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Psychiatric Casualties (Military History)

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  1. Introduction
  2.  
  3. Most readers from the United States, Britain, and many other countries who have yet to investigate the extensive literature on the topic of psychiatric casualties will no doubt remember the scene in the motion picture Patton (1970), in which George C. Scott’s character, General George Patton, strikes a soldier who is not physically wounded but who had broken down emotionally in combat. Patton actually struck two soldiers in Sicily, in August 1943, about a week apart, and the resulting controversy threatened his career. The so-called slapping incidents are a useful introductory window through which to view this topic, for they demonstrate, first, that the long-held, deeply entrenched, traditional view of psychiatric breakdown in combat as solely a “lack of character” issue had not died out as late as 1943 (this despite the experience of World War I) and, second, that even beforehand (witness the controversy), views were indeed changing and becoming more tolerant. Cowardice and fraudulent behavior on the battlefield do happen, but they do not explain all or even most cases of mental breakdown.
  4.  
  5. Introductory Works
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  7. D’Este 1996 is an excellent biography of the controversial general and also the best secondary source on his problems in Sicily. The Official Website of George S. Patton, Jr. has valuable primary material in addition to that on the slapping incidents.
  8.  
  9. D’Este, Carlo. A Genius for War: A Life of General George S. Patton. New York: Harper Perennial, 1996.
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  11. Contains the most complete discussion of the slapping incidents (pp. 521–546).
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  13. The Official Website of George S. Patton, Jr.
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  15. Includes both doctors’ reports detailing the slapping incidents. Also here is President Dwight D. Eisenhower’s letter of reprimand to Patton.
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  17. General Overviews
  18.  
  19. Recognizing that psychiatric breakdown has existed as long as war itself, the best overviews discuss the early pre-1914 history of this subject before analyzing the 20th-century experience. They also break down the various kinds of war neuroses and discuss the evolving attitudes of medical and military establishments toward causation and treatment. Gabriel 1987 (cited under Definitions) and Binneveld 1997 earn the distinction of best in this class even though Gabriel’s preoccupation with the coming of a NATO–Warsaw Pact clash—as well as his thesis that psychiatric breakdown will make war obsolete—seriously date his project. The sources that follow are close runners-up to these two works, but most do not discuss the pre-1914 period adequately (Holden 1998, Jones and Wessely 2005, Shephard 2001), are limited to one country (Alpert and Kent 2011), or focus primarily on World War I (Babington 1997). Readers may want to begin online, with Jayatunge 2010, for a good, brief overview covering earliest times to the present.
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  21. Alpert, Jon, and Ellen Goosenberg Kent, dirs. Wartorn 1861–2010, 2010. DVD. Burbank, CA: Home Box Office, 2011.
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  23. Excellent documentary overview that covers a wide swath of US history and features many interviews with veterans of World War II, Korea, Vietnam, Iraq, and Afghanistan, but is limited to the American experience.
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  25. Babington, Anthony. Shell-Shock: A History of the Changing Attitudes to War Neuroses. London: Leo Cooper, 1997.
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  27. Very strong on pre-1914 attitudes, which mainly regarded mental breakdown in battle as cowardice. Rightly regards World War I, the book’s primary focus, as a turning point. Thin on the rest of the century.
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  29. Binneveld, Hans. From Shell Shock to Combat Stress: A Comparative History of Military Psychiatry. Translated by John O’Kane. Amsterdam: Amsterdam University Press, 1997.
  30. DOI: 10.5117/9789053562703Save Citation »Export Citation »E-mail Citation »
  31. Part 1 analyzes the military developments after 1600 that produced increasing numbers of “psychologically wounded soldiers” and set the stage for the emergence of modern military psychiatry in the wars of the 20th century, the focus of Part 2.
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  33. Holden, Wendy. Shell Shock: The Psychological Impact of War. London: Channel 4 Books, 1998.
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  35. The best written of this class. Thin on pre-1914, but an excellent discussion of the 20th century, from World War I to the Gulf War and the United Nations peacekeeping effort in Bosnia. Charts the change by military establishments from seeing breakdown as cowardice to a growing awareness of the psychological fragility of men in combat.
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  37. Jayatunge, Ruwan M. The Psychophysical Effects of Combat from the Ancient Times to Modern Day. LankaWeb. 2010.
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  39. Along with Jayatunge’s History of PTSD (2011), also on LankaWeb, provides sweeping historical coverage of this subject. A brief but good springboard to the other overviews.
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  41. Jones, Edgar, and Simon Wessely. Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War. Maudsley Monographs 47. Hove, UK, and New York: Psychology Press, 2005.
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  43. Excellent survey of the 20th-century experience. Opening chapter also includes brief but valuable material on the Crimean War, the Boer War, the Russo-Japanese War, and the Balkan Wars. Heavily jargonized style may present problems to readers untrained in psychiatry.
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  45. Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century. Cambridge, MA: Harvard University Press, 2001.
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  47. Widely considered to be the standard work on the topic, although it is the best overview of only the 20th century because it glosses over the pre-1914 period.
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  49. Definitions
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  51. Psychiatric casualties, also known as shell shock, war neuroses, combat reactions, and neuropsychiatric (NP) disorders, are mostly nonphysiological debilitations brought on by battle or the fearful anticipation of battle, psychiatric conditions that reduce or completely eliminate a soldier’s fighting effectiveness (Gabriel 1987). The studies in this section describe the nature of the various kinds of psychiatric casualties. One of the most common is nostalgia (Rosen 1975), which the Germans called Heimweh (“homesickness”), whereby a combatant simply stops fighting, eating, and following orders and just wants to go home. There are also two categories of battlefield shock: (1) acute battle shock, or combat shock, and (2) gradual battle shock, or combat fatigue. The former is usually caused by the violent death of a buddy or comrade close by, resulting in instant panic, loss of control, amnesia, stupor and physical inability to function, or suicide. The latter, gradual varieties of shock often take weeks to develop and can be categorized as follows (Hanson 1949, Miller 1943, Ranson 1949, Swank and Marchand 1946): First, physical fatigue can erode a soldier’s mental stability, leading to indulgence in drugs or alcohol, or both, and eventually to a confusional state. Second, weeks-long buildup of anxiety also occurs frequently and ends in all kinds of phobias and, finally, hysteria. A third type, conversion reactions, are the psychiatrically most complicated kind of gradual battle shock. After weeks of enervating, frightening, dangerous combat, a soldier’s mind can cause an actual debilitating condition that will have him or her removed from harm’s way. These psychosomatic “conversions” of fear into a physiological ailment include paralysis, blindness, deafness, muteness, tremors, dysentery, and total loss of appetite. Finally, veterans who have been psychiatric casualties of one sort or another often suffer long-term mental health disorders (Roehr 2007), known after World War II as character disorders and more recently as post-traumatic stress disorders (PTSDs).
  52.  
  53. Gabriel, Richard A. No More Heroes: Madness and Psychiatry in War. New York: Hill and Wang, 1987.
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  55. The best, most concise description of the various kinds of psychiatric casualties and also the best overview.
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  57. Hanson, Frederick R. “The Factor of Fatigue in the Neuroses of Combat.” Bulletin of the U.S. Army Medical Department 9 (1949): 147–150.
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  59. Good analysis of breakdown from fatigue written by an American neurologist who worked with US psychiatric casualties in North Africa in 1943.
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  61. Miller, Emanuel, ed. The Neuroses in War. New York: Macmillan, 1943.
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  63. Based on the experience of American soldiers in World War I, the author analyzes battle fatigue confusion, battlefield anxiety and hysteria, conversion reactions, permanent character disorders, and other forms of psychiatric casualties. Unfortunately, this work was ignored by the US Army during World War II.
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  65. Ranson, Stephen W. “The Normal Battle Reaction: Its Relation to the Pathologic Battle Reaction.” Bulletin of the U.S. Army Medical Department 9 (1949): 3–11.
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  67. Based on army psychiatrists’ observations in Italy, 1943–1945. All soldiers develop trauma symptoms, but some break down sooner than others, and very few not at all. Readers should bear in mind, however, that combat breakdown is more common in high-intensity wars, like World War I and World War II, and less frequent in lower-intensity struggles.
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  69. Roehr, Bob. High Rate of PTSD in Returning Iraq War Veterans. Medscape News. 2007.
