Proponents of the PIE and BICEPS principles argue that it leads to a reduction of long-term disability but opponents argue that combat stress reactions lead to long-term problems such as post-traumatic stress disorder. The use of psychiatric drugs to treat people with CSR has also attracted criticism, as some military psychiatrists have come to question the efficacy of such drugs on the long-term health of veterans. Concerns have been expressed as to the effect of pharmaceutical treatment on an already elevated substance abuse rate among former people with CSR.Recent research has caused an increasing number of scientists to believe that there may be a physical (i.e., neurocerebral damage) rather than psychological basis for blast trauma. As traumatic brain injury and combat stress reaction have very different causes yet result in similar neurologic symptoms, researchers emphasize the need for greater diagnostic care. See also
Acute stress disorder
Eye movement desensitization and reprocessing (modern treatment)
Lack of Moral Fibre
Shell shock
Social alienation – among returning war veterans

References
Further reading
West, Rebecca (1918). The Return of the Soldier. Garden City, NY: Garden City Pub. Co.
Woolf, Virginia (1925). Mrs Dalloway. Barker, Pat (1991). Regeneration. Dutton. ISBN 978-0525934271. Holden, Wendy (1998). Shell Shock. (Channel 4 Books). Grabenhorst, Georg (1928). Zero Hour. Roth, Joseph (1924). Die Rebellion. A Review on the Disarm Doctumentary
Corns, Cathryn and Hughes-Wilson, John (2001) Blindfold and Alone – British Military Executions in the Great War (Cassell)
Lamprecht, Friedhelm and Sack, Martin, "Posttraumatic Stress Disorder Revisited"
Dispatches: Lessons learned for Soldiers; Stress Injury and Operational Deployments, The Army Lessons Learned Centre, Canadian Forces Base Kingston, Vol.
John Appel found that the average American infantryman in Italy was "worn out" in 200 to 240 days and concluded that the American soldier "fights for his buddies or because his self respect wont let him quit". After several months in combat, the soldier lacked reasons to continue to fight because he had proven his bravery in battle and was no longer with most of the fellow soldiers he trained with. Appel helped implement a 180-day limit for soldiers in active combat and suggested that the war be made more meaningful, emphasizing their enemies plans to conquer the United States, encouraging soldiers to fight to prevent what they had seen happen in other countries happen to their families. Other psychiatrists believed that letters from home discouraged soldiers by increasing nostalgia and needlessly mentioning problems soldiers could not solve. William Menninger said after the war, "It might have been wise to have had a nation-wide educational course in letter writing to soldiers", and Edward Strecker criticized "moms" (as opposed to mothers) who, after failing to "wean" their sons, damaged morale through letters.Airmen flew far more often in the Southwest Pacific than in Europe, and although rest time in Australia was scheduled, there was no fixed number of missions that would produce transfer out of combat, as was the case in Europe. Coupled with the monotonous, hot, sickly environment, the result was bad morale that jaded veterans quickly passed along to newcomers. After a few months, epidemics of combat fatigue would drastically reduce the efficiency of units.