THE CLASSICAL WORLD
The important conclusion to be drawn from the classical world regarding combat events is that they (i.e., killing and wounding) are not the only events with the power to create profound alteration of behavior. Their weight and power is embedded in the cultural ascriptions that provide them with value, as are related noncombat events that may contribute to the undoing of the soldier. In this context, in classical Greece, murder was considered to be ritually polluting, defiling both the hands and the mind, and required religious rites of purification, but slaying enemies and even accidentally killing friends in battle brought no such onus with it (Vernant, 1990). One of the most significant parts of battle and warfare has always been the creation of conditions designed to psychologically overwhelm the enemy. In The Western Way of War, Hanson (1989) points out that one of the primary weapons of the Greek phalanx was the terror it evoked through its synchronized movement and sound. One aim of the phalanx was to break the enemy psychologically. History often focuses upon the effects of weaponry without recognizing that warfares main weapon is the creation of overwhelming destruction that destroys the enemys capacity to maintain organized behavior. Even in classical Greece there were attempts to find answers that might explicate the sources of the power of war to alter behavior. It is first important to understand that Greece was a warrior society and all citizens of the polis served as the citys military force. Hanson has pointed out that the Greek heavy infantry were tough small-holding farmers who from youth through middle age served as the soldiers of the phalanx. Because they had to rely on each other to maintain the unbroken ranks of the phalanx to ensure their survival, the sanctions against withdrawing from ones part in battle were extraordinary (Hanson, 1995). Burkert (1985) points out that the ceremonies and rites before a battle, in which the battle was dedicated to the God of the polis, served functionally to prevent withdrawal from battle. Dedication to a God sacralized the battle; thus withdrawal could be characterized as sacrilege for which the penalty was to be stoned to death. The psychological efficacy of a sure and greater penalty for not facing the enemy than the risks of battle is well known and was routinely used by armies through the first quarter of this century to ensure that soldiers stayed at task and performed. Looking at this phenomenon, Euripides (trans., 1971, p. 27) tried to frame an answer to it in The Bacchae, in one of the speeches of Teiresias, the great seer, as he describes the attributes of Dionysus:
Somewhat of Ares dues he shares withal:
Hosts harness-clad, in ranks arrayed, sometimes
Are thrilled with panic ere a spear be touched;
This too is a frenzy Dionysus sends.
A More Recent Culture Illuminates Perspectives from the Classical World Cultural perspectives from some of my prior fieldwork may help to illuminate these points and to reinforce that it is wrong to impute contemporary American or Western middle-class evaluations of the effects of combat and violence to warrior societies of any type or, indeed, to our own past. A societys approach to trauma, violence, and death is a complex outcome of many factors, including the valuation of the "way of the warrior"; the cultures belief systems and eschatological notions, particularly about the afterlife; and its sources of status, guilt, and shame. In my work during the 1950s with the Barsana, a warrior society and a lineage of the Hawiya Clan Confederacy of central Somalia, I encountered a social and value system close to that of the time of the Iliad. The war leader of the lineage, a wise and gentle man, claimed to have killed well over three hundred men in combat with spear and knifean assertion vouched for by many of his contemporaries. I found him to be a thoughtful counselor and a voice of prudence and judiciousness. He could describe with immense pleasure slashing open a pregnant woman and killing her unborn child pointing out that, "It could not then in the future kill one of my children or grandchildren when it was grown." Such an act was perceived as neither brutal nor horrific but as fulfilling an obligation of the warrior to his kin (Marlowe, 1963a and b). A warrior who did not perform to these levels of expectation would incur public shame and the potential withdrawal of critical societal privileges. Thus when a causus belli was perceived, social insistence upon recourse to battle was great. The power of shame can also be directed against the enemy to humiliate him, disrupt his sense of competency, and injure his morale. A Somali analog to an event in the Iliad (and one undoubtedly carried out for many of the same inherent reasons) was the dragging of the corpses of American Rangers through the streets of Mogadishu, a direct parallel to Achilles humiliation of the corpse of Hector. Such events lead to another range of stressful sources for a deployed force: "culture shock." Just as Priam was emotionally distraught (and in contemporary terms, deeply stressed) by Achilles violations of the expected rules for respect of the dead, so were Americans stressed and shocked by the Somali disregard for sacralization of our dead.
The Relation Between Group Cohesion and Soldier Sustainment From classical times until the French Revolution, a soldiers psychological and physical survival depended upon the physical cohesion of the line of battle. The line was his armor, both physically and psychologically. In the phalanx or the legion, the soldier knew that he was essentially "safe" in combat as long as the men to his right and left kept the line intact, as the shield of each covered the man next to him. "Line" in this sense includes the maintenance of the physical integrity of square or column. True danger came when the line was broken and all were vulnerable. At that point it was legitimate to runto be overwhelmed by fear and to try to survive. The organic cohesion of the line maintained behavior and sustained the soldiers performance and perhaps also his mental health. The alternative was panic, defeat, and often death. Therefore, maintaining the cohesion of the battle line was extremely important. It was then and is now critical that, if men are to survive the terrors of war and the hardships of deployment, they must be tightly bonded together. The group, with which the soldier lived and worked, was the primary source of social support and psychological strength.