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  71. Good Veterans Administration source from 2007, analyzing 52,000 veterans with PTSD. Problems in this sample were grouped as intrusive memories (nightmares, flashbacks), avoidance (isolation, withdrawal, emotional numbing, detachment memory loss), or hyper-arousal (irritability, insomnia, anger outbursts, poor concentration, hyper-vigilance, exaggerated startle).
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  73. Rosen, George. “Nostalgia: A Forgotten Psychological Disorder.” Psychological Medicine 5 (1975): 346–351.
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  75. The best description of this form of combat reaction, including historical examples from early in history, not just the 20th century.
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  77. Swank, Roy L., and Walter E. Marchand. “Combat Neuroses: The Development of Combat Exhaustion.” Archives of Neurology and Psychiatry 55 (1946): 236–247.
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  79. Analysis of the stage-by-stage development of gradual battle shock based on the experience of World War II.
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  81. History Before 1914
  82.  
  83. As demonstrated in Binneveld 1997 (cited under General Overviews), Dyer 2004, and Gabriel 1987 (and Rosen 1975, cited under Definitions), combat reactions are as old as combat itself—witness examples from the Bible (Jayatunge 2010, cited under General Overviews); Homer (Mumford 1996, Shay 1995); the case of the two (of three) hundred Spartans who fell out before Thermopylae, with apparent conversion reactions (Hastings 1985); and the psychological unraveling of Major Marcus Reno and many of his men at the Battle of the Little Big Horn (Connell 1997). As shown in Dean 1999, Deutsche 1944, Jones and Wessely 2005 (cited under General Overviews), Lengwiler 2000, and Wanke 2005, even the meeting of psychiatry and the technology of modern warfare predates 1914, to the Crimean War (1853–1856), the American Civil War (1861–1865), the Franco-Prussian War (1870–1871), the Boer War (1899–1902), and the Russo-Japanese War (1904–1905). Gabriel 1987 (cited under Definitions) includes a valuable discussion of three vying schools of thought among medical and military leaders in the long generation before World War I: (1) Many casualties were indeed psychiatric, (2) mental breakdown in combat was physiological (i.e., the result of brain damage), and (3) breakdown was mere cowardice. The first school had completely lost out to the second and third by 1914.
  84.  
  85. Connell, Evan S. Son of the Morning Star: Custer and the Little Bighorn. San Francisco: North Point, 1997.
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  87. Contains descriptions of Reno and his men during their two-day battle at Little Big Horn that today could only be diagnosed as cases of acute battle shock. Originally published in 1984 (San Francisco: North Point).
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  89. Dean, Eric T., Jr. Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. Cambridge, MA: Harvard University Press, 1999.
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  91. Debunks the view that PTSD began in Vietnam by examining the post–Civil War case files of 291 veterans and wards of the Indiana Hospital for the Insane, who today would have been diagnosed with PTSD. Significantly, many were granted disability pensions by the War Department.
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  93. Deutsche, Albert. “Military Psychiatry: The Civil War, 1861–1865.” In American Psychiatric Association: One Hundred Years of American Psychiatry. Edited by J. K. Hall, 367–384. New York: Columbia University Press, 1944.
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  95. Details the early Civil War practice by the North of weeding out the “insane” during training and after the early battles, which gave way by 1863 to the establishment of the country’s first military psychiatric hospital, which treated twenty thousand patients and dealt mainly with nostalgia cases (“soldier’s heart”) and misunderstood conversion reaction cases (e.g., paralysis and epilepsy).
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  97. Dyer, Gwynne. War. 2d ed. Toronto: Random House, 2004.
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  99. Although colored by the extreme antiwar views of the 1980s and that decade’s widespread fear of impending nuclear Armageddon, this book remains valuable as a resource for psychiatric casualties of the pre-1914 era. Originally published in 1985 (Toronto: Stoddart).
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  101. Hastings, Max, ed. The Oxford Book of Military Anecdotes. Oxford and New York: Oxford University Press, 1985.
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  103. Full of fascinating examples of combat from ancient, medieval, and early modern times that can be compared with the modern literature on psychiatric casualties to demonstrate the long history of these wartime debilitations.
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  105. Lengwiler, Martin. Zwischen Klinik und Kaserne: Die Geschichte der Militärpsychiatrie in Deutschland und der Schweiz 1870–1914. Zurich, Switzerland: Chronos Verlag, 2000.
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  107. For readers of German. The most valuable portions of the book discuss psychiatric casualties during the Franco-Prussian War and the reaction to these by psychiatrists in the decades leading to World War I. The main lesson drawn by the Germans, like so many other military establishments in World War I and World War II, was the prevention of psychiatric casualties by weeding out “feeble-minded” and “degenerate” recruits during the conscription process.
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  109. Mumford, David B. “Somatic Symptoms and Psychological Distress in the Iliad of Homer.” Journal of Psychosomatic Research 41.2 (1996): 139–148.
  110. DOI: 10.1016/0022-3999(96)00091-8Save Citation »Export Citation »E-mail Citation »
  111. Interesting discussion of probable conversion reactions reflected in Homer’s epic poem about the sacking of Troy. Available online for purchase.
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  113. Shay, Jonathan. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Simon & Shuster, 1995.
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  115. Influenced by his treatment of Vietnam veterans with PTSD, Shay mines the Iliad to find many probable examples of this and other combat reactions in Homer’s descriptions of Achilles and Patroclus.
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  117. Wanke, Paul. Russian/Soviet Military Psychiatry, 1904–1945. Cass Series on the Soviet (Russian) Study of War 20. London and New York: Frank Cass, 2005.
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  119. Contains introductory, otherwise hard-to-find material on the Russian army’s recognition and treatment of psychiatric casualties, from the aftermath of the Crimean War to the Russo-Japanese War. By 1905 Russian doctors suspected that somatic (i.e., nonphysiological) causes were at work when rear-area mental breakdown cases took longer to recover—a condition known as secondary gain. Consequently, Russia established recovery stations close to the front lines. See especially pp. 5–29.
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  121. World War I
  122.  
  123. Although the history of psychiatric casualties, their causes, and their treatment did not begin with World War I, the Great War nevertheless saw a dramatic upward spike in the number of studies devoted to this subject, and such studies continue to accumulate. The most important of these primary and secondary sources are described in this section—the lists are necessarily long because such a high percentage of the literature on psychiatric casualties deals with the two world wars.
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  125. Secondary Sources
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  127. This section and Returning Soldiers discuss later histories by academic as well as nonacademic historians, in contrast to the primary sources listed under Contemporary Studies. For a good introduction to all these sources, readers may want to begin with the best secondary sources, especially Alexander 2010 (see Britain) and Micale and Lerner 2001 (see Other Countries), but also chapters 1–4 of Holden 1998 and chapters 1–12 of Shephard 2001 (both cited under General Overviews), Barham 2004 and Lerner 2003 (cited under Returning Soldiers), and Watson 2008 (see Britain).
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  129. Britain
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  131. Many soldiers found ingenious ways to avoid combat breakdown (Watson 2008), yet those who did succumb were seen more and more by British psychiatrists as suffering from emotional/psychiatric causes mixed with basic character issues (Alexander 2010, Hibberd 1986, Young 1999). Military establishments were difficult to convince, continuing right through 1918 to believe it better to shoot soldiers who lost their nerve and, most probably in some cases (Corns and Hughes-Wilson 2001), to actually execute psychiatric casualties for cowardice.
  132.  
  133. Alexander, Caroline. “The Shock of War.” Smithsonian, September 2010, 58–66.
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  135. A well-written, must-read introduction to the subject by one of the best of the popular historians. Strong on Britain.
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  137. Corns, Kathryn, and John Hughes-Wilson. Blindfold and Alone: British Military Executions in the Great War. London: Cassel, 2001.
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  139. The place to start for those researching executions of probable psychiatric casualties.
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  141. Hibberd, Dominic. Wilfred Owen: The Last Year 1917–1918. London: Constable, 1986.
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  143. Includes valuable material on the poet’s relationship with fellow shell-shock victim Siegfried Sassoon and their experience with the famous “talking cure” practiced at the military mental hospital at Craiglockhart.
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  145. Watson, Alexander. Enduring the Great War: Combat, Morale and Collapse in the German and British Armies, 1914–1918. Cambridge Military Histories. Cambridge, UK, and New York: Cambridge University Press, 2008.
