This puzzling paradox―a concussion-like syndrome in the absence of documentable head trauma―challenged the explanatory powers of contemporary medicine, particularly in an era when no tools were available to explore the living brain non-invasively. Ultimately this paradox led to the introduction of a distinction between a neurasthenic/emotional/“nervous” condition and a more

physically based one caused by a specific explosion exposure. During subsequent years multiple scholarly attempts were made to determine whether these two conditions Inhibitors,research,lifescience,medical represented discrete disorders or syndromes and whether clear boundaries could be set to distinguish between them.3-6 This debate was paralleled by the rise of two competing traditions within neuropsychiatry: biological vs psychodynamic explanations for the development of disorders. Within the biological tradition one important perspective Inhibitors,research,lifescience,medical (particularly relevant to the etiological debate and remarkably prescient of future developments) was presented Inhibitors,research,lifescience,medical by Selye, who coined the term “stress” and hypothesized that it was mediated by the hypothalamic-pituitary-adrenal (HPA) axis.7 He described the General Adaptation Syndrome as a response to stress and considered

the traumatic neuroses to be a consequence of chronic or severe stress. Walter Cannon also proposed a related physiological basis for fear responses in his description of the “fight or flight” syndrome.8 A second important perspective was provided Inhibitors,research,lifescience,medical by the psychodynamic tradition, which developed an extensive explanatory system that could account

for the role of psychological factors in producing symptoms and in developing both healthy and unhealthy coping mechanisms.9 Inhibitors,research,lifescience,medical This debate, and the perspectives provided by the competing traditions, had a significant impact on policy Cell press decisions. This distinction was invoked in making decisions about the grounds for determining disability both during and after combat, and it was also significant for determining JAK inhibitor criteria for awarding pensions.6,10,11 Veterans from World War I were eligible for pensions as a consequence of suffering from shell shock, but concerns were raised about the large number of recipients and the possibility of malingering. As World War II loomed in the future and then occurred, British policy created strict criteria for recognizing and awarding disabilities secondary to shell shock/stress/neurasthenia―all in the direction of minimizing or eliminating any rewards for disabilities considered to be psychogenic.10 After the end of World War II.