Medical Science Publication No. 4, Volume II
FRIDAY MORNING SESSION
30 April 1954
MODERATOR
DAVID McK. RIOCH, M. D.
COMBAT STRESS*
BRIGADIER GENERAL S.L. A. MARSHALL, RETIRED
In a meeting of this kind, there is the initial difficulty that theaudience does not really know the speaker, his experience, his credentialsand his reliability, and the speaker may only guess what those whom hefaces would be most interested in hearing. That is especially the casewhen an amateur comes before professionals not too well qualified to speaktheir language or to relate what he has learned to the practices of a quitedifferent field of endeavor. With no effort at modesty, I would thereforeplead my sense of shortcoming for the task at hand, being encouraged togo on only by the realization that it is a subject concerning which noman alive has a truly competent knowledge. My approach to it is that ofone who has learned a few things from practice rather than acquired a generalwisdom of a great many things through prolonged exposure to theory. I amnot a scientist or a soldier though I have been a dabbler in both fields.I am a reporter and, as such, I have always thought of the human race asthe material of my workshop.
I have long been interested in the combat field in war because it isthe crucible of human experience; there is no better place to know manas he really is, stripped of nearly all of his pretensions. Still, lookingback over 50 years, I would say in the summing up that there are but threethings I have learned from this earthly journey: No. 1. Life is much tooshort; there is not time to learn very much; just about the time we beginto scratch beneath the surface of knowledge, fate jerks us shrieking toanother stage. No. 2. It is not necessary to learn very much to win anunmerited reputation for expertism in a given field: gaining about 1 percentmore knowledge and experience than the competition, "you just can'tmiss." No. 3. Practically every new truth one may develop which addsanything original or different to the mainstream of human knowledge arrivesby accident. Intelligence and logic have little to do with the matter.The new idea has to rise out of earth and "smack you about three timesbetween the
*Presented 30 April 1954, to the Course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington,
D. C.
348
eyes" before you see it. Truly, I have concluded that there isno such thing as intelligence; there are merely varying degrees of ignorance.
The one exceptional note in my background is that I have gone 10 timesto war in a relatively short life, sometimes as a soldier, and part ofthe time as a correspondent. In 15 American campaigns, I have been withinfantry, operating ahead of regimental headquarters, either as a commanderor staff officer. There is a type of lunacy in which the victim hits himselfin the head because it feels so good when he stops. But that is notmy difficulty, I am sure, though an initial curiosity had much to dowith it. In my first go at the combat line during World War I, I discoveredto my utter astonishment and delight that its normal dangers did not giveme an abnormal concern. I did not dream at night about whatever horrorI had witnessed in daylight. Machine gun and artillery fire did not giveme the involuntary urge to duck or wince. Nothing was greatly oppressivebut the dugout smell and the loathing for having to live underground. Beingthen 17, I wondered whether it was because, as the junior in the company,I was not weighed down by responsibilities toward a wife and children.It seemed an argument for not getting married. But I could not tell. Thewonder continued: "Was a man born or conditioned in a certain mold?"If he could "take it," was this because of prior fortune, mainly?I went back a sufficient number of times to find out. A man remains thesame, though years come and responsibilities change. Provided he remainsfavored by good health, he will react in much the same way at 50 as hedid at 20. Always on going up, there is the same dreadful sweat of anticipation,as if one were doing it for the first time, except for the inner voicesaying: "You fool, why did you let yourself in for this again? Willyou never learn?" But always on arrival the habit of applying one'sself to necessary work takes over. This is the essential, the one necessaryadjustment. At the front no other therapy helps more than marginally.
My subject is combat stress; I would like to state my thoughts aboutit as simply as possible. The object of all training and disciplinary proceduresshould be toward systematizing the doing of effective, collective workin the danger area, so that the individual, finding a use for his handand mind, is recalled from a rising terror. The main difference betweenseasoned and green troops is not that the former, having felt fire, cometo discount its danger. To the contrary, the longer one stays, the moresuperstition takes over. But seasoned troops have learned to habituatethemselves to duty as a personal easement which in the end insures unitstability.
