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Shell shock: an outcome study of a First World War 'PIE' unit
Edgar Jones1, Adam Thomas, Stephen Ironside
1Institute of Psychiatry, King's Centre for Military Health Research, Weston Education Centre, London, UK. edgar.jones@iop.kcl.ac.uk
Psychological Medicine
|November 11, 2006
Summary
Forward psychiatry (PIE) aimed to keep soldiers in service but was ineffective in returning combat troops to fighting units. It did, however, prevent many from being discharged by reassigning them to support roles.
Area of Science:
- Military Medicine
- Psychiatry
- Trauma Studies
Background:
- Forward psychiatry, or PIE (proximity, immediacy, expectancy), was developed in 1915 to retain soldiers by providing rapid treatment near the front lines.
- This approach was adopted by Allied forces in World Wars I and II, and later by the US in Korea and Vietnam.
- Despite its widespread use, empirical evidence supporting its effectiveness, particularly through randomized controlled trials, remains limited.
Observation:
- A study analyzed 3580 shell shock admissions at a 1917 stationary hospital, categorizing soldiers by combat role, service duration, and military operations.
- Admission rates for shell shock significantly increased during offensive operations when physical casualties were high.
- Combat troops constituted a disproportionate number of admissions, with many having less than nine months of service in France.
Findings:
- Forward psychiatry did not effectively return soldiers to combat roles, with less than 20% reintegrating directly into fighting units.
- The majority of admitted soldiers were reassigned to other hospitals, support duties, or convalescent depots.
- A significant proportion of admissions occurred early in deployment, suggesting vulnerability among newer personnel.
Implications:
- While not successful in immediate combat return, forward psychiatry played a role in preventing medical discharge and retaining personnel within the armed forces.
- Further research is needed to understand long-term outcomes, relapse rates, and alternative methods soldiers may have used to exit combat zones.
- The findings highlight the complex interplay between combat intensity, troop experience, and mental health outcomes in military settings.
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