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  147. Although psychological combat reactions are not the central focus of this work—rather, the various factors that enabled many German and British soldiers to survive without breaking down—Watson’s book is very important for anyone studying the general phenomenon of psychiatric casualties.
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  149. Young, Allan. “W. H. R. Rivers and the War Neuroses.” Journal of the History of the Behavioral Sciences 35.4 (1999): 359–378.
  150. DOI: 10.1002/(SICI)1520-6696(199923)35:4%3C359::AID-JHBS3%3E3.0.CO;2-9Save Citation »Export Citation »E-mail Citation »
  151. Important article on the wartime neurological work of William H. R. Rivers, of the military mental hospital at Craiglockhart, famous for its Freudian talking cure.
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  153. Other Countries (France, United States, Germany, and Russia)
  154.  
  155. Micale and Lerner 2001 is a good introduction to the experiences of many different World War I armies. Wanke 2005 shows that the Russians entered the war attempting, unsuccessfully, to build on the lessons of the Russo-Japanese War. Komo 1992 and Riedesser and Verderber 1996 offer valuable insights into the often-cruel methods of the Germans. Watson 2008 is excellent on how many German and British soldiers avoided breakdown. As the sources here on the United States (Bond 1950, Strecker 1944) demonstrate, American psychiatrists, entering the war late, benefited from the hard lessons the British, French, and Germans had learned by 1917.
  156.  
  157. Bond, Earl D. Thomas W. Salmon, Psychiatrist. New York: Norton, 1950.
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  159. Indispensable source based on Salmon’s private correspondence. As the medical director of the National Committee for Mental Hygiene, Salmon advocated progressive treatments like those of the French neurologist Jules Derjerine. Salmon adopted the Russian and German practice of locating treatment stations close to the front and believed that recruitment/training-stage screening of neurotics could reduce combat mental breakdown.
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  161. Komo, Günter. “Für Volk und Vaterland”: Die Militärpsychiatrie in den Weltkriegen. Münster, Germany: Lit, 1992.
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  163. Good overview for readers of German of German military practices in both world wars. Highly critical of World War I officers and military doctors (as opposed to the initially usually more sympathetic civilian psychiatrists) in the German army who usually equated breakdown with weak character and consequently treated it as a disciplinary problem.
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  165. Micale, Mark S., and Paul Lerner, eds. Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930. Cambridge Studies in the History of Medicine. Cambridge, UK, and New York: Cambridge University Press, 2001.
  166. DOI: 10.1017/CBO9780511529252Save Citation »Export Citation »E-mail Citation »
  167. Together with Alexander 2010 (see Secondary Sources: Britain), a good introduction to psychiatric casualties in the World War I era. The French were the first to tackle this problem on the Allied side; the British, and later the Americans, followed with their own preferred methods of treatment. Good discussion of the various national efforts.
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  169. Riedesser, Peter, and Axel Verderber. “Theorie und Praxis im ersten Weltkrieg.” In “Maschinengewehre hinter der Front”: Zur Geschichte der deutschen Militärpsychiatrie. By Peter Riedesser and Axel Verderber, 23–74. Frankfurt am Main: Fischer Taschenbuch Verlag, 1996.
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  171. Good chapter for readers of German on the German experience with secondary gain and the need to treat psychiatric casualties near the front and tell them to anticipate returning to combat. Good comparison of the cruel treatments practiced in military hospitals, such as electrocution, with the more humane approach of civilian psychiatrists discussed in Ferenczi, et al. 1921 (cited under World I: Contemporary Studies: Other Countries).
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  173. Strecker, Edward A. “Military Psychiatry in World War I.” In One Hundred Years of American Psychiatry. By American Psychiatric Association, 378–391. New York: Columbia University Press, 1944.
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  175. Good on American efforts to deal with secondary gain by treating psychiatric casualties in forward areas and on the principle of expectancy, the practice of emphasizing to soldiers that they could expect to be returned to the front.
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  177. Wanke, Paul. Russian/Soviet Military Psychiatry, 1904–1945. Cass Series on the Soviet (Russian) Study of War 20. London and New York: Frank Cass, 2005.
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  179. Best work on Russia in World War I. Attempts to build successfully on the experience of the Russo-Japanese War (see Wanke 2005, cited under History Before 1914) failed amid the general chaos of the war. See especially pp. 30–41.
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  181. Watson, Alexander. Enduring the Great War: Combat, Morale and Collapse in the German and British Armies, 1914–1918. Cambridge Military Histories. Cambridge, UK, and New York: Cambridge University Press, 2008.
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  183. A must read for those studying not only psychiatric casualties in the Great War but also the whole phenomenon of how soldiers kept from going insane.
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  185. Contemporary Studies
  186.  
  187. Works in this second subsection are contemporary (i.e., wartime and postwar) attempts by army physicians and psychiatric professionals to understand mental breakdown cases.
  188.  
  189. Britain and the Dominions
  190.  
  191. The list of the most valuable primary sources on Britain’s long learning curve with psychiatric casualties in World War I is clearly the longest and most famous of any country. As various authors here demonstrate, in Britain and the Dominions, proponents of combat breakdown as caused solely by psychiatric factors reemerged from pre-1914 oblivion during World War I to seriously challenge the older notions of mental collapse as caused by physiological brain damage or by cowardice and lack of character. The term shell shock was coined by the British medical officer Charles Myers, who initially believed that paralysis, blindness, deafness, and other debilitations resulted from artillery shelling damage to the brain (Myers 1940). Although basic character issues were still of interest, psychiatric causes were generally recognized by British psychiatrists by 1916–1917 (Butler 1943, Johnson and Rows 1922–1923, McDougall 1926, Read 1918, Great Britain War Office 1922, Rivers 1918, Rivers 1922). Military establishments were slower to change. As Shephard 2001 (cited under General Overviews) shows, some army doctors, such as Myers’s nemesis, the infamous Gordon Holmes, also continued to take a pitiless approach to mental breakdown. Moran 2007 is not much more sympathetic.
  192.  
  193. Butler, A. G. “Moral and Mental Disorders in the War of 1914–18.” In Official History of the Australian Army Medical Services in the War of 1914–1918. Vol. 3, Special Problems and Services. By A. G. Butler, 56–147. Melbourne, Australia: Australian War Memorial, 1943.
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  195. Essential material for anyone studying the Australian Army, but Australian practices did not differ from those of the British.
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  197. Great Britain War Office. Report of the War Office Committee of Enquiry into “Shell-Shock.” London: His Majesty’s Stationery Office, 1922.
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  199. The reams of testimony given in this postwar British parliamentary inquest stacked heavily against the notion of physiological causes of nervous breakdown in combat. An extremely valuable primary source that reflects the change from prewar notions of fear as shame to the more modern acceptance of fear in battle as normal.
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  201. Johnson, William, and R. G. Rows. “Neurasthenia and War Neuroses.” In Medical Services, Diseases of the War. Vol. 2. Edited by Sir W. G. Macpherson, Sir W. P. Herringham, T. R. Elliott, and A. Balfour, 1–54. History of the Great War Based on Official Documents. London: His Majesty’s Stationery Office, 1922–1923.
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  203. Indispensable material for those researching British psychiatric casualties in World War I.
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  205. McDougall, William. Outline of Abnormal Psychology. New York and Chicago: Charles Scribner’s Sons, 1926.
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  207. Having treated shell-shock cases at Netley and Oxford military mental hospitals, McDougall details here the worst of his war-induced amnesia and regression cases. The most famous of the “shell-shock texts.”
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  209. Moran, Lord (Charles McMoran Wilson). The Anatomy of Courage. 2d ed. New York: Basic Books, 2007.
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  211. A somewhat more sophisticated “character” approach to mental breakdown in combat. A medical officer in World War I, Moran argues that only courage overcomes fear; that leadership, training, discipline, patriotism, upbringing, and faith build courage; but that courage is expendable. Soldiers who use up their account of courage are not cowards. Only men of “bad stock,” who never built courage, are born cowards. Proper recruiting is thus essential. Originally published in 1945 (London: Constable).
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  213. Myers, Charles S. Shell Shock in France, 1914–18: Based on a War Diary. Cambridge UK: Cambridge University Press, 1940.
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  215. Valuable firsthand account of the evolution of treatment and a contemporary critique of both the bureaucratic quagmire of the Royal Army Medical Corps and the intolerant military mindset toward psychiatric casualties. Myers, who in a 1915 article popularized the term shell shock, phraseology already common in the ranks, later published his wartime diary. He treated thousands of shell-shock victims of World War I.
