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Traumatic Brain Injury, Shell Shock, and Posttraumatic Stress Disorder in the Military—Past, Present, and Future

Shively, Sharon B. MD, PhD; Perl, Daniel P. MD

Section Editor(s): Bushnik, Tamara PhD; Gordon, Wayne PhD, ABPP/Cn

Journal of Head Trauma Rehabilitation: May/June 2012 - Volume 27 - Issue 3 - p 234–239
doi: 10.1097/HTR.0b013e318250e9dd
3rd Federal Interagency Conference on TBI

With preferential use of high explosives in modern warfare, traumatic brain injury (TBI) has become a common injury for troops. Most TBIs are classified as “mild,” although military personnel with these injuries can have persistent symptoms such as headache, memory impairment, and behavioral changes. During World War I, soldiers in the trenches, undergoing unrelenting artillery bombardment, suffered from similar symptoms, designated at the time as “shell shock.” Dr Frederick Mott proposed studying the brains of deceased soldiers to elucidate the neuropathology of this clinical entity. Subsequent to a British government enquiry after World War I, the term “shell shock” was banned and further investigation into a possible organic cause for these symptoms was discontinued. Nevertheless, similar clinical entities, such as combat or battle fatigue and posttraumatic stress disorder, continue to be encountered by combatants in subsequent military conflicts. To this day, there exists a paucity of neuropathology studies investigating the effects of high explosives on the human brain. By analogy, studies have recently revealed that athletes with repeated head trauma can develop a neurodegenerative disease, chronic traumatic encephalopathy, who present with similar clinical features. Given current circumstance, we propose completing the work envisioned by Dr Mott almost 100 years ago.

Department of Pathology, Uniformed Services University of the Health Sciences (Drs Shively and Perl), and Neuropathology Core, Center for Neuroscience and Regenerative Medicine (Drs Shively and Perl), and Henry M. Jackson Foundation for the Advancement of Military Medicine (Dr Shively), Bethesda, Maryland.

Corresponding Author: Sharon B. Shively, MD, PhD, Uniformed Service University of the Health Sciences, Department of Pathology, 4301 Jones Bridge Rd, Bethesda, MD 20814 (

The authors thank the Center for Neuroscience and Regenerative Medicine for their ongoing support by, the Uniformed Services University of the Health Sciences, and the United States Army Medical Research and Materiel Command for their ongoing support. They also thank the following individuals for their invaluable discussions: Drs Ramon Diaz-Arrastia, Ann McKee, and Stanley Prusiner. Dr McKee has generously allowed one of the authors (D.P.P.) to evaluate many cases of athletes with chronic traumatic encephalopathy in her neuropathology laboratory. They also acknowledge Professor Edgar Jones's scholarship in delineating the history of World War I, shell shock, and the connection to PTSD.

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the US Government.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.