According to its mission statement, Homeward Bound Adirondacks aims to stabilize "the cascade of cognitive, emotional, physical, behavioral, moral and spiritual issues that characterize recovery from war trauma." I sincerely hope some measure of recovery is realized by as many veterans as possible.
This three-part commentary will examine the history of war trauma from the Civil War through the post-Vietnam War era, how post-traumatic stress disorder (PTSD) became an accepted psychiatric disorder, and the treatment of it.
What we have learned since the American Civil War (1861-65), notes psychologist Simon Wessely, is that every major armed conflict produces a unique variety of psychological casualties. British medical researcher Edgar Jones and his colleagues contend that war-related psychological symptoms (as well as the physical manifestations of these symptoms) are influenced by contemporary medical knowledge, changes in the nature of warfare, and underlying cultural forces. To this list I would add existing military and political structures and the dynamics of these structures.
A Marine returns after two days of battle on the Marshall Islands in February 1944.
(Photo — U.S. National Archives)
During the Civil War, soldiers suffered from "soldier's heart" or Da Costa's Syndrome (named after Dr. Jacob Mendes da Costa who investigated this disorder both during and after the war). Manifestations of soldier's heart included fatigue, shortness of breath, sweating, chest pain and heart palpitations. These symptoms typically persisted even though examining physicians could not detect any physical abnormalities. At a loss to accurately explain much less treat these symptoms, military physicians simply rid the army of problem soldiers. In his book "No More Heroes: Madness and Psychiatry in War," Richard Gabriel notes that many of these men "were put on trains with no supervision, the name of their hometown or state pinned to their tunics, others were left to wander about the countryside until they died of exposure or starvation." According to Gabriel, the growing number of afflicted soldiers wandering about triggered a public outcry that resulted in the first military hospital for the insane in 1863. This institution was closed at the conclusion of the war two years later.
An early explanation for soldier's heart was nostalgia, the yearning for home, family, and the familiar rhythm of life. Afflicted soldiers were considered nothing more than duty-shirking malingerers. In 1864, the assistant surgeon general stated, "It is by lack of discipline, confidence and respect that many a young soldier has become discouraged and made to feel the bitter pangs of homesickness, which is the precursor to more serious ailments." From this perspective the real problem had little to do with the war. Rather, it was the soft-heartedness of men unwilling to meet their military obligations.
With significant advances in destructive weapons in the latter half of the 19th and early 20th centuries, World War I (1914-18) is often called the first modern war. Hunkered down in trenches, soldiers in all armies endured frequent and prolonged artillery barrages and mortar attacks. British physicians coined the term "shell shock" to describe the dazed, disoriented, and withdrawn condition that afflicted an increasing number of troops. Doctors attributed this condition to physiological damage to the brain sustained by exploding shells.
However, physicians discovered that soldiers not close enough to the shelling to suffer physical injuries exhibited many of the same psychological symptoms as their wounded comrades. Just as in the Civil War, military leaders and many physicians believed these soldiers were attempting to shirk their duty. They were malingerers if not outright cowards as well-adjusted, brave men could withstand the rigors of combat with little risk of breaking down. The British Army executed 306 men during the war for a variety of reasons including "cowardice" and "refusing to fight." Military historians note that an undetermined number of these men were likely suffering from shell shock and shot after mock trials as a "lesson to others."
Based on his own front-line observations and the growing number of shell shock casualties (in some units up to 40 percent of all casualties), British Army Captain C.S. Myers, a specialist in psychological medicine, advanced a psychological, prolonged high-stress explanation for the shell shock condition. British psychiatrist Derek Summerfield states that Myers's perspective gained favor in the army for two reasons. First, in the midst of an expanding war, the army would not have to deal with tens of thousands of disciplinary cases implicit in the malingering and cowardice interpretation. Second, any explanation that allowed for the eventual return of shell-shocked troops to the front lines (after their damaged psyches were repaired) in a high casualty war was desirable.
Sociologist Wilbur Scott states this explanation and strategy was followed by the U.S. Army as well. A psychiatrist was assigned to each U.S. division to treat soldiers as quickly and as close to the front lines as possible.
"Treatment consisted of several days of creature comforts and the firm expectation that a soldier would return to duty," Scott writes.
This rest and recuperation treatment was considered a success as almost two-thirds of afflicted soldiers returned to the battlefield. Psychologist Edgar Jones and his colleagues state that by the end of World War I, some physicians believed physical and psychological injury symptoms overlapped and it was difficult to distinguish the effects of a mild head injury from those of an exceptionally stressful experience.
Psychiatrist Peter Howorth argues that as the war dragged on and casualties (including shell shock) mounted, many British soldiers came to view the conflict as senseless.
"They despised the warmongers at home," Howorth states, "more than they hated the Germans, and felt alienated from the civilian world." One can imagine the adjustment problems these men - especially those who also suffered from shell shock - endured upon returning to their families.
Beginning in 1940, the U.S. military embarked on a plan to identify inductees who might be predisposed to emotional battlefield problems. During the course of World War II, draft boards would eventually determine that almost 1 million young men were psychologically unfit to serve. Because psychiatric tests were designed to screen out individuals likely to breakdown, the problem of what would eventually be called "combat fatigue" was thought to be largely solved.
In 1943, Navy Commander Edwin Smith reported on his treatment of more than 500 Marines who were suffering from a condition he described as "Guadalcanal Neurosis." As a consequence of prolonged and particularly savage fighting on the Pacific Ocean island of Guadalcanal, these men had broken down emotionally. Among a long list of symptoms, they suffered from headaches, periods of amnesia and tremors and "wept easily." Smith believed the condition of these Marines was a "disturbance of the whole organism, a disorder of thinking and living, of even wanting to live." Smith stated that no screening tests at recruiting stations or boot camp could indicate the psychological problems these men would experience in combat.
With mounting evidence that battle-hardened veterans from the nation's elite Army and Marine Corps units were susceptible to various manifestations of combat exhaustion, the military halted the psychiatric screening of inductees in 1944. The reality among commanders that any individual could crack after prolonged combat began to take hold.
One in four World War II casualties was caused by "combat fatigue," one in two among men who had experienced prolonged, intense fighting. The 82-day-long battle of Okinawa (1945) involved four Army and two Marine divisions (along with troops from other allied nations). More than 14,000 American soldiers, sailors and Marines died. There were approximately 26,000 cases of combat fatigue, the greatest number of the war in a single campaign.
"Let There Be Light," a 1946 documentary funded by the U.S. Army, followed 75 "psycho-neurotic" soldiers being treated in military hospitals. The narrator states that "every man has his breaking point ... and these were forced beyond the limit of their endurance." Upon review, the Pentagon banned the film. It was declassified in 1980.
George J. Bryjak lives in Bloomingdale, retired after 24 years of teaching sociology at the University of San Diego. He served in Okinawa and Vietnam with the First Marine Air Wing.