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  217. Read, C. Stanford. “A Survey of War Neuro-Psychiatry.” Mental Hygiene 2.3 (1918): 359–387.
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  219. A good summary of the state of thinking on the causes and treatment of psychiatric casualties in Britain toward the end of World War I.
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  221. Rivers, W. H. R. “An Address on the Repression of War Experience.” Lancet 191.4927 (1918): 173–177.
  222. DOI: 10.1016/S0140-6736(01)23233-4Save Citation »Export Citation »E-mail Citation »
  223. Rivers, of Craiglockhart fame, lays out succinctly the rationale behind his talking cure: Because repression of bad war experiences causes neuroses, a psychiatric casualty patient should keep his or her memories on a conscious level by talking about them. Also available online.
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  225. Rivers, W. H. R. Instinct and the Unconscious: A Contribution to a Biological Theory of the Psycho-Neuroses. 2d ed. Cambridge Medical Series. Cambridge, UK: Cambridge University Press, 1922.
  226. DOI: 10.1037/11187-000Save Citation »Export Citation »E-mail Citation »
  227. The famous Craiglockhart War Hospital psychiatrist argued that hysteria and anxiety casualties were a result of regression to a basic “dog beneath the skin” level of the nervous system.
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  229. Other Countries (France, United States, Germany, and Russia)
  230.  
  231. The best introductions to World War I psychiatric casualties in countries other than Great Britain are Shephard 2001 (cited under General Overviews) and Wanke 2005 (cited under History Before 1914). For France in World War I, consult Roussy and Lhermitte 1918; for the United States, Kardiner 1941, MacCurdy 1918, Bailey, et al. 1929, and Rhein 1906; for Germany, Ferenczi, et al. 1921, Nonne 1917, Weiler 1933; for Russia, Farmborough 2000.
  232.  
  233. Bailey, Pearce, Frankwood E. Williams, Paul O. Komora, Thomas W. Salmon, and Norman Fenton, eds. Neuropsychiatry: In the United States and in the American Expeditionary Forces. Washington, DC: Government Printing Office, 1929.
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  235. Official account of the US psychiatric effort in World War I, full of correspondence and special reports, including Thomas Salmon’s excellent 1917 study of British efforts to date in the war. The section on the American Expeditionary Forces was compiled by Salmon and his colleague Norman Fenton.
  236. Find this resource:
  237. Farmborough, Florence. With the Armies of the Tsar: A Nurse at the Russian Front, 1914–18. New York: Cooper Square, 2000.
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  239. Very valuable memoir of a British nurse whose account of World War I on the eastern front is not only insightful concerning Russia’s unsuccessful effort to organize treatment of psychiatric casualties amid the debacle of the Tsar’s war effort, but also a necessary source for World War I nursing in general.
  240. Find this resource:
  241. Ferenczi, Sándor, Karl Abraham, and Sigmund Freud. Psycho-Analysis and the War Neuroses. Papers presented at the Budapest Psychoanalytic Congress of September 1918. Vienna: International Psychoanalytical Press, 1921.
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  243. Among the attendees at this conference of Freudians held in Budapest in September 1918 were the German psychoanalyst Ernst Simmel, who had some success with hypnosis; the Hungarian Ferenczi; and Sigmund Freud himself.
  244. Find this resource:
  245. Kardiner, Abraham. The Traumatic Neuroses of War. New York: Paul B. Hoeber, 1941.
  246. DOI: 10.1037/10581-000Save Citation »Export Citation »E-mail Citation »
  247. Heavily influenced by Freud as well as the Russian behavioralist Ivan Pavlov, the New York practitioner Kardiner studied the long-term effects of extreme battle breakdown cases in World War I. His book became a bridge to later PTSD studies.
  248. Find this resource:
  249. MacCurdy, John T. War Neuroses. Cambridge Medical Series. Cambridge, UK: Cambridge University Press, 1918.
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  251. Valuable account of American wartime practices by Thomas Salmon’s assistant.
  252. Find this resource:
  253. Nonne, M. “Über erfolgreiche Suggestivbehandlung der hysteriformen Störungen bei Kriegsneurosen.” Zeitschrift für die gesamte Neurologie und Psychiatrie 37.1 (1917): 191–218.
  254. DOI: 10.1007/BF02917386Save Citation »Export Citation »E-mail Citation »
  255. Although quite the self-promoter and spinmeister, Nonne nevertheless registered some success with suggestion and hypnosis techniques. Key material here for readers of German. Available online for purchase.
  256. Find this resource:
  257. Rhein, John H. W. “Neuropsychiatric Problems at the Front during Combat.” Journal of Abnormal Psychology 14.1–2 (1906): 9–14.
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  259. Good account of his experience with psychiatric casualties as director of two of Thomas Salmon’s forward-area, advanced neurological hospitals in France. Available online for purchase.
  260. Find this resource:
  261. Roussy, G., and J. Lhermitte. The Psychoneuroses of War. Translated by Wilfred B. Christopherson; edited by William Aldren Turner. London: University of London Press, 1918.
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  263. The French doctor Roussy headed the asylum for combat veterans at Salins-les-Bains. Charts his conversion from the use of electric shock and the harsh traitement brusque of Joseph Babinski to the more humane practices of Jules Dejerine, whose therapy consisted of suggestion and emotional empathy with the patient.
  264. Find this resource:
  265. Weiler, Karl. Arbeit und Gesundheit: Sozialmedizinische Schriftenreihe aus dem Gebiete des Reichsministeriums. Heft 22: Nervöse und seelische Störungen bei Teilnehmern am Weltkriege, ihre ärztliche und rechtliche Beurteilung. Erster 1: Nervöse und seelische Störungen psychogener und funktioneller Art. Leipzig: Georg Thieme, 1933.
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  267. Insightful analysis for readers of German of psychiatric casualties among Bavarian soldiers serving on the western front. Found that most veterans in the trenches who broke down were remarkably resilient, taking ten months normally before succumbing to gradual combat shock; 15 percent broke down, however, before ever reaching the front lines. Compare with Watson 2008 (cited under Secondary Sources: Britain).
  268. Find this resource:
  269. Returning Soldiers
  270.  
  271. Today’s preoccupation with post-traumatic stress disorders (PTSDs) makes it advisable to include a separate section on works dealing with the postwar experiences of World War I veterans. Barham 2004 and Kent 1993 describe the British experience, which is also reflected in Christie 1983. Brose 2005 is a brief discussion of postwar gender relations related to psychiatric casualties in Britain, France, Germany, and Italy. Crouthamel 2010 and Lerner 2003 cover Germany, whereas Fenton 1926 deals with the United States.
  272.  
  273. Barham, Peter. Forgotten Lunatics of the Great War. New Haven, CT: Yale University Press, 2004.
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  275. Valuable narratives of numerous English soldiers who broke down before, during, or after combat in World War I. Details their attempts, often in vain, to be reintegrated into society and to secure social justice. Steeped in primary source research.
  276. Find this resource:
  277. Brose, Eric Dorn. A History of Europe in the Twentieth Century. New York and Oxford: Oxford University Press, 2005.
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  279. Expands on the discussion in Kent 1993. Looks at women’s reaction to male war-related suffering and violence in Germany, France, and Italy during and after World War I. Draws on primary sources for Germany. See especially pp. 109–119.
  280. Find this resource:
  281. Christie, Agatha. The A. B. C. Murders. Agatha Christie Mystery Collection. New York: Bantam, 1983.
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  283. Good example from literature of the widespread abhorrence in post–World War I England of shell-shock victims who, like the killer in this novel, murder in a mental state of hypnotic suggestion.
  284. Find this resource:
  285. Crouthamel, Jason. “‘Hysterische Männer?’: Traumatisierte Veteranen des Ersten Weltkrieges und ihr Kampf um Anerkennung im ‘Dritten Reich.’” In Krieg und Psychiatrie, 1914–1950. Edited by Babette Quinkert, Philipp Rauh, and Ulrike Winkler, 29–53. Beiträge zur Geschichte des Nationalsozialismus 26. Göttingen, Germany: Wallstein Verlag, 2010.
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  287. Very important sequel study for readers of German to Lerner 2003. Having already been denied pensions in 1926, psychiatric casualties of World War I fought against Nazi psychiatrists, who branded these men as degenerates with no claim to a place in Nazism’s Folk Community.
