Medical Science Publication No. 4, Volume II
OBSERVATIONS ON PRISONERS OF WAR IMMEDIATELY
FOLLOWING THEIR RELEASE*
MAJOR HENRY A. SEGAL,MC
Introduction
From the psychiatric viewpoint, Operations Little Switch and Big Switchpresented an unusual challenge. Not only did they present an opportunityto apply the knowledge gained through the handling of repatriated prisonersof World War II, but also to augment that knowledge and, particularly,to evaluate the enemy's tactics and technics in the war to control men'sminds.
The psychiatric literature contains many references to the deleteriouseffects of enemy imprisonment (1-14). Follow-up studies of formerPOW's strongly suggest that the problems have not been self-limiting andthat many men continue to experience difficulty in readjusting to theirnon-prison environment. Often, failure to resolve these problems has causedthe individual concerned to become an emotional cripple, unable to acceptor discharge responsibility in the military or civilian setting. To a largemeasure, the difficulty lies not only with the former prisoner himself,but with the environment to which he returns following repatriation. Wan,beaten, and sometimes maimed, the former prisoner serves as a vivid, visual,guilt-producing stimulus to the civilian population and often to the militaryas well. How better to assuage this feeling than to "do everythingpossible for those poor men?" Hence, there follows an unreal, oftenprotracted period of adulation beyond belief with free giving, total permissiveness,and absent need for responsibility. This veritably universal relief fromguilt has an opposite effect upon the repatriate. For him, it may verywell be guilt-inducing by reminding him anew of his capture and his prisoncamp behavior. Under such circumstances it is not unusual to find men unconsciouslyexpressing the desire to remain helpless and pitied. Quite often repatriateswho had been relatively asymptomatic throughout the course of their imprisonmentdeveloped psychogenically determined symptoms after repatriation. Thesesymptoms are tenaciously maintained for purposes of secondary gain. ("IfI am sick like this because of my
*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. The views expressed in this paper are those of the author and do not necessarily reflect official opinion of the Department of the Army.
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imprisonment, how can I be expected to perform the duties of a soldier?")
It was amply evident, even before Little Switch had begun, that publicopinion was unshakably fixed. The hue and cry to "bring those poorboys right home" had already been sounded throughout America. Civic-mindedorganizations had already planned their heroes' parades. Radio, television,and the press were vying with each other to provide the most complete coverage.We had lost the battle for time-time in which to carry out the essentialprophylactic measures aimed at forestalling the appearance of the POW syndromeseen amongst World War II repatriates. What remained for us was only theopportunity to work briefly with the returnees and to define and delineatefor them the unreal atmosphere to which they had returned and the problemsconfronting them should they fail to recognize them as such.
Problems of Readjustment
What were the specific problems facing the men at the time of theirreturn to friendly hands? We have already touched upon one in the precedingparagraphs. Our World War II knowledge suggested others. They were confirmedby our findings in both Little Switch and Big Switch (15, 16).
1. Reintegration
For the most part, the repatriates tended to view their families andthemselves as they were at the time of capture rather than in terms ofthe present time. They might fail to recognize that with the passage oftime and the lack of common experiences, their interests and their family'sinterests may have become divergent.
2. Financial
The large sum of back pay which was made immediately available couldbe foolishly squandered thereby creating future financial difficulty. Thegroup in general appeared to be potentially easy targets for vigorous salesmen.The temptation would exist to spend it all in an effort to prolong theperiod of "unreal" living they would encounter on their returnhome.
3. Return to a Disinterested Environment
Prisoners of war, many of whom had spent up to 36 months in captivity,would find it exceedingly traumatic to return to an environment where theKorean War had not always been a popular one, where public interest wasnot always high, and where some disinterested individuals might even referto them as "foolish" for having taken a part in the war.
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4. Communication
During the period of prolonged imprisonment a distinct system of idiomaticcommunication amongst groups of fellow POW's was created. In this systemthere are often striking condensations, displacements, and references sothat one not thoroughly familiar with the system is hard put to understandits real meanings. Hence, the repatriates upon their return to ordinarycivilian and military life could find a strange lack of understanding betweenthemselves and those who had not been former prisoners. This might createfor them a feeling of rejection, helplessness, and frustration in not beingable to make satisfying human contacts. They might then find the greatestcomfort for some time to come in meeting and talking to old fellow formerprisoners who, alone amongst all others, would respond with some understandingof the pressing and non-explicit difficulties which they found.
5. Curiosity Seekers and Patronizers
Individuals who approached and questioned repatriates regarding theirexperiences, not out of genuine interest or concern, but rather throughcuriosity, would present a challenge to the returnee's ability to controlhostility. Similarly, people who evidenced an overly sympathetic or overlysolicitous attitude could evoke considerable anger.
