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'Shell Shock'—The 100-Year Mystery May Now Be Solved

'Shell Shock'—The 100-Year Mystery May Now Be Solved

A research team in the United States may have solved a mystery that has haunted soldiers and veterans for more than a century: how blast force from battlefield explosions injures the human brain.

The findings, published Thursday in the medical journal the Lancet Neurology, reveal a unique and consistent pattern of damage in the autopsied brains of eight military service members who had served in Iraq, Afghanistan, and elsewhere in the Middle East.

All had suffered trauma after exposure to blast force on the battlefield, mostly from improvised explosive devices (IEDs)—the signature injury of recent campaigns, just as shell shock from exploding artillery shells had been the signature injury of World War I, a hundred years before.

In medical terminology, traumatic brain injury, or TBI, covers conditions that range from penetrating head wounds to blunt-force trauma typical of concussions.

But as the new study claims to demonstrate, the pattern of damage caused by exposure to blast force observed in the eight military personnel is distinct from that commonly observed in the brains of football players or boxers who have suffered blunt-force TBI.

Outside medical opinion has yet to weigh in on the findings. But Daniel Perl—a neuropathologist at the Uniformed Services University of the Health Sciences, in Bethesda, Maryland, who led the team behind the groundbreaking paper—said that when he realized that the lesion representing blast damage was distinctive, he knew it was the kind of once-in-a-lifetime breakthrough scientists dream of.

“What we found was a pattern of scarring that in 40 years of examining thousands of brains at autopsy I’ve never seen before and as far as I know is not described in any of the medical literature,” Perl said.

The implications of this finding are profound, pointing to the possibility that symptoms long thought to be psychological—ascribed to post-traumatic stress disorder (PTSD)—may instead be direct results of physical damage to the brain.

“It will mean reevaluating people we’ve labeled as having PTSD,” Perl said. “There’s nothing obvious in terms of treatment, but at least it suggests that one should not think about approaching the problem as a purely mental health problem.” It would mean reexamining such treatments as talk therapy and psychological medications.

The blast shock finding also opens up potentially fertile new ground for research: Can the injury be healed or even mitigated? What equipment can be designed to protect service members against blast damage to their brains? Can tests be devised to identify damage in combatants on the battlefield in real time?

And it raises a philosophical question for young men and women drawn to military service: If you know that exposure to a blast event—the signature mechanism of injury in modern warfare–may well irreparably damage your brain, will you still join up?

From the earliest years of the Iraq campaign, military personnel exposed to blast reported symptoms that included headache, sleeplessness, problems with memory and concentration, mood disorders such as anger and depression, and impulsiveness. Many of these symptoms are also characteristic of PTSD, which afflicts an estimated 11 to 20 percent of all veterans of the wars in Iraq and Afghanistan in any given year.

Medical practitioners therefore initially assumed the symptoms to be psychological. Furthermore, no routine imaging technology had succeeded in identifying any evidence of physical injury to the brain. But by the end of the first decade of this century, researchers had begun to recognize that while blast damage could not be seen, it was nonetheless real.

The U.S. Department of Defense estimates that some tens of thousands of U.S. veterans and military service members deployed in Iraq and Afghanistan have sustained traumatic brain injury as a result of exposure to a blast event. But given that exposures to blast events were not even logged in the early years of the campaigns, the figure may be much higher.

One of the brains that the team studied also showed signs of chronic traumatic encephalopathy (CTE), a neurodegenerative disease caused by the repetitive blunt-force trauma typical of concussions sustained in contact sports. Another showed features suggestive of an extremely early stage of the disease.

“CTE is not what these service members are suffering when they come home,” Perl said. “But this study suggests there are further concerns. They come home with the symptoms caused by the immediate damage—the blast injury—but down the line, in decades, many of these guys will also be hit with CTE.”

