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geons in the Franco-Prussian War of 1870, in the Civil War (DaCosta, 1871), and in the Boer War of 1899-1902 (Nemiah, 1980). Various labels have been given what is now called PTSD. In the Civil War, PTSD was called ''soldier's heart" (Horowitz, 1976); later in that century Oppenheim introduced the term "traumatic neurosis"; and Mott used the World War I (WWI) term "shell shock" (Trimble, 1985). Idelson (1923), writing about his observations on one of the larger samples of men with "traumatic neuroses" from WWI, attempted to distinguish between "toxic sequelae" and "psychic or psychogenic sequelae." Without achieving the separation, yet in the best tradition of clinical observation, he described clearly and convincingly in men exposed to toxic gases, those behaviors and responses that are now termed PTSD.

There was little understanding of combat stress reactions in WWI, however, and many of the disagreements about labels were really disagreements about whether or not certain individuals were "predisposed" to develop adverse psychological effects following traumatic events (Horowitz, 1976). Further, there was uncertainty regarding the contributions of physical trauma and the precise type of mental disturbances that could be caused by stressful experiences. A paper by Hulbert in 1920 deemed "gas neurosis" to be the reaction of "discontented soldiers with a morbid, ignorant fear of being gassed." Later analysis by Jewett (1942) distinguished between panic and anxiety states in groups of WWI combat casualties. He further defined a subgroup that exhibited "psychoneuroses" typified by anxiety with psychosomatic components, conversion reactions, and dissociation (amnesia). In one field hospital, Jewett reported that 500 troops suffered psychological symptoms, which were accepted as real effects of combat (as opposed to malingering) because these were all seasoned troops. In his conclusion, Jewett called for "intelligent handling" of psychological casualties.

In WWII (Andreasen, 1980; Kinzie, 1989), many labels appeared: "traumatic war neurosis, combat neurosis, combat fatigue, combat exhaustion, battle stress, operational fatigue, and gross stress reaction." Early in WWII, Kardiner (1941) wrote of the traumatic neuroses of war, warning that while some men were responding rapidly to treatment of acute stress symptoms (now recognizable as PTSD), studies were needed of all phases of such responses, including chronic phases. The importance of the chronic phase of PTSD in WWII veterans was recently affirmed by Kolb (1990), who wrote, "We now know that such symptoms may persist up to 40 years." Yet as van Kammen and Ver Ellen (1990) noted, "After every war, disaster, or publicized atrocity of the last 125 years, the renewed public interest in the stress response syndromes quickly wanes, whereas the victims continue to suffer."

Labels continued to change through the 1950s and 1960s. In 1952, the first edition of APA's Diagnostic and Statistical Manual (DSM-I) used the

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