Foreword
It is well recognized that the deprivations and hazards suffered by personnel in modern war produce emotional disorders in such large numbers as to constitute a major problem of military medicine and a principal cause of manpower attrition. However, during the preparatory and early phases of World War II, there was little appreciation of the magnitude of wartime psychiatric disorders. The considerable prevalence of incapacitating emotional reactions in military personnel of World War I, including 'shell shock' and neurocirculatory asthenia, was known. But, then, it was widely believed by responsible professional and military authorities that such psychiatric cases were derived from so-called weaker personnel who were predisposed to situational stress. For this reason, major reliance was placed upon psychiatric screening at induction in order to exclude vulnerable individuals from entering military service.
As World War II proceeded, it became increasingly apparent that psychiatric screening had failed to prevent the appearance of vast numbers of emotional disorders. Further, battle experiences clearly demonstrated that combat psychiatric breakdown could originate from normal or previously stable personnel as well as from those of weaker predisposition. Thus, the Army Medical Department was confronted with the difficult task of dealing with an unprecedented incidence of psychiatric casualties from both combat and noncombat sources for which there had been little preparation in either organization or methodology or training psychiatric personnel. The struggle to overcome these handicaps and the eventual establishment of effective programs of prevention and treatment present an epic achievement in military medicine and is the subject of this history of neuropsychiatry in the U.S. Army in World War II.
In this first volume of the history is recorded the administrative and professional frustrations, failures, and successes as they occurred in the Zone of Interior. The second volume, now well along in preparation, will contain an account of neuropsychiatric problems in oversea theaters, both combat and noncombat.
Despite the vicissitudes that were encountered, military psychiatry gained immeasurably from the experiences of World War II. As a result, psychiatry became a major component of the Army Medical Service and rendered important contributions to 'conserving the fighting strength' during and since the Korean War. Perhaps even greater gains were made by civilian psychiatry as evidenced by its explosive expansion following World War II. The exigencies of war stimulated those concepts and practices which fostered the early and widespread treatment of mental disorders. Indeed, the current nationwide movement for the establishment
of community mental health centers can be traced to techniques developed by training camp consultation services and by forward combat psychiatric units wherein it was demonstrated that emotional illness was most effectively treated when such treatment was accomplished as soon as possible and as near as possible to the site of origin.
Military service also made a major contribution to the professional growth of psychiatrists on active duty during the war. With their experience broadened, they were better equipped, upon return to civil life, to develop further their private, institutional, and teaching practices. Moreover, the increased Army needs for psychiatrists required the utilization and training of large numbers of general medical officers in psychiatric assignments. Most of these physicians became interested in this specialty and sought further training upon their return to civilian life. Thus, the heightened wartime requirements for psychiatrists provided many of these urgently needed specialists to satisfy, at least partially, the huge unmet needs for mental health care in the civilian community.
In this volume, the editors have wisely included a summary chapter, 'Lessons Learned,' thus making available in one small section the essentials of the hard-won knowledge gained by military psychiatry in World War II. A similar summary final chapter is planned for the second volume. With this information so readily available, there can be little excuse for repetition of error in future wars, should they occur.
Again, as in previous volumes, I wish to extend to my staff of The Historical Unit who are helping me in preparing these histories and to the authors, technical editors, and reviewers of manuscripts my very special praise and gratitude for their contributions. Particularly do I wish to acknowledge the conscientious and dedicated work performed on this volume from 25 February 1957 to 28 February 1963 by Lt. Col. Robert J. Bernucci, MC, USA (Ret.), as special project officer and the initial editor, and by his successor, Col. Albert J. Glass, MC, USA (Ret.), who picked up so ably where Lieutenant Colonel Bernucci left off.
I am also indebted to the Advisory Editorial Board for Neuropsychiatry for its wise guidance and support in this project. In this regard, I am especially saddened by the deaths of three of its distinguished members as this volume goes to press, Dr. Frederick R. Hanson, Dr. William C. Menninger, and Dr. Manfred S. Guttmacher, all widely known for their valuable contributions to neuropsychiatry. May this volume serve an additional purpose as a fitting memorial to them.
LEONARD D. HEATON,
Lieutenant General,
The Surgeon General.