There is a point which may apply here: I have read somewhere that ourmedical authority has set 265 days or some number of combat
349
days as the ceiling for the American soldier, the idea being that ifwe exceed it, the breakdown rate will become excessive. With this, I donot agree, because I could not accept the validity of any set of statisticsin support of it. It is not a problem to be approached statistically; atleast, that is my conviction. The figures prove nothing because in ourrecent wars, there has been too little flexibility, individually and collectively,in the administration of the infantry commitment. The line commander, seeinga good subordinate nearing the cracking point-and this is relatively easyto determine-has no authority to rotate him briefly to rear area duty forrecuperation. Because our infantry reserve has been invariably less thanthe need in our more recent efforts, there was small chance to apply commonsense in affording the combat unit rehabilitation respite from pressure.But had we ever been in position to apply conservation to our vital fightingmaterial, we would have saved much wreckage, and we might have learnedthat the American soldier, rightly used, can continue on for an indefinitenumber of combat days. Fear and its degenerative effects are not, as Isee it, cumulative. We continue to discount the amazing regenerative capabilityof the human mechanism. This is not because the specialists in that mechanismhave been shortsighted or unimaginative but because soldiers who make policieswith slide rules are not prepared to listen. We may be approaching thepoint where we will either do better or go down.
I recall July 1918, my regiment was making an 11-mile approach marchto the front line. It was a balmy evening, and clear. There should havebeen no sweat. There was nothing particular prompting foreboding aboutthat journey except the vast pyrotechnical display forward, raising thepresumption that if the lights were that much needed, the action must beterrific.
As we arrived at the line, I was astonished to see my platoon in a stateof collapse; men dropped in their tracks and could hardly remove theirpacks. I could not understand it. Three weeks later I was more surprisedto see the same men-those who survived-shoulder the same packs and march35 miles rearward, doing it "in a breeze." The contrast thenspelled nothing more important to me than that it is easier to march awayfrom a fight than to march into it.
Years passed and I still, in reflection, saw no more meaningful lesson.Then at Makin Island during the Gilberts invasion, I was once again withinfantry in an attack at the line of the equator. Fourteen days earlierI had flown out of Washington and therefore had had no chance to get acclimated.In the early morning I landed with the First Battalion against Red Beach.They continued on into the bush. Feeling quite myself, I returned to thetransport to keep track of the logistical movement. At noon, I landed withthe Second Battalion
350
against Yellow Beach. Their task was to cut through the heart of theJap citadel to the lagoon, a distance of less than 600 yards. I intendedto go with them. I got at least 100 yards. By then we were under mild sniperand machine gun fire. Suddenly my physical strength was completely spent,and with it, my nerve and my ability to think. I was a shattered wreck,much too old for the wars. In my mental fog, I concluded I was a victimof combat fatigue, and I lay down under a palm, awaiting a stretcher bearer.I intended to return to the ship and have myself marked a casualty. Buta solitary rifleman came along, stopped in front of me and swallowed somepills. I asked what it was and he said salt. I said: "Give me some;they can't make me feel worse than I do." I bolted 10 of them. Withinone-half hour I felt a whole man again. I did not again make that mistakein the Pacific, though it caused me to wonder how many men have been shotfor cowardice on the field of battle who had needed only that simple cure.But no one had ever told me that from neglect of this elementary precautioncould come not just heat stroke but the loss of that essence which we call"manhood" in the human spirit. I had to learn it the hard waythough I paid no price.
