Post-War Syndromes: Illustrating the Impact of the Social Psyche on Notions of Risk, Responsibility, Reason, and Remedy Charles C. Engel, Jr. Abstract: The 20th century offered many examples of post-war syndromes such as Da Costa’s syndrome, irritable heart, shell shock, effort syndrome, medical evacuation syndrome, post-traumatic stress disorder, and Gulf War syndrome. These post-war syndromes occur under conditions of substantial medical and scientific uncertainty, conditions that potentially magnify the impact of social context on clinical care for these syndromes. This article reviews the social circumstances surrounding four post- war syndromes. The case is made that social context has significantly impacted pro- fessional and lay perceptions of causal mediators, relevant risk factors, defining symp- toms, and appropriate therapies for these syndromes. Furthermore, it is argued that social context influences what parties are held responsible for post-war syndromes, and what clinical disciplines are ultimately deemed appropriate to provide legitimate post-war illness care. The unique context of the military offers many opportunities for examina- tion of the impact of social context on notions of disease, illness, and the practice of medicine. The purpose of this article is to use examples from the history of post-war syndromes to discuss and examine how social context in- fluences the way that we think about our patients and the illnesses that affect them. I will review the social, scientific, and clinical circumstances surround- ing four post-war syndromes and examine how these syndromes have shaped and been shaped by the social contexts in which they occur. I will refer to the social circumstances surrounding each syndrome as its “illness scenario.” Through these illness scenarios I will attempt to elaborate on how social con- text can affect societal, personal, and medical notions of risk, responsibility, Journal of The American Academy of Psychoanalysis and Dynamic Psychiatry, 32(2), 321–334, 2004 © 2004 The American Academy of Psychoanalysis and Dynamic Psychiatry Charles C. Engel, Jr., M.D., M.P.H., Associate Professor and Assistant Chair (Research), De- partment of Psychiatry, and Director, Deployment Health Clinical Center, F. Edward Hebert School of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD. Article presented at the 47th Annual Meeting of the American Academy of Psychoanalysis and Dynamic Psychiatry, San Francisco, California, May 16, 2003. All opinions expressed are the private views of the author and are not necessarily those of Walter Reed Army Medical Center, Uniformed Services University, the U.S. Army, Department of Defense, or the U.S. Government.