History

Part IV

SUPPORTING SERVICES AND PERSONNEL

CHAPTER XIX

Clinical Psychology

Morton A. Seidenfeld, Ph. D.

HISTORICAL NOTE

Just where or under what circumstances the use of psychological services first became necessary in military action is not known. Certainly, commanders such as Wellington and Bonaparte must have recognized the psychological elements that made men fight, that maintained their loyalty, and that kept them from deserting.

In the Hitopadesa ('Book of Good Counsel'), written about 500 A.D., in India, it is said: 'A small army consisting of chosen troops is far better than a vast body chiefly composed of rabble; for when the bad give way, the good are inevitably broken in consequence.'

Early recognition of the importance of army leadership in ancient times led to such statements as: 'The leaders of this people cause them to err; and they that are led of them are destroyed.' (Isaiah ix: 16, c 75 A.D.) And witness Tacitus who said: 'Reason and judgment are the qualities of a leader.' (History III c 105 A.D.) And the Latin proverb: 'An army of stags led by a lion would be better than an army of lions led by a stag.'

Thomas Jefferson, writing to James Monroe (1813), said: 'We must train and classify the whole of our male citizens and make military instruction a regular part of our collegiate education. We can never be safe till this is done.'

Henry Knyvett, in 'The Defense of Realme,' wrote in 1596: 'Because such as are to become men of war are to be of perfect age most apt for all manner of services and best able to support and endure the infinite toils and continual hazards of wars, I have chosen all between the age of eighteen and fifty to become trained soldiers.'

With all due respect for psychological factors that influenced military performance, it was not until the professional psychologist's role in selection and utilization of personnel was appreciated that consideration was given to regular employment of psychology by the Army.

Shortly before World War I, the state of the psychological arts was such as to permit adoption by the Military Establishment. The demand for the rapid induction and training of men associated with the entry of the United States into World War I made it apparent that some suitable means of selection and placement was essential.

568

The history of the psychological services in World War I is recounted in the two excellent volumes entitled 'The Personnel System of the United States Army.' This excellent history will not be reviewed here; suffice it to say that, on 6 April 1917, when Congress declared war on Germany, the U.S. Army of 190,000 grew, in 20 months, to a force of 3,665,000.¹

Much of the organizational structure and function ultimately evolved by the Committee on Classification of Personnel became the pattern for personnel practice in World War II. A word regarding the relations of the committee and the Medical Department that prevailed in 1918 is pertinent to this present discussion.

Personnel procedures and the Medical Department.-In World War I, as later in World War II, a moderately close working relationship existed between the Army personnel organization and the Medical Department. Physical status must influence vocational assignment much as psychological characteristics do. The weight of emphasis throughout World War I was placed on proper job assignment and the attainment of effective on-the-job performance from each able-bodied person in the service. The maintenance of the individual's mental health and the emphasis on the healthy personality was not fully appreciated in the Military Establishment until World War II.

It is significant to note that Maj. Robert M. Yerkes, SnC (Sanitary Corps), was the first commissioned psychologist in the Army. He remained at the head of the Division of Psychology in the SGO (Surgeon General's Office) during the entire World War I period. In civilian life, Dr. Yerkes was one of the leading scholars in the field of animal psychology and pioneered many of the great advances leading to modern clinical psychology. Similarly, Maj. Louis M. Terman, SnC,² was responsible for the development and standardization of the Stanford revision of the Binet-Simon Intelligence Test. Majs. C. S. Yoakum and Terman prepared chapter X, 'Intelligence Ratings,' in the 'Personnel Manual'³ which clearly indicated how intelligence when properly evaluated could be used in the assignment of men. Obviously, with the clinical program in the hands of men of such stature, it was destined to make many fundamental contributions to the Army program.

Rehabilitation.-By late 1918, psychological personnel were working in collaboration with the Division of Physical Reconstruction, SGO, in the restoration to duty of temporarily and permanently disabled soldiers. When duty restoration was not completely feasible, these soldiers were restored sufficiently to return to a satisfactory social and vocational role in civilian life. Thus, psychology's role in rehabilitation became estab?

¹Committee on Classification of Personnel in the Army: The Personnel System of the United States Army:Volume I. History of the Personnel System. Washington, D.C., 1919, p. 28.
²(1) Terman, L. M.: Tests of General Intelligence. Psychol. Bull. 15: 160-167, 1918. (2) Terman, L. M.: The Use of Intelligence Tests in the Army. Psychol. Bull. 15: 177-187, 1918.
³Committee on Classification of Personnel in the Army: The Personnel System of the United States Army: Volume II. Personnel Manual, 1919.

569

lished. This role was extended in World War II and has become a major area of clinical interest.

DEVELOPMENT OF CLINICAL PSYCHOLOGY PROGRAM IN WORLD WAR II

Initial Phase

Clinical psychologists were present in Army installations almost from the beginning of the mobilization period which preceded World War II. The earliest reception centers of the Army, which began operation in the late fall of 1940, frequently had such personnel assigned. They worked in the classification program and were also responsible for orienting officers and enlisted men to basic psychological concepts. From the start, the value of the person inducted into the service was emphasized. Emphasis was placed on the need for doing something to aid the inductee in assignment, in personal adjustment, and in learning to be a soldier.

The specific utilization of clinical psychologists, as such, in the Army during World War II, occurred in the spring of 1942. Six clinical psychologists were directly commissioned as first lieutenants in the Sanitary Corps at the request of Lt. Col. (later Col.) Patrick S. Madigan, MC, then chief of the Neuropsychiatry Branch (later the Neuropsychiatry Consultants Division), Professional Service Division, SGO. They were assigned to six of the permanent named general hospitals for duty with the neuropsychiatric sections, as follows: Michael Dunn, to Darnall General Hospital, Danville, Ky.; Robert M. Hughes, to Lawson General Hospital, Atlanta, Ga.; James W. Layman, to Walter Reed General Hospital, Washington, D.C.; William C. Murphy, to Letterman General Hospital, San Francisco, Calif.; Lawrence I. O'Kelly, to Fitzsimons General Hospital, Denver, Colo.; and L. Grant Tennies, to McCloskey General Hospital, Temple, Tex.

The assignment of clinical psychologists was regarded as an experiment, undertaken at the instigation of Dr. Winfred Overholser and Dr. Franklin G. Ebaugh, members of the Medical Section, and of Dr. Yerkes and Dr. Leonard Carmichael of the Psychology and Anthropology Section of the National Research Council.⁴ The National Roster of Scientific and Specialized Personnel had submitted a list of qualified psychologists to the Surgeon General's Office in 1941,⁵ but no action had been taken until Colonel Madigan's request in 1942.

The utilization of clinical psychologists had adequate precedence. In World War I, the Division of Psychology was composed of psychologists,

⁴Minutes, Meeting, Sub-Committee on Psychiatry, National Research Council, 6 Mar. 1942. At this meeting, Dr. Overholser stated that clinical psychologists were not being used and recommended that further action be taken.
⁵Layman, J. W.: Utilization of Clinical Psychologists in the General Hospitals of the Army. Psychol. Bull. 40: 212-216, 1943.

570

then commissioned in the Sanitary Corps, working under the direction of The Surgeon General. During the intervening years, provision had been made for psychologists who desired commissions in the Officers' Reserve Corps to obtain appointments in the Sanitary Corps.

There was virtually no provision for the training of psychologists in the Reserve Corps before World War II. Most reservists, trained as psychologists, preferred that their Reserve commissions be granted in branches and services of the Army other than the Sanitary Corps, for this Corps' prime interest was generally directed to professional services other than psychology. Even in the immediate prewar days, when planning for the use of psychologists was underway, most psychologists were strongly opposed to assignment in the Sanitary Corps where they feared their special professional skills might be minimized. As a result of this, many psychologists, both in the Reserve and those called from civilian life, were assigned to the Adjutant General's Department. This was not surprising since their initial assignments were to develop suitable means of carrying out the programs of induction, classification, and assignment of the hundreds of thousands of newly inducted personnel.

Extension of Clinical Psychology Services

Colonel Madigan was succeeded by Col. Roy D. Halloran, MC, in August 1942. In December 1942, Colonel Halloran investigated the desirability of extending the psychological services.⁶ He sent inquiries to the hospitals, then using psychologists, regarding the psychologist's role in neuropsychiatric sections. The supervising psychiatrists reported that psychologists were engaged in a variety of important duties. The consensus indicated that they were an extremely useful adjunct to psychiatric practice in the military setting.⁷

Colonel Halloran was succeeded by Col. (later Brig. Gen.) William C. Menninger, MC, in December 1943. Formal talks between the Surgeon General's Office and the Adjutant General's Office led to the appointment of a liaison officer between these two agencies. Since most of the psychologists in the Army were in the Adjutant General's Department, this was an extremely necessary step in securing psychological services for Army hospitals. Lt. Col. Morton A. Seidenfeld was called upon to assume this liaison position. He established close relationship between the Neuropsychiatry Branch, SGO, and the Classification and Replacement Branch, AGO (Adjutant General's Office), to which he was assigned.

In late December 1943, Colonel Seidenfeld prepared a standing operating procedure which clarified the liaison role of his office and which indicated the initial special assignments of psychologists. Frequent dis?

⁶Letter, Col. Roy D. Halloran, MC, Surgeon General's Office, to Dr. Steuart H. Britt, Executive Director, Office of Psychological Personnel, National Research Council, 21 Dec. 1942, subject: Psychologists.
⁷See footnote 5, p. 569.

571

cussions between Colonels Menninger and Seidenfeld finally brought concrete results on the matter of assignments.

On 23 May 1944, the Surgeon General's Office,⁸ in a letter to the Commanding General, ASF (Army Service Forces), relative to a program for establishing the assignment of clinical psychologists to general and large station hospitals, pointed out as follows:

For a considerable period, this office has been attempting to obtain the services of clinical psychologists in general and larger station hospitals. * * * where these officers have been employed, they have been invaluable assistants to the hard pressed neuropsychiatrists. * * * The services of these clinical psychologists are needed more than ever before because of the increasing scarcity of neuropsychiatrists. Their assignment would permit a more adequate distribution of these specialized medical officers. It is the opinion of this office that they should be procured, commissioned, and assigned to duty through a special section of clinical psychology under the direction of the Classification and Replacement Branch of the Adjutant General's Office, and that the * * * psychologists now commissioned in the Sanitary Corps should be reassigned to the Adjutant General's Department for the following reasons:

The Classification and Replacement Branch of the Adjutant General's Office already has an administrative structure designed and adequately functioning to determine qualifications and select all psychologists * * *.

The present location of clinical psychologists among a varied group of technicians in the Sanitary Corps does not provide adequate supervision.