  288. Find this resource:
  289. Fenton, Norman. Shell Shock and Its Aftermath. St. Louis, MO: Mosby, 1926.
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  291. Good information on the suspicious and fearful reaction of the American public to psychiatric casualties in their midst even though most had returned to normal within five years. Fenton was Thomas Salmon’s close colleague.
  292. Find this resource:
  293. Kent, Susan Kingsley. Making Peace: The Reconstruction of Gender in Interwar Britain. Princeton, NJ: Princeton University Press, 1993.
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  295. Seminal work and a sort of companion study to Barham 2004. Whereas the latter focuses directly on British psychiatric casualties after 1918, Kent deals with the passive and emotional reaction of the women’s movement to the violence and suffering of returning soldiers.
  296. Find this resource:
  297. Lerner, Paul. Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930. Cornell Studies in the History of Psychiatry. Ithaca, NY: Cornell University Press, 2003.
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  299. Well-researched account of the efforts of the German psychiatric community to heal traumatized veterans through electric shock, hypnosis, or suggestion as well as the veterans’ attempts to secure pensions after 1918. Psychiatrists’ underlying skepticism about their victims’ masculinity, which influenced the War Ministry to deny pensions to psychiatric casualties in 1926, paralleled the German Right’s glorification of war.
  300. Find this resource:
  301. World War II
  302.  
  303. Divided into the sections Secondary Sources, Contemporary Studies, and Returning Soldiers, with subsections on different countries, the works here describe the World War II experience with psychiatric casualties. As noted earlier, the list is necessarily long because so much of the overall literature concentrates on the two world wars. Remarkably, despite the vast literature on psychiatric casualties that had amassed since 1914, the notion that mental breakdown in combat simply reflected badly on a soldier’s character—that fraud and cowardice, which admittedly do occur, explained all or most cases—remained alive and well in military establishments in Britain, the United States, Germany, and the Soviet Union.
  304.  
  305. Secondary Sources
  306.  
  307. The following sources (and most of those listed under Returning Soldiers) are biographies and histories usually written well after events occurred. These works use many of the primary sources listed under Contemporary Studies. It is always advisable to start with secondary works, paying close attention to the materials used. Researchers may want to begin with the relevant material in Gabriel 1987 (cited under Definitions), and chapters 4–6 of Holden 1998 and chapters 13–22 of Shephard 2001 (cited under General Overviews), before wading deeper into the literature in this section.
  308.  
  309. Britain and the Dominions
  310.  
  311. The British army largely ignored the whole issue of psychiatric casualties in 1939, except for experiments with drug treatments (Ahrenfeldt 1958, Collier 1961). Civilians who suffered emotionally during the Blitz did not fare much better (Harrison 1989, Janis 1976). The British fell back on a recruiting/screening approach in 1942 (British Privy Council Office 1947, cited under Contemporary Studies: Britain) as advocates of counseling, suggestion, and group therapy stood mostly on the sidelines. In the latter stages of the war, their experience and psychiatric expertise reluctantly came to be relied on by the top brass (Copp and McAndrew 1990, Harrison 2000).
  312.  
  313. Ahrenfeldt, Robert H. Psychiatry in the British Army in the Second World War. New York: Columbia University Press, 1958.
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  315. Indispensable, seminal work on the British experience in World War II.
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  317. Collier, Richard. The Sands of Dunkirk. New York: Dutton, 1961.
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  319. Good descriptions here of how unprepared the British army was in 1939 to deal with the significant number of psychiatric casualties suffered at the outbreak of World War II. Ignoring World War I lessons, army doctors began to experiment with drug treatments.
  320. Find this resource:
  321. Copp, Terry, and Bill McAndrew. Battle Exhaustion: Soldiers and Psychiatrists in the Canadian Army, 1939–1945. Montreal and Buffalo, NY: McGill-Queen’s University Press, 1990.
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  323. One of the most important sources for research on psychiatric casualties in the British Liberation Army (BLA) from D-Day to VE Day (1944–1945). Suitable for anyone specializing in the Canadian divisions’ experience.
  324. Find this resource:
  325. Harrison, Tom. Living through the Blitz. New York: Shocken, 1989.
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  327. Great resource for civilian psychiatric casualties. With tens of thousands of British civilians killed in German bombing raids in 1940–1941, thousands of shell-shocked civilian survivors needed treatment for emotional breakdowns, but usually got little more than sedation and rest before being released. Originally published in 1976 (London: Collins).
  328. Find this resource:
  329. Harrison, Tom. Bion, Rickman, Foulkes, and the Northfield Experiments: Advancing on a Different Front. Therapeutic Communities 5. London and Philadelphia: Jessica Kingsley, 2000.
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  331. Seminal work on group therapy and other psychiatric experiments undertaken by three leading psychiatrists at Northfield Hospital, Britain’s main center for treating serious psychiatric casualties that could not be dealt with quickly near the front.
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  333. Janis, Irving L. Air War and Emotional Stress: Psychological Studies of Bombing and Civilian Defense. Westport, CT: Greenwood, 1976.
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  335. This Rand Corporation study contains useful material for those researching civilian psychiatric casualties during the Blitz. Originally published in 1951 (Santa Monica, CA: RAND).
  336. Find this resource:
  337. United States
  338.  
  339. The US Army entered the war believing it could avoid psychiatric casualties altogether with the proper screening out of bad-apple recruits (Perry 1982). When this approach failed (van Creveld 1982), the army turned first to advocates of drug treatments (Grinker and Spiegel 1945, cited under Contemporary Studies: United States). Eventually, the United States, like Britain, came to rely more on psychiatric treatments (Ginzberg, et al. 1959; Hanson 1949 and Ranson 1949, cited under Definitions).
  340.  
  341. Ginzberg, Eli, James K. Anderson, Sol. W. Ginsburg, and John L. Herma. The Lost Divisions. New York: Columbia University Press, 1959.
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  343. The Eisenhower administration, prompted by the president’s alarm over soldiers who broke down in combat in World War II, provided funding for a staff of researchers at Columbia University. Comprehensive discussion of the US experience in World War II.
  344. Find this resource:
  345. Perry, Helen Swick. Psychiatrist of America: The Life of Harry Stack Sullivan. Cambridge, MA: Belknap, 1982.
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  347. Good material here on Sullivan, the chief American psychiatrist in charge of the selection process on which the US Army relied so heavily—and unsuccessfully—early in World War II. His methods were too amateurish; he was removed in 1942, and his approach to selection was dumped after the rash of psychiatric casualties in North Africa in 1942–1943.
  348. Find this resource:
  349. van Creveld, Martin. Fighting Power: German and U.S. Army Performance, 1939–1945. Contributions in Military History 32. Westport, CT: Greenwood, 1982.
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  351. Good analysis here of the higher rate of combat trauma cases in the US Army as compared with the German army.
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  353. Germany and the Soviet Union
  354.  
  355. The German military and psychiatric establishments had turned their backs on the psychiatric victims of World War I already in the 1920s (Lerner 2003). Later, the Nazis believed that screening; indoctrination; and, once in combat, the threat of summary execution or severe electric shock treatment would solve what was seen as a character/disciplinary problem (Kalinowsky 1950, Komo 1992, Riedesser and Verderber 1996, Schneider 1986, van Creveld 1982), but men broke down nevertheless (Bartov 1991).The Soviets, like Russian psychiatrists before 1914, continued to view mental breakdown as either a disciplinary or physiological problem (Gabriel 1986, Wanke 2005). Not surprisingly for two dictatorships, there were parallels between the Soviet and the Nazi experiences with psychiatric casualties in World War II.
  356.  
  357. Bartov, Omer. Hitler’s Army: Soldiers, Nazis, and War in the Third Reich. New York: Oxford University Press, 1991.
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  359. Excellent study of the disintegration of the German army on the eastern front, including the psychological unraveling of so many soldiers.
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  361. Gabriel, Richard A. Soviet Military Psychiatry: The Theory and Practice of Coping with Battle Stress. Contributions in Military Studies 53. New York: Greenwood, 1986.
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  363. Chapters 2 and 3 contain valuable material on the development and practice of Soviet military psychiatry before and during World War II (pp. 33–71). Based largely on interviews with Red Army psychiatrists who had left the Soviet Union. Good on harsh treatment of psychiatric casualties. Superseded by Wanke 2005.
