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It was not until World War I that specific clinical syndromes came to be associated with combat duty In prior wars it was assumed that such casualties were merely manifestations of poor discipline and cowardice However with the protracted artillery barrages commonplace during The Great War the concept evolved that the high air pressure of the exploding shells caused actual physiological damage precipitating the numerous symptoms that were subsequently labeled shell shock By the end of the war further evolution accounted for the syndrome being labeled a war neurosis Glass 1969 During the early years of World War II psychiatric casualties had increased some 300 percent when compared with World War I even though the preinduction psychiatric rejection rate was three to four times higher than World War I Figley 1978a At one point in the war the number of men being discharged from the service for psychiatric reasons exceeded the total number of men being newly drafted Tiffany and Allerton 1967 During the Korean War the approach to combat stress became even more pragmatic Due to the work of Albert Glass 1945 individual breakdowns in combat effectiveness were dealt with in a very situational manner Clinicians provided immediate onsite treatment to affected individuals always with the expectation that the combatant would return to duty as soon as possible The results were gratifying During World War II 23 percent of the evacuations were for psychiatric reasons But in Korea psychiatric evacuations dropped to only six percent Bourne 1970 It finally became clear that the situational stresses of the combatant were the primary factors leading to psychological casualty Surprisingly with American involvement in the Vietnam War psychological battlefield casualties evolved in a new direction What was expected from past war experiences -- and what was prepared for -- did not materialize Battlefield psychological breakdown was at an all-time low 12 per one thousand Bourne 1970 It was decided that use of preventative measured
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