* * * * * *

It is believed that as a fundamental consideration, psychology is so specialized that all psychologists in the Army should be grouped in one service, namely: Classification and Replacement Branch of the Adjutant General's Office.

Recognizing its importance, The Adjutant General designated Colonel Seidenfeld as Chief Clinical Psychologist, responsible for the implementation of this procurement and utilization program.

Following this initiation of the program, the Director of Personnel, ASF, stated: 'It is recommended that this program be approved; that The Adjutant General be given procurement authority for 175 officers who meet the requirements * * * to be appointed in the grade of First and Second Lieutenant.'⁹

On 23 June 1944, the Secretary of War directed that a WD (War Department) circular be published informing commanders that clinical psychologists commissioned in the Adjutant General's Department would be made available for assignment to the neuropsychiatric section of certain hospitals, defining their duties, and directing that requisitions be forwarded through the necessary channels to the Adjutant General's Office. The circular was prepared and issued on 1 July 1944 as WD Circular No. 270.

⁸Letter, Lt. Col. Robert J. Carpenter, MC, Executive Officer, Surgeon General's Office, to the Commanding General, Army Service Forces, Washington, D.C., 23 May 1944, subject: Clinical Psychologists,
⁹Memorandum, Director of Personnel, ASF, for Assistant Chief of Staff, G-1, War Department General Staff, 14 June 1944, subject: Procurement and Utilization of Clinical Psychologists.

572

PROCUREMENT

Survey of Eligible Personnel

With official approval of the War Department, in July 1944, procurement of personnel to fill the anticipated requisitions was given top priority. A preliminary survey revealed that few clinical psychologists with the necessary educational qualifications and experience were available. Most of them were already in the service or were serving in vital civilian capacities. A survey of enlisted and officer personnel of the Army revealed that the comparatively small immediate requirement could be met from the resources within the Army. Since War Department policy indicated that direct commissioning of civilians was to be curtailed, it was decided that officer personnel to meet the requirements of the program could be obtained by reassignment or by training enlisted personnel, with subsequent promotion to officer status.

To prepare for the anticipated needs, several activities were promptly initiated. A survey of the available talent within the Army was made, standards for the granting of a commission were established, and procedures for processing applications were instituted.

War Department policy directed that direct commissioning from civil life or from enlisted ranks was not to take place until all existing officers with suitable skills had been considered. Accordingly, a survey was made of the records of all officers on duty to determine those qualified for assignment as clinical psychologists in accordance with established requirements. This survey was conducted by the Classification and Replacement Branch, AGO, and completed on 24 July 1944.

Reassignment of Qualified Officer Personnel

From the total records reviewed, 41 field grade and 309 company grade officers were found to be qualified as clinical psychologists. As field grade officers were not eligible for assignment to this program and as 66 of the company grade officers were already assigned as clinical psychologists at station and general hospitals, there remained 243 officers to be considered. Of this group, it was found (1) that 164 were already in key positions where their psychological experience was essential, and (2) that the remaining 79 were assigned to various ASF, AGF (Army Ground Forces), and AAF (Army Air Forces) installations where their psychological training was reported as being essential. Contact with the using agencies involved, however, revealed that about 20 percent of these officers could be transferred to clinical work.¹⁰

¹⁰Letter, The Adjutant General, to Director, Military Personnel Division, ASF, 5 Aug. 1944, subject: Assignment of Clinical Psychologists.

573

On 14 August 1944, the Director, Military Personnel Division, ASF, in a memorandum to The Adjutant General, indicated, as follows:

* * * the War Department directed that priority be given the transfer of officers qualified as clinical psychologists. In view of this directive, it is believed that more than 20 percent of the qualified officers should be made available for reassignment to fill requisitions submitted in accordance with WD Circular No. 270, dated 1 July 1944. In order to insure compliance with War Department instructions, it is desired that the availability of all clinical psychologists be determined. Cases of those officers who are not being currently utilized as clinical psychologists, on whom a nonconcurrence is received, will be referred to this office, with full details regarding present duties and qualifications for appropriate disposition.¹¹

This memorandum from the Military Personnel Division made possible the reassignment of these well-qualified officers. Occasionally, an injustice may have been done when the arbitrary rulings of the Military Personnel Division transferred an officer from an assignment in which he was highly qualified. This, however, happened in but very few instances, and the gains from such reassignment clearly overshadowed any harmful results.

The resultant transfers of officers to positions as clinical psychologists eventually brought to the program 130 officer personnel whose psychological competence had not been adequately used by the Army.¹²

It was soon found that reassignment of officers with psychological experience could in no way adequately meet the requirements of the program. This was evidenced by the increasing number of requisitions received by the Classification and Replacement Branch from the field during the summer of 1944 as a result of the publication of WD Circular No. 270.

Enlisted Personnel Source

As early as 3 August 1944, the Office of the Chief Clinical Psychologist had requisitions from all service commands, calling for a total of 213 psychologists. On the strength of this need, The Adjutant General requested the Director, Military Personnel Division, to authorize procurement of an additional 130 clinical psychologists, by direct appointment as second lieutenants, AUS (Army of the United States), from among 'enlisted men in the Army who had the proper professional and military qualifications.'¹³ This and succeeding authorizations for procurement eventually gave the program an allotment of 346 to be filled by direct commissioning from the enlisted ranks.¹⁴ Of these, 35 were allotted to the Army Air Forces and 6 to the Office of Strategic Services, leaving a balance of 305 for ASF

¹¹Memorandum, Director, Military Personnel Division, ASF, for The Adjutant General (Attn: Classification and Replacement Branch), 14 Aug. 1944, subject: Assignment of Clinical Psychologists.
¹²Memorandum, Lt. Col. Morton A. Seidenfeld, for Lt. Col. Malcolm J. Farrell, MC, Surgeon General's Office, 26 May 1945, subject: Report on Clinical Psychologist Program.
¹³See footnote 10, p. 572.
¹⁴Memorandum, Director, Military Personnel Division, AGO, for The Adjutant General, 12 July 1945, subject: Procurement Objective for the Appointment in the Army of the United States of Clinical Psychologists.

574

medical installations in the Zone of Interior and overseas. By the end of July 1945, 250 of the 346 total number allocated had been secured.

Qualifications established

Contact was made with the Officer Procurement Service, ASF, and an agreement was reached regarding the minimal qualifications that would be considered acceptable in enlisted applicants for commissions as clinical psychologists. These were published in WD Circular No. 392, issued on 2 October 1944. The qualifications of the clinical psychologist were based in large part upon the standards established by the American Psychological Association and the then existing American Association for Applied Psychology. At no time was it found necessary to utilize personnel who fell below the minimal standards of both official professional organizations.

The minimum educational standards, as set forth in WD Circular No. 392, were as follows:

* * * a bachelor's degree in psychology, educational psychology, industrial psychology, or sociology. A master's or doctor's degree, or the equivalent in academic credits, in one of these fields is desirable.

Concern, however, was not merely with the academic training. Thus: 'These men will be selected from among officers and men capable of interpreting clinical findings in the light of total personality structure and who make use of this knowledge in diagnosis.'¹⁵

Military experience and a knowledge of military life were considered important 'but may be weighted less heavily when the professional background justified such action.'¹⁶

Elsewhere, Seidenfeld had said:

It is apparent to all who have had the task of locating clinical psychologists * * * there are comparatively few who received the kind of training during their academic periods to justify the assumption of adequate qualifications for the assignment. * * * The deficiencies in training have made it necessary * * * to place a premium upon the experience obtained after leaving college. As a result, oftentimes 'clinical' must be interpreted as work experience obtained in any environment with individuals on whom psychological judgments must be made * * *. Thus, psychological work done in penal institutions, industrial establishments, social service activities, and the like, are given favorable consideration as well as that done in medical institutions.

In order to secure personnel capable of carrying on this professional role and flexible enough to fit their varied experience into an oftentimes completely new frame of reference, selection was of the utmost importance. To make this possible-

* * * in the Army, a board [Clinical Psychologist Officers Selection Board] of qualified military personnel sifted each application with great care. Evaluation was based upon breadth of professional experience; evidence of ability to interpret and present interpretations of data gained from psychological examinations; freedom from

¹⁵Seidenfeld, M. A.: Clinical Psychology in Army Hospitals. Psychol. Bull. 41: 510-514. 1944.
¹⁶Ibid.

575

rigidity in approach to problems, as well as more orthodox criteria such as academic degrees, age, and other formal elements in the application blank.¹⁷

Processing of applications

Applications were processed according to the following plan: Interested enlisted men, of the opinion that they met the standards of WD Circular No. 392, submitted their applications in accordance with the regulations (WD Circular No. 363, 7 September 1944) governing all initial appointments in the Army of the United States other than by officer candidate schools. Applications were then reviewed by the Chief Clinical Psychologist and his staff. If an applicant appeared to meet minimum requirements, a 'request for processing of applicant' was submitted to the Officer Procurement Service, ASF, and the application was processed. A local board of officers interviewed the applicant; then a report of its proceedings, together with the applicant's medical record and proof of citizenship, was forwarded to the Officer Procurement Service and the Office of the Chief Clinical Psychologist. This process usually required from 2 to 3 weeks.

Clinical Psychologist Officers Selection Board.-With completed papers at hand, the applicant was then considered by the Clinical Psychologist Officers Selection Board,¹⁸ Classification and Replacement Branch, established by the chief of that branch. This board consisted of the chief of the Classification and Replacement Branch (Col. George R. Evans), Dr. Walter V. Bingham, and the Chief Clinical Psychologist (Colonel Seidenfeld), or their respective alternates.

Following the action of this board, cases 'disapproved' were placed in file for later review if the applicant had a deficiency that could be overcome merely by spending more time 'on the job' as an enlisted man. If an applicant was deficient in fundamental training, the papers were returned with appropriate notation 'applicant does not meet standards' and a request that he be so informed.

Applications passed by the board were returned to the Officer Procurement Service through channels, accompanied by Form OPS-3, 'Appointment Request,' under the signature of the Director, Operations and Training Division, AGO. When the applicant was under the age of 30 and was found to possess superior qualifications for appointment, the application was accompanied by a request for a waiver of age standards.

Approved papers were processed through the War Department Personnel Board and the Assistant Chief of Staff, G-1 (personnel), when an age waiver was needed. Upon approval of these agencies, the applicant was appointed. The first officer thus processed and appointed to a direct

¹⁷Seidenfeld, M. A.: Psychological Services for the Individual in the Armed Forces. J. Clin. Psychol. 1: 93-98, 1945.
¹⁸Memorandum, Col. A. P. Sullivan, AGD, Director, Operations and Training Division, AGO, for The Adjutant General, 17 Oct. 1944, subject: Action of Clinical Psychologist Officers Selection Board.

