Shellshock

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Wartime psychiatry, no less than wartime medicine in general, had as its official objective the prompt treatment and return to duty of the wounded soldier. Psychiatrists in uniform took pride in turning in the highest “return to duty” rates they could manage, and indeed, wounded soldiers were often anxious to get back to their buddies on the fighting lines. Combat fatigue was meant to be transient; when a soldier’s condition intensified, military psychiatry had failed its primary purpose of maintaining the fighting strength of the army in the field. A cure was hardly the point. Perfectly well-adjusted soldiers were not required for combat. The adjustments, if they occurred, were postponed until after the victory parades.

The best known of all World War II’s heroes and the quintessential infantryman, Audie Murphy, had a celebrated homecoming. But he was also lucky. When Murphy was invited to Hollywood by the actor James Cagney, his fatigued appearance so alarmed Cagney that he gave the young soldier the use of his pool house for a year. Despite his advantages, Murphy never really got over his war. Twenty-two years after his last combat experiences, Murphy slept with the lights on and loaded .45 by his bed.

As the American memory commemorated the image of the Second World War, other veterans picked up their lives again and took on the comfortable identity that so characterizes them today: children of the Depression generation who went off to wage a victorious defense of freedom and humanity—tough, uncomplaining, irrepressible in their pursuit of the American Dream. If there were those, like my childhood friend Frank, who did not quite fit the image, they never seemed to interrupt the public consciousness. They lived on with their torments or in the clinical quite of VA hospitals.

In 1951 two psychiatrists working at the Los Angeles VA Hospital’s mental-hygiene clinic published a disturbing report in the American Journal of Psychiatry . For the preceding five years Samuel Futterman and Eugene Pumpian-Mindlin had been treating two hundred veterans who exhibited persistent symptoms of intense anxiety, battle dreams, tension, depression, guilt, and aggressive reactions and who were easily startled by minor noises. The psychiatrists’ general impression of their patients was of a “well-adjusted individual who broke down in [the] face of an overwhelming trauma.” More disturbing still, Futterman and Pumpian-Mindlin wrote, “even at this late date we still encounter fresh cases that have never sought treatment until the present time.” And although some veterans responded to treatment, they added, for others “it is as if they lived in the ever present repetition of the traumatic experience that so overwhelmed them.”

Nearly fifteen years after the Los Angeles psychiatrists’ report another article appeared in the Archives of General Psychiatry . Working in a VA outpatient mental-health clinic near San Francisco, Herbert Archibald and Read Tuddenham had been “struck with the persistence and severity of the combat syndrome” in their patients. A systematic study of these cases revealed “a clear-cut picture . . . of the combat veteran’s chronic stress syndrome” consisting of precisely the same complaints as those identified in 1951. Nor, in the authors’ judgment, were these mild cases; most were ”severely disabling. . . chronic, highly persistent over long intervals and resistant to modification.” As in the earlier investigation, some of the men who saw Archibald and Tuddenham had never before sought treatment. The article concluded on a forbidding note: ”Perhaps the most disturbing in the latest reports is the suggestion that the incidence of the syndrome is increasing, as aging makes manifest the symptoms of traumatic stress which have been latent since the war.”

Just two months before this report was published, President Lyndon Johnson ordered the U.S. Marines to South Vietnam. The cycle of war experience, and the repression of it, was about to begin anew. Maybe this is what Frank saw, so far away.

 

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