Later on, during the Marshalls invasion, General Arch Arnold asked meto determine why it was that an infantry line, checked three times by enemyfire in a quite short movement, even though it took no losses, became spentand could not renew the advance. It was a puzzling phenomenon. I foundcertain things wrong with our tactical procedures. We were fighting throughsemi-jungle country, much like the growth on the Florida Keys. When theline went flat after being fired upon, the men could not see one another.They remained inert and fearful; there were no devices for giving themquickly a sense of the presence of others. So group collection stagnatedand the individual spirit withered. A technical solution was immediatelypossible. It was recommended that at the onset of any such situation, itbe made SOP for all junior leaders to crawl along the deployed line, eachcalling to his men. In this way we could partly overcome the greatest enemyof the rifleman-individual loneliness. Man is a gregarious animal. Hisgreatest steadying force is the touch of his fellows. Under battle's pressure,he cannot long endure out of sight and voice contact with them. It wasso in the time of the Medes and Persians; it will be so in the wars ofundefined dimension in a terrible tomorrow. Such marvels as radio and televisiondo not change it. We need the touch of the hand, even as we need the convictionthat we are a useful part of something much larger and more important thanourselves, whenever the pressures of life put inordinate demands upon ourfrail persons. One of the most challenging military statements I know isthat in World War II more than 50 percent of our
351
so-called combat fatigue cases failed their first time in battle, andthat the majority of these were men who had just arrived and were givenno opportunity to meet their unit.
Yet we still tolerate procedures which directly promote this rate ofwastage, and we even call it good. The condition in Korea under rotationwas the sorriest example I can call to mind. Replacements would arriveat a front-line unit and be given a battle station. For maybe 6 weeks ormore, they would belong to a company without ever seeing it, though theywere part of it in combat. They knew only the men living in their own bunkers.When at last the company went out of line, they began to feel an identitywith it.
Dr. Rioch was with me for several weeks in Korea. My work at that timewas the setting up of a new system for the debriefing of patrols. InvariablyI dealt with shattered patrols which had been full-bodied and fresh theprior evening. The cases were far too numerous in which men had been senton patrol deep into no-man's land or enemy country, and had failed to returnfrom it, before they had ever been given the chance to meet their own unit.In one patrol, 7 of the 18 men who had not made it back had arrived inthe line for the first time on the same evening they were sent out. Therewas one greatly encouraging thing about it-one only-the ability of theaverage young American fighter to take this kind of mishandling by hisnation and still remain loyal, eager, and full of fight is a modern phenomenon.They are better than we know, potentially far more willing and able thanwe have yet admitted to ourselves. Some of the statistics seem to reflectthat we are becoming a nation of "weakies," that an alarmingpercentage of young Americans are mentally or physically unfit for militaryservice, and that among those who qualify, the flesh, though full, is toooften excessively soft. I would simply bear witness that the American troops-combat-withwhom I dealt during two tours in Korea were perhaps the best all-out fightingmen who have ever served the country-certainly, the ablest within my experience.
The policy-rotation-which too often denied them the substance of thatstrong uniting force which is supposed to be a combat soldier's right isdefended on the ground that by providing a terminal point, and giving thema hope for home, it bulwarked morale in a difficult period. But it wasthe cheapest form of rotation, arrived at to achieve a dollar saving, andin balance, it was a greater load on command and to the rifleman than ahelp to the human spirit. It signally bypassed the main principles of militaryorganization. As one artillery brigadier put it to me: "The troubleisn't that we can't get along with it but that some chump in Washingtonwill think it's good and we'll be stuck with it from now on." Rotationis worth mentioning only
352
because it is symptomatic of a national ailment. In the Twentieth centurywe are supposed to have gained more light on the spirit, mind, nervousorganization and flesh of man, and to have arrived at clearer undertandingof the balance coming of the relationship between these things than inany prior period. Nonetheless, the trend of policy within the militaryestablishment, as I see it, is toward placating weakness rather than rallyingstrength. This was not forced upon us; rather, we did not make any realeffort to resist the diverse and untoward pressures which brought it about.So today, coca-cola works, lollipops, and R & R are falsely given apriority over the re-invigorations of ideals and requirements which putthe utmost claim upon the manhood of the male individual. We say that thefuture will require us to get a higher level of performance out of ouraverage soldier than ever before; but we are not doing the things whichwould make it possible.