'Shell Shock'—The 100-Year Mystery May Now Be Solved

'Shell Shock'—The 100-Year Mystery May Now Be Solved

A wide array of research has attempted to discover the nature of blast injury. (See “The Invisible War on the Brain,” National Geographic, February 2015.) Efforts have included sophisticated studies of the physics of blast itself, as well as lab experiments conducted on animals, computer modeling of blast effects, and searches for biomarkers of blast exposure.

An explosion is a complex event that unleashes multiple mechanisms of injury. The primary blast effect is the shock wave, a balloon of rapidly expanding gases that compresses surrounding air and advances outward from the detonation faster than the speed of sound. This shock wave is what enters the brain, passing so rapidly that it has come and gone before the people hit have even had time to move their heads.

Just how a shock wave enters the brain is still not understood. Some believe entry is through the natural openings in the skull: the eye sockets, ears, nostrils, and mouth. Another theory is that since shock wave pressure hits the entire body, not just the head, it’s transmitted into the chest or abdominal cavities and surges to the brain by way of the body’s vasculature.

Once inside the skull, the wave advances through the brain at the speed of sound, passing through both fluids and matter, which respond differently to the wave’s properties. As the new paper reports, the distinctive pattern of scarring occurs precisely in those places where different compositions of brain tissue intersect.

'Shell Shock'—The 100-Year Mystery May Now Be Solved

In 2013 the Department of Defense established the Center for Neuroscience and Regenerative Medicine Brain Tissue Repository, under the direction of Perl, to pursue postmortem study of brains at the tissue level.

“Our microscopes have resolutions a thousand times greater than any imaging technology,” Perl said. “Autopsy is the gold standard for this kind of investigation.”

The eight brain specimens his team studied represented chronic cases, in which the person had lived at least six months after the blast event, as well as acute cases, in which death had followed within 60 days. “The acute cases are revealing,” Perl said. “The injury is only four days old, and yet we see the very beginning of the foundation of scars. And these early signs—these early scars—are in the right places, form the right pattern.”

Blast waves seem to cause damage at the boundaries of different structures, such as between brain matter and cerebrospinal fluids and between gray and white brain matter. That damage, Perl said, “is consistent with experiments that have modeled blast waves’ effects on the different substances forming the brain.”

More starkly revealing than any words are the brain images that illustrate what Perl describes. Panels show brain tissue, as delicate as butterfly wings, spatter-marked as if with buckshot, bearing outright tears surrounded by broken tendrils of scarring or dark clouds of damage looming from the folds and furrows.

This blast damage reaches its spider legs into different regions of the brain: the frontal lobe, which controls attention span and emotional control; the hypothalamus, which regulates sleep; the hippocampus, responsible for the formation of memories. The symptoms resulting from damage to these areas are exactly the kinds of symptoms often attributed to PTSD.

What the Eight Men Endured

Emerging from the welter of medical data are details about the lives of the men who make up the research study. They had all been exposed to bombs, IEDs, and high explosives, and they had lived from as long as nine years after blast exposure to as little as four days. They ranged in age from 26 to 45 at the time of death. They had endured headaches, anxiety, depression, insomnia, memory and concentration problems, seizures, and chronic pain.

One was a Navy SEAL who conducted explosives training exercises and lost his coherence of thought; he began to jumble his speech and became overwhelmed by such routine tasks as driving or even packing a car.

Three of the men had acute brain injury and died shortly after exposure to the explosion, suffering burns, fractures, and hemorrhage. Four of the remaining five men who had chronic blast-induced brain injury died by suicide or from drug overdoses. The cause of death of the eighth service member was not determined.

In December 2015, Congress passed a bill mandating the Department of Defense and the Department of Veterans Affairs to examine the effects of combat service “on suicides and other mental health issues among veterans.”

The new paper may add to mounting evidence that destructive behaviors, including suicide, are outcomes directed by damaged regions of the brain—as symptomatic of blast damage as such common conditions as sleeplessness and ringing in the ears.
Déjà Vu

A century ago, in February 1915, the Lancet, the parent journal of the Lancet Neurology, published the first medical case study of shell shock in World War I. In the war’s aftermath, medical judgment held that thousands upon thousands of shell-shocked men were “neurasthenic” or subject to “neuroses.”

