More than 30 centuries ago, long before even the written word Homer talked about combat stress in his epic poems on the Trojan War. 

During the Civil War soldiers were removed from the front and considered for disability and pensions for Soldiers Heart or “nostalgia”, but in reality combat stress during that time was considered a form of insanity.

By 1914, at the outbreak of World War I, combat stress and its civilian counterpart, “railway spine” had actually risen to the position of being considered physical ailments that deserved medical treatment. 

By the summer of 1916, the brutal trench warfare on the Western Front had produced an epidemic of shell shock among French and British troops, and “nervenshock” among Germans troops which was draining the treasuries and manpower pools on both sides. To address this crisis, Kaiser Wilhelm directed the German Association of Psychiatry to convene a special War Congress.

 After briefly discussing the evidence, these leading psychiatrists of their day settled the debate by declaring –“Persistent distress or functional impairment following exposure to a traumatic stressor could only occur in individuals already afflicted with the pre-existing personality weakness that they termed hysteria”.

Subsequently, the German government was relieved of its responsibility to pay disability pensions to veterans sufferingfrom combat stress, while commanders in the field were no longer obligated to evacuate stress casualties from the front.

The term “hysteria” was never intended to be a neutral label. It was chosen to be intentionally stigmatizing, especially when applied to male service members who understood it to be a feminizing term. 

The French and English and later the Americans also adopted the doctrine. The term shell shock was dropped and there was a drastic reduction in the evacuation of stress casualties along with the responsibilities of paying compensation fees.  

As a result of these new tenets the rates of wartime psychiatric evacuations during the 20th century fell to approximately 10% in WWII, 3.7% in the Korean War and barely 1.2% in Vietnam.

September 2014

Tom Mahany started a hunger strike on Veterans Day 2009 lasting 29 days to draw attention to the issue of combat stress and related suicide. He fasted again in August of 2012, this time for 17 days, when he learned that the number of suicides among active duty service members had doubled from June to July.

Now Mahany heads up the veterans’ advocacy group Honor for ALL, which organizes an annual event, Visible Honor for Invisible Wounds, to raise awareness of posttraumatic stress injury.

This year’s event recognized the passing of legislation introduced by U.S. Senator Heidi Heitkamp designating June 2014 as National Posttraumatic Stress Disorder Awareness Month. JB Moore, NAMI Manager for Military and Veterans Policy and Support, represented NAMI at the event.

Though usually held in Washington, D.C., Visible Honor for Invisible Wounds took place in New York City on Saturday, June 28, 2014 and was co-hosted by the Mental Health Association of New York City. The scope of the program was expanded to include first responders and victims of abuse.

The keynote speaker Staff Sergeant Ty Carter, who has struggled with PTSD, was the 2013 recipient of the Congressional Medal of Honor. When awarding the Medal of Honor, President Obama described SSgt. Carter this way, “He’s as tough as they come. And if he can find the courage and the strength to not only seek help, but also to speak out about it, to take care of himself and to stay strong, then so can you.”

In addition to SSgt. Carter, officials included commissioners from the New York City police and fire departments, representatives from the Chiefs of Staff of the Army and Navy; the Wounded Warrior Project; Iraq Afghanistan Veterans of America (IAVA); Service Women’s Action Network.

“It is reprehensible that an estimated 22 veterans take their lives each day”, declared JB in her remarks.  “Posttraumatic stress is treatable. Let’s eradicate stigma!”

According to Mahany, “There was an unmistakable message from the event. Posttraumatic stress is an injury that needs to be accepted and honored as such. If we don’t attend to it, it will be allowed to progress into a disorder.”

Earlier this year, the Senate Armed Services Committee passed the Jacob Sexton Military Suicide Prevention Act of 2014 – introduced by U.S. Senator Joe Donnelly (D-Ind.), as part of this year’s National Defense Authorization (NDAA) bill.  If passed, this legislation will: (1) Require annual mental health assessments for all service members-Active, Reserve, and Guard; (2) Establish a working group between the Department of Defense and Department of Health and Human Services; and (3) Require an interagency report to evaluate existing military mental health practices and provide recommendations for improvement.