6. Indoctrination
This did not constitute a problem for any previous group of repatriatedprisoners. Throughout the Korean War considerable concern existed aboutthe enemy's propaganda and indoctrination tactics. A warning note was soundedby Edward Hunter in his book, "Brain Washing in Red China" (17)in which he detailed the Communist's coldly calculated, highly systemizedplan to alter men's basic attitudes and beliefs. The overconcern on thepart of the public and press was heightened by Communist threats to BigSwitch returnees that they would be severely punished by our Governmentupon their return to America. The unnecessary focusing on this area (indoctrination)diverted attention from the important therapeutic task of aiding in readjustment.
The Setting
Because of the importance of environmental factors opera ting upon themen at the time of their return, it is essential that the initial environmentinto which the men were placed be discussed in some detail.
In Operation Little Switch all of the repatriates were regarded as hospitalpatients and their care and subsequent transfer to America was entirelythrough medical channels. They were maintained for the first day and nightof freedom at an Army Evacuation Hospital
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near Seoul, Korea. Here they received needed emergency medical careand were given a brief, initial physical examination. On the followingday they were air-lifted to the two Tokyo Army Hospitals designated toprovide their care. In these hospitals special wards were reserved forthem. The former prisoners were not given the freedom of the hospitalsor the city, ostensibly to conserve time in order that essential medicaland administrative processing could be carried out. The regular hospitalcomplement was augmented by additional medical and administrative personnel.The POW's were given certain unusual privileges such as a free telephonecall home, short-wave bedside radios, special PX ward carts. Above allelse, they were given copious quantities of that special nursing care knownas "t. l. c." (tender loving care). The imposition of restrictionsand limitations concerning their behavior and movements undoubtedly servedas a reminder to them that they were, as before, still members of our country'sfighting arm. Their Tokyo hospital stay was, unfortunately, all too briefand did not permit necessary psychotherapeutic intervention. At the endof 3 days the men were air-evacuated to America via Hawaii to Army hospitalsnearest their homes, where their processing was completed.
In Operation Big Switch only the sick and wounded were regarded as medicalpatients and evacuated through medical facilities. The remainder, and byfar the overwhelming majority, were accorded a status most closely resemblingthat of the rotatee who has completed his Korean tour of duty and is enroute to the Zone of Interior. They were maintained at an Army ReplacementDepot in Inchon, Korea, in an area specially set aside for them. It wasobvious that all concerned had taken great pains to insure their comfort.The area was freshly painted and equipped. New shower units had been installed.A splendidly staffed Red Cross unit was in continuous operation. A PX wasinstalled solely for the use of repatriates and was elaborately stockedwith expensive radios, cameras, etc. In contrast to the ordinary rotateethey were given bunk-type beds with fresh linen. The entire area was deckedout with such incongruous signs as "Howdy Partner," "LongTime No See," "Times Square and Broadway," "The LittleGolden Gate."
The Replacement Depot, which was still charged with its customary functionof processing normal rotatees, was understaffed and hard put to dischargeits added difficult mission. Despite the fact that the repatriates werequartered in an Army Replacement Depot, there was little if anything tosuggest to them that they were still members of the Armed Services. Disciplinewas extremely lax. Initially there were no formations. Retreat ceremonywas never held. Saluting, either between prisoners or cadre was seldomseen. The repatriates
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were asked, rather than told, to keep appointments. As is so often thecase, men who fail to be treated as soldiers fail to act like soldiers.Fully 30 to 40 percent of them failed to keep necessary appointments andcould be found instead lounging in the PX, the Red Cross Recreation Room,the barber shop, shoe shine parlor, or simply lying on their beds. An increasingnumber of men jumped over the fence at night for an evening of drinkingand play.
It soon became apparent to all concerned that a semblance of disciplinewas needed. The institution of two formations each day proved somewhathelpful. There was a mild "tightening up" by the cadre. Needlessto say, no harmful effects by the change in policy could be detected. Infact, the author overheard one repatriate saying to another, "Boy,that Captain sure did chew me out." "Yeah," replied theother, "how did you feel about it?" "Boy, it sure felt great."
Aboard the troop ships carrying the men to the United States their "specialtreatment" continued. In addition to the POW's these ships also carrieda large number of normal Korean rotatees (men who had completed their Koreantour of duty and were en route to the United States for reassignment orseparation). The allocation of troop space differed between the two groups,with the repatriates being given additional living space. They were segregatedfrom the other troops aboard as well as from the ship's complement. Thisdid much to foster in them a feeling of being different and precluded asatisfactory group reintegration which we considered so necessary. An excellentnarrative of the conditions and work performed aboard these ships may befound in an article by Lifton (18).