576

commission was 2d Lt. Max L. Hutt, who reported to active duty as an officer on 18 September 1944.

Factors Influencing Procurement

A number of factors involved in the procurement of personnel for this program are of interest and importance. Basically, procurement was strictly dependent upon the number of requisitions received for psychological personnel from the field. In some instances, service commands were reluctant to submit requests for needed clinical psychologists because additional personnel would increase the actual number of officers above their authorized allotment. To eliminate this problem, the Director, Military Personnel Division, stated:

It is desired that The Surgeon General be informed that in the event service command personnel authorizations are inadequate to provide for the clinical psychologist requirement, consideration will be given requests submitted by the service commands concerned for necessary increases.¹⁹

Further, the original procurement authority assumed that all psychologists secured under this program would be assigned only to station and general hospitals within the continental limits of the United States. However, requests for clinical psychologists were received from many other installations and agencies, such as numbered general hospitals preparing for movement overseas, elements of the Army Air Forces, and the Office of Strategic Services. As a result, the original circular (WD Circular No. 270) was revised and issued as WD Circular No. 71, 6 March 1945. This revision officially established the services of clinical psychologists in consultation services (mental hygiene units) of training centers, disciplinary barracks, rehabilitation centers and regional and convalescent hospitals. These increased uses authorized for clinical psychologists resulted in the increased procurement authorizations previously noted (p. 573).

WAC.-Until March 1945, personnel of the WAC (Women's Army Corps) could only be commissioned through officer candidate schools. Quotas for these schools were limited, and as the graduates were used for comparatively general purpose assignments, special skills and talent among the enlisted women were often overlooked. This deficiency was remedied by WD Circular No. 77, issued on 10 March 1945, enabling all enlisted women to apply for commission under specific procurement objectives which included clinical psychology. As a result, five enlisted women were commissioned, in the Adjutant General's Department, as clinical psychologists.

Prejudice.-There was one unfortunate facet to the procurement problem. As has been noted, procurement of clinical psychologists depended

¹⁹See footnote 11, p. 573.

577

entirely upon the number and type of requisitions received. A number of well-qualified Negro psychologists applied for commission under this program, but only one was commissioned. For a long time, he languished in an officers' pool, his talents unused, for there were no suitable vacancies for Negro personnel as clinical psychologists. Although a distinction was made between white and Negro operating personnel of hospitals, no such discrimination was made among the patients. The need for clinical psychologists was evident, but prejudice, rationalized by the administrative difficulties which commanders felt would arise with the assignment of Negro personnel to their hospitals, prevented adequate use of this source of available talent.

Results

In general, the procurement phase of the program worked well. Reports upon the men selected for commissioning as clinical psychologists were more than satisfactory.²⁰ However, there is little doubt that the results of procurement would have been better if the applicant had been personally interviewed by a professional board which could have more thoroughly explored the person's qualifications.²¹ This feeling was echoed by the War Department Personnel Audit Team, emphasizing that paper qualifications did not show personality traits which were of paramount importance in this program.

It is most unfortunate that clinical psychology, in spite of its significant contributions, always began its program separated from its normal function with the physician and, most especially, with the psychiatrist. It is to be hoped that in the future such personnel will, from the beginning, work in close relationship with psychiatry. As Menninger²² has so well described the situation:

The clinical psychologists proved their value to Army psychiatry * * their commission in the Adjutant General's Department was a handicap because it did not identify them with medicine. Even after their transfer to the Medical Administrative Corps, they occasionally were assigned to nonpsychologic duties by * * * commanding officers [too lacking in perspective or knowledge to appreciate the value of their psychological skills]. * * * It is to be hoped that the War Department does not discard the present system as it did after World War I.

Perhaps this is too much to hope for since an adequate program for reservist training for psychologists has not been established.

²⁰Report, War Department Personnel Audit Team, 5 May 1945.
²¹Opinion of Lt. Col. Morton A. Seidenfeld, Chief Clinical Psychologist, Classification and Replacement Branch, AGO.
²²Menninger, William C.: Psychiatry in a Troubled World. Yesterday's War and Today's Challenge. New York: The Macmillan Co., 1948, p. 245.

578

PROFESSIONAL TRAINING

Planning

It was deemed highly desirable that all commissioned officers in the Army of the United States possess a certain amount of basic military information. Also, enlisted men who were to receive direct commissions as clinical psychologists required a course of training to obtain necessary knowledge of military subjects and proper orientation in the Army clinical psychology practice.

Colonel Seidenfeld²³ outlined a plan to conduct such training at each of five hospital centers and suggested that a total of 25 officers and 50 enlisted men be trained each month. He also suggested that the training course be repeated as many times as necessary to supply the required number of personnel.

This matter was held in abeyance for several weeks pending the actual granting of the authority to procure the necessary instructors to staff the proposed training program. As soon as authorization had been assured, definite plans for establishing a training course were put into operation. During the interim, outlines of protracted courses had been written by Colonel Seidenfeld and Capt. Jon Eisenson, assistant to the Chief Clinical Psychologist. Capt. Clement H. Sievers was assigned to the Classification and Replacement Branch on temporary duty to assist in preparing the final form of the program of instruction.

On 25 August 1944, the Chief, Classification and Replacement Branch, AGO, in a letter to the Chief, Troops Branch, AGO, indicated the need for a training program and attached a copy of a projected training program prepared by the Office of the Chief Clinical Psychologist.

The projected course required 26 days, of which 22 were to be teaching days. Clearance and concurrence were secured from the Surgeon General's Office for the content of the course and the hospital training to be conducted at Brooke General Hospital, Fort Sam Houston, Tex.²⁴ Since the Adjutant General's School was located on the same post as Brooke General Hospital and the psychologists who were newly commissioned were being detailed to the Adjutant General's Department, it was desirable to have this training activity under the Adjutant General's School. Four

²³Personal letter, Colonel Seidenfeld, to Col. George R. Evans, Chief, Classification and Replacement Branch, and Col. William C. Menninger, Director, Neuropsychiatry Division, SGO, 22 May 1944, subject: Training of Clinical Psychologists.
²⁴It will be noted that the original idea of having the training conducted at five hospital centers was dropped. In a conversation on 11 August 1945, Dr. Walter V. Bingham gave, purely as an opinion, two reasons for this move. Hospital psychiatrists were tremendously overworked. The help they would receive from the student psychologist would be less than the work entailed. Furthermore, a review of the qualifications of the students of the first two or three classes indicated more clinical experience in hospitals than had been expected; it was, therefore, not essential that all the training take place in a hospital center.-M. A. S.

579

instructors were initially supplied to the school from the Office of the Chief Clinical Psychologist.²⁵

Psychologist School

Permission for the establishment of the course was granted by the Director of Military Training, ASF, in a first indorsement to the letter of 25 August 1944 (p. 578). This indorsement was dated 9 September 1944 and authorized the establishment of-

* * * a course for Clinical Psychologists at The Adjutant General's School, Fort Sam Houston, Texas, with a capacity of 24 officers. The estimated total to be trained is 144 officers, and will require 6 classes of 22 training days' duration with the first class starting on or about 1 October 1944. No increase in the total capacity of The Adjutant General's School is authorized.

Approval of the submitted program of instruction was also included. The scope of this program included a review of testing and interview techniques, hospital procedures, types of problems encountered, diagnosis, clinical techniques, and therapeutic measures in dealing with neuropsychiatric patients in Army hospitals.

Objectives

The proposed duties of the clinical psychologist were considered to represent the goals to be achieved by the training program. These duties, as set forth in WD Circular No. 270 and amplified by War Department Technical Bulletin (TB MED) 115, 'Clinical Psychological Services in Army Hospitals,' dated 14 November 1944, were as follows:

a. Aid in the development and administration of the program of counseling designed to prepare convalescent patients for return to military service.

b. Assist in the preparation of clinical records, particularly including those requiring the use and interpretation of special psychological tests as desired by the chief of the neuropsychiatric section.

c. Assist in studies of special psychological problems related to the classification and retraining of neuropsychiatric casualties.

d. Assist in the determination of the appropriate military occupational specialty of men who are designated as ready for assignment, and to advise regarding their assignment to a specific duty or special training.

e. Perform such other professional and administrative duties in the hospital as will best assist the neuropsychiatrist in the accomplishment of the best management and disposition of patients.

Sievers,²⁶ in discussing the training of students at the Adjutant General's School stated:

²⁵The four instructors in clinical psychology, assigned to the Adjutant General's School, who prepared the first set of detailed lesson plans for the program of instruction were Captain Sievers and Lts. Paul C. Greene, Max L. Hutt, and Henry Sisk.
²⁶Sievers, C. H.: The Current Program of Instruction for Clinical Psychologists at the Adjutant General's School. J. Clin. Psychol. 1: 130-133, 1945.

580

In many instances, formal psychometric testing is a minor responsibility of the psychologist, most of whose time is spent in taking case histories, conducting psychological interviews and group psychotherapy, or in various phases of the educational or physical reconditioning program. Other units, however, often require routine testing of all patients thus making formal psychometrics the major part of the psychologist's task. It was therefore decided that the course should contain a broad fund of information. * * * The second major problem to be considered involved the variation in the professional backgrounds of the student officers to be trained.

This led to the decision to include strong clinical orientation wherever possible in the training course.

Curriculum

The subject contents of the Clinical Psychology Course and the hours of instruction were as follows:²⁷

Subject	Hours of instruction
The Organization of the Neuropsychiatric Section of a Hospital	4
Hospital Record Keeping	2
Psychological Examination	2
Psychological Instruments	7
Test Interpretation	5
History Taking	5
Interview Techniques	3
Mind-Body Relationships	2
Psychodynamics of Behavior	4
Major Types of Mentally Disturbed Patients	22
Brain-Injured Patients	4
Seeing the Whole Patient	3
Examinations	6
Miscellaneous military subjects	19
Total	88

In addition, 96 hours of applicatory training were given in the neuropsychiatric section and reconditioning center of an Army hospital.

Problems encountered

Insufficient time.-It became apparent that the course of instruction was entirely too cramped for time. A total of 22 working days did not provide sufficient time for even the minimum of military knowledge to be attained and crowded the training in the professional subjects far too much.²⁸ As a result, with Class 5 (3 March 1945), a new program which

²⁷See footnote 26, p. 579.
²⁸At the first meeting of the Advisory Board on Clinical Psychology, 6-7 November 1944, the members discussed this problem and recommended lengthening the course. At its second meeting, on 29 March 1945, the board again called attention to the fact that the time allowed was insufficient to 'familiarize student officers with the complicated duties they are called on to perform in close collaboration with psychiatrists and psychiatric social workers.'-M. A. S.