  364. Find this resource:
  365. Kalinowsky, Lothar B. “Problems of War Neuroses in the Light of Experiences of Other Countries.” American Journal of Psychiatry 107.5 (1950): 340–346.
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  367. Good discussion, based on his talks with German military psychiatrists after the war, of their practice of treating psychiatric casualties as a disciplinary problem and thus holding down these kinds of losses. Kalinowsky was a German expatriate in the United States.
  368. Find this resource:
  369. Komo, Günter. “Für Volk und Vaterland”: Die Militärpsychiatrie in den Weltkriegen. Sozialgeschichte de Medizin 1. Münster, Germany: Lit, 1992.
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  371. Valuable material here for readers of German on the German handling of combat stress as a disciplinary issue.
  372. Find this resource:
  373. Lerner, Paul. Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930. Cornell Studies in the History of Psychiatry. Ithaca, NY: Cornell University Press, 2003.
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  375. Although it does not deal with World War II, this work is indispensable background material for the hard-line German approach to psychiatric casualties in World War I. Based on the advice of skeptical psychiatrists, the War Ministry refused to grant disability pensions to mental breakdown cases after 1926.
  376. Find this resource:
  377. Riedesser, Peter, and Axel Verderber. “Maschinengewehre hinter der Front”: Zur Geschichte der deutschen Militärpsychiatrie. Frankfurt am Main: Fischer Taschenbuch Verlag, 1996.
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  379. Good for readers of German not only on the lessons of World War I that were incorporated by the German army in the 1930s, but also on the usually harsh methods of dealing with psychiatric casualties in World War II.
  380. Find this resource:
  381. Schneider, Robert. “Military Psychiatry in the German Army.” In Military Psychiatry: A Comparative Perspective. Edited by Richard A. Gabriel, 119–146. Contributions in Military Studies 57. New York: Greenwood, 1986.
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  383. Like Watson 2008 (cited under World War I: Secondary Sources: Britain) for the Great War, Schneider concentrates on the success of the German army in avoiding high rates of breakdown in combat, but, like Kalinowsky 1950 and van Creveld 1982, tends to overlook the cases of psychiatric breakdown that actually occurred, especially on the eastern front.
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  385. van Creveld, Martin. Fighting Power: German and U.S. Army Performance. Contributions in Military Studies 32. Westport, CT: Greenwood, 1982.
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  387. Good analysis of the lower incidence of psychiatric breakdown in the German army, but, like Schneider 1986, does not pay attention to the cases of German soldiers who did break down.
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  389. Wanke, Paul. Russian/Soviet Military Psychiatry, 1904–1945. Cass Series on the Soviet (Russian) Study of War 20. London and New York: Frank Cass, 2005.
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  391. Best source on psychiatric casualties in the Red Army; supersedes the still important Gabriel 1986. Because combat breakdown was seen as a physiological, not psychological, issue, these soldiers received no sympathy in the land of the Great Purge, especially in 1941–1942. By 1943 the Red Army finally implemented decades-old plans for the treatment of more serious conversion reaction cases. See especially pp. 49–150.
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  393. Contemporary Studies
  394.  
  395. The sources listed in this section dealing with Britain and the United States are primary sources, the best building blocks of solid research, but, as noted earlier, readers are advised to orient themselves with some of the psychiatric literature in Definitions, introductory material in General Overviews, and secondary sources on World War II listed previously before diving into firsthand accounts that are not always easy to interpret or understand.
  396.  
  397. Britain
  398.  
  399. Except for experimental treatment with drugs (Sargent 1967), Britain had little response to psychiatric casualties at the outset of World War II. Screening of recruits was tried next, amid some controversy (British Privy Council Office 1947). As the war progressed and Royal Air Force (RAF) casualties mounted, those sympathetic to the stress of airmen (Gillespie 1945) vied with their opposite counterparts (Symonds and Williams 1947). On balance, as the years passed to 1945, psychiatric treatments gained more credibility (Fidler 1947, Rees 1945).
  400.  
  401. British Privy Council Office. Report of an Expert Committee on the Work of Psychologists and Psychiatrists in the Services. London: His Majesty’s Stationery Office, 1947.
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  403. This wartime inquiry produced some criticism from army doctors about the screening/selection methods of Rees and the psychiatrists, but mainly praised these efforts. Useful source.
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  405. Fidler, R. F. “A Psychiatrist’s Observations in the B. L. A.” Journal of the Royal Army Medical Corps 88 (1947): 186–191.
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  407. One of the most important sources for psychiatric casualties in the British Liberation Army (BLA) on D-Day and after.
  408. Find this resource:
  409. Gillespie, R. D. “War Neuroses after Psychological Trauma.” British Medical Journal 1.4401 (1945): 653–656.
  410. DOI: 10.1136/bmj.1.4401.653Save Citation »Export Citation »E-mail Citation »
  411. Important source to balance with Symonds and Williams 1947. Gillespie, a psychiatrist consulting the RAF who jousted with Symonds over his unsympathetic approach, believed that much more could have been done to help RAF fliers, whom he thought were unjustly branded “LMF”—lack of moral fiber. Available online by subscription.
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  413. Rees, John Rawlings. The Shaping of Psychiatry by War. New York Academy of Medicine: Thomas William Salmon Memorial Lectures. London: Chapman & Hall, 1945.
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  415. A memoir from the director of the famous Tavistock Clinic and a leading psychiatric consultant to the British army during World War II details the relative obscurity of psychiatrists early in World War II; their involvement with screening and selection efforts after 1942; and the development of treatments, such as group therapy, for psychiatric casualties.
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  417. Sargent, William. The Unquiet Mind: The Autobiography of a Physician in Psychological Medicine. London: Heinemann, 1967.
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  419. A practicing psychiatrist at London’s Belmont Clinic, Sargent recalls his efforts to treat psychiatric casualties with sodium amatol and other barbiturate drugs, which helped patients emotionally but did not succeed in returning them to action.
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  421. Symonds, Charles P., and Donald Williams. Psychological Disorders in Flying Personnel of the Royal Air Force Investigated during the War, 1939–1945. London: His Majesty’s Stationery Office, 1947.
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  423. Important source for appreciating the traditionalist, lack-of-moral-fiber, character-oriented view of psychiatric casualties in the RAF by Gillespie’s nemesis, Symonds, a consulting neurologist in the RAF.
  424. Find this resource:
  425. United States
  426.  
  427. Readers well versed in the secondary sources should begin with two US official reports: Hastings, et al. 1944 and Glass and Bernucci 1966–1973). Like the British, the Americans were initially drawn to treating psychiatric casualties with drugs, as opposed to counseling alone (Grinker and Spiegel 1945), but soon psychiatric counseling and treatment for fatigue took precedence (Kaufman and Beaton 1947, Menninger 1948), although top brass remained skeptical (Bland 1996)—despite the controversy over Patton’s slapping incidents.
  428.  
  429. Bland, Larry I., ed. The Papers of George Catlett Marshall. Vol. 4, “Aggressive and Determined Leadership,” June 1, 1943–December 31, 1944. Baltimore: Johns Hopkins University Press, 1996.
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  431. Marshall’s memorandum of December 1943 regarding psychiatric casualties in North Africa and Sicily is noteworthy, for in the immediate aftermath of Patton’s slapping incidents, the secretary of war castigates trauma victims as frauds and scammers and blasts psychiatrists for their coddling of weaklings. Fraud exists but does not explain most cases. Like Eisenhower, Marshall bemoaned the “lost divisions” of World War II. See especially pp. 221–225.
  432. Find this resource:
  433. Glass, Albert J., and Robert J. Bernucci, eds. Neuropsychiatry in World War II. 2 vols. Washington, DC: Government Printing Office, 1966–1973.
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  435. This nearly 900-page tome, many years in the making, contains a plethora of articles by participants in the military psychiatry efforts of the US Army in World War II. An absolutely invaluable primary source.
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  437. Grinker, Roy R., and John P. Spiegel. Men under Stress. Philadelphia: Blakiston, 1945.
  438. DOI: 10.1037/10784-000Save Citation »Export Citation »E-mail Citation »
  439. Insightful memoir of the American army psychiatrist who broke into prominence with his barbiturate treatments of US psychiatric casualties in North Africa in 1943. Because it returned men to combat more successfully, Frederick Hanson’s fatigue treatment approach (see Hanson 1949, cited under Definitions) was favored by the army over Grinker’s.