The Method
In Operation Little Switch the Department of the Army prescribed minimumstandards to be met in the examination of prisoners of war, including acomplete medical and physical examination. It was determined in the FarEast Command that the psychiatric examination would consist of a psychiatricinterview of at least 1 hour's duration, a complete psychological testbattery (Wechsler-Bellevue, Rorschach, TAT, Miole-Holsopple and DAP Tests)and, where time permitted, a psychiatric social history. The men receivedtheir psychiatric evaluation in Tokyo within 24 to 48 hours of their arrival.
In performing the psychiatric examination, the psychiatrist usuallybegan by introducing himself to the patient with the explanation, "Iam a psychiatrist and I am interested in talking with you about any problemswhich may have arisen as a result of your imprisonment in order that Imay be helpful not only to you, but also to your buddies." The examineewas then asked to discuss in detail the events leading up
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to capture. In so doing, the majority of men interviewed developed thestory of their capture, their period of captivity, and their attendantfeelings. Specific areas of interest which the psychiatrist investigatedin detail were: Circumstances surrounding capture; attitude toward capture;narrative of prison experiences; attitude toward fellow prisoners; attitudetoward captors; motivation and future plans. In addition, a minimal amountof background information in terms of family, schooling, religious preference,and siblings was obtained.
Psychological testing was performed in two separate testing periods.These tests were administered at varying times in the course of the POW'sstay. The results of these tests are currently under analysis and willbe reported at a future date.
At the time of the arrival of the first group of Big Switch returneesat Inchon, seven psychiatrists were available to carry out psychiatricexaminations. When it became evident that only a minimal amount of timewould be available for this task, because of the pressing need for administrativeprocessing, additional psychiatric personnel were made available. The personnelselected for this task came from both the Far East Command and the Zoneof Interior. Army, Navy, Marine Force, and Air Force personnel participated.A considerable number of the psychiatrists and psychologists received theirinitial briefing at the U. S. A. H. 8167 A. U. where the Big Switch sickand wounded had been evacuated. Many of the men were assigned briefly tothe hospital on temporary duty in order to work with the prisoner patients.
A second briefing session was held at Inchon in which the author madefull use of the experiences gained in Operation Little Switch. The psychiatricpersonnel then undertook the difficult task of interviewing the repatriateswhile they awaited ship at Inchon. The men thus seen were examined at periodsranging from 5 hours to 96 hours after their return to friendly hands.A minimum of 20 and a maximum of 80 returnees were seen daily. It was believedthat the experience gained was responsible for making a coordinated well-integratedteam of the psychiatric personnel assigned to the ships returning the repatriatesto America. Each ship carried a psychiatric team consisting of senior psychiatrist,three psychiatrists, clinical psychologist and clinical psychology techniciansor psychiatric social work technicians.
Group Therapy
The psychiatric evaluation as well as the initial clinical psychologyimpressions confirmed our initial impression that the Little Switch returneescould not be considered "normal." The men appeared not only tohave no awareness of the specific problems of readjustment
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facing them, but also to lack the capacity to handle them. There wasa clear and definite need for vigorous psychotherapeutic measures. Withthe pressure of time and personnel limitations under which we operatedit was quite obvious that individual psychotherapy was not feasible. Thegroup psychotherapeutic approach appeared ideal. Not only would such anapproach conserve time and personnel, but it also would enable former prisonersto utilize the support of that group with which they appeared most comfortablein working through their problems. Accordingly, two pilot groups were organized,but met only twice. In general, the group of 8 to 10 men remained silentand appeared somewhat hostile toward the therapist. They failed to respondto a non-directive approach. When the session was structured by the therapist'sintroduction of specific problems facing the entire group they became moreactive and appeared capable of discussing these difficulties. While noone would be presumptuous enough to state flatly that these pilot groupswere helpful to the participants, we nonetheless believed that with moretime and more meetings such an approach would yield beneficial results.
It was therefore recommended most strongly during the planning phaseof Operation Big Switch that all returnees who had been held captive forover 6 months be seen in group therapy. There was no time for this to becarried out at Inchon. However, all of the members of the psychiatric teamshad been briefed regarding the need for and rationale of group therapyto be carried out aboard ship en route to the United States. It was feltthat the 14-day voyage would enable the psychiatrists and clinical psychologiststo hold at least six group therapy sessions of a reasonably structurednature. No effort whatsoever was to be made at delving into the past. Guiltuncovered in such a technic would have proven most difficult to deal with.Instead, the focus was to be on the "here and now" situation.Unfortunately, the press of administrative and other processing was sogreat that on some ships no group therapy was performed while on othersonly a few sessions could be held.
An appraisal of the effects of group therapy is contingent upon a carefullyexecuted follow-up study utilizing controls. Such a study will be undertakenin the future.
Accomplishments
A total of 149 United States military personnel repatriated in OperationLittle Switch received their complete psychiatric evaluation (includingpsychological testing) at the two Army hospitals in Tokyo. The comprehensivemedical evaluation performed on 68 repatriates at the United States ArmyHospital, 8167th Army Unit is reported elsewhere. Included is a brief surveyof the psychiatric findings (15).
