirement, he obtained a Masters degree and taught American History for Ranger and Central Texas Colleges. He is a member of the International Society for the Scholarship of Teaching and Learning in History.