World War II


By: Aakash Ramsay


In World War II, the nature of combat changed significantly from the Great War, and so did the nature of post-traumatic stress disorder. Foxholes were used rather than the trenches of the First World War. Foxholes generally held two men and were dug by hand (Sledge, 1981).

In World War II, PTSD was known as combat stress or combat exhaustion. Combat stress can be looked at as “psychological disintegration suffered during the stresses of battle” (Watson, 1978, pg 233). Men engaged in combat in World War II lost their fighting effectiveness after 90 days, which was seen as the peak of fighting effectiveness. (Ambrose, 1992, pg 203). Ambrose notes in Band of Brothers, “The experiences of men in combat produce emotions stronger than civilians can know, emotions of terror, panic, anger, sorrow, bewilderment, helplessness, uselessness, and each of these feelings drained energy and mental stability” (Ambrose, 1992, pg 203).    

Medics helping an American soldier on the coast of France

A paratrooper in the 101st Airborne Division went blind after a prolonged engagement with the enemy. Later, he recovered after some much needed food and rest. An infantryman in the European Theater of Operations (ETO) would have dealt with more urban combat than his Marine counterpart. An American soldier fighting through Europe also experienced the terror of modern artillery fire (Ambrose, 1992). Artillery not only inflicted terrible physical casualties but psychological ones as well. It left many soldiers feeling terribly helpless (Ambrose, 1992). This differed significantly from a Marine’s experience in the Pacific.

Marine Eugene Sledge noted in his memoir that he thought about how he would deal with the psychological and physical strain of combat (Sledge, 1981). Sledge later found himself depairing on Okinawa due to the miserable conditions that he found himslef in. On this wet, muddy and rainy island, he nearly came to his breaking point (Sledge, 1981).

The Marines in the Pacific fought off both the Japanese and the jungle. This fighting in the jungle of the Pacific Islands was very chaotic as the Marines could not always see their enenmy. This notion of fighting an elusive and very nearly hidden enemy would have put serious psychological and mental strain, as well as physical on the Marines (Sledge, 1981).

The following is a clip from HBO’s miniseries Band of Brothers. It shows the stress that one man of Easy Company, Albert Blithe went through. After fighting in a prolonged engagement, Blithe realized that he could not see. The recent skirmish had stressed him out to the point where he manifested physical symptoms. He only recovered when his commanding officer calmed him down and had him relax (Ambrose, 1992). Blithe was fortunate in that he was able to find respite from some of the fighting, other men in the European Theater were not so lucky.


This is a 1947 documentary entitled “Shades of Gray: Shell-Shock- Combat Stress Reaction.” It is a good depiction of was combat stress looked like in American soldier’s and how it affected their fighting capability.

One very interesting piece of the fighting in World War II
is that the physical issues went right alongside the psychological ones.
Marines on Okinawa dealt with the strain of constant artillery shelling, rain,
and mud. While the other factors just added to the overall misery, it was the
artillery shelling which actually broke men (Sledge, 1981).

The constant threat from death and maiming was coupled with
concussion blasts from the shells themselves. Sledge notes in his memoir that
the cases of combat stress varied with each man. Some still functioned rather
well, and others just walked around aimlessly (Sledge, 1981).

The realities of combat for many men serving on the front
lines in World War II became their existence. They accepted their fate and pushed on
forward even when they thought they could not. Part of the reason for this
acceptance may have been the treatment in the field of combat stress. The
solution was to pull a soldier or Marine off of the fighting line, so that they
could get some rest.

This constant stress puts incredible wear and tear on the
body as well as the mind. Hypertension as well as chronic pain can result
(MacFarlane, 2010). The effect of this constant stress had one very interesting
result after the Second World War. American psychiatrists struggled with identifying
and naming the variety of effects that the veterans came back with. The term
that was finally settled upon came to be called “Gross Stress Reaction”, which was
written into the Diagnostic and Statistical Manual in 1952, the DSM-I (Andreasen,
2011). This diagnosis was short lived however, due to the want by psychiatrists
for it to act as more of a placeholder, until another diagnosis could be found.
“Gross Stress Reaction was seen as having a wide spectrum of effects; it was
not specific enough to cover all the effects that psychiatrists witnessed.


Ambrose, S. E. (1992). Band of brothers: E Company, 506th Regiment, 101st Airborne : from Normandy to Hitler’s Eagle’s nest. New York, NY: Simon & Schuster.

Andreasen, Nancy C. MD, PhD. (2011). What is post-traumatic stress disorder? Dialogues Clin Neurosci. 2011 September; 13(3): 240–243. Retrieved from:

McFarlane, Alexander C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry.February;9(1): 3–10. Retrieved from:

Sledge, E. B. (1990). With the old breed, at Peleliu and Okinawa. London: Oxford University Press.

Watson, P. (1978). War on the mind: the military uses and abuses of psychology. New York: Basic Books.




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