One truth, I feel, has stood the test of the ages: The will to riskgreatly, and to fight when it becomes necessary, is the ultimate proofof masculinity. This is said with all possible deference to the valuesof that other great proving ground-the boudoir-which, like John Paul Jones,I would not despise. There may be a common demnominator in the two undertakings.The main wheel in the drive of the real fighting man is the feeling thathe personally, and also his company, are both a startling success. Givehim that pulse, and he not only wears well, but continues to improve. Oneof the main signs that the Army-largely by a tug on its own bootstraps-hadlifted itself in Korea was the return of the competitive feeling betweenone combat unit and another. Able wanted to believe that it did a betterfighting job than Baker. King or Love would ask the question where otherline outfits had better fighting tricks unknown to them. They took pridein what they represented as a company group. In World War II, that spiritwas signally missing. Questions about the relative unit capability werenever once raised by any unit-yet I dealt with more than 500 rifle companies.
This remark may seem aside from a discussion of combat stress. I believeit has bearing. In the midst of terrible endeavor, when fear mounts andcrisis thickens, the rifleman-though it may not be a conscious thought-needsthe steadying awareness that his nation and its military system have donethe best possible to harden him toward his ordeal. No soundness in treatmentat the time can overcome the degenerative effects of policies which putless than an exacting demand upon the loyalty, integrity, and will of themale individual.
Having made tribute to the strengths of young Americans in Korea asI found them, I add that during the bitter hours of our retreat out
353
of North Korea, our shattered rifle formations continued to ask me whythe Army had taught them so little about how to survive in combat thoughit had found time for ample indoctrination on practically everything else.They expected me to answer for the system; I did not know what to tellthem. As the Army's Chief of Orientation in 1942, I had witnessed the deplorablesurrender to the idea that schooling a man in the justice of his causewas the main thing instead of assisting him to a feeling of personal achievementin a new, but worthwhile environment. Man is a finite being. As to hispersonal adjustments, his horizons are not far beyond his fingertips. Hecannot enthuse about a world cause if he is treated like a dog in his squad.But in the person of an inspired company commander, he can catch the reflectionof his noblest ideals, his faith in the nation, his love for his people.
Could we all but believe in this until policy guides firmly upon it,far less of your time would have to be spent in sweeping up the debris.I, too, have dealt with it. In the ETO, I screened personally 353 lineofficers who had failed in combat, looking for the number which could besalvaged and put to useful work. Finally, I took 27 of them as replacements;no one of them ever let me down. But as I remember them in mass, the outlastingimpression is one of a body of men who felt they had lost their man's estateand were looking for any opening by which to reclaim it. They were intelligent,earnest Americans. They were not cowards; but there were pressures to whichthey could not be conditioned. Of those who came with me, I sent as manyas seemed wise back to the line on duties which took them at least withinthe sound of guns. It simply seemed to me that this was part of the businessof giving them more secure personal foundations.
After this long detour, I return to the subject of the findings in thePacific. Though we had administered a tactical specific, the mystery stillremained: Why did the riflemen erode so rapidly under fire though the physicalstress undergone was relatively light?
No light came until months later when I dealt with the rifle companieswhich landed on Omaha Beach. On that dreadful field, panic and hysteria,halfway action and extreme intrepidity were co-mingled. Some companieswere so thoroughly beaten by the early fire that in mid-afternoon the mensat on the sands staring into space, seemingly, seeing and hearing nothing.They did not even stir to find cover. Such officers as remained mobileforced weapons into their hands, instinctively feeling that any act wouldbe the beginning of recovery. But there were other companies which, undercompletely adverse conditions, because of strong leadership, forged aheadwith painful slowness. There had been control in these units at all times.Some had arrived unscathed at the sands; finally they had triumphed. Yetone
354
and all, as they recounted the maneuver, they spoke of the sudden shockdiscovery of their physical weakness. Resolute of will, they still couldnot carry the loads or move the distance possible under training.