581

required 34 days of actual training time was introduced. The authorized size of the class was increased to 50 officers to compensate for the time increase.

Limited facilities.-When the Adjutant General's School moved to Camp Lee, Va., the facilities at Camp Lee were too limited for the proper training of clinical psychologists. In an informal discussion, Lt. Col. Wayne A. Starkey, MC, of the Training Branch, and Colonel Menninger of the Neuropsychiatry Consultants Division, both of the Surgeon General's Office, Lt. Col. (later Col.) Douglas A. Thom, MC, Neuropsychiatric Consultant of the Second Service Command, and Colonel Seidenfeld agreed that Mason General Hospital, Brentwood, Long Island, N.Y., with the added facilities of the convalescent hospital at Camp Upton, N.Y., was the most desirable location for the training of clinical psychologists. This decision was considered appropriate since the training of neuropsychiatrists was also given at Mason General Hospital. As a result, it was recommended that the course for clinical psychologists in its entirety be transferred to Mason General Hospital but that it remain under the Adjutant General's School for administrative purposes. However, with the proclamation of V-J Day and the subsequent cancellation of the unexpended portions of the procurement objectives for clinical psychologists, no final action was taken on the recommendation. Class 8 was the last class in clinical psychology at the Adjutant General's School.

Results

By the end of September 1945, there had been eight classes in the Adjutant General's School 'Officer's Course-Clinical Psychology.' A total of 281 students were graduated. Only 3 percent of the men entering this school failed to do satisfactory work. The high degree of success in the school was additional evidence of the effectiveness with which the selection process had worked out in this program. More than 63 percent of all second lieutenants (new appointees) were rated superior or excellent by the school.

Informal Training

While the academic preparation of clinical psychologists was stressed in the selective process and further training was obtained through the clinical psychologist course at the Adjutant General's School, additional training was necessary so that standards could be maintained.

This was accomplished, first, by frequent visits to the field by the Chief Clinical Psychologist and his assistants and, second, by attendance at a number of conferences where many psychologists were assembled.

The visits included a variety of installations, such as all types of

582

hospitals, service command headquarters, disciplinary barracks, and rehabilitation centers. The conferences assisted officers in the field and provided a means for interchange of ideas, thus avoiding the emphasizing of 'arm chair' procedures. Most valuable were a series of conferences held at service command level. These were encouraged by the Office of the Chief Clinical Psychologist, but the individual service commands selected their own time and date to meet the local situation. Conferences were held at the First, Fourth, Fifth, and Sixth Service Commands.

Postwar Changes

Upon completion of Class 8, the course for clinical psychologists in the Adjutant General's School was terminated because of the cancellation of procurement objectives. By this time, the entire clinical psychology program had been transferred to the Surgeon General's Office, and further training policy was provided within the framework of the Medical Department. Early in September 1945, the Training Division, SGO, was furnished a complete outline of the clinical psychologist training course together with recommended changes of content. After a conference with the Chief of the Neuropsychiatry Consultants Division, General Menninger, and the Director of the School of Military Neuropsychiatry, Col. William C. Porter, MC, it was agreed that further training of clinical psychologists would be under the jurisdiction of the School of Military Neuropsychiatry. Since the curriculum of this school was then undergoing reorganization, no definite length of course was decided upon. In February 1946, the School of Military Neuropsychiatry was moved to Brooke General Hospital, and its postwar plans were indefinite.²⁹

Recommendations

Problems relative to professional training, interpretation of field policy, site of training, and other factors did arise. As a result, the following recommendations regarding training were made:

First, it is recommended that a direct liaison be established with the Adjutant General's School and the Office of the Chief Clinical Psychologist so that errors in the interpretation of field policy may be minimized.

Second, that selection of professional psychologists to carry on the psychological training (in contrast to other military subjects) will be made by the Office of the Chief Clinical Psychologist. Alterations in the professional personnel would likewise be made by the Chief Clinical Psychologist after consideration of the reasons for such changes

²⁰Training programs for officers and enlisted men in clinical psychology were established at the School of Military Neuropsychiatry, Fort Sam Houston, in 1947-48. Such courses operated as needed during and since the Korean War, although in recent years the Department of Neuropsychiatry, Medical Field Service School, Fort Sam Houston, the successor to the School of Military Neuropsychiatry, only provides training in clinical psychology for enlisted personnel. Officer courses are on a standby basis to be used in the event of mobilization. Present standards for commissioning of officer clinical psychologists include a doctorate degree-A. J. G.

583

with the school. Concurrence with the Commandant, the Adjutant General's School, would be necessary before final placement is made.

Third, the content of professional courses would be controlled as to policy and practices contained therein by concurrence from the Chief Clinical Psychologist.

Fourth, the site at which training is given would be governed by the Chief Clinical Psychologist, The Surgeon General, and The Adjutant General.

Fifth, the major portion (at least 75 percent) of training would be conducted in a medical installation.

RELATIONSHIPS WITH THE ADJUSTANT GENERAL AND THE SURGEON GENERAL

Dual Supervision

War Department Circular No. 270 placed the clinical psychologist under the professional jurisdiction of the hospital psychiatrist, a medical officer.³⁰ However, the clinical psychologist, wearing The Adjutant General's shield, was under administrative control of the Adjutant General's Office, more specifically, of the Chief Clinical Psychologist. This dual supervision had in it the seeds of tension, referred to in a veiled manner in at least two documents, and much more explicitly in many conversations.

The Advisory Board on Clinical Psychology, in November 1944, recognized the 'administrative difficulties involved in bringing about collaboration of psychological and medical personnel in the work of classification and disposition of neuropsychiatric casualties and records' but was gratified at the progress made in the resolution of the difficulty.³¹ At the second meeting of the board, Capt. Beverley C. Holaday of the Second Service Command drew attention to 'opposing pressures from higher authorities.'³²

The Surgeon General's Office by the very nature of the personnel and functions under its jurisdiction was fitted for professional control. In contrast, the Adjutant General's Office, because of its work and wider variety of assigned personnel, was better constituted for administrative control.

Like all the psychological programs of the Army, clinical psychology grew out of the need to insure proper assignment to duty, military education, and adaptation to the military society. It is not surprising, therefore, that the Personnel Research Section, Classification and Replacement Branch, AGO, should have provided the principal source of clinical psychologists.³³

Some psychologists, working under the ?gis of the Adjutant General's Office, were carrying out clinical functions before any formal designation

³⁰The utilization of clinical psychologists in the Army Air Forces followed in general a similar plan to that encompassed in WD Circular No. 270 but did not place the psychologist jurisdictionally under the psychiatrist in the convalescent hospital.-M. A. S.
³¹Minutes, First Meeting, Advisory Board on Clinical Psychology, 6-7 Nov. 1944.
³²Minutes, Second Meeting, Advisory Board on Clinical Psychology, 29 Mar. 1945.
³³The Staff and Personnel Research Section, Classification and Replacement Branch, AGO: Some Aspects of the Relationship Between Personnel Research and Clinical Psychology in the Army. J. Clin. Psychol. 1: 105-112, 1945.

584

of 'clinical psychologist' had been established as an integral activity in the service. 'Classification and Assignment Officers Personnel Consultants and others have made beginnings in this work in Consultation Services, Mental Hygiene Units, Development Training Units (later called Special Training Units), Rehabilitation Centers, and Separation Centers.'³⁴

However, the need for clinical psychologists in the neuropsychiatric program within Army hospitals became so great that The Adjutant General was asked to furnish properly trained clinicians for this purpose. Thus, the Office of the Chief Clinical Psychologist was established initially in the Classification and Replacement Branch, AGO, paralleling the already existing Personnel Research Section.

Unfortunately, such a complicated hierarchy made adequate professional guidance and contact difficult for the Chief Clinical Psychologist.³⁵ Lack of direct contact with the Office of the Chief Clinical Psychologist was definitely felt in the field. Capt. Lawrence I. O'Kelly, MAC, reported: 'A closer contact between the Service Command and the Office of Chief Clinical Psychologist on professional psychological questions was a desire expressed by most clinical psychologists in the First Service Command.'³⁶

Transfer of Clinical Psychologists to the Medical Department

While close liaison was maintained between the Neuropsychiatry Consultants Division and the Office of the Chief Clinical Psychologist, it was evident that inclusion of clinical psychologists in the Adjutant General's Department had several disadvantages. Thus, in the field, service command supervision of clinical psychologists was largely delegated to personnel consultants. In many instances, personnel consultants were not clinical psychologists and possessed little knowledge of hospital procedures or requirements. Inspection from these officers of the Adjutant General's Department was not uniformly welcomed by hospital commanders. There was no administrative channel through which service command supervision of clinical psychologists could be delegated to responsible Medical Department authorities. This created difficulty in assignment and supervision of professional work.

After a series of conversations between the Neuropsychiatry Consultants Division, SGO, and the Classification and Replacement Branch, AGO, Maj. Ivan C. Berlien, MC, of the Neuropsychiatry Consultants Division and Captain O'Kelly of the Classification and Replacement Branch were ordered to prepare a staff study recommending the transfer of the entire clinical psychologist program to the Office of The Surgeon General. This study,

³⁴See footnote 33, p. 583.
³⁵Conversation with Capt. Lawrence I. O'Kelly, Assistant Chief Clinical Psychologist, 7 Aug. 1945.
³⁶Memorandum, Office, Chief Clinical Psychologist, for Chief, Neuropsychiatry Consultants Division. SGO, 26 June 1945, subject: Semi-monthly Report.

585

completed and forwarded to the Assistant Chief of Staff, G-1, on 4 August 1945,³⁷ presented the following:

I. THE PROBLEM:

The desirability of detailing to duty with the Medical Department of these Clinical Psychologists presently or in the future working in medical installations who are commissioned in The Adjutant General's Department.

II. DISCUSSION:

1. Clinical Psychologists are at present commissioned in The Adjutant General's Department, but the majority are assigned to Medical Department installations where they perform clinical professional duties in conjunction with medical officers in the testing and treatment of patients.

2. Personnel involved: A total of approximately 339 officers and 2 civilian aids are involved.

3. Advantages of transfer: Because the duties of Clinical Psychologists are essentially of a medical nature their supervision and teaching should properly be administered by the Medical Department, whereas, at present, these functions can only be done by The Adjutant General.

4. Nothing herein is intended to reflect upon the outstanding service of The Adjutant General to Medical Department. The Adjutant General concurs in this study and its recommendations.

