Constructive criticism from a collaborator is always welcome. Palmer is right to point out the importance of evacuation syndromes, although sadly no psychiatric casualty statistics are readily available from the Russo-Japanese war. He also properly points out the broader cultural environment in which psychological casualties are framed. However, the purpose of our paper was to suggest that these factors shape the expression of these disorders rather than their incidence, which is largely determined by battle intensity irrespective of place or period. This explains why rates may vary considerably in the same theatre of operations as we demonstrated (Jones & Wessely, 2001, Table 4). Although it is generally true that “winners get fewer psychological casualties”, this does not apply to Pyrrhic victories. Ultimately, the French defeated the Germans at Verdun in December 1916 but suffered greater casualties, many of which were treated in their newly established ‘neurological’ centres set up close to the front line (Roudebush, 1995).

We cannot accept that the term ‘fatigue’ was misused. In fact, the War Office report (1951) from which we quoted used both “exhaustion” and “ fatigue” to describe servicemen suffering from acute combat stress (War Office, 1951: 7). It is not true to say that all of these men were simply ‘war-weary’ as Palmer claims. A detailed analysis of 153 cases admitted to 30 corps's Exhaustion Centre in the week ending 18 June 1944 showed that 47 (30.7%) were recently enlisted replacements (Wishart, 1944). It is likely that these men had not been given adequate time to become fully assimilated in their units and, without the protection of group cohesion, rapidly broke down. Equally, UK reservists recalled to fight in Korea, who might be presumed to have been war weary, often recorded lower rates of cold injury (an index of morale) than their younger and less experienced counterparts (Watts, 1952).