Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War

David H. Marlowe


Chapter One: Introduction

Chapter Two: Historical Overview: Psychological Consequences of Battle Stress

The Classical World
A More Recent Culture Illuminates Perspectives from the Classical World
The Relation Between Group Cohesion and Soldier Sustainment
The Importance of the Leader
Western Values Regarding Behavior During and Following Combat
Mind-Body Decoupling in the West

Chapter Three: Modern War: The American Civil War

Postwar Phenomena

Chapter Four: Conceptual and Theoretical Medical Developments in the 19th and Early 20th Centuries

Hysteria and Hypochondria
Neurasthenia (Neurocirculatory Asthenia)
Changes in the Concept of Hysteria and Traumatic Neurosis
The Major Medical Text: Osler’s Definitions
Traumatic Neuroses
Beyond Osler's Definitions
Ancillary Developments in Military Medicine

Chapter Five: World War I

Shell Shock
The Shift to a Psychological Interpretation
Treatment of Shell Shock
Changes in the Significance of Military Groups and Treatment Near the Front Lines
The Redefinition of Hysteria
The American Experience
Postwar Concerns
The Lessons of World War I

Chapter Six: 1919-1941: The Interwar Years

Mind-Body Dichotomy
Diagnosis and Classification

Chapter Seven: World War II

Combat Realities and the Failure of Selection
The Role of the Group
Battle Fatigue/Combat Fatigue
A Noncombat Hysteriform Behavioral Epidemic: The Case of Atabrine
Other Non-Battle-Fatigue Psychologically Implicated Disorders
The World War II Paradigm Shift

Chapter Eight: Post-World War II Conceptual Developments

The Development of the Contemporary Concept of Stress
Other Theoretical Developments Bearing on the Psychogenic and Psychosomatic Consequences of "Being Ill"

Chapter Nine: Vietnam

Vietnam As a Paradigmatic Case
Psychiatric Casualties in Vietnam
Vietnam Combat Reaction
The Ecology of Combat and the Sociocultural Context of the Vietnam Conflict
The Phases of the Vietnam Conflict
The Problems in Respect to Psychologically Based Casualty Generation
The Temporal Patterns of Combat-Stress Casualties
Factors Some Presumed to Account for Rate Variations
Prescribed Medications
Group and Unit Cohesion
Short-Timers Syndrome
Life Restructure As a Factor
Substance Abuse in Vietnam
Traumatic Exposure in Vietnam and Its Attributional Role in the Development of the PTSD Outcome Category
Some Further Considerations on the Issue of PTSD
Health Consequences of Service in Vietnam
Herbicide Exposure
Homecoming Pattern

Chapter Ten: The Gulf War: Operations Desert Shield and Desert Storm

The Stresses of the Gulf Deployment
Assessing Stress and Adaptation
The Structure of the Studies
The Field Study and Assessment Phase
Factors Contributing to the Stress of the Deployment
Stress Generated by Concerns About Home
Stressful Living Conditions
Stresses Generated by the Perceived Threat
Organizationally Attributed Stressors
Other Sources of Stress
Stress Mediators
Population Variation in Response to Stressors
Stresses in Anticipation of Combat
Measuring Stress Levels
The Stresses of the Combat Period

Chapter Eleven: Return From the Persian Gulf and Its Consequences

The Effects of Traumatic Exposure to Combat
The Stresses of Return from the Persian Gulf

Chapter Twelve: Conclusions


Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War, David H. Marlowe, MR-1018/11-OSD, 2000 RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions or policies of its research sponsors. Copyright © 2000 RAND

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Published 2000 by RAND