III. RECOMMENDATIONS:

1. That the Adjutant General's Department Clinical Psychologists be detailed to duty with the Medical Department.

2.That the Chief Clinical Psychologist, his Assistants, and civilian aids be moved to the Office of The Surgeon General as a Branch of the NP Consultants Division and the allotment of authorized personnel be increased accordingly for officers and civilians.

IV. This recommendation has been concurred in by Army Air Forces (Lt. Col. Dale Rice) and by The Adjutant General (Col. Frederick S. Foltz, Chief, Classification and Replacement Branch).

The recommendations of the staff study were supported by a statement of the duties and functions of the clinical psychologists, abstracted largely from TB MED 115, and also by a statement of the major reasons for requesting the transfer, as follows:

1. Supervision at Service Command level of clinical psychologists is at present largely delegated to the Personnel Consultant of the Service Command, who may not be a clinical psychologist himself, and is not trained in army or civilian hospital procedures or requirements. Although he works in cooperation with the Service Command Neuropsychiatric Consultant, there is no clear-cut division of supervisory responsibility.

2. War Department responsibility for assignment of clinical psychologists is in The Adjutant General's Department, although assignment of clinical psychologists should be handled by the agency with the most intimate knowledge of the changing needs of neuropsychiatric sections of medical installations, i.e., Surgeon General's Office. Economy and efficiency of utilization would be promoted by closer coordination in assignment.

3.The professional work of the clinical psychologist is done for and in the Medical Department, and is under the control of the Surgeon General's Office. It would be desirable to place the administrative responsibility under the same department for more effective coordination with the professional duties.

³⁷Memorandum, Col. Robert J. Carpenter, MC, Executive Officer, for War Department, Assistant Chief of Staff, G-1, thru: The Commanding General, Army Service Forces (attention: The Director, Military Personnel), 4 Aug. 1945, subject: Clinical Psychologists.

586

4. Supervision and professional assistance at the War Department level by the Chief Clinical Psychologist as a representative of The Surgeon General.

5. The task of developing testing and therapeutic procedures for use in neuropsychiatric services can best be accomplished within the Surgeon General's Office, where psychiatrist and psychologist can work in more effective cooperation.

6. Training of clinical psychologist has largely taken place outside medical installations, although one of the primary aims of training is to perfect techniques of working with patients. Training should properly be done in hospitals where clinical material and psychiatric instruction is readily available.

Following the initiation of this proposal, there was a meeting of Colonel Menninger and Colonel Foltz of the Classification and Replacement Branch in which it was agreed that the procurement objective of clinical psychologists would remain with The Adjutant General and that any psychologists who became surplus to the needs of The Surgeon General would be made available to The Adjutant General for assignment. The entire request was approved by Assistant Chief of Staff, G-1, on 17 August 1945, and WD Circular No. 264, effecting the transfer, was issued on 1 September 1945.

All clinical psychologists were then detailed from the Adjutant General's Department to the Medical Department as MAC (Medical Administrative Corps) officers. The Office of the Chief Clinical Psychologist was transferred to the Surgeon General's Office and became the Clinical Psychology Branch of the Neuropsychiatry Consultants Division. Service command supervision of clinical psychologists became the responsibility of the service command neuropsychiatric consultants. During the short time of its operation, the Clinical Psychology Branch proved to be extremely effective.

Reactions of clinical psychologists.--There was some reaction from psychologists in the field both for and against the transfer to the Surgeon General's Office. While they agreed that assignment to the Medical Department was desirable, many believed that their professional status would be threatened by incorporation into the Medical Administrative Corps. In general, they would have preferred the Sanitary Corps. Although the Sanitary Corps might have been more desirable, the matter is only of theoretical importance since a Sanitary Corps no longer existed within the Army structure. Some officers believed that a separate corps within the Medical Department should have been created. Later, with the reorganization of the Army Medical Department and the creation of a Medical Service Corps, this problem appeared to be solved.³⁸

One cannot help being impressed by the wide variety of opinions that prevail about the professional psychologist and his proper 'utilization' in the Army. Much of the hue and cry for a separate 'Corps' for the psychologists appears to be derived from experiences gained from assignments

³⁸Unhappily, the problem is not solved. It continues to erupt periodically as clinical psychologists as well as bacteriologists, biochemists, social workers, and others of the minority allied science section of the Medical Service Corps argue for a separate corps and for freedom from performing administrative and staff functions.-A. J. G.

587

in the Sanitary Corps, the Medical Administrative Corps, or the Medical Service Corps where they had been called upon, from time to time, to perform nonpsychological duties. The complaint has been that while they were carrying out these nonprofessional obligations patients have been deprived of their services.

One can hardly argue against the propriety of a professional person's desire to devote his time to bettering the lot of the patient. Yet, it is unwise and unrealistic to assume that under conditions of stress any officer can hope to limit himself solely to duties requiring only his specific skills. Actually, he shares dual professional responsibility-one, as a military officer; the other, as a psychological specialist. Assignment to a specific 'Corps of Psychologists' would be unlikely to provide relief from administrative obligations carried out by all military officers regardless of the arm or service to which they are assigned.

There is also a professional obligation to 'pinch-hit' for missing services which are essential in the best interest of the patient. Thus, there were times when the psychologist took on the role of a social worker or an educational officer because these services were needed and an appropriate specialist was not available. This, in general, the psychologist accepts and carries out without feeling badly 'put upon.' Similarly, such duty as Officer of the Day or as a member of a court-martial does, from time to time, fall 'into the psychologist's lap' and must be accepted as part of the military profession, even though removed from the psychological sphere. Psychologists who accepted these duties gained a great deal by becoming more familiar with the military environment.

FUNCTIONS AND DUTIES

Medical Installations

Perhaps the best means of surveying the work performed by the clinical psychologists in medical facilities is to review the report of the War Department Personnel Audit Team which audited 33 medical installations, including 18 general hospitals, 7 ASF convalescent hospitals, 3 ASF regional hospitals, and 4 AAF convalescent hospitals.³⁹ In these hospitals, there were 79 officers, 236 enlisted personnel, and 4 civilians on duty in the clinical psychology program. This study was conducted 'to ascertain if the needs of these installations were being adequately met and to determine if suggestions could be made to make the program more effective.'

With the exception of two cases, all officer psychologists were found to be fully qualified. The two exceptions were officers who lacked technical background and had not been commissioned as clinical psychologists. With no exceptions, commanding officers, neuropsychiatrists, and chiefs of neuro?

³⁹The material in this section is from the War Department Personnel Audit Team's report of 5 May 1945.

588

psychiatric sections were satisfied with the clinical psychology program. The neuropsychiatrists, especially, expressed the opinion that the assistance of the psychologists made it possible to increase the effectiveness of the psychiatric program and permitted them to devote more time to psychiatric functions. In all cases, satisfaction was expressed with the caliber of men commissioned to perform the duties of clinical psychologists.

Duties of clinical psychologists at the various hospitals were found to be varied. In most of the ASF installations, the clinical psychologists were performing duties directly related to the clinical field, which included testing, accomplishing case histories, and conducting individual and group psychotherapy. The emphasis on these functions varied from hospital to hospital but, for the most part, was confined to patients in the neuropsychiatric section. At some installations, it was found that the psychologists were involved more in administrative work than in actual clinical functions. In ASF convalescent hospitals, the chief psychologists were supervising the clinical program and acting as liaison officers with the reconditioning sections and the various educational therapy activities. At two convalescent hospitals, clinical psychologists were used to perform duties under the supervision of the director of convalescent training. This work involved supervision of the educational program and the classification and counseling activities, which duties would normally be performed by a separation, classification, and counseling officer as prescribed by ASF Circular No. 90, 12 March 1945.

In AAF convalescent hospitals, psychological personnel performed the following duties:

1. Initial and continuous orientation of patients to assist in self understanding and adjustment.

2. Initial evaluation of patients' abilities and interests for program placement, including followup and terminal contacts.

3. Counseling of all patients referred for any reason by personal physicians and psychiatrists.

4. Supervision of administrative duties and research in technical procedures for evaluation and improvements of the program.

In contrast to ASF convalescent hospitals, the psychological section of AAF convalescent hospitals provided psychological services for all patients in the hospitals, not being restricted to neuropsychiatric patients. Duties of the psychological staff in AAF convalescent hospitals were uniform, due to the organization prescribed by the Army Air Forces and Personnel Distribution Command.

In general hospitals, with the exception of those specializing in neurology and neurosurgery, clinical psychologists worked directly under the neuropsychiatrists. As has been stated, a definite lack of uniformity of organization was found in the ASF convalescent hospitals. In AAF convalescent hospitals, the psychological branch was a separate section under

589

the chief of professional services. This branch was headed by a chief psychologist who had four subordinate sections under his control.

In the 28 ASF installations studied, the total patient census was 73,031, of which 11,762 were neuropsychiatric patients. The 46 officer psychologists and 185 enlisted personnel assigned to these installations indicated a ratio of 1 officer psychologist to each 255 neuropsychiatric patients. Although the psychological section of AAF convalescent hospitals processed all patients, not just neuropsychiatric patients, it is significant that the ratio of officer psychologists to total patients was 1 to 207. If ASF convalescent hospitals were to have rendered similar services to all hospital patients, the ratio of officer psychologists to total patients would have been 1 to 1,025.

In the various installations visited, factors were encountered which hampered maximum utilization of the psychological services, as follows:

1.Lack of coordination of the clinical psychology program with other consultant services.-Activities of the personal affairs branch, the separation, classification and counseling section, and education reconditioning, particularly in general hospitals, were operating independently and not transmitting information from one to the other.

2. Psychological program confined largely to neuropsychiatric patients.-In 75 percent of the ASF installations visited, the psychological section rendered no professional services to patients in other sections of the hospital. In three general hospitals, there were no clinical psychologists desired because the installation understood the program to be restricted to neuropsychiatric sections. It is the judgment of the auditors that, while the hospital carried no patients classified as neuropsychiatric, clinical psychologists would do much to prevent such cases from developing.

3. Need for transmittal of pertinent information by Chief Clinical Psychologist.- In ASF installations, the majority of officer psychologists did not have knowledge of certain pertinent directives. Since directives are issued by various branches of the War Department, there is a need for coordination of this material which might well be furnished by the Office of the Chief Clinical Psychologist of AGO. Due to the recent inauguration of the clinical psychology program, individual officers felt the need for an exchange of techniques and ideas between installations, which could also be handled in the same manner.

4. Delay in filling requisitions for testing materials.

5. Need for standardized forms to record and transmit psychometric data.

6. Need for allotment for clinical psychologist personnel.-While it is recognized that service commands are required to perform their missions with the personnel allotments authorized, the clinical psychology program has been initiated with no provision in local installations for increased allotment. This has resulted in some installations being reluctant to obtain sufficient number of personnel to carry out the program.