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In Operation Big Switch a total of 1,301 repatriates received theirpsychiatric examination (exclusive of psychological study) at Inchon. Twohundred and fifty sick and wounded repatriates, evacuated through medicalchannels, received complete psychiatric and psychological work-ups in Tokyo.Of the men seen in Inchon, 30 were considered overtly psychotic, pre-psychoticor severely neurotic. They were transferred to the Neuropsychiatric Centerin Korea (the 123d Medical Holding Company) for interim care and ultimatetransfer to the Neuropsychiatric Center in Tokyo. Ninety-three former prisonerswere considered sufficiently disturbed and tense to preclude interviewby the press or television reporters. Twelve repatriates, though obviouslyemotionally disturbed, were considered capable of returning to the Zoneof Interior via ship with supportive care.
Psychiatric Findings
The initial psychiatric evaluation carried out in Operations LittleSwitch and Big Switch must be regarded as objectively cross-sectional ratherthan conclusive. The majority of repatriated prisoners of war observedmanifested a moderate to marked degree of blandness, retardation, and apathy.These features had been previously noted amongst repatriated World WarII prisoners of the Japanese and the term, "Zombie Reaction"was applied (19). In general, Big Switch returnees appeared moreinterested in their environment and somewhat less "Zombie"-likethan did the Little Switch group. In most cases the blandness and apathycleared spontaneously 3 to 4 days after repatriation and was then replacedby a mild degree of euphoria (happy "Zombies"). Talk was veryshallow, often vague, and with definite lack of content.
The majority of men examined spoke with little coaxing or promptingby the interviewer. None of the Little Switch returnees appeared reluctantto submit to psychiatric evaluation. In some instances Big Switch personnelexpressed opposition to psychiatric interview on the grounds that they"might violate security." It was believed that the Big Switchgroup were more guarded and suspicious during interview and demonstratedevidence of overt anxiety and concern regarding their future treatmentby military and civil authorities. It appears reasonable to ascribe thisanxiety to Communist statements of impending prosecution on their returnto America as well as the avid interest shown by our press and televisionreporters regarding Communist indoctrination efforts (brain-washing).
In both groups of returnees it was strikingly evident that details ofthe events leading up to and immediately following capture were missing.In many cases their behavior when captured suggests a
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panic reaction with concomitant dissociative state and loss of memoryfor specific events. Many of the men spent painstaking hours with fellowprisoners in an effort to reconstruct the situation at the time of theircapture. Virtually all of the men interviewed described an initial fearthat they would be put to death by the enemy. They expressed considerablesurprise at the treatment accorded them by the Chinese who gave every appearanceof being friendly and helpful when taking them prisoner. Many prisonersopenly expressed gratitude for the "good treatment" which theyreceived. Actually, the "good treatment" merely meant that theChinese did not torture or kill them as they had anticipated. Althoughmost repatriates could clearly recall earlier fantasies of death or maiming,none remembered having fantasies of being taken prisoner of war prior tothe time they were captured. Most said simply, "I never consideredbeing captured as a possibility."
In discussing the "Death Marches" considerable resentmentwas expressed by some senior officers toward junior officers and noncommissionedofficers whom they accused of selfishness, poor discipline, and failureto comply with orders. On the other hand, some junior officers and noncommissionedofficers stated with considerable anger that senior officers defected,refusing to take command and to accept responsibility.
In the early stages of the war, particularly the period from July 1950to April 1951, atrocities and stories of atrocities were rampant. Manyof the men had personally witnessed, prior to capture, the results of NorthKorean atrocities. This undoubtedly exerted a strong "conditioning"effect so that when captured they believed they too would be torture victims;however, even after no further positive evidence of widespread atrocitiesexisted, men, when captured, continued to be fearful and to anticipatetorture and death.
Both the Little Switch and Big Switch repatriates demonstrated an incredibletolerance toward the medical and administrative processing. There was evidentlyno burning desire to return home immediately. Many were consciously awareof the anxiety engendered by their imminent return home and asked for additionaltime in which to "get on my feet." Others, perhaps through anunconscious attempt at delay, asked for leave or exaggerated minimal physicalcomplaints in order to gain access to the less hurried medical channelof evacuation.
Little and Big Switch returnees during their brief period of observationin Korea and Japan appeared to be highly non-cohesive and isolated. Thegroup identifications maintained prior to capture were, in several cases,absent. The repatriates often referred to themselves as, "The Americans"or "American Forces." It was not uncommon
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for men to respond to the question, "What unit were you with?"with the reply, "Camp number so and so."
