[Psychiatric causalties among soldiers in the 20th century with a focus on the Congo 1960-4]

Psychiatric casualties among soldiers constitute an inevitable part of modem warfare. For the past hundred years Medicine and Society have shown a growing interest in the combat reactions. The focus has shifted from an organic one towards a psychological and psychiatric perspective. Cultural, social, economical and political forces have influenced the scientific development from the Shell shock to Posttraumatic Stress Disorder. The aims of this literature review are to describe how military psychiatry has viewed combat reactions and in what way this has affected civil psychiatry and medicine in general, and also to follow the development of the diagnosis PTSD. Furthermore, one aim was to study the events in Congo in 1961 when Swedish UN-soldiers participated in combat. The military and associated psychiatrists has by different means tried to prevent and treat psychiatric casualties, but the knowledge was constantly forgotten and the principles of PIE-treatment (proximity, immediacy, expectancy) had to be reinvented over and over again. The experiences of military psychiatry have in some aspect enriched medical science but did also raise questions. Many factors seem to have interacted in the creation of PTSD and this diagnosis is still being questioned and debated. In 1961 PTSD did not exist and according to a follow-up study by Kettner the Swedish soldiers who suffered psychological combat reaction did not differ significantly from the rest, except that they were younger. This study has shown that the dilemma of either serving the demands of war or the individual is a common feature among military psychiatrists. Second, during the last decades there has been a convergence trend of military psychiatry and civil catastrophe psychiatry. The military psychiatry is now part of the socio-medical movement of psyhcotraumatology. Finally, for every war since World War I physicians and psychiatrists have had to relearn the importance of PIE-treatment.