These mostly young veterans suffered through their lives in the belief that they had lost their nerve on the field of battle—in short, that they had failed. From the British government Ministry of Pensions files we can catch occasional glimpses of their postwar fates.

One case: a shell-shocked soldier who’d spent 118 days in the hospital being treated for loss of speech, inability to sleep, and loss of memory and concentration—and had been returned to active duty. Case notes made after the war remark on his complaints about “general weakness” and tremors in his hands. It is noted that his mental development is poor, and his answers to questions are “vague and contradictory.” Then, like so many others, he slips from history’s sight.

“We can’t let this happen again,” Daniel Perl said. “This study will certainly stimulate important further research and, we predict, will dramatically change how we think about these problems.”

Beyond the specifically medical questions, the finding raises a number of issues, such as care costs many years into the future and whether those diagnosed with TBI should be awarded the Purple Heart.

“People that have seen the paper are very excited about it. Blast people working on military TBI are very excited,” Perl said. “Then they start asking questions: How large a dose of blast is damaging? Are multiple small exposures doing this? How common is this?—I have a feeling this is pretty common. Can you see it by imaging? And so far the answer to all of these is, we don’t know.”

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Diubah oleh: stuka1788
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jadi.....kerusakan fisik yg terjadi disini adalah kerusakan pada otak, yang dampaknya juga adalah kerusakan mental bagi penderita ybs
apa artinya akan ada perubahan desain thdp gear yg dipakai oleh tentara, sehingga perubahan tsb dapat meminimalisir dampak shockwave ke otak?
sepertinya memang anxiety ditimbulkan oleh luka/trauma, mungkin selain gear, diperlukan terapi tambahan seperti pengobatan anti anxiety. IMHO
summon dr. izza nih...
ke 2 nya bisa jadi punya sumbangsih.

Philocrates, adalah salah 1 drama Yunani kuno (450 BC) ditulis oleh Sophocles. yang bercerita tentang War Hero yang Depresi, tiba2 terbangun dan berteriak teriak dari tidur.
Depresi berat, kehilangan kontrol dan Emosi membuat si Pahlawan di kuclikan dari Rekan2 sejawatnya. tangisan dan ratapan Istri dan anaknya yang memerlukan kehadiranya sebagai suami dan ayah. tak mampu mengobati luka mental dari si pahlawan.

Diaakhirnya bunuh diri karena tidak kuat, dengan menjatuhkan diri ke hunusan pedangnya sendiri. "falling upon one's sword". adalah phrase yg akhirnya menjadi populer.

itu satu dari kisah/deskripsi PTSD di Era Ancient. jauh sebelum gunpowder.
Bahkan kalau kita meneliti lebih jauh, banyak cerita2 dimana si Pahlawan menjadi "Gila" / "Black out" sesudah kembali dari medan perang. sebut saja La Morte d'Artur, Ajax atou bahkan kutipan2 d shakespare

sedikit Trivia, Ketika Heracles / Herkules pulang dari Perang, dia menjadi gelap mata dan membunuh Istri serta anaknya sendiri. Tentu kalau legenda dipercaya itu semua gara2 kutukan Hera, tapi beberapa peneliti mempercayai bahwa Herkules menderita PTSD, dan kehilangan kontrol diri karena trauma perang emoticon-Ngacir
Make sense sih, krn bbrp pemain American football yg bermain di posisi yg mengharuskan dia men-tackle/hantam pemain lawan vice versa, most of them are having CTE


tentu. tapi pertama dipelajari dulu gmana sebenarnya terjadi. apakah karena aliran shockwave ke arah rongga2 mata, hidung, mulut ataukah karena getaran dari badan yang lalu secara internal disalurkan oleh tulang belakang ke arah otak.


