Medicine: Spit It Out, Soldier

It used to be called “shell shock.” Doctors now call it “traumatic war neurosis.” The term “shell-shock” has been loosely used for symptoms ranging all the way from temporary nervousness and hysteria (e.g., a soldier thinks his arm is paralyzed but moves it when the doctor proves the reflexes are in working order) to permanent insanity. So far, about 5% of all World War II battle casualties and about 20% of the casualties returned to the U.S. have been nervous cases.

From the U.S. medical service in North Africa last week came word that a modern treatment (now having its first large-scale trial) is curing many front-line nervous crackups and rapidly returning them to the front line. In World War I, a very small percentage of such casualties were able to fight again. In those days, the most usual practice was to take a shell-shocked man as far as possible from the front.

Talk Treatment. Modern Army psychiatrists have a better notion. As soon as a front-line soldier loses his grip, he is urged to tell what is the matter, preferably to an Army psychiatrist, just behind the battle lines. The doctors do not let him get the idea that he will be pulled out of battle and sent for a good long rest. For doctors have found that the surest cure for such cases is fast treatment.

The modern treatment was foreshadowed—in extremes—in World War I: the British sent shell-shocked men home, feeding them on the fat of the land and making very few fit to go back to the front.

The French were harder on shell-shock cases, did not send them to rest homes nor promise them pensions, were able to send large numbers back to fight. When the British got tougher with their nervous cases, their cures increased.

Early in the Tunisian campaign the U.S. Medical Corps was still using the old treatment—hospitalization, long rest, etc. Only 2% of the patients were able to return to combat duty. Then U.S. doctors tried the quick method. Now at forward battalion aid stations they urge nervous cases to talk out their fears. If the men are exhausted or hold back their stories, they get barbiturate sedatives to quiet them and loosen their tongues. Once their story is told, most nervous cases feel relieved and, after a few days’ rest at evacution hospitals, 60% are ready to go back to active duty. Many of the remaining 40% are fit for rear-line duty.

A typical case was a tank sergeant who went berserk after the body of his commander, decapitated by a shell, fell in his lap. The sergeant shrieked, jumped out of the tank, ran wildly in circles with shells falling around him. His comrades got him back into the tank and to a first-aid station. After three days of treatment, the sergeant was able to rejoin his unit.

Controlled Steam. One of the chief exponents of the modern treatment is Major Frederick Hanson, an intrepid psychiatrist who has studied battle neuroses on three Commando raids, including Dieppe, and in the front lines at Maknassy and El Guettar. Says he: “It is amazing how much difference it makes to get at these men early. It’s like releasing steam before it has a chance to build up to explosive point in a kettle.”

Says a British medical brigadier: “This forward-area treatment is the greatest advance in military psychiatry in this war or the last.”