7. Psychotherapy in ASF convalescent hospitals minimized by emphasis on separation.-It was found that arbitrary rates of discharge from these installations have been prescribed by higher headquarters. While it is realized that there is a need for a rapid turnover of patients in convalescent hospitals, psychiatrists and psychologists stated that patients were not receiving the amount of treatment they felt desirable.

The Personnel Audit Team recommended that consideration be given to revising Section IV, WD Circular No. 71, 1945, to expand the scope of the clinical psychology program to include all patients in medical installations. It further recommended that a standing operating procedure

590

be prepared to include such points as an outline of the duties of the clinical psychologist, a clarification of his position in the functional organization, methods to bring about a better coordination of the clinical psychology program with other consultation services, and a standardization of procedure for recording and transmitting psychometric data.⁴⁰

Role of Psychologist on Psychiatric Team

Psychologists had worked with psychiatrists as well as with other medical practitioners long before World War II. Unfortunately, the number of such working relationships had been rather limited. The number of 'clinical psychologists' were so limited that the Clinical Division of the American Psychological Association had difficulty in keeping itself alive. The relatively few members often felt dissatisfied and frustrated in attempting to attain recognition because they were so completely overwhelmed by the academic as well as the applied branches of psychology. This lack of importance of clinical psychology was further emphasized by the relatively small role assigned this field of endeavor in the development of the psychological program of the Army within the Personnel Research Section, AGO. It was not until Colonel Menninger and a few of his associates began to make an appeal for clinical psychologists to meet the demands for overall psychological services that attention was paid to utilizing this professional group.

Once the need was recognized and competent clinical psychologists procured, they were well received by the psychiatrists. Especially valuable were those clinicians, with excellent prewar training and experience, who had developed keen clinical judgment, professional integrity, and ability to work in an orthopsychiatric environment without feeling threatened by medical and allied medical personnel.

Only in rare instances were serious conflicts or antagonisms expressed by the psychiatrist for the psychologist, or vice versa. These occurred in those instances where either, or both, the psychiatrist or the psychologist concerned had been inadequately prepared for working in a joint relationship. Then, the more threatened individual often projected his fears and anguish upon his coworker. This points up the necessity for continuing a close working relationship between the psychiatrist, the psychiatric social worker, and the clinical psychologist in the peacetime Army. When professional personnel work together over a long period of time, they develop mutual respect and understanding of what each can do for the other and for the patient. Out of such a relationship, a better functioning team approach will exist in the future.⁴¹

⁴⁰Before any action was taken on any of these recommendations, the whole clinical psychology program was transferred from the jurisdiction of The Adjutant General to that of The Surgeon General, as authorized by WD Circular No. 264, 1 September 1945.-M. A. S.
⁴¹Menninger,op. cit., p. 245.

591

The following extract from the report given by Rein and his associates,⁴² at the Neuropsychiatric Conference of the Sixth Service Command held in Chicago, Ill., on 16-17 November 1945, is illuminating and serves as a typical example of the relationship that existed between psychiatrist and psychologist:

The clinical psychologists were made part of a psychiatric team with specific duties * * * the combined efforts of psychiatrists, psychiatric social workers, clinical psychologists, occupational therapists, instructors in arts and skills and reconditioning officers and instructors are needed to make the program succeed.

In describing the organizational plan of the neuropsychiatric section of a convalescent hospital, Rein and his associates stated, as follows:

* * * that it is that of a regiment with four battalions. Each battalion is further broken down into four companies, each with a capacity of 100 patients. Hence, at maximum capacity, there would be 1,600 patients in the neuropsychiatric section. There are 11 commissioned psychologists and 10 enlisted psychologists allotted to assist the psychiatrist in the diagnosis and treatment of a possible 1,600 patients.

* * * The duties of the Regimental Psychologist are primarily to supervise and coordinate the psychological program for the four battalions. He holds weekly meetings in which each psychological unit of each battalion may express itself as to improving the psychological services. Results of techniques and methods used by the different psychological units are discussed and modifications may be made to attain the best ones so that the psychologist will make a maximum contribution to the psychiatric team. He puts into effect policies and plans bearing on psychological work that the Chief of Neuropsychiatric Service may request.

In their report, the authors pointed out that the regimental psychologist is responsible for 'coordinating the program of the regiment.' As a result, the regimental psychologist could aid the chief psychiatrist 'in seeing that at all times, the several aspects of the daily program are observed for their effect upon the neuropsychiatric patient.' He was also in a position to maintain 'a close liaison * * * with the occupational therapy and educational and physical reconditioning sections of the Convalescent Hospital.'

They also indicated that it is at the battalion level 'that the real psychological work is done.' Usually, two commissioned and two enlisted psychologists were responsible for carrying out the following three main functions: 'One, psychometrics; two, individual and group therapy; three, vocational counseling and placement. All three functions are closely coordinated with the psychiatrist and the psychiatric social worker.'

It is fortunate that, in the postwar setting of the Percy Jones Convalescent Hospital as described in this report, 'all new patients, in the course of their processing, are seen by the psychologist,' who was able to utilize the 'quick screening devices' in getting at patient adjustment problems promptly. They were thus able to reassure and prepare the patient

⁴²Rein, B. D., Brown, W., and Allyn, M.: The Position of the Psychologist on the Psychiatric Team. In Proceedings of the Neuropsychiatric Conference, Sixth Service Command, Chicago, Ill., 16-17 November 1945, pp. 185-187.

592

for his prehospitalization furlough as well as deal with his psychiatric needs more effectively upon his return to the treatment center.

Capt. Ray S. Miller,⁴³ in discussing this report at the same meeting, emphasized: 'The psychiatrist has been sold first of all on the skill and efficiency of the clinical psychologists who have been assigned to work with him. The effectiveness of the team work outlined in this paper probably depends more upon the individuals of the team than upon the tools with which they work.'

In hospitals and clinics.-Few people were aware of the extent and breadth of services rendered by the clinical psychologist in hospitals, clinics, and a variety of treatment situations both in the Zone of Interior and in all oversea theaters. TB MED 115 outlined some of these duties but at least a few deserve special attention, from a historical point of view.

So far as the type of treatment facilities in which the clinical psychologist served, perhaps the most important were the named and numbered general hospitals. Here, he was generally a part of a large neuropsychiatric service in which team relationship was most likely to be stressed. As a rule, the psychologist learned to work cooperatively with the psychiatrist and the psychiatric social worker in developing the complete picture of the patient's problems and their correction. Here, he was exposed to clinical conferences, rounds, and even 'post-mortems' that permitted him to see just how his role was clinically important and to recognize the areas for further professional growth.

Because the patient was often in the general hospital for a lengthy stay, the clinical psychologist had the opportunity to participate in a therapeutic role. Where he possessed the necessary training and skill and his psychiatric associates properly appraised his capabilities, he often was given wide latitude in exercising this professional function, thus doing his best work. These experiences were rich and rewarding to the patient as well as to the psychologist.

Not all psychologists working in the general hospitals were equally well equipped to accept or carry on these professional roles, especially the therapeutic ones. However, some who were undoubtedly well trained may have encountered psychiatrists who because of past experiences, bias, or basic insecurity were unwilling to use the psychologist except for the most prosaic or unimaginative types of duty. By and large, however, this was the exception rather than the rule. The psychiatrists generally were quick to discover information indicative of the preparation of the psychologist to participate in both diagnosis and treatment and, after a short period of observation, sought to place the psychologist in a position of responsibility commensurate with what the psychiatrist was convinced he could do. As a rule, this was fairly accurate placement and served to please both professional workers and reflected in the clinical improvement of the patients.

⁴³Miller, R. S.: Discussion of the Position of the Psychologist on the Psychiatric Team. In Proceedings of the Neuropsychiatric Conference, Sixth Service Command, Chicago, Ill., 16-17 November 1945. pp. 188-189.

593

In a somewhat similar fashion, psychologists assigned to convalescent centers were utilized fairly promptly in accordance with their real and potential abilities.

In the mental hygiene units and consultation services, psychologists often achieved the most professional gratification. Working with psychiatrists and social workers who were enthusiastic in the development of a program that had a heavy weighting in 'preventive psychiatry,' it was obviously a rewarding kind of work. Psychologists who worked in this type of environment, like their professional colleagues from the medical and paramedical professions, derived the satisfactions that came from minimizing the traumatic effects of the environment and in seeing many of their patients return to duty with the least possible delay. There is something extraordinary in knowing that one has prevented illness. Clinical psychologists fortunate enough to participate in such programs often became imbued with an appreciation for the mental hygiene approach which they carried back to civilian life.

Summary.-Clinical psychologists performed a wide variety of services in the various treatment environments. They worked in the areas of diagnosis and treatment and served as consultants on classification and assignment of the recovered patient. In some medical facilities, they worked not only with the psychiatrist but also with other medical specialists, including the neurologist and audiologist, and dealt with problems of such handicapped patients as the paraplegic and monoplegic, the blind and visually defective, the deaf and hard-of-hearing, and the aphasic and language disorders. Their utilization was as broad as their training and adaptability and the latitude permitted by their senior officers.⁴⁴

Correctional Facilities

A few psychologists actively participated in programs centered around the treatment of the recidivist in the disciplinary barracks. They worked closely with the psychiatrist and the social worker in attempting to get at the sources of the deviant behavior.

By directive, general prisoners 'who are judged to be restorable and who have more than six months of their sentence to serve are to be sent to a Rehabilitation Center.' Goldberg,⁴⁵ in his description of the training program in the rehabilitation centers in the Army, reported:

A considerable percentage (about 50%) of the men forwarded to a Rehabilitation Center do succeed in having their dishonorable discharges suspended and their sentences eventually fully remitted. Some men in Disciplinary Barracks are similarly honorably restored to duty, although the percentage is much smaller than that of the Rehabilitation Center.

General prisoners were assigned to such rehabilitation programs in

⁴⁴See footnote 15, p. 574.
⁴⁵Goldberg, S.: The Rehabilitation of General Prisoners in the Army. J. Clin. Psychol. 1: 126-129, 1945.

594

terms of their 'demonstrated ability to get along in the training program of the Rehabilitation Center' as well as upon an evaluation of their basic personality structure.

The psychologist's role was primarily in the determination of intellectual capacity and assessment of personality. Then, in collaboration with the psychiatrist and social worker, the psychologist frequently assumed a treatment role especially in group therapy, although from time to time he was called upon to administer individual therapy under competent psychiatric supervision.

This program was administered under the Division of Psychiatry and Sociology (p. 493) which 'functions very much like a Classification Board in civilian penal institutions.' Members of this division determined the restorability of the prisoner, carried out treatment, and made appropriate recommendations to the commandant and the Clemency Board when the prisoner was considered eligible for restoration to duty.