nggak harus dari ledakan. blunt force trauma pun tampaknya bisa, helm tanpa padding yang cukup bisa menyebabkan hasil yang sama. seperti tinju disebutkan dalam artikel.
tentang CTE dah dibuatin film nya barusan nonton ... Intinya agak sama sih gangguan mental yg awalnya di anggap bukan penyakit fisik ternyata justru di pengaruhi aktifitas fisik

Concusion bisa berkontribusi tapi bukan berarti itu sama dengan PTSD.

dan mengenai cerita ancient greece. kalo sampeyan sedikit banyak tahu perang di ancient greece.
itu Hoplites berperang pake formasi Phalanx, Shield + Spear.
Mengayunkan Tombak sepanjang 2 meter lebih ke kepala orang jauh lebih susah daripada nusuk emoticon-Ngacir

either way, Blunt weapon baru populer setelah steel armor menjadi hal umum. di eropa sendiri kebanyakan yg pakai dari order warrior monk, atau penganut kristen yang rada fanatik. diluar itu Tombak adalah senjata plg dominan
karena dulu adalah haram bagi mereka2 untuk megunakan senjata yang bisa membuat musuh berdarah (tapi OK, untuk bikin tengkorak musuhnya remuk - what a sick thought lol)

catatan tertua tentang PTSD dari kerajaan Assyria 3200 tahun lalu
“If in the evening, he sees either a living person or a dead person or someone known to him or someone not known to him or anybody or anything and becomes afraid; he turns around but, like one who has [been hexed with?] rancid oil, his mouth is seized so that he is unable to cry out to one who sleeps next to him, ‘hand’ of ghost......."

Dihantui arwah yang dia bunuh/ rekan yg terbunuh...... - yah ampe sekarang sindromnya sama
oh dan Assyria salah 1 kerajaan yang Gemar berperang, dan setiap Penduduk dirotasi di berbagai military campaign melalui wajib militer selama 1 tahun, setiap 3 tahun sekali.
Ada banyak teks medis dan catatan mengenai PTSD, tapi tentunya obatnya kebanyakan Talisman dan jimat untuk ngusir setan yg enghantui si pasien + obat sakit kepala
Diubah oleh humus
tubuh manusia terbagi 2 yaitu tubuh fisik dan tubuh jiwa. jadi dampak suatu pertempuran bisa mempengaruhi fisik dan jiwa seseorang. apabila kerusakannya di otak seperti pembahasan artikel, dunia medis menyebutnya PTSD karna kerusakan otak organik sedangkan apabila otak tidak mengalami kerusakan tapi terdampak pada jiwa berarti terdapat gannguan jiwa non organik yang bisa berupa neurosa anxietas maupun sampai psikosis.

tampaknya yang dimaksud artikel adalah PTSD karna kerusakan otak organik.

Agree....untuk kasus shell shock...karena adanya cacat atau kelainan pada jatingan otak bisa membuat seseorang berhalusinasi, terlebih dengan perawatan yang salah....

Hanya saja PTSD tidak hnya disebabkan oleh shell shock saja



Iya, artikel ini lebih membahas tentang tumbukan yg diterima tubuh yg berefek samping pada rusaknya bbrp bagian di dalam otak yg mengakibatkan munculnya gejala2 disorder seperti halusinasi, mood swing etc..

Kalau gangguan jiwa karena deraan psikologis yg berulang, apalagi ke pribadi yg mungkin batas ambang-terima agak rendah, itu hal lain yg menarik dan bisa dibahas disini..


ah, betul. memang gak bermaksud bilang semua PTSD itu karena cedera fisik di jaringan otak. tapi ternyata sebagian yang dikategorikan PTSD ternyata disebabkan oleh cedera fisik dan bukan mental disorder. terutama yang kategori shell shock. untuk yang memang mentalnya terganggu karena kebiadaban perang atau kehilangan teman, tentu jenisnya mental.

blunt force trauma itu justru paling tua dalam peradaban manusia. sebelum senjata tajam, manusia prasejarah menggunakan batu dan pentungan. seperti hercules yang pakai pentungan/ club sebagai senjata.

