In "An Echo in the Bone," author Diana Gabaldon reflects on the psychological toll of warfare, using terms like "shell shock" from World War I and "battle fatigue" from World War II. These phrases encapsulate the intense stress and trauma experienced by soldiers who survive harrowing events that seem beyond human endurance.

The quote highlights the internal conflict faced by veterans, who struggle to cope with the reality of their survival despite the horrors they witnessed. It emphasizes how living through traumatic experiences can lead to deep emotional challenges as individuals attempt to reconcile their existence with the pain of their memories.