A large number of the men examined appeared "suspended in time."They had a highly idealized picture of themselves and their family andhad failed to take into consideration that both their families and themselveshad changed during the period of imprisonment. There was little, if any,talk of future plans. Such plans for the future as were discussed appearedpoorly conceived, of a short-term nature, often conflictual and highlyunrealistic.
"Give-Up-Itis"
American medical officers held prisoner of war by the enemy have commentedupon this "syndrome" which they observed at first hand amongsttheir fellow prisoners.
Symptoms and Course
Men who developed this syndrome were observed to abstain gradually fromphysical activity. They remained supine within the confines of their prisonhut. With the passage of time, they withdrew more and more from all contactsand became mute and motionless. They refused to eat unless given largeamounts of cold water. Eventually, they completely refused to eat and developedwhat amounted to an obsession for cold water. Finally they "turnedtheir faces to the wall" and died. From the onset of first symptomto demise took a period of 3 weeks, "almost to the day."
Incidence
In units with poor morale and poor unit identification, this conditionwas responsible for a large number of deaths. "Give-up-itis"alone was considered the primary cause of 25 to 50 percent of all the prisoncamp deaths. In conjunction with exposure, "give-up-itis" accountedfor 75 percent of the deaths, while in almost 100 percent of the casesa combination of "give-up-itis," exposure, and malnutrition wasconsidered the cause of death. The condition was most prevalent amongstsingle, young, immature enlisted men from broken homes. It was rarely notedamongst noncommissioned officers or officers. In the 25-35-year-old agegroup regardless of rank, the condition was uncommon. It was rare amongstpsychopaths. The syndrome is said to have been nonexistent amongst otherAllied prisoners of war.
Treatment
In attempting to cope with this condition our captive medical officersat first made use of a sympathetic approach with exhortations to "rememberthe family," "the girlfriend," "wife," "friends."When
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this approach failed to yield results, the doctors then employed a stern,strict regimen in which they attempted to provoke hostility from the afflictedindividual. They persisted in their anger-producing tactics until a positivehostile response was produced. When the individual was forced into thisresponse early in the course of his syndrome he recovered completely anddid not relapse in the future; however, the use of such a technic is mostdifficult for the anger thus induced is both profound and protracted. Onephysician employed the technic of forced eating to prevent deaths from"give-up-itis." He and his trained enlisted personnel supervisedthe prisoners' eating habits. Any prisoner who refused to eat was chokeduntil he consented to take food. If the food was spit out it was re-fedto the individual.
Indoctrination
During the period prior to the entry of the Chinese Communist Forcesinto the Korean War, no indoctrination attempts were made by the enemy.The North Koreans proved themselves totally barbaric and ruthlessly cruelcaptors. The Chinese Communists, on the other hand, appeared more interestedin indoctrination than in death and torture. This is not to say that theywere the epitome of kindliness for their brutality too is well known. Therewas evidently no distinction between Chinese or Korean by our soldier whencaptured, since he regarded both as intent upon torturing and ultimatelykilling him.
At the time of capture, the Chinese, by word and deed assured the newprisoner that he would be unharmed and well treated. Most often he wasoffered a "friendly" cigarette. Though poorly fed, to be sure,the enemy was quick to point out, "We are feeding you the same foodwe eat-for we are your friends." To the soldier anticipating tortureand death such treatment produced a considerable emotional confusion. Howcould he help but feel some gratitude to his new-found "benefactor"for having spared him from death itself? The silent removal of leadersfrom time to time during the course of imprisonment served as a constantreminder that one must continue to fear the future. Compliance and cooperationwere achieved by subtle hints at torture, occasional physical mistreatment,chiefly in the form of slapping or the maintenance of uncomfortable positionsfor protracted periods, solitary confinement, deficient diet, dummy firingsquads, and perhaps worst of all, threats of exile to Siberia and eternalnon-repatriation. On the other hand, "good" behavior was rewardedby improved diet and living conditions. In some cases the enemy hintedat "early repatriation" and referred to a group of American Marinesthey had released in December of 1950, after a brief period of indoctrination.
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The Chinese utilized every possible method to deny the prisoners internalleadership. The relative absence of organized food, escape, disciplinarycommittees within the camp membership bears testimony to their successin this regard. Results were obtained first by segregating all officersinto a special camp. The noncommissioned were similarly removed. This deprivedthe bulk of prisoners of their leaders with resultant deficient discipline,leadership, and morale. Into this leaderless group the Chinese injectedthe English-speaking Chinese Communist squad leader. He was responsiblefor the group's discipline, indoctrination, and for constant informing.Whenever natural leaders emerged amongst the prisoner group they were removedsilently and expeditiously by the Chinese usually with subtle hints thatthey would never return again.
