Social Psyche and Post-War Syndromes: Response to Commentary by Sheila Hafter Gray

Sheila Hafter Gray raises several points in response to my article entitled, “Post-War Syndromes: Illustrating the Impact of the Social Psyche on Notions of Risk, Responsibility, Reason, Responsibility, and Remedy.” I will focus on four of her central assertions: 1) key points of my article are based on biased historical interpretations; 2) there are self-serving inconsistencies in my interpretations of empirical evidence pertaining to the treatment of post-war syndromes; 3) dualism “haunts” this historical analysis of social determinants of post-war syndromes; and 4) the paper is short on psychodynamic or psychoanalytic wisdom. I will address these one at a time.

First, Gray notes that some of my key points are based on secondary rather than primary sources, and hints that these sources offer “biased” interpretations of history. Indeed, I reference several historical reviews that draw scholarly but subjective conclusions. However, it is inappropriate to characterize these reviews as biased. These mainstream scholarly works offer novel perspectives employing standard historical methods. From my perspective, having served as a psychiatrist in the military during both war and peace, these perspectives are at least as valid as the doctrine that military psychiatrists have long promoted. In fact, a range of valid perspectives is possible because of the high degree of uncertainty that exists when health concerns arise in the aftermath of war. This is perhaps the central point of my article and comes up again below.

Gray's second point is related to the first. She suggests, mistakenly I believe, that in the service of making my case I have applied inconsistent interpretations of scientific evidence. She notes that I criticize definitive statements proclaiming the efficacy of forward psychiatric treatment in wartime because no controlled clinical trials have been completed. (Note that Jones and Wessely [2003] arrived at the same conclusion in a recently published review of l