The Importance of the Leader Another cohesive factor for sustaining the soldier in the psychosocial climate of his unit is good leadership. Leaders who combine tactical knowledge and skill with the ability to take care of their troops ensure the best possible available conditions for them. These leaders are perceived as respecting soldiers and their needs and are not seen as wasteful of life in battle. These principles have not changed from ancient times to today.
WESTERN VALUES REGARDING BEHAVIOR DURING AND FOLLOWING COMBAT
The history of the psychological consequences of warfare for most of the next two thousand years in the West appears to be one of decoupling perceived combat effects from combat itself. If men broke in combat or suffered psychologically afterwards, the fault lay in themselves and was not a consequence of war. This decoupling governed most thought about the consequences of combat through World War I and for the most part continues today. It is in a conjoining of the Biblical tradition with the Greek concept of arete that the maintenance of effective behavior during and following battle appears to shift primarily to an internal locus. A soldier was either a courageous man or a coward. The issue is not one of disregarding the battlefields potential psychological or behavioral injury but rather allocation of etiological factors to behavioral failure. That men might fail had been accepted throughout classical times and appears to have been central to the evolution of disciplinary techniques, tactical formations, and increasing emphasis upon the organic cohesion of the combat group. Delbruck (1990) summed this up very well, discussing the switch from the tactics of the Greek and Macedonian phalanx (in which the organic mass maintained the behavior of the whole or broke as a whole) to Roman Legionary tactics and the development of cohort tactics (based upon mutually supporting small groups rather than the mass). Contamine (1986, pp. 250259) has pointed out the critical role that the concept of courage played in the Middle Ages; it was a "necessary" trait that characterized the warrior aristocracy. He traces its importance and saliency from both the classical world and major Christian thinkers, particularly Aquinas and Saints Ambrose and Augustine. Contamine also points out that
MIND-BODY DECOUPLING IN THE WEST
The focus on courage and inner qualities was reinforced by the decoupling of the psychological (mind) from the physical (body), which became more and more commonplace in the West. Much of medicine and the general intellectual culture were also engaged in a fairly absolute decoupling of mind from body. This decoupling made it conceptually difficult to define how events of the mind could have serious bodily consequences. Cartesian dualism separated an abstract spiritual "mind" from the corporeal nonspiritual body. While the two met, presumably in the pineal gland, the possibilities of the impact of the one upon the other were unclear. Hippocratic and Galenic medicine posited an interaction between the internal organization of the humoral structure and external events, and the effects of strong emotional situations on both behavior and physiology continued as a critical part of medicine. However, such thinking was seldom applied to war. While physicians in practice (see Martin, 1997) continued to deal with the impacts of event-mind-body, most possibilities of the mind-body relationship ceased to be part of formal academic discourse or theoretical speculation. This differentiation was intensified by the evolving pattern of the objectification of the concept of disease and its isolation from both the life of the patient and the patients social universe. These were, as Foucalt (1975) asserted in one of his studies that appears to maintain high validity, contaminants that interfered with true knowledge of the disease through study of its signs and symptoms and not its impact upon the patients life or that lifes impact upon the disease. Intriguingly Cartesian dualism and the reification of disease begin their ascent during a period in which armies were changing radically in both size and composition. This also led to dramatic rises in casualty rates and in levels of lethality. From the later middle ages until the French Revolution (17891799), the primary military psychiatric disability recognized was "nostalgia," which was described as a pathological form of homesickness marked by depressive and anorectic symptoms. It is noteworthy that nostalgia was believed to develop in the long periods between battles rather than as a consequence of battle. In addition, it was consistently treated as a true mental disease and not as malingering (see Rosen, 1975). During this time period, the culture of military service in the West was markedly different from that with which we are now familiar. The aristocracy and the gentry traditionally provided officers. Soldiers were long-term volunteers in professional or mercenary forces. On average, few married until they reached higher rank, and the families of those who did marry became camp followerspart of the baggage train of the army on the move. Concern about the longer-term effects of combat, soldiering, and military life was minimal. After battle, modest numbers survived their wounds, and many more died of disease. Until the 19th century, when first anesthesia and then germ-theory-based sanitation and antisepsis were introduced, life for many soldiers was fairly Hobbesian: "nasty, short, and brutish." Concepts that our culture is presently concerned about, such as freedom from aches and pains, personal and economic fulfillment, etc., were nonexistent. Life was hard and all expected to be used hard by life. If the soldier survived, he normally continued service until old age. At that time, the physical and mental health problems of soldiers were not the problems of society in general but those of the restricted and marginal social category of soldiers. Because soldiers were drawn from the poorest margins of society, the process of socialization and professionalization fairly completely alienated them from civilian life. As Hall (1997) puts it, "Once one became a soldier, there was little else one could do in this life but continue as a soldier." Adding to this military cultural picture was a high rate of desertion. The era of the French Revolution, and most particularly the development of conscription and the levee en masse, altered the constitution of armies and, through the instrumentality of the short-term "citizen soldier," increased societal concern about the effects of service upon the soldier. Particularly from the 17th century onward, the culture, social structure, technologies, and tactics of armies began to evolve. The major changes were development of "Napoleonic" mass armies, and the Napoleonic view that soldiers were as disposable as shot, shell, and musket ball. Concepts of soldier "psychological vulnerability" did not evolve further during this period. Prior to the French Revolution, smaller professional forces made attempts to be selective and avoid the presumedly inferior. Conscription had been used, but on a small scale for all except for the Armies of Charles the IX and Gustavus Adolphus of Sweden, which, beginning in the early 17th century, attempted "universal" conscription but drew primarily on the peasantry. If Parker (1996) is correct in his assertion that "Enlistment, in effect, had become a sentence of death," combat consequences while devastating demographically to farming communities did not have much effect on society in terms of the ills of survivors. The extent of the experience was dramatically widened with the advent of mass conscription for the Revolutionary and Napoleonic Armies. Thus, the soldiering experiences of the exclusive citizenry of the small Greek city-state now became the experiences of the widely inclusive citizenry of the nation state. Most of the elements that soldiers were exposed to and that likely affected their physical and mental state remained similar: deployment far from home and family; hard and physically demanding conditions of the campaign; and the shock, chaos, and blood of battle that punctuated each campaign. In terms of mediating the experience of war for the soldier, two constructs remained stable: These two were the necessity of organizational cohesion and the role of the leader, as discussed above. We shall return to these themes as we explore the factors that mediate the psychological and psychophysiological consequences of war and deployment.
