Commentary on “Post-War Syndromes: Illustrating the Impact of the Social Psyche on Notions of Risk, Responsibility, Reason, and Remedy,” by Charles C. Engel, Jr.

Charles Engel is a psychiatrist to soldiers and has first-hand knowledge of the nature of war. He offers an argument for the notion that postwar syndromes are as much social as they are medical. His presentation is driven as much by the emotional aspects of military medicine as it is by the science. The author selects from the vast literature on postwar syndromes items that strengthen his argument. Psychodynamic contributions are strikingly underrepresented, perhaps because the author is a participant in a movement he describes as the “paradigmatic shift … away from psychoanalysis and toward empirically defined disorders …” as is anything written before the year 1991. The important publications of people who attended WWII and Vietnam veterans are noted only through secondary sources, some of which seem biased. The rich contributions derived from a century of clinical observation are lost. Some readers of this Journal may wonder whether an approach that negates the past can offer anything useful for the future. They might note that it is cogent; and that it provokes reflection. Others may be challenged to translate the author's comments into the—for us—more familiar language of psychodynamic theory to see whether his argument is as persuasive in that language as it appears on the surface.

The notion that to be scientific one must draw a dichotomy between the medical (biological) and the psychosocial causative factors of post-battle syndromes haunts this work. It reflects the perspective of 19th century German medicine which was caught up in its scientific prowess and tended