Persistent Stress Reaction After Combat

I. DURING WORLD War II and shortly afterward, the problem of "combat fatigue," or gross stress reaction was studied intensively. Lewis and Engle'sWartime Psychiatry, published in 1954, reviewed 1,166 articles by 1,431 authors. In this massive literature there was some disagreement as to whether or not the combat fatigue syndrome should be differentiated from psychoneurosis, but nearly all investigators concurred in viewing it as a transient state. The Gray Manual, published in 19521and representing the consensus at that time, listed five diagnostic criteria: (1) unusual stress; (2) previous normal personality; (3) reversibility; (4) possible progress to one of the neurotic reactions; (5) if persistent reaction, "this term is to be regarded as a temporary diagnosis to be used only until a more definite diagnosis is established" (reference 1, p 40). However, there was no provision or official name for the persistence