ABSTRACT
Military psychiatry in the UK is generally regarded as having begun in World War One and, indeed, the recognition of psychiatric injury in general (Binneveld, 1997; Stone, 1985). Certainly, it then became an important service designed in the main to treat troops suffering from so-called shell shock, the acute effects of battle, so that they could be returned to their units as quickly as possible. However, a significant developmental phase pre-dated this conflict when physicians attempted to explain and treat servicemen suffering from a range of unexplained, somatic disorders, including disordered action of the heart (DAH) and psychogenic rheumatism. These arose in a context of ‘palpitation’ seen during the Crimean War and irritable heart described by Da Costa in the American Civil War. In addition, military doctors encountered cases whose symptoms suggested a neurological cause. These were both acute (cases of exhaustion after combat), and chronic (veterans who remained debilitated for years after their discharge), mirroring neurasthenia in the civilian population.
