How Today’s Soldiers Might Solve The Mystery Of Shell Shock

“Shells used to come bursting on my bed at midnight, even though Nancy shared it with me; strangers in daytime would assume the faces of friends who had been killed… I could not use a telephone, I felt sick every time I travelled by train, and to see more than two new people in a single day prevented me from sleeping.” —Robert Graves autobiography recounting life after the trenches of World War I

In A Nutshell

Through autopsies, researchers discovered that improvised explosive devices (IEDs) may leave a lasting, distinctive pattern on the brains of combat veterans who survived attacks in Iraq and Afghanistan only to die later of other causes. In World War I, soldiers with similar injuries were described as suffering from “shell shock,” an antiquated term for their inexplicable difficulties with memory, reasoning, decision-making, and other executive brain functions. The honeycomb patterns of swollen and broken nerve fibers found in the brains of these recent veterans may finally solve the century-old mystery of the shell shock that plagued World War I veterans.

The Whole Bushel

Some of today’s veterans from the wars in Afghanistan and Iraq share an often devastating consequence of battle with veterans from World War I. They may return home without any physical scars, yet unable to function well in civilian society because they suffer from inexplicable difficulties with memory, reasoning, decision-making, and other executive brain functions. It’s common for survivors to experience depression, anxiety, and other psychological symptoms. In World War I, those difficulties were called “shell shock.” Senior officers viewed veterans of that era who did not recover quickly as lacking in character. Some were even executed for cowardice.

But no one uses that antiquated term any longer. Today, these symptoms are more likely to be grouped under the umbrella term “post-traumatic stress disorder” (PTSD), which is largely considered to be a mental health problem even though it’s poorly understood.

In these two groups, the common element experienced by many combat veterans is blast injuries. In World War I, the Allied and German soldiers tried to force each other from entrenched positions with bombardments for months at a time. That type of warfare largely disappeared after the First World War. As a result, the symptoms of shell shock became rare until today’s soldiers faced similar types of blasts from IEDs, car bombs, rocket-propelled grenades, mortar fire, and suicide bombers.

We’re now learning that there may be nearly invisible damage to the brain in these cases. Through autopsies, researchers from Johns Hopkins University have discovered that IEDs may leave a lasting, distinctive pattern on the brains of combat veterans who survived the attacks in Iraq and Afghanistan only to die later of other causes.

The remains of five male US military veterans who had survived IED attacks in the Afghanistan and Iraq wars were donated by their relatives to the Armed Forces Institute of Pathology. Three of these veterans had died of methadone overdoses, one of a bullet wound to the head, and the last of multiple organ failure. The Johns Hopkins researchers compared the brains of these veterans to 24 other people who had died of other causes including car accidents, heart attacks, and drug overdoses.

The brains of four of the five veterans displayed distinct honeycomb patterns of swollen and broken nerve fibers not found in the 24 other corpses or even in people with punch-drunk syndrome, a degenerative neurological disease caused by multiple concussions.

“[In the brains of the veterans], we identified a pattern of tiny wounds, or lesions, that we think may be the signature of blast injury,” said researcher Vassilis Koliatsos. “The location and extent of these lesions may help explain why some veterans who survive IED attacks have problems putting their lives back together.”

Researchers believe there are two possible explanations for the lesions. They may be parts of nerve fibers that fractured during a blast and deteriorated over time or they may be nerve fibers weakened by a blast that later fractured by an injury such as a concussion or drug overdose.

Our brains map our life histories, including blasts, drug abuse, fighting, and more. To figure out exactly what’s happening in these veterans, researchers probably need to study their brains at various times after a blast. In other words, how does a survivor’s brain look one week, one month, one year, or a few years after a blast?

Not only could a better understanding of these blast injuries finally solve the historical mystery of World War I shell shock, it could also lead to more effective treatments for our current veterans who are grappling with devastating symptoms today.

Show Me The Proof

Featured photo: Afghan National Army cadet training in Kabul, 2012.
The Independent: The mystery of shellshock solved: Scientists identify the unique brain injury caused by war
Johns Hopkins Medicine: Combat Veterans’ Brains Reveal Hidden Damage from IED Blasts
Mayo Clinic: Post-traumatic stress disorder (PTSD)