Generally, prisoners were held at least 6 months in a rehabilitation center, of which time half was spent at the prehonor training level and half at the honor level. The training basis was largely determined by the literacy of the prisoner. During the prehonor period, 24 hours a week were spent in work and an equal period in training. The training included instruction in reading, arithmetic, language expression on the academic side, infantry drill, physical conditioning, and Army orientation to provide military preparation. In addition, group therapy was also provided.

At the honor level, additional Army orientation, individual and group therapy, some technical training, and extensive basic military training was provided on a 48-hour-per-week basis.

According to Goldberg: 'The training program represents a sound educational, psychological and military approach to the problem of rehabilitation of prisoner personnel.'

Induction Stations

While induction stations were primarily charged with the general task of determining, by examination, the mental, physical, and moral suitability of registrants for military service, one of their most difficult responsibilities was psychological assessment in terms of the mental standards established by each of the components of the Armed Forces.

Late in 1940, the War Department announced that it would not accept for induction men who had been discharged from the Regular Army or Navy because of 'inaptness,' nor would men 'who cannot understand simple orders given in the English Language' be inducted 'until such time as the War Department authorizes the establishment of special training battalions.'

Numerous and varied were the procedures initially tried to screen out men who could not reach the rather loosely defined standard of literacy.

595

Ultimately, it was agreed that the standard to be met was 'fourth grade literacy' and was to be given psychological recognition by the development of a 'minimum literacy test,' from the Personnel Research Section, the Adjutant General's Office.

While it was hoped that these tests would, for the most part, be administered at the level of the local selective service boards when the registrant came in for his physical examination, this was not actually put into practice. The determination of literacy was, for the most part, carried out by psychiatrists at the induction stations.

Public demand for the induction of many men who had been turned down because of deficits in their literacy culminated in a change in policy.⁴⁶ This authorized the induction of 10 percent of white and 10 percent of Negro registrants processed each day at each induction station, who could neither read nor write English at a fourth-grade level provided they could understand simple orders in English and possessed 'sufficient intelligence to absorb military training rapidly.'

To make the determination of inductees who were capable of meeting these standards, the Personnel Research Section developed the Visual Classification Test which was introduced at induction stations on 1 August 1942. This test relied upon pantomime to convey directions, and while it did not actually fully meet the stated criteria, it did at least help select men who might reasonably be expected to learn the duties of a soldier if given a minimum amount of training in the use of language.

While, initially, the psychiatrist had been administering the literacy tests, with the introduction of intelligence as a criterion for induction, it was deemed necessary to provide psychologically trained personnel to determine minimum mental capacity.

It was readily apparent that there were not a sufficient number of available trained psychologists in the Army to cover induction stations. There were, therefore, 140 psychologists commissioned as first and second lieutenants and assigned as personnel consultants to induction centers.

Psychological personnel assigned to induction stations were given specific technical training by the service command personnel consultant, or by other qualified personnel, before they assumed their duties.

The role which the psychologist played in the induction station did much to lessen the problem of special training units by providing an effective screening for the majority of men who could not meet the demands for learning even under the most optimal of circumstances which the rapidly expanding Army could provide.

MENTAL AND EDUCATIONAL DEFICIENCY

One of the most immediate clinical problems in which psychologists

⁴⁶War Department Circular No. 169, 1 June 1942.

596

were invited to participate was that of the illiterate soldier and of the individual with less than normal capacity for learning.

Magnitude of the Problem

It has been estimated that some 692,100 registrants were classified as IV-F because of mental deficiency, as of August 1945, either because they could not meet the minimum educational requirements or because they were unable to pass the mental tests applied in World War II. Some 4.3 percent of the registrants examined during World War II were thus so classified. (See appendix A, tables 5 and 7.) Actually, this percentage was surprisingly low.⁴⁷ This low percentage may be explained by the fact that prescreening tests as such, as well as the standards based on these tests, varied greatly in World War II, depending on the military needs. Thus, Menninger⁴⁸ stated:

Induction policy in regard to the educationally deficient varied as the manpower needs fluctuated. Initially, from May 15, 1941, to August 1, 1942, when a quality army was the goal, there were more rejections for, and less discrimination between, mental and educational deficiency. From August 1, 1942, until February 1943, 10 percent of the inductees could be illiterates. Only 5 percent were allowed between February and June 1943. Again the policy was changed, and from June 1943, until September 1945, all illiterates were inducted if they could pass certain tests. After September 1945, only those illiterates then in the process were to be inducted.

Variance in the numbers inducted was not due to any basic consistency in the utilization of this category of personnel but rather to an expedient approach to the demands of the public that the military find ways and means of utilizing the less adequate in at least the same proportion as they were being used in the civilian industrial scene.

Actually, on the basis of an analysis of the Army General Classification Test scores of some 10 million men, Bingham⁴⁹ pointed out that in Grade V (the lowest level of intelligence) there were 8.8 percent of such individuals in the services. This, in itself, was not too serious a problem, but during the period from January 1942 to December 1945, some 29,000 patients were admitted to hospitals for disorders of intelligence, constituting 2.6 percent of all patients admitted to hospitals for psychiatric conditions (see ch. IX, table 8). About 15 percent of these patients were admitted overseas.

It is rapidly apparent that during a major emergency many thousands of individuals are brought into the Military Establishment who are not readily capable of adapting themselves to its rigors. Some can, with

⁴⁷On the basis of the current standards, it has been estimated that about 10 percent of the examined youths could not meet the minimum requirements as established by the Armed Forces Qualification Test. See Karpinos, Bernard D.: Qualification of American Youths for Military Service. Medical Statistics Division, Office of The Surgeon General, Department of the Army, 1962, table 5, p. 26.-A. L. A.
⁴⁸Menninger,op. cit., p. 203.
⁴⁹Bingham, W. V.: Inequalities in Adult Capacity-From Military Data. Science 104: 147-152, 16 Aug. 1946.

597

special training, be prepared to render useful services. Others cannot be utilized for any but the simplest assignments. In a static situation, this problem would not be insurmountable; however, unfortunately, the number of such limited personnel inducted reaches its peak during maximal mobilization when the military is undergoing its greatest stress. World War II has taught that this problem could and should be solved during peacetime.

Special Training Units

Out of this problem of illiterates and mentally defective personnel grew the need for establishing a military unit capable of coexisting at a regular military training establishment, with the goal of educating and orienting these men to at least a minimal functional command of basic educational skills. Thus, such marginal personnel could complete their military training and, subsequently, carry out their duties, perform useful work in their units, and protect their associates as well as themselves. This was accomplished without embarrassment to the soldier or to the service. A report of how this was done follows.

Plans and preparation.-In August 1942, Colonel Seidenfeld was directed to set up a program for the education of personnel found to be mentally or educationally retarded and for the relatively few with minimal physical limitations, such as poor coordination or inadequate motor control. These became the STU (special training units) of the Army. Earlier, Lt. Col. (later Lt. Gen.) Walter Weible and his associates worked on the adaptation of a number of texts and training devices used for a similar program developed by the Army when the Civilian Conservation Corps had been in operation. Examination of this material made apparent its unsuitability for the Army program. It was clear that more functionally suitable training materials had to be developed. Colonel Seidenfeld requested permission to commission from civilian life a number of experts competent to prepare such materials. Among those brought in were Capt. (later Maj.) Henry Beaumont, Maj. Paul Witty, Capt. Samuel Kirk, and Capt. (later Maj.) Samuel Goldberg.

At about the same time, a small cadre of enlisted men, all of whom were skilled artists and cartoonists, was assigned to handle the very necessary artwork.

With this team assembled, the task was that of preparing suitable texts for training men not only in the basic '3 R's' but also in an understanding and acceptance of military conduct, morale, and discipline. Out of this need, 'Private Pete' was born-a figure who was to become the pattern for the educationally limited personnel. The excellent work of these officers and enlisted men made the task of educating thousands of men a month a reality.

598

PSYCHOLOGICAL TESTS

In the early days of the psychological program, no definite instructions concerning the selection or the use of psychological tests had been issued. Each psychologist used those tests which he personally owned or which could be procured through local funds. In general, the tests selected conformed with acceptable civilian practice and with the training of the examiner. Army-wide distribution of testing equipment was confined to those instruments supplied by The Adjutant General Supply Depots. These were primarily group tests and, for the most part, were of little direct help for use in a clinical setting.

Authorization of Testing Materials

Because of this situation, TB MED 115, the material for which was prepared by the Office of the Chief Clinical Psychologist, was issued (p. 579). This bulletin briefly outlined the duties of clinical psychologists and provided uniform standards with respect to procedures and tests. It established procurement channels for obtaining testing supplies and prescribed certain tests as officially recognized. In recognition of the fact that a completely rigid acceptance of some tests and exclusion of others was unwise, it stated: 'Tests not included on the above list will not be supplied unless for special reasons. These reasons should be presented in support of the particular request.' In practice, the tests listed in TB MED 115 were sufficient for most installations. The outstanding exception was in certain convalescent hospitals with many illiterate patients who could be more adequately tested with the Stanford-Binet Intelligence Test than with the prescribed Wechsler-Bellevue Intelligence Scale. Pertinent extracts of TB MED 115 are, as follows:

5. TESTS. The Army General Classification Test, Forms 1c and 1d, and/or its replacement which will be available in the near future, and the Wechsler-Bellevue Intelligence Scale should ordinarily suffice as instruments for the measurement of intelligence. There are additional psychological tests which are authorized and available for general use in the Army. A list of these tests and the places or situations for which they are primarily intended is presented below as a matter of information for the clinical psychologist. Unless otherwise specified, the listed tests (when their use is justified) and the Army General Classification Test may be obtained from adjutant general depots. Requests for the Wechsler-Bellevue Intelligence Scale should be forwarded to the Office of the Chief Clinical Psychologist, Classification and Replacement Branch, The Adjutant General's Office.

For personality evaluation, the Rorschach Test, the Murray Thematic Apperception Test, and the Minnesota Multiphasic Test should be adequate. These are available on request through channels to the Office of The Surgeon General.