 As Whitman (1971) put it: "Ajax is the first full length portrait of a tragic hero in Western Literature, and it is by no mere coincidence that both he and Achilles, the first epic hero, find themselves in identical situations. Both isolate and destroy themselves in the struggle with their own offended honor." (See also Shay, 1994.)
 This issue has been cogently dealt with by G.E.R. Lloyd (Lloyd, 1987).
 In one instance that I observed, young women of the nomadic section involved lined up to sing mocking songs. The gist of the lyrics was that if the young men did not sharpen their spears and seek blood vengeance, the women, many of whom were their wives, would be sealed against them as possible sexual partners. However, a possible causus belli that took place between kin groups too close for the allowableness of warfare was rejected as such by the lineage elders as a forbidden taking of blood that would be an abomination (Marlowe, 1963a and b).
 Sun-tzu (trans. 1963) enjoins commanders to always place men from the same town or neighborhood in the line together because they will not leave or desert each other. The Macedonian phalanxes were composed of long-service soldiers, most often organized by community of origin. The Roman legionary line of battle was formed from the interlocking of small groups, the maniples, (hand or bundle) who lived together for the long term. The need for such bonding was expressed well by Xenophon in the Cyropaedia, which was written in the fourth century B.C. In describing the reasons for Cyrus to encamp his soldiers by regiments of 100 men, Xenophon (trans., 1992, p. 52) states:
The living in common would help the men to know each other, and it is only by such knowledge, as a rule, that a common conscience is engendered; those who live apart, unknowing and unknown, seem far more apt for mischief, like those who skulk in the dark. Cyrus thought the common life would lead to the happiest results in the discipline of the regiments . . . . And finally, he felt, there was the fact that those who live together are the less likely to desert one another; even the wild animals, Cyrus knew, who are reared together suffer terribly from loneliness when they are severed from each other.
 This is perhaps best expressed in the book of Joshua (verse 1, line 9), "Have I not commanded you? Be strong and of good courage; be not frightened, neither be dismayed; for the Lord, your God, is with you wherever you go."
 These began to be perceived as inborn characteristics of both individuals and of racial and ethnic groups.
 But to establish in the place of one large mass a number of small groups that could compensate for their weakness by helping each other mutually, there was needed a new power, military discipline, which bound a number of individual fighters into a unit spiritually stronger than the sum of its parts, controlled by one will, standing fast so that even the soul-shaking excitement, the melee, the noise, the fear, the danger of death in the battlenone of these things could break it up. The cohort remained firmly under the control of its leader, and the leaders followed the orders of the army commander.
 Primacy was shifted from one and other depending upon the case being analyzed (see Siegel, 1973).
 In 1649 Harvey noted:
"and what indeed is more deserving of attention than the fact that in almost every affection, appetite, hope or fear, our body suffer, the countenance changes and the blood appears to course hither and thither" (quoted in Hunter and Macalpine, 1963).
 The period when the growth of armies becomes most marked is the 17th century. While field armies did not increase in size dramatically overall, military strengths did. The historical reasons for this growth are covered in Hall (1997) and appear to relate to the way in which changing technologies and tactics had shifted the primacy to the defense.
 Desertion rates were up to 23 percent per month during wartime in the late 16th century. "The mere report that a French army might be moved into Germany was sufficient, according to Richelieu, to reduce its strength by 50%" (Hall, 1997, p. 229).
 It was popular in both military and military medical circles to compare the neurologically weak and/or cowardly with the courageous and the strong nerved or "nerveless." A late 17th century British medical encyclopedia points out, particularly in reference to military service, that a significant proportion of human beings are simply constitutionally inferior.