'Shell Shock'—The 100-Year Mystery May Now Be Solved

atau slinger yang selalu menemani pasukan hoplite yunani kuno dan populer sampai dipakai oleh romawi. soal efektif, ada kisah Daud dan Goliath yang populer. ada dokumenter yang bilang kalau prajurit yunani memprioritaskan helm sebelum body armor. karena cedera kepala sangat lumrah terjadi, karena itu ada kebutuhan untuk melindungi kepala sebelum tubuh. tokh untuk tubuh ada perisai.

'Shell Shock'—The 100-Year Mystery May Now Be Solved

kalau dikira kena kepala itu susah, ya raja sekelas philip II macedon bapaknya alexander saja kena panah di mata. emoticon-Big Grin

Beda kali pin, antara Senjata yg umum dipakai sama tertua.

Slinger ato mungkin lebih dikenala sebagai Skirmisher, jumlahnya relatip sedikit.
karena prajurit mengunakan ketapel jauh lebih sulit dilatih daripada archer. jika untuk menjadi archer butuh tahunan, Slinger baru bisa dibilank proficient kalo emang dilatih dari bocah.
Specialized infantry itu mah pin

macem Hannibal di 2nd punic war dr 700.000 Prajurit, cuman 1000 orang yang pake Sling
Trus gimana dgn mereka yg tidak terjun dalam pertempuran, tapi tiap hari lihat temennya banjir darah. Banyak juga yg kena PTSD

betul. tapi pada masa sebelumnya slinger itu sangat umum. soal efektif tidaknya, pernah ada barisan hoplite sparta yang di ambush oleh skirmisher dan berantakan. lalu juga diketahui kalau triremes yunani dipersenjatai dengan amunisi batu untuk para pendayung agar bisa bantu nembak infantri lawan.

infantri romawi sendiri punya mini darts dengan pemberat yang fungsinya kurang lebih mirip walaupun akurasinya kurang. demikian pula di berbagai kebudayaan blunt weaponry itu sudah ada sejak lama. seperti contohnya mahabarata punya gada.


sebenarnya yang jadi case ini seperti pict yang di bawah ini:

'Shell Shock'—The 100-Year Mystery May Now Be Solved

remember, patton slap?

yup. seringkali pasien shellshock dianggap sebagai pengecut, penyakit kehilangan nyali. lalu kemudian di masa modern dianggap sebagai gangguan mental dan hanya butuh diterapi. ternyata memang jaringan otaknya secara fisik luka sehingga terapi saja tidak cukup.

bukan berarti PTSD karena mental semata tidak ada. PTSD karena mental tetap ada. hanya saja nanti ada diagnosa baru terutama kepada korban ledakan atau blunt force trauma karena diketahui ada kemungkinan besar jaringan otak mereka mengalami luka. kalau sudah begitu jalur pengobatan dan penanganannya sudah berbeda. karena konseling semata tidak bisa mengobati luka di jaringan otak.

penemuan ini juga sedikit banyak nantinya akan merubah metode pertempuran karena diketahui kalau ledakan ternyata bisa membuat cacat permanen di otak walaupun tidak menimbulkan luka luar yang serius. terutama regu penjinak bom, walaupun mobil ranpur nya anti ranjau dan crew di dalamnya selamat, tetapi jaringan otaknya belum tentu bebas gangguan.
Klo ngebaca postingan sampeyan, yg dianggap PTSD itu krn pengaruh shellshock, gempuran dll emoticon-Stick Out Tongue
Sementara pengaruh mental nga dibahas emoticon-Big Grin

Berbeda antara Umum digunakan dengan Main Arms.
Sidearms macam pistol juga umum dijumpai di masa sekarang, tapi korban tewas di medan perang akibat senjata jenis pistol juga jarang dijumpai karena penggunaanya terbatas

