From September 1990 to June 1991, the UK deployed 53,462 military personnel in the Gulf War. After the end of the conflict anecdotal reports of various disorders affecting troops who fought in the Gulf began to surface. This mysterious illness was given the name “Gulf War Syndrome” (GWS). This book is an investigation into this recently emergent illness, particularly relevant given ongoing UK deployments to Iraq, describing how the illness became a potent symbol for a plethora of issues, anxieties, and concerns. At present, the debate about GWS is polarized along two lines: there are those who think it is a unique, organic condition caused by Gulf War toxins and those who argue that it is probably a psychological condition that can be seen as part of a larger group of illnesses. Using the methods and perspective of anthropology, with its focus on nuances and subtleties, the author provides a new approach to understanding GWS, one that makes sense of the cultural circumstances, specific and general, which gave rise to the illness.

Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories-fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic-that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.

“Eddington’s book comes off as a well-written, well-documented account of what happens when a CIA employee rocks the boat. It raises concerns that go beyond Desert Storm, a fear that the CIA has given up its independence form the Pentagon.”—The Birmingham News, 7/13/97

Many individuals, groups, and federal agencies have a strong interest in finding answers to the numerous and complex questions regarding the health of Gulf War veterans. Various types of research and health measurement are needed to address these diverse issues. The Institute of Medicine (IOM) was asked by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) to undertake a study to identify important questions concerning the health of Gulf War veterans and then to design a study to answer those questions. The committee determined that it is of fundamental importance to ask how healthy are Gulf War veterans? Are they as healthy as others? What characteristics are associated with differences between the health of Gulf War veterans and the health of others? To address these questions, it will be necessary to measure not only the health status of those who served in the Gulf War, but also to compare Gulf War veterans with other groups. Further, one must continue to follow these groups through time to determine whether the groups differ in the way their health status is changing. As the committee began to develop a design that would address the fundamental questions identified, it realized that such a study could have important implications for understanding not only the health of Gulf War veterans, but also the health of veterans of other conflicts.

In January 1995 the Institute of Medicine released a preliminary report containing initial findings and recommendations on the federal government's response to reports by some veterans and their families that they were suffering from illnesses related to military service in the Persian Gulf War. The committee was asked to review the government's means of collecting and maintaining information for assessing the health consequences of military service and to recommend improvements and epidemiological studies if warranted. This new volume reflects an additional year of study by the committee and the full results of its three-year effort.

The application of psychiatry to war and terrorism is highly topical and a source of intense media interest. Shell Shock to PTSD explores the central issues involved in maintaining the mental health of the armed forces and treating those who succumb to the intense stress of combat. Drawing on historical records, recent findings and interviews with veterans and psychiatrists, Edgar Jones and Simon Wessely present a comprehensive analysis of the evolution of military psychiatry. The psychological disorders suffered by servicemen and women from 1900 to the present are discussed and related to contemporary medical priorities and health concerns. This book provides a thought-provoking evaluation of the history and practice of military psychiatry, and places its findings in the context of advancing medical knowledge and the developing technology of warfare. It will be of interest to practicing military psychiatrists and those studying psychiatry, military history, war studies or medical history.