In this way, I began to see what I should have known a quarter centuryearlier-that fear and fatigue are concomitant and reciprocal in their effectson man on the combat field. There is no point here in attempting to becometechnical by describing the body reaction, the increase of lactic acidin the muscles, the diminution of glycogen and the gradual paralysis ofthat function in the male individual which gives him his most celebrated-andtroublesome-distinction. In more recent years I have collected many learnedpapers on this subject. I could have lifted their language. But it wouldnot have impressed you and it could have baffled me. All that is worthsaying is what it does to the fighter. The more heavily men are loaded,the farther they move, the more susceptible they become to fear. The moreintense becomes their fear, the greater becomes the impairment of theirphysical power. Whether the degradation come of work or of terror, recoveryis a function of time and of the extraordinary regenerative potential ofthe body mechanism.
What was 10 years ago simply a theory based upon data from the battlefieldwhich seemed mathematically to exclude other hypotheses has been in theyears since a subject for rather comprehensive battlefield experiment inaddition to repeated laboratory tests with varying degrees of relevance.Suffice to say that the general conclusion has been substantiated, thoughscientific argument about the particulars continues. The Army moved withastonishing speed. One of its field boards picked up the subject: Therewas brought about a wholly new concept of one-man logistics, which hasresulted in a broad program modifying all man-carried equipment and procedures,whereby what we expect of our average man in battle conforms to commonsense. Some of my scientist colleagues in Korea ran combat tests to determinethe changing chemistry of man under fire. Perhaps science must proceedin this way. To me it seems like running for a street car after you havecaught it.
By then my attention was drawn in quite another direction. I felt thatwe needed to know more about the recuperative factor, or interval, andI believed that Korea was an excellent laboratory for learning. It is notenough to show that a fighter can be knocked down by fear: One need ask,how soon, and by what means, can he be expected to get up from the canvas,swinging? Had this line of inquiry been seduously followed up in Korea,I feel confident that by now we would have a set of radically surprisinganswers, some of which would alter training methods and tactical procedures.
355
Because my time was directed toward other lines of study, all I cangive you are a few definite impressions. The first is that relatively littlesleep is needed to re-invigorate and make combat-worthy a totally exhaustedcompany. While on that point, I would like to add that when fighting menare totally exhausted, no amount of discipline can make them dig foxholesor use average prudence. It becomes a physical impossibility. The timecomes when inertia overpowers reason and men would rather take a chanceof death than make one more move.
When first dealing with troops, I heard numerous reports of riflemenwho had become caught and killed while in their sleeping bags. The bagwas described as a "death trap." In all my searching, I did notfind one provable case.
But I did find numerous examples where this happened: The company hadarrived late and exhausted at its ridgeline objective. The commander knewhe was supposed to remain at total alert because of the near presence ofthe enemy. Looking his men over, he also saw they were in no shape to fight.So he took a chance and told them to get into the sacks. Perhaps 20 minuteslater they were hit. The men were out, up and fighting with greater speedand more fury than he had imagined possible. In other companies, alongsidethem, or at least under the same conditions, the commander had followedthe opposite course, playing it safe, he thought, by keeping all hands"alert." When hit, the command had no unity of action and rapidlydissolved. Nature cries out against arbitrary orders in circumstances likethese. Squad leaders do lip service to it, then on returning to their positions,modify the order, put one man on guard for a spell, and tell the othersto keep one eye open. But it is an unsatisfying compromise.
After an all-night defense in which from hard body blows and fear ithad been reduced to a state of paralysis, one company of the 27th Regimentwas told to sleep by its captain. One-half hour later came the word thatit would prepare an attack against the key enemy ridge blocking the withdrawalof the division. It hit at 1100. As the assault started, its officers wereshot down. The uphill attack which followed, carrying right to the skylineunder NCO leadership against heavy fire, was one of the most thorough andcourageous charges in our history.