599

Test	Situation or place of primary use
Arithmetic Test EA-3, X-1	WAC.
Army General Mechanical Test MA-2 and MA-3	Reception Center.
Army Radio Code Aptitude Test ARC-1	Reception Center.
Classification Test R-1	Induction Station and WAC.
Clerical Aptitude Test CA-1	Training Center.
Clerical Aptitude Test CA-2, X-2	WAC.
Crytography Test TC-4a	Basic Training Ctr (AAF).
Dictation Test	Training Center and WAC.
Driver and Automotive Information Test TK-2, X-1	WAC.
General Electrical and Radio Information Test TK-1, X-2	WAC.
General Technical Test TC-2a	Basic Training Ctr (AAF).
Group Target Test-1 GT-1	Induction Station.
Individual Examination IE-1	Induction Station.
Interview Aids for Occupational Specialties	Reception Center.
Mechanical Aptitude Test MA-4, X-1	WAC.
Non-Language Test 2abc	Training Center.
Non-Language Individual Examination NIE-1	Induction Station.
Nut and Bolt Manual Dexterity Test TC-5a	Basic Training Ctr (AAF).
Oral Trade Questions	Reception Center & WAC.
Qualification Test-1 and 2	Induction Station.
Radiotelegraph Operator Aptitude Test ROA-1, X-1	Reception Center & WAC.
Technical Trade Test TC-7a	Basic Training Ctr (AAF).
Trade Information Test TC-1a	Basic Training Ctr (AAF).
Typing Test	Training Center & WAC.
U-Bolt Assembly Test TC-6a	Basic Training Ctr (AAF).
Weather Aptitude Test TC-3a	Basic Training Ctr (AAF).
Women's Classification Test WCT-2	WAC.

It is obvious that many of the tests listed above, and especially group tests, will have no direct application in the hospital situation. A general policy which may serve as a guide in regard to test requisitions is to limit requests to those tests which are actually needed and whose use in the hospital can be justified. Duplication of tests should be avoided. There is no point in asking for two or more tests which have the same primary use. Tests not included on the above list will not be supplied unless for special reasons. These reasons should be presented in support of the particular request.

For testing intelligence and differential intellectual impairment, the Army General Classification Test and the Wechsler-Bellevue Intelligence Scale were authorized. For personality evaluation, the Rorschach Test, the Murray Thematic Apperception Test, and the Minnesota Multiphasic Test were considered to be adequate. These tests were authorized for procurement through medical supply channels to the Surgeon General's Office. Later, the Bender-Gestalt Test was supplied. In April 1945, it became apparent that the neurology services of Army hospitals would be handling a large number of patients with head injuries. Accordingly, TB MED 155 was issued, which was concerned primarily with establishing diagnostic and language therapeutic procedures with aphasic patients. This bulletin authorized the procurement and use of the Goldstein-Scheerer Test of Abstract and Concrete Behavior.

Handbook.-As a means of furnishing the psychologist with further

600

flexible aids to examination, a handbook of miscellaneous testing material was issued.⁵⁰ The material for this handbook was prepared by Dr. Frederic L. Wells of Harvard University and by Dr. Jurgen Ruesch of the Langley-Porter Clinic of San Francisco. These authors generously relinquished their copyrights for the purposes of Army publication. The final handbook was 128 pages in length and contained both verbal and pictorial material. It proved extremely useful in the field, particularly in those installations where other testing material was slow in arriving. Many psychologists have suggested that this handbook be expanded, for future use, into a complete examination kit, which would be issued individually to each psychology officer.

Difficulties Encountered

The greatest single difficulty with testing procedures in Army psychology arose in connection with the problem of supply. Although official recognition and authorization for procurement of materials was accomplished relatively early in the program, by the end of the war officers in the field were still waiting for testing equipment. Many orders were not filled for as long as 10 to 15 months after having been approved by the Surgeon General's Office. The most difficult item was the Rorschach Test. The test plates, 10 ink blots mounted on thick cardboard, were printed by a Swiss firm which held an exclusive copyright; only two firms in the United States imported this test material and, then, only in small quantities. The demand of the Army for over 300 sets of the plates soon exhausted the limited stock in the United States, and further imports were extremely slow in arriving. The situation had become so acute by the summer of 1945 that Dr. Molly R. Harrower-Erickson, a leading research worker in Rorschach technique, had printed a duplicate set of plates which were advanced as substitutes for the original Rorschach designs. These were authorized by the Surgeon General's Office, but did not reach the market until October 1945, too late to meet the peak demand of the field.

SUMMARY

One cannot bring this history of clinical psychology in World War II to a close without expressing appreciation to the men and women who, serving either as enlisted personnel or officers, made it possible for clinical psychology to establish a permanent place in the cooperative program of orthopsychiatry, preventive psychiatry, and combat psychiatry in the U.S. Army. Certain basic lessons were learned that merit consideration for future planning, and these are that-

1. As a result of the efforts of clinical psychologists, sound interpro?

⁵⁰War Department Pamphlet No. 12-9, 'Handbook for Clinical Psychologists,' 1 Nov. 1944.

601

fessional working relationships were established, and the best interest of the patients and the service were served when this occurred.

2. Effective working relationships between and among the clinical professions were dependent upon proper orientation, mutual respect, and a sense of self-worth in each practitioner, regardless of the professional field of endeavor.

3. A well-organized plan of training, strengthened by the development of carefully established clinical procedures and a program of implementation by qualified personnel resulted in ready acceptance of the psychologist by the psychiatrist.

4. Careful self-assessment, modesty, and humility, as evidenced by knowing one's own limitations, were assets for the psychologist, which helped him from undertaking more than was warranted by his professional capability.

5. In times of stress, when everyone must carry duties and obligations beyond ordinary competency, the psychologist along with his clinical coworkers in allied fields found the opportunity for growth and development in accordance with intelligence, adaptability, and preparation to meet the new and the unknown. Out of just such experiences, many clinical psychologists and psychological technicians reached new heights of professional attainment and accomplishment.

6. Psychologists, like all other professional workers in the fields of mental health, needed to be flexible yet knowledgeable; to be emphatic, yet aware of the realities; to take pride in their professional competency, yet be capable of maintaining perspective with regard to working with members of all other professions whose responsibilities also encompassed elements of behavior.

Psychology in the Army of World War II has written an illustrious chapter in the Medical Department, especially in relationship to its symbiotic support of neuropsychiatry in the oversea theaters and in Zone of Interior installations.

Once the basic teaching materials were developed, a suitable training environment was established to permit the education of the man in the three R's concurrently or closely paralleling his military training. The mission of the special training units was to prepare linguistically handicapped and mentally limited personnel to carry out their military duties effectively.

Initially, special training units were established in the reception centers. Soon they were moved to the large replacement training centers where the major basic training programs of the Army were being carried out.⁵¹ As a direct result of the increase in industion quotas that allowed up to 10 percent illiterates per day, the War Department granted authority

⁵¹Seidenfeld, M. A.: Training Linguistically Handicapped and Mentally Limited Personnel in the Military Services. J. Educ. Psychol. 34: 26-34, 1943.

602

to organize such units in 'armies, corps, service commands, divisions, and field units.' Up to June 1943, when this program was altered to meet changing points of view, there were 239 special training units in operation.⁵²

As Ginzberg and Bray pointed out: 'When the selection procedure was altered in June 1943, and illiteracy per se was no longer a bar to induction, a major alteration was introduced into the structure of the special training units * * * they were transformed into an efficient school system.' The multiplicity of small units was reduced by establishing 24 large special training units. All these units were in reception centers, permitting the educational program to begin immediately upon admission to the military scene. By this time, men with physical limitations or emotional disturbances were no longer assigned to these units, thus allowing concentration on the linguistically handicapped, educationally deprived, or slow learners.

The procedures employed in the special training units were described by Goldberg.⁵³ He pointed out that the specific aims of this program were fivefold, as follows:

1. To teach the men to read at a fourth-grade level so that they will be able to comprehend bulletins, written orders and directives, and basic Army publications.

2. To give the men sufficient language skill so that they will be able to use and understand the everyday oral and written language necessary for getting along with officers and men.

3. To teach the men to do number work at a fourth-grade level, so that they could understand their pay accounts and laundry bills, conduct their business in the PX, and perform in other situations requiring arithmetic skill.

4. To facilitate the adjustment of the men to military training and Army life.

5. To enable the men to understand in a general way why it was necessary for the country to fight a war against Germany, Japan, and Italy.

Ginzberg and Bray,⁵⁴ in their carefully controlled study of the records of 400 STU assignees in which areas of assignment, color, and time of assignment were controlled, found: 'Of the 400 men, 57 (14.5 percent) failed to graduate from STU's. However 6 of these men were withdrawn for defects not considered as related to their mental ability and who under existing regulations should not have been accepted for induction.' Of the remaining 51 men, 42 were inept and the remainder received medical discharges for psychiatric problems, enuresis, and the like. Of the 400 men studied, 86 percent were found, during training or upon completion of training, capable of satisfactory performance of duty. Excluding the number discharged for medical reasons, only 7 percent actually failed in STU training.

To further substantiate this result, Ginzberg and Bray⁵⁵ studied the

⁵²Ginzberg, Eli, and Bray, Douglas W.: The Uneducated. New York: Columbia University Press, 1953, p. 68.
⁵³Goldberg, S.: Psychological Procedures Employed in the Army's Special Training Units. J. Clin. Psychol. 1: 118-125, 1945.
⁵⁴Ginsberg and Bray, op cit., pp. 77-85.
⁵⁵Ginzberg and Bray, op. cit., pp. 94-98.

603

military effectiveness of the 331 who successfully completed STU training. Their findings are shown in table 64. The classification used indicates that men in the 'very good' category attained status of 'sergeant and combat decoration or higher'; in the 'good,' meant 'long period in combat and Bronze Star'; in the 'acceptable,' attained 'no higher than PFC and undistinguished'; and in the 'not acceptable,' was equivalent to 'dishonorable discharge, discharge without Honor, et cetera.'

Thus, it will be noted that 85 percent of the STU graduates performed at 'acceptable' or better levels, as compared to 90 percent of the controls. 'Clearly, at a time when the Armed Forces needed men badly, they were able with a small investment to turn many illiterates and poorly educated men into acceptable soldiers.'

Seldom has there been a more graphic picture of the successful outcome of a clinical program. Here, the clinical psychologists, the medical specialists, the social services, and the educators linked arms with the military specialist to produce personnel who were capable of rendering effective service during a period when every serviceable man was desperately needed.

TABLE 64.-Military effectiveness of special training unit graduates and the control group

Classification	Total		White		Negro
Classification	STU	Control	STU	Control	STU	Control
	Percent	Percent	Percent	Percent	Percent	Percent
Very good	9	23	12	25	5	20
Good	28	34	35	40	21	26
Acceptable	48	33	41	26	55	42
Not acceptable	12	7	10	5	14	10
Nonchargeable	3	3	2	4	5	2
Total	100	100	100	100	100	100

Source: Ginzberg, Eli, and Bray, Douglas W.: The Uneducated. New York: Columbia University Press, 1953, p. 98.

RETURN TO TABLE OF CONTENTS