  440. Find this resource:
  441. Hastings, Donald W., David G. Wright, and Bernard C. Glueck. Psychiatric Experiences of the Eighth Air Force: First Year of Combat (July 4, 1942–July 4, 1943). New York: Josiah Macy Jr. Foundation, 1944.
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  443. Valuable primary source on the high rate of combat trauma in the US Eighth Air Force during the initial year of dangerous daylight bombing over Germany.
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  445. Kaufman, M. Ralph, and Lindsay E. Beaton. “A Psychiatric Treatment Program in Combat.” Bulletin of the Menninger Clinic 11.1 (1947): 1–14.
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  447. Based on their work with US Marines in the Pacific, these practitioners weaned themselves from Grinker’s drug treatments and, like Hanson (Hanson 1949, cited under Definitions), began to treat for fatigue.
  448. Find this resource:
  449. Menninger, William C. Psychiatry in a Troubled World: Yesterday’s War and Today’s Challenge. New York: Macmillan, 1948.
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  451. Harry Stack Sullivan’s replacement as leading psychiatric consultant to the US Army, Menninger provides necessary firsthand information on American efforts from 1943 to 1945. His influence in Washington helped psychiatrists overcome the biting criticism of Marshall (Bland 1996).
  452. Find this resource:
  453. Returning Soldiers
  454.  
  455. Today’s preoccupation with post-traumatic stress disorders (PTSDs) makes it advisable to include a section on works dealing with the postwar experiences of World War II veterans and their loved ones. As Childers 2009, Gambone 2005, Hartmann 1978, and Ripley and Wolf 1951 demonstrate for the United States, and Brose 2004 and Turner and Rennell 1995, for Britain and Europe, homecomings were almost always problematic. Hollywood has also dealt successfully with this topic (Wyler 2000, Huston 1985).
  456.  
  457. Brose, Eric Dorn. A History of Europe in the Twentieth Century. New York and Oxford: Oxford University Press, 2004.
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  459. Good discussion of the impact of broken down returning soldiers on gender relations in Britain, France, Germany, and Italy (pp. 313–319). Parallels discussion earlier in the text of the post–World War I situation in these countries (pp. 109–119).
  460. Find this resource:
  461. Childers, Thomas. Soldier from the War Returning: The Greatest Generation’s Troubled Homecoming from World War II. Boston: Houghton Mifflin Harcourt, 2009.
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  463. Very well written and innovatively conceived study of the difficulty of three American veterans in making the transition to civilian life after World War II. Widens from the core group, which was close to Childers’s family, to discuss the spike in divorce rates in the late 1940s and other societal trends related to PTSD issues.
  464. Find this resource:
  465. Gambone, Michael D. The Greatest Generation Comes Home: The Veteran in American Society. College Station: Texas A&M University Press, 2005.
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  467. Good overview of the US experience, including the healing process for men and women and minorities.
  468. Find this resource:
  469. Hartmann, Susan M. “Prescriptions for Penelope: Literature on Women’s Obligations to Returning World War II Veterans.” Women’s Studies 5.3 (1978): 223–239.
  470. DOI: 10.1080/00497878.1978.9978450Save Citation »Export Citation »E-mail Citation »
  471. Excellent study on the US campaign to ready wives to sacrifice and be compliant for troubled husbands coming home from the war.
  472. Find this resource:
  473. Huston, John, Let There Be Light, 1946. DVD. Chicago: International Historic Films, 1985.
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  475. Responding to public and presidential pressure to highlight psychological problems of returning veterans, William Menninger, psychiatric consultant to the US Army, commissioned the Hollywood director John Huston in 1944 to document the difficult readjustment process of psychiatric casualties. Filmed at Mason General Hospital, near New York City, but then suppressed by the army.
  476. Find this resource:
  477. Ripley, Herbert S., and Stewart Wolf. “Long-Term Study of Combat Area Schizophrenic Reactions.” American Journal of Psychiatry 108.6 (1951): 409–416.
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  479. As Norman Fenton found in the 1920s, most American World War II psychiatric casualties recovered within a few years, but about a fifth of them, like those studied by Ripley and Wolf, continued to suffer from disorders we would diagnose as PTSD in the early 21st century.
  480. Find this resource:
  481. Turner, Barry, and Tony Rennell. When Daddy Came Home: How Family Life Changed Forever in 1945. London: Hutchinson, 1995.
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  483. Good material here, especially when comparing the somewhat smoother homecoming experience in Britain with that in the United States.
  484. Find this resource:
  485. Wyler, William, The Best Years of Our Lives, 1946. DVD. Santa Monica, CA: MGM, 2000.
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  487. Director William Wyler’s 1946 portrait of three veterans who have trouble adjusting to civilian life after many years of combat. This excellent film won seven Academy Awards.
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  489. Korea
  490.  
  491. Despite lessons relearned by American military psychiatrists in World War II, and despite the heightened awareness of the US public about the phenomenon of psychiatric casualties, American units had no psychiatrists available in 1950 to deal with the worst outbreak of fear- and anxiety-related cases in US military history. This sorry state undoubtedly reflected a lingering Patton-Marshall-like skepticism regarding the whole notion of psychiatric casualties. The specialists were quickly made available, however, and they went to work using findings like those of Hanson 1949 and Miller 1943 (cited under Definitions) and Kaufman and Beaton 1947 (cited under World War II: Contemporary Studies: United States). Artiss 1963, Glass 1954, and Peterson and Chambers 1952, all studies by military psychiatrist insiders, discuss the American experience in Korea.
  492.  
  493. Artiss, Kenneth Leslie. “Human Behavior under Stress: From Combat to Social Psychiatry.” Military Medicine 128 (1963): 1011–1015.
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  495. Traces the evolution of “PIE” from the World War I lessons of Thomas Salmon, forgotten in the interwar years and reapplied in World War II and Korea: proximity (P), treating soldiers close to the front; immediacy (I), treating them immediately; and expectancy (E), telling them to expect to return to their units.
  496. Find this resource:
  497. Glass, Albert J. “Psychotherapy in the Combat Zone.” American Journal of Psychiatry 110 (1954): 725–731.
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  499. Glass, one of Hanson’s men in the Mediterranean in World War II, quickly took charge of the situation in Korea by taking a PIE approach.
  500. Find this resource:
  501. Peterson, Donald B., and Rawley E. Chambers. “Restatement of Combat Psychiatry.” American Journal of Psychiatry 109 (1952): 249–254.
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  503. Restatement of PIE lessons forgotten and relearned. Also attempts to explain the high rate of psychiatric breakdown in 1950 by pointing to attitudes like opposition to aggression and notions like the automatic release from one’s responsibilities and obligations through illness or debility—attitudes and notions new to this generation of men. Available online for purchase.
  504. Find this resource:
  505. Vietnam and the Falklands
  506.  
  507. The best introductions to the source material listed on Vietnam and the Falklands are the relevant parts of Gabriel 1987 (cited under Definitions), and Holden 1998, Jones and Wessely 2005, and Shephard 2001 (all cited under General Overviews). Military psychiatrists were ready for the Vietnam War of the 1960s and 1970s, but the conflict’s controversy led some to question the ethics of trying to restore broken men to combat readiness. However, because the Vietnam War and the British retaking of the Falklands in 1982 were quite different from the two world wars—the former had little of the constant grinding combat of those wars, the latter was over quickly—psychiatric breakdown in the combat zone was much rarer (Price 2007). Conversion reactions, fatigue cases, and anxiety/hysteria cases were almost unseen by military psychiatrists—initially the British, trusting in the professionalism of their soldiers, had no psychiatrists available. Rather, psychiatric casualties in Vietnam took the form of substance abuse (Ratner 1972) and unruliness (Renner 1973), and both wars saw postwar problems eventually deemed PTSD, caused by memories of violence and atrocities (Coleman 2006, McManners 1993). It took many long fights, however, to convince veterans’ administrators and psychiatrists, civilian and military, that PTSD was real (Ørner 1997, cited under Arab–Israeli Conflicts and the Red Army in Afghanistan; Scott 1993) and not just “compensation-itis,” although cases of fraud did certainly exist (Burkett and Whitley 1998).
  508.  
  509. Burkett, B. G., and Glenna Whitley. Stolen Valor: How the Vietnam Generation Was Robbed of Its Heroes and Its History. Dallas: Verity, 1998.