Studying both the Marine Corps and Army operations, I found also whatappeared to be a direct correlation between the duration of the periodin which the individuals had been under excessive emotional pressure andthe time required for complete rest, after which they would bound backto normal. If the fear-and-fatigue exhaustion, or the panic shock, wereconsequent to a brief few hours of excessive strain and terror, a quitebrief rest, as I have indicated, would restore their fighting mobilityand response to order. But if the period of
356
stress was prolonged over some days-and here I speak of acute stress-itwas found necessary to give them 24 to 48 hours of almost uninterruptedrest. The point is, however, that they did bound back to normal.When returned to duty in the line, there was no noticeable carry-over fromthe experience; no marked incidence of slacking, disobedience, physicalor emotional collapse among them. No troops in Korea knew a harder ordealthan those who were trapped on the eastern side of the Chosin Reservoir.In 5 days these men of 7th Division experienced defeat, loss of their commander,capture, starvation and exposure in 30-degree-below-zero weather. But afterthe few still mobile survivors-there were about 350-were given 48 hoursrest, they fitted into the Marine line, did their part and marched outwith the column.
It would be unbecoming to reason from the particular to the general.The few propositions which I have advanced here should be supported byseveral volumes of proof. But while my collection of data is mountainous,I do not have time to write all the books I would wish. I must make a living;writing military books is not a good way to do it. But the mind, I hope,is still able to assimilate much which the hand is not free to transmit.In strengthening the governing military principle-conservation of force-preventionis still better than cure; yet in what we do with men, we too often goagainst nature. The thoughts which I have expressed are all pertinent toone central theme. Whether we are thinking about doing that at sunset whichwill restore man for the engagement of the night or so administering himover war's long term that he can be returned as a more useful and believingcitizen of the Republic, the rule of action is that he not be pushed beyondhis tolerance limits, but rather, that he be afforded temporary reliefin time. Dean Inge described man as a creature half angelic, half satanic.Any father of a 3-year-old would certainly agree. No matter whether itapplies to men of combat age, it is only through an understanding of theelementary truth that a fighter's clay has well-defined mortal limits thatwe achieve that enlightened usage of him which lifts his heart and exhaltshis spirit. In this, soldiers are no different than bookkeepers.
My World War I commander, General Summerall, once said that he won hisvictories by making men march one mile beyond their possible limit. Tothat, I would reply that no force on earth ever made a man extend one milebeyond his possible limit, and when commanders try for it, they risk leavingtheir fight on the road and condemning too many of their men to life ina mental institution.
One observation which I made in Korea was that the physical capacityof the average American for marching, and for effective fighting at theend of a march, shows that in our time the book has
357
exaggerated his powers by approximately half. We are becoming a half-leggedpeople. We are not rearing a generation of lusty, confident, weather-conditionedsons and daughters of democracy. In fact, we are letting our people forgethow to walk. Thirty pounds on the back of the average young man in thiscountry will break him down. We think we are getting somewhere physicallybecause 100,000 people gather in the Philadelphia stadium to see 22 menstruggle around a ball. We forget that 65 percent of American boys reachmanhood without ever having taken part in a group game.
In Korea, the average country-bred porter could walk three times asfar under the same load, or walk an equal distance under a triple load,as the average American soldier. I personally recommended the organizationof the Korean Service Corps because it was obvious that our troops wereunequal to the logistical requirement which, in the straitened circumstances,many of our commanders were disposed to put upon them. For exercise, matureAmericans travel farther under cover and on the seats of their pants thanany people the world has ever known. But this does not help the troop leaderwho is ordered to take a ridge far beyond leg-reach by his men, thoughit does contribute to those group failures of which come personal defeat,frustration, and breakdown. I do indeed believe that the well-regulatedcompany, and above it, an understanding by command of the endurance limitsat the lower levels, are both the open sesame to battle success and themain safeguard within an army against those ills which, when too littleregarded, make mountainous our problems.
As for my own view of why, in Korea, there was relatively less difficultywith casualties of the noncombat type-and I am not speaking here of freezing-thoughthe subject is debatable, I would attribute progress to three factors:
1. Revival of the spirit of the good company.
2. Improvement in evacuation of the battle casualty.
3. The absence of a hospitable rear: Korea does not look good anywhere.
Having no more than skirted the fringes of my subject in this discourse,I feel this the proper point to call a halt. As Mark Clark writes in hislatest book, I have but sighted down the lines of my rifle, and the targetcannot be more than what I see. Of the little I have learned, I am nottoo sure. Of the much I do not know, I am absolutely certain.