Before the group could adopt a new identity and pattern of behavior,it was essential that the old one be dissolved. This was achieved in partby denying that the prisoners were soldiers. They were addressed by theirlast name only and told that since they were now prisoners and war criminalsthey no longer had any rank. By adroitly regulating mail from home, theenemy made use of an insidious and ingenious method of cutting the hometies. Letters from home of a pleasant or at least neutral nature were deliberatelywithheld. Those of a complaining or pessimistic type were delivered uncensoredto the men. Because of the depressing effect of such letters, many ceasedto look forward to mail from home and tended to lose their identificationwith home.
The autobiography required of each prisoner presented the enemy witha powerful club to wield over their heads. Obvious misstatements were quicklydiscovered and employed as evidence that the prisoner had failed in hisduty to "always tell the truth." One also paid a price for honestyand accuracy since it was not difficult to show that at least one memberof the prisoner's family had committed a crime against the people and wasan enemy of the people-a crime for which the prisoner must recant by goodbehavior. To the Communists there were no crimes against individuals-onlycrimes against the people. Hence the theft of a single turnip by a prisonerwas a crime against the poor people of North Korea and the culprit a warcriminal whose punishment could be exile to Siberia.
Isolation was nurtured also by the enemy's insistence upon the needto confess (inform) which was constantly stressed even though it implicatedone's self, family, friends, or country. To fail to do so constituted acriminal act against the people, for which punishment was frequently given.Close relationships between fellow prisoners became virtually impossibleunder such conditions. Not only could one's own friends not be trusted,but no one could even be sure that
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he himself would not be the informer. To tell the truth once meant totell the truth always. ("Why are you not telling us the truth thistime? Have you changed and become an enemy of the people?")
Communist propaganda was disseminated largely by formal "classes"held under the supervision of the Chinese squad leader. The propagandainitially presented was not totally unreasonable or hostile so as to arousethe group's ire. So successful was the enemy at stimulating the anger ofthe prisoner group that there were very few evidences of organized or spontaneousresistance. The material consisted, in part, of questions as to "WhySouth Korea Had Invaded North Korea?" "America's ImperialisticAims in Asia," "The Role of the Communists in Fostering Peace,""The Maldistribution of Wealth in America," "Racial andClass Discrimination," and "The Need for Peace." In additionto the squad leader, each group had an enemy-appointed monitor selectedfrom amongst the group membership. He often proved sympathetic towardsthe Communists and worked with the squad leader in indoctrinating the men.A check on the squad's attentiveness in the classroom was maintained byquestions about each day's lessons. The need for cooperation was stressedand subtle hints made at non-repatriation. The enemy made full use of defectorsamongst our prisoners. Officers who confessed to germ warfare atrocitieswere taken on tours of the camps to tell the men of "the barbaricAmerican germ warfare efforts." These presentations were evidentlyhighly effective, for the majority of returned prisoners interviewed appearedquite convinced that we had employed such tactics.
The majority of our captured personnel did not have access to secretinformation; however, the Chinese repeatedly questioned them about Tablesof Organization and Equipment, Field Manuals, and Training Manuals. TheChinese would often openly exhibit these documents to show that they alreadypossessed the information but insisted nonetheless that the prisoner revealall he knew of their contents. Many men tried to deceive the enemy by submittingfalse information. This was dealt with sternly and the prisoner threatenedwith the brand of "enemy of the people." Often, the Chinese wouldtake the information and throw it in the waste basket with the enjoinder"Write it over again." When the second document was submittedthe first would "reappear" and the two would then be compared.Any difference, no matter how slight, formed a basis for the accusation,"You are not telling the truth." Having once entered into thisbusiness, the prisoner could never turn back but must, perforce, producemore and more of the desired material ultimately betraying some bit, eventhough seemingly insignificant, of security material.
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There appears to have been considerable confusion amongst the prisonergroup as to how they were to deport themselves in captivity. Hence, somebelieved that they were to "give name, rank, serial number only."Others maintained that their instructions had been "give name, rank,serial number and nothing else-unless the enemy looks like he really intendsto get what he wants." Some understood their instructions to be togive the enemy anything he wanted to know except security information.In retrospect, it would appear that no compromise was possible. One eithertold absolutely nothing or was eventually maneuvered by theenemy into telling everything.
The Chinese divided prisoners into two categories: "Progressives"and "Reactionaries." These two terms, long associated with Americanpolitical life, in the short period of months have now taken on an entirelydifferent meaning. One has become an epithet synonymous with "Communist;"the other has become a badge of honor awarded anti-Communist. Within theprison environment and, as used by the enemy, the words have still differentmeanings.
