It should be noted that what is often called “shell shock” is at least two distinct things that get lumped together (though they can absolutely co-occur). The

It should be noted that what is often called “shell shock” is at least two distinct things that get lumped together (though they can absolutely co-occur). The first is what we typically mean by “psychological” trauma, which can have physical secondary effects, but not reliably. Spending months being hunted is going to rewire some things. From what I’ve read, those who consistently imagine themselves “the hunter” rather than “the hunted” seem to fare better. The second is blast-induced neurotrauma, direct brain damage that blast waves physically cause. If a shell lands nearby, even if the head is fully protected, the wave can propagate up the spine into the skull. These force waves can then cause microshearing in the extremely fragile tissue there, resulting in inflammation and oxidation of the highly reactive polyunsaturated fats that make up our brains. The cascade of complex negative effects that follow only finally started getting proper attention due to the large number of IED injuries when the US invaded Iraq/Afganistan. Autopsies of those subjected to blast effects can often show a brain filled with nodules, either tiny like sand or much larger. This is the one that is really the cause of involuntary tremors and seizures that resulted in the brain damaged victim blamed for “cowardice”. The former can kinda-sorta be addressed. The later gets “hopes and prayers”.