Pertempuran skala kecil, mungkin sering dijumpai. hence the name Skirmisher from Skirmish
tapi pada dasarnya Sling hampir tidak pernah terpakai dalam Massed Infantry Formation yang umum dijumpai dalam perang besar,

unit auxiliary macem cavalary melibas skirmisher seperti mentega. apalagi mounted archer dengan composite bow yang punya reach + mobility. or maybe the famous asyrian war chairot.
Infact, skirmisher lebih rentan daripada Infantry kalo urusan menghadapi kavaleri, karena Skirmisher mengorbankan armor supaya lebih cepet dari Armored Infantry. tapi Usain Bolt pun kalah cepet sama kuda

Sebelum era roman dan Greek. Kavaleri merajai Medan pertempuran.
Oleh karena itu meskipun setiap pihak sudah umum mengenal Sling, pengunaanya tetap terbatas. dan Sangat sulit untuk mahir menangani Sling karena itu biasanya Army hanya sebatas mengHire Mercenery dari bangsa tertentu yang spesialis mengunakan sling di medan tempur.

Javelin bahkan lebih populer dari Sling, karena Tombak yang nyangkut di perisai. kadang mengangu gerakan prajurit. tak jarang perlu dibuang oleh si prajurit, yang akhirnya menjadi titik lemah dari formasi musuh.
Sling is a special weapon, that have spesific purpose rather than outright kill afterall
Berbicara mengenai Sling dan kenapa banyak dipakai pada era lalu, ternyata proses membuatnya sangat-sangat mudah, dan cukup efektif dalam menyerang musuh dari jarak jauh ( namun cara memakainya yang susah, salah lempar bisa-bisa kena kepala sendiri / kepala teman ).

Bayangkan kalau target itu adalah kepala kita terkena projectile sling tersebut


true, lebih baik di edit sedikit.

biasanya ane copas saja source nya tapi itu panjang sekali jadi ane singkat.
bahasan trit ini jadi melantur kemana-mana..ampe bahas blunt trauma dan perang era lalu segala
menurut gua ada miskonsepsi dari judul trit dan bahasan pembuka TS om hannepin

PTSD itu bukan sinonim dari shell shock
Post Traumatic Stress Disorder itu kumpulan gejala (sindroma) yang berhubungan dengan exposure kejadian psikologis traumatik yang berkepanjangan/berulang..dia gak spesifik untuk korban perang aja..ada orang yang mengalami PTSD karena pernah dikejut listrik berulang2, ada yang PTSD karena pemerkosaan..PTSD itu terjadi setelah kejadian yang traumatik secara psikologis
sedangkan ,
"shell shock" itu fenomena yang baru ditemukan pada Perang Dunia Pertama ketika bombardment artileri dan peledak dipakai secara masif (hence the term, "shell").. dia ditemukan hanya di tentara..dia spesifik untuk peperangan..dan spesifik disebabkan guncangan dan shockwave ledakan (sebelum WW1 shell shock ini belum pernah ditemukan).. gejalanya diantaranya bengong (thousand yard stare) dan tremor..
di artikel disebut shell shock itu menyerupai PTSD, atau menyerupai gugus gejala sindroma PTSD, karena gejalanya mirip..tapi gak pernah disebut shell shock = PTSD

awalnya shell shock itu diduga murni masalah psikologis
ternyata penemuan terbaru ada gangguan otak organik yang spesifik berhubungan dengan shell shock ini
sehingga paradigma rehabilitasi-nya pun akan berubah..dahulu diobati dengan cara-cara psikiatrika seperti konseling dan penggunaan anti depressan..
sekarang harus diobati problema physical-nya juga
metode prevensinya pun akan berubah, bukan dengan penguatan mental, tapi mencegah kerusakan struktur otak
Diubah oleh mengkom
PTSD paling ngeri nonton dokumenter WW 1, ada yg meraung2,ada yg ketawa2 sendiri,

nyerbu bareng2 ke parit musuh sambil di terjang artileri dan machine gun, pas nyampe parit cuma sendiri doang. ga kebayang deh.
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