The term "Reactionary" was given to those prisoners of warwho for whatever reason either actively or passively opposed Communistideology or who acted in violation of prison camp regulations. Amongstthe group so labeled we find the "true heroes"-men who activelyresisted all indoctrination efforts and who refused to impart any informationwhatsoever to the enemy. These men maintained their identity, integrity,and honor throughout the period of imprisonment. In general, they wereill-treated by the enemy, often subjected to torture, and most spent considerabletime in solitary confinement. A very small number of prisoners who werepsychotic during their incarceration were labeled "Reactionary"for, in their psychotic behavior, they defied the enemy by spitting, hurlinginvectives or rocks, etc. Also to be found within the "Reactionary"group were some men with life-long personality disorders. These men hada virtually life-long history of inability to accept authority and of constantrebellion thereto. In prison camp their continued course of aggressivebehavior earned for them the label "Reactionary." They may beconsidered "Reactionary" by accident rather than by design.
Although the "Reactionary" group appears reasonably specificand capable of definition, the "Progressive" group is a confusingone by reason of its heterogeneousness. In general we may say that theCommunists regarded anyone who accepted their views or at least did notactively or passively oppose them, as a "Progressive." Yet, thisdistinction on pseudo-political grounds breaks down quite readily. Amongstthe group labeled "Progressive" by the Communists and their fellowprisoners we find a group of men with apparently little
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ability to withstand stress who early reacted to enemy threats, realor implied, by giving military information or by confessing to germ warfarecharges. Although labeled "Progressive" by the enemy and thepublic, this group does not profess any sympathy whatsoever for Communismor its tenets and these men regard themselves as "Americans."Many are quite outspoken in their hatred of the Communists.
Informers have been labeled "Progressives." These men, duringimprisonment, informed upon their fellow prisoners to curry favor for themselvesin the form of better creature comforts. They do not regard themselvesas Communists, nor is there anything to suggest that their behavior waspolitically determined. These men behaved no differently in prison campthan they had prior to imprisonment out of camp. They had and have no senseof loyalty or identification with any group. They act only for what theyconsider to be their own best interests. Nothing suggests that their behaviorwas contingent upon indoctrination. On the contrary, many were not sufficientlyendowed intellectually to grasp the indoctrination material.
The largest group of "Progressives" were those prisoners whoelected, in their words, "to play it cool." This group felt thatthe best method for survival during imprisonment was at least superficialcooperation with the enemy by not vigorously opposing the indoctrinationprogram. Enemy petitions signed by these men were regarded by them to berelatively benign. There was a strong tendency to set limits for they consistentlyrefused to sign what they considered to be traitorous allegations.
Another sub-group consisted of those having a rather naive desire tolearn. These men displayed an avid, possibly sincere, interest in Communistteachings and literature. They were encouraged in this by the enemy whoemphasized the need for them to "learn the truth." It need notbe presumed that this group was of necessity indoctrinated. For the mostpart, these men were immature, insecure, and highly susceptible to theflattering interest shown in them by the enemy.
The smallest sub-group are those who were truly indoctrinated and insome cases at least, there is evidence to show that their indoctrinationtook place long before their capture in the Korean War. These individuals,as a result of the enemy's indoctrination efforts and their own personalitydeficits, radically altered their political beliefs and at the time ofrepatriation openly and unqualifiedly subscribed to Communism and its teachings.This small group considered themselves the elite "Peace-fighters."They have no doubt about their future plans. They will return to Americaand teach Communism! It is predicted, however, that for many their indoctrinationwill not
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last long and upon return to America they will once again alter theirbeliefs in order to conform with the majority. Many in this group are hysterics,schizoid personalities and psychopathic personalities. The total numberor truly "indoctrinated" returnees is very small (20).
Areas for Future Investigation
1. Adequate counter-measures to employ against the enemy's psychologicalwarfare efforts cannot be devised until we first become thoroughly conversantwith his technic and rationales. To achieve this, a vigorous, scientificallyobjective dissection of the Communist indoctrination and propaganda effortsmust be performed. There has been a growing tendency to regard the Communistenemy as supermen. Their program of brain-washing has been viewed, in somecircles at least, as being so fiendishly diabolical that no one could possiblywithstand its pressures. Yet, there are many amongst the returnee groupwho successfully withstood all of the enemy's indoctrination efforts. Wewould do well to study this group in an effort to learn what traits ofcharacter, personality types, mechanisms of defense, degree of intellect,etc., are needed to emerge victorious from the war designed to destroybasic loyalties and beliefs.
2. It may well be that the enemy's results have far more to do withour "weaknesses" than with his "strengths." One ofthe major forces sustaining a soldier during periods of combat stress ishis close identification with his unit and, particularly, with his fellowsoldiers. Many prisoners captured by the enemy in the early months of theKorean conflict showed a striking lack of identification and unit pride(esprit). The initial tactical situation in Korea necessitated the commitmentto battle of large numbers of unseasoned troops. Urgently needed replacementswere thrust into the breech without an opportunity to become acquaintedwith their leaders or fellow soldiers. Under such conditions it is notsurprising to find that during their period of imprisonment they lackeda sense of "belonging," and had poor identifications. These menconceivably proved more susceptible to the enemy's indoctrination tacticof isolation.