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  511. Highly influential, albeit controversial, study of cases of fraud and misrepresentation by Vietnam veterans and those claiming to be veterans.
  512. Find this resource:
  513. Coleman, Penny. Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War. Boston: Beacon, 2006.
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  515. An excellent and very readable account of PTSD after 20th-century wars. Focuses mainly on the post-Vietnam experience and the stories of twelve women whose husbands, like Coleman’s, committed suicide. Very critical of the American military establishment’s neglect of veterans’ PTSD problems.
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  517. McManners, Hugh. The Scars of War. London: HarperCollins, 1993.
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  519. Excellent study by a veteran of the Falklands War about the psychological effects of combat on the soldiers who fought there. Also includes interesting material on the skepticism about PTSD in the British military establishment.
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  521. Price, H. H. “Rate of British Psychiatric Combat Casualties Compared to Recent American Wars.” In Special Issue: Falklands Conflict Anniversary Commemorative Issue. Edited by M. von Bertele. Journal of the Royal Army Medical Corps 153.3 (2007): 56–61.
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  523. Favorable assessment of the psychological durability of British professional soldiers in comparison with American conscripts allegedly more susceptible to PTSD. Good example of an author, in this case a British military psychiatrist, who scoffs at the notion of PTSD in his army.
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  525. Ratner, Richard A. “Drugs and Despair in Vietnam.” University of Chicago Magazine, January 1972, 15–23.
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  527. The high incidence of drug and alcohol use in Vietnam was one form of psychiatric casualty, as Renner 1973 argues, that emerged as a disciplinary problem rather than a conversion reaction or other psychosomatic illness. Substance abuse no doubt calmed many anxious soldiers but clearly undermined fighting effectiveness.
  528. Find this resource:
  529. Renner, John A., “The Changing Patterns of Psychiatric Problems in Vietnam.” Comprehensive Psychiatry 14.2 (1973): 169–181.
  530. DOI: 10.1016/0010-440X(73)90009-6Save Citation »Export Citation »E-mail Citation »
  531. Questions the reality of official low rates of psychiatric casualties by pointing to a long list of disciplinary problems that may have been the Vietnam War’s psychological equivalent of World War I’s shell shock—rather than internalize their problems with combat, Vietnam veterans “acted out.”
  532. Find this resource:
  533. Scott, Wilbur J. The Politics of Readjustment: Vietnam Veterans since the War. New York: De Gruyter, 1993.
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  535. Seminal work on the controversial homecoming of American soldiers from Vietnam, the whole phenomenon of PTSD among Vietnam veterans and their political battle at the side of one faction of the psychiatric community to have PTSD recognized and treated. PTSD was finally recognized by the American Psychiatric Association in 1980.
  536. Find this resource:
  537. Arab–Israeli Conflicts and the Red Army in Afghanistan
  538.  
  539. Largely because of the Jewish experience of the Holocaust and Israeli experience with the survivors of genocide, the Israeli army in the Yom Kippur War of 1973 and in Lebanon (1982–1985) was, as praised by Ørner 1997, sympathetic toward and impressively equipped to deal with the fuller range of psychiatric casualties seen there—and afterward, with PTSD (Belenky, et al. 1983). Little has been published about the other major wars of this time period between Iraq and Iran, and the Soviet Union and Afghanistan, but the latter is touched on briefly in Jayatunge 2010.
  540.  
  541. Belenky, Gregory L., C. F. Tyner, and F. J. Sodetz. Israeli Battle Shock Casualties: 1973 and 1982. Report NP-83-4. Washington, DC: Walter Reed Army Institute of Research, 1983.
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  543. Important statistical breakdown of a range of psychiatric casualties in these wars, including anxiety, fatigue, and conversion reaction cases.
  544. Find this resource:
  545. Jayatunge, Ruwan M. The Psychophysical Effects of Combat from the Ancient Times to Modern Day. LankaWeb. 2010.
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  547. Because the Red Army did not recognize PTSD and the Soviet health authorities did not treat psychologically disturbed veterans, many suffer decades later from memories of the ferocious resistance of Mujahedeen fighters.
  548. Find this resource:
  549. Ørner, Roderick. “Falklands War Veterans.” The Psychologist 10 (1997): 351–355.
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  551. Very critical of the British military establishment for long neglecting PTSD. Holds up the Israelis as the model to follow.
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  553. The Gulf War, Bosnia, Iraq, and Afghanistan
  554.  
  555. As ably presented in Holden 1998 and Shephard 2001 (both cited under General Overviews), coalition forces were well prepared to deal with psychiatric casualties at the outset of the 1991 Persian Gulf War; the long history of the usual types of breakdown in combat was well known, and PTSD was now recognized. What they were not prepared for, however, was what came to be known as Gulf War Syndrome, a series of physical debilitations, including headache, fatigue, muscle coordination problems, heart disease, and cancer. That one explanation, exposure to toxic substances, has never been proven (Jones and Wessely 2005, cited under General Overviews) points toward psychiatric explanations (Laslof, et al. 1997; Ismail, et al. 2002; Showalter 1997). Following the Persian Gulf War, United Nations peacekeepers experienced PTSD problems caused by witnessing atrocities in Bosnia (Holden 1998, cited under General Overviews). The American experience there led to the implementation of a new program known as the Recruit Assessment Program (RAD) (Jones and Wessely 2005, cited under General Overviews). Unlike World War II screening attempts, the test on recruits is meant to gather baseline data that, coupled with subsequent combat performance, may be able to predict a soldier’s vulnerability to stress disorders on the battlefield. The early-21st-century wars in Iraq and Afghanistan involving American, British, and other NATO forces have produced a veritable avalanche of articles, many of them online, on combat-related psychological problems. A Google search for “psychiatric casualties in Iraq and Afghanistan” yielded thousands of results, which, despite obvious repetition, indicate intense interest in the early 21st century in PTSD and other war-related psychiatric problems, such as depression, substance abuse, and fatigue. Three of these online entries—Riddle, et al. 2008; Roehr 2007; Walker 2010—are included here as a representative sample.
  556.  
  557. Ismail, Khalida, Kate Kent, Traolach Brugha, et al. “The Mental Health of UK Gulf War Veterans: Phase 2 of a Two Phase Cohort Study.” British Medical Journal 325.7364 (2002): 576–579.
  558. DOI: 10.1136/bmj.325.7364.576Save Citation »Export Citation »E-mail Citation »
  559. Concluded that the incidence of PTSD among British Gulf War veterans was higher, but only slightly, than in previous wars. Available online for purchase.
  560. Find this resource:
  561. Laslof, Joyce C., Marguerite Knox, and John D. Baldeschwieler, eds. Presidential Advisory Committee on Gulf War Veterans’ Illnesses: Final Report. Washington, DC: Diane Books, 1997.
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  563. Appointed by President Bill Clinton to investigate the strange phenomenon of Gulf War Syndrome, the committee concluded that the main culprit was stress that negatively affects the brain, the immune system, the cardiovascular system, the nervous system, and the hormonal system.
  564. Find this resource:
  565. Riddle, Mark S.,John W. Sanders, James J. Jones, and Schuyler C. Webb. “Self-Reported Combat Stress Indicators among Troops Deployed to Iraq and Afghanistan: An Epidemiological Study.” Comprehensive Psychiatry 49.4 (2008): 340–345.
  566. DOI: 10.1016/j.comppsych.2007.07.007Save Citation »Export Citation »E-mail Citation »
  567. Excellent material on surveys of 40,000 US soldiers in Iraq and Afghanistan (2003–2004). Combatants reporting depression, suicidal tendencies, or need to see a psychiatrist or chaplain were twice as high in the intense fighting in Iraq. The authors place their findings in the context of wars that produced higher rates of psychiatric breakdown in intense combat (World War I and World War II). Available online for purchase.
  568. Find this resource:
  569. Roehr, Bob. High Rate of PTSD in Returning Iraq War Veterans. Medscape News. 2007.
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  571. Summarizes a talk given by Evan Kanter, MD, staff psychiatrist at the PTSD Outpatient Clinic of the VA Puget Sound, in November 2007. With 52,000 returning veterans from Iraq having been treated, representing 12–20 percent of troops serving in Iraq, numbers will probably reach 300,000, at a cost over the lifetime of these soldiers exceeding the military cost of the war.
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