According to Mary Giliberti, NAMI’s Executive Director, “The National Alliance on Mental Illness strongly supports the Jacob Sexton Military Suicide Prevention Act of 2014 and applauds Senator Donnelly for his recognition that suicide rates among active duty service members, National Guardsmen and Reservists are unacceptably high and in dire need of attention.  This important piece of legislation advances NAMI’s goals of parity, accountability, collaboration and action.”

Honor for ALL is already at work organizing next year’s National Posttraumatic Stress Awareness activities. Events will be held in New York, Michigan, San Diego, and Indianapolis, all on Saturday June 27, 2015.

Tom Mahany believes the sure sign of true awareness about posttraumatic stress will be when Major League Baseball plays with purple bats for the month of June


   February 12, 2013                       

Jonathan Woodson, Department of Defense

Robert Pretzel, Department of Veterans Administration

Pamela Hyde, Department of Health and Human Services

Cate Miller, Department of Education

Rosye Cloud, Director of Policy for Veterans, Wounded Warriors and Military Families

and all Members of the Federal Interagency Task Force on Improving the Mental Health of Veteran Service Members and Military Families:

We respectfully ask that you consider the following recommendations for inclusion in your report to the President:

  1. Expand and coordinate research;

One Mind for Research is now developing the Brain Data Exchange Portal to enable comparable results in advancing the science brain function, illness and injury.

  • We ask the Task Force and the Administration direct the Department of Education to develop new policies providing incentives for academic and governmental analysts to collaborate on mental health research.
  • We ask the Task Force and the Administration direct to all relevant agencies to contribute to the Brain Data Exchange Portal.
  • Embrace and educate the public sector;

The Veterans Administration’s Make the Connection campaign and of the Department of Defense’s Real Warrior campaign are primary examples of working ant-stigma programs, but still targeted principally toward the military and veterans. There is no current parallel messaging campaign aimed at the remaining 90-plus percent of the population.

  • We ask that the Task Force and the Administration establish, or otherwise procure through a professional public relations firm, a campaign targeting the general public to include: local and national awareness functions; volunteer walk/run events; benefit concerts; participation of professional sports; and celebrity public service announcements.
  • Invest in education of our youth;

Paramount to the permanent elimination of the stigma of invisible wounds and illnesses is the education of our youth during their formative years, before prejudices develop.

  • We ask that the Task Force and the Administration direct the Department of Education to develop accredited syllabuses for the formal instruction of our youth on the subject of invisible wounds and illnesses. Social stigma, self-stigma, bullying, revenge and obliteration are all topics which need to be included in such instruction.
  • Invest in continued education of primary care providers;

Many veterans and families at risk first look to their primary care providers for help with invisible wounds.  We should insure that these providers are equipped with the best possible knowledge available

  • We ask that the Task Force and the Administration direct the appropriate agency to develop an accredited syllabus for the continued education of primary care providers on the symptoms of mental health issues, and the eligibility and availability of mental health resources in their area.
  • Qualify invisible wounds for entitlement of the Purple Heart.

Originally conceived by George Washington, then called the Badge of Military Merit, The Purple Heart is now a sacred entitlement meant to distinguish and help mend those who have been wounded in defense of the nation. To continue to deny the Purple Heart for invisible wounds is to continue to deny the reality of these wounds. We are in fact excluding those who most disparately need inclusion. Bestowal of the Purple Heart is the singularly most effective means we now have at our disposal to immediately carve away at the social stigma, and more importantly, the self-stigma of invisible wounds.

  • We ask that the discussions left unfinished in 2009 on the award of the Purple Heart to ALL those wounded in battle immediately be continued.
  • We ask the Task Force to endorse the changing of the name, in the Diagnostic and Statistics Manual, fifth Edition (DSM V), of the diagnosis Post-traumatic Stress Disorder to Post-traumatic Stress Injury.