Soldiers of other United Nations held prisoner of war by the enemy arereported to have remained cohesive and to have actively opposed the enemy'sindoctrination efforts. No cases of "give-up-itis" are reportedamongst this group.
These findings may be due to the fact that they were not subjected toas severe an indoctrination program by the enemy as were our forces. Theexplanation may lie, at least in part, in the fact that their men had strongunit identification, knew their fellow soldiers and leaders thoroughlyand, above all, possessed a high degree of
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esprit and discipline. Without exception, these nations employed unit,rather than individual, rotation. When committed to battle, their combatunits were well integrated and the men had a strong sense of "belonging"with friends who could be thoroughly trusted and relied upon. Under suchconditions enemy efforts to cause loss of identification and subsequentisolation were hampered.
While it cannot be definitely concluded that unit rotation is one ofthe needed counter-measures to block enemy indoctrination efforts, thereappear to be reasonable grounds for investigating this possibility.
3. In Operation Little Switch and Operation Big Switch stress was placedupon prophylactic psychiatric measures in an effort to forestall the so-called"POW Syndrome." An evaluation of the results of our planningcan be gained only through a follow-up study of the repatriates. Similarly,the effects of Communist imprisonment cannot be measured merely by a studycarried out immediately following repatriation. Further evaluation performedat varying time intervals are needed.
4. The potential combat soldier undergoes rigorous, thorough, detailedtraining so that he will be capable of properly deporting himself uponthe battlefield. Yet, this same soldier receives only minimal, highly generalizedinformation regarding his behavior if captured. He learns little aboutenemy tactics of interrogation and indoctrination. He may know nothingof the enemy's political system, his way of life, aims, and intents. Often,unfortunately, he knows very little about his own country, about Democracyand its true meaning and working. He is, at best, ill-equipped to withstandpolitical discussion and indoctrination efforts. Although he has heardthat it is important to resist the enemy and, indeed, to resist capture,he has been told little about how to accomplish this. His misapprehensionof death and torture at the hands of the enemy remains uncorrected so thaton capture he becomes emotionally confused by the enemy's seeming kindlinessand benevolence. He has been told to "give name, rank, serial number. . . and nothing more" and when this avails him not, he is confusedas to what to reveal and what to conceal. He has not been apprised of theenemy's specific weaknesses and of how to utilize them to disrupt his program.A revision of our current training regarding capture appears warranted.Admittedly, such a program is most difficult to devise for it is incumbentupon our Army not to discuss defeat (capture), but to stress victory (non-capture).Nonetheless, reality dictates that some men will be captured in battle.With proper training they will remain, even though prisoners of war, Americansoldiers, disciplined, loyal, and capable of constantly opposing theircaptors.
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Summary
1. Repatriated prisoners of war are confronted with specific problemsof readjustment following repatriation. In the past, failure to resolvethese problems has resulted in emotional "crippling" of an incapacitatingdegree. In Operations Little Switch and Big Switch group psychotherapywas prophylactically employed to forestall the "POW Syndrome"described following World War II.
2. The planning and method of the psychiatric evaluation performed onall repatriates of the Korean War is discussed. The initial findings, basedon examination of 149 Little Switch returnees and 1,551 Big Switch returnees,showed the men to be retarded, disinterested in their environment, apathetic,andwith carefully modulated affective display.
3. American medical officers held prisoner by the enemy noted a largenumber of prison camp deaths apparently caused by the "loss of thewill to live." Men suffering from "give-up-itis," as itwas termed by our captured doctors, died within 3 weeks of the appearanceof the first symptom. Treatment of a palliative nature was not successful.The patients responded satisfactorily to an approach aimed at evoking stronghostility from them.
4. The Chinese Communists employed a technic of isolation and indoctrination,which has been termed "brain-washing," upon our prisoners. Thetechnic and an initial appraisal of its effects are discussed in some detail.
5. Several areas for future study are suggested by the author:
(1) Followup studies to measure the effects of imprisonment by the Communistsand also to evaluate the results of prophylactic group psychotherapy.
(2) A study of the traits of character, personality types, and mechanismsof defense of repatriates who successfully withstood the "brain-washing"program.
(3) A change in information given combat soldiers with regard to theirdeportment should they be taken prisoners of war. Better knowledge of theenemy's weaknesses and methods of exploiting them as well as increasedknowledge of the true meaning and working of Democracy.
(4) A consideration of unit vs. individual replacement in an effortto foster strong identification with combat unit and fellow soldiers.
References
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2. Bettelheim, B.: Individual and Mass Behavior in ExtremeSituations. J. Abn. Soc. Psychol. 38 : 417, 1943.
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