Prologue
In relating the history of neuropsychiatry in World War II, it should be understood at the outset that the problems of psychiatry were basically the problems of mobilization, manpower, selection, training, and utilization of military personnel, as well as those of industrial mobilization and coordination with powerful civilian agencies. Although psychiatrists could be expected to do their part in the war effort, they could not deal completely with the vast problems mentioned, and it may be of interest to physicians to read about some of the processes which determined their workload.
It is not easy to picture the scene as it seemed to those of us who lived it. Any brief statement is an oversimplification, and every observer is limited by his necessarily curtailed personal experience and his own personal bias as well as by those inevitable distortions of memory which occur during the years which have passed. However, the documentation which is available enables even a biased observer to cite evidence for major trends. Unfortunately, the official language of both published regulations and unpublished reports does not convey sufficiently the strength of the rejection of psychological problems in the Army from the very beginning. Informally and privately, many Regular Army officers of all branches would express concern over the so-called psychiatric problem, which was really one facet of the need 'to conserve fighting strength.' Officially, however, particularly in the higher ranks, there was no realistic appraisal and willingness to take active responsibility for Army-wide correction of the difficulties, as seen by Brig. Gen. Elliot D. Cooke, USA; by Maj. Gen. Frederick H. Osborn, Director, Information and Education Division, War Department, in his survey; or by the Doolittle Board. The attempts by the Information and Education Division, in 1943 and 1944, to improve morale were, at best, rather piecemeal, half-hearted, and inadequate to the task.
It is also regrettable that few published regulations and reports reflect the dissatisfactions and failures inherent in any given situation. By the very nature of army organization and human ambition, it is essential that deficiencies are minimized or denied. An officer's pride and his group loyalties often prevented candid appraisals. Only in some contemporary diaries does one get the full flavor and intimate detail of the operations in question. Furthermore, it is only too well known that regulations are interpreted variously, if they are utilized at all. This was the case with many Army Air Forces, Army Ground Forces, and some service command commanders. They had vigorous defenses against a better attitude for prevention and treatment of those soldiers in need of help. Although
psychiatrists were often well regarded as individuals, they were usually accepted as a rather painful, necessary evil which it would be better to do without. The psychiatrists had few defenses in those posts where there was active animosity against them.
Basically, as any student of history knows, the major factors determining our military policy are the attitudes of the people of the United States. Through their elected representatives to Congress, they determine what our military strength and goals should be. Congress in turn determines what the War Department should do in preparation for war and exercises power on the conduct of a war. Without firm instructions from Congress, particularly with regard to a coordinated foreign policy and adequate preparation for contingencies as they present themselves, the Military Establishment is almost reduced to impotence until asked to produce a fighting force overnight. It is a fact that in none of our eight major wars have we been prepared, with resulting confusion and waste.
The central problem was the proper use of manpower in all of its ramifications. Men with good morale are ultimately more important in a war effort than material, as stated by Gen. George C. Marshall, but despite the well-recognized importance of this principle, it seemed as if our most glowing successes were in the field of materials, and our most glaring failures in the management of men. Only gradually under severe pressures both at home and overseas did the Military Establishment begin to deal realistically with the human problems of the 'lost divisions,' even in such simple procedures as malarial control. The deeper prejudice against dealing realistically with the emotional problems of military personnel was never overcome completely.
The words of General Osborn, in his official report to the Chief of Staff, 16 November 1945, are a reminder of the basic issue: 'War is no longer a game to be played by a guild of professional soldiers, but a business which involves mobilization of all the resources, human and otherwise, of the Nation.'
However, the War Department, acutely conscious of the desperate need of proper and ample supplies, apparently gave priority to this endeavor. Gen. Brehon B. Somervell, Commanding General, Army Service Forces, stated the alternative clearly: 'Broken armies can reform to fight again, while broken lines of communication and supply of all the nations are too long to be quickly replaced.' It will require military historians with greater mastery of the problem than the author to render a judgment on this question. This review is made to describe the facts as we saw them, and hope future planners can do better.
It is well known that the mission of the Medical Department of the Army is to conserve manpower and maintain the health of the Army. The vicissitudes of the Medical Department in the effort to accomplish these missions were particularly strong in the psychiatric area because medical and psychiatric channels were employed to control the size of the Army and thus strongly affected our total manpower.
The neuropsychiatrists who were charged with the responsibility of
discharging either sick or ineffectual soldiers found themselves at a disadvantage from the beginning of the war because some of their seniors in civilian medicine and psychiatry and the War Department had placed too much emphasis upon initial screening at induction and had the mistaken belief that, for all practical purposes, manpower was unlimited. Only after a large number of soldiers had been separated during 1942-44 was serious attention given to developing methods to prevent a large percentage of medical and administrative discharges by improved leadership, personnel policy, and motivation. Neuropsychiatrists were only one part of the entire organization but a critical one. Some commanders even blamed them for the huge loss of manpower until an Inspector General's report in December 1944 definitely placed the responsibility upon command: 'Actually, the majority of these cases are not psychoneurotic conditions because medical officers wish to make patients out of them but because the line officers have been unable to make soldiers out of them.' Only gradually were means found to retain soldiers who could perform duty and yet permit separation of those who could not or would not do so.
The problem of conserving manpower has always been a traditional one in the Army but was complicated in this war by the unprecedented and enormous size of the Army for which there was no adequate planning, the rapidity with which this size was attained, and the unexpected losses due to poor motivation and personnel policies which accompanied the accelerated mobilization. Other volumes in this series tell in greater detail the various facets of command policy, personnel practices, and administrative decisions which helped to shape the events recorded here.
There were many misunderstandings and controversies at all levels, although most service personnel at lower levels did their best to cooperate and help each other. From the record which follows, it can be seen that The Surgeon General did all in his power to give strong support to all medical officers to practice the best medicine possible, and succeeded to a remarkable degree in keeping the level of medical care very high in spite of many handicaps, including the crucial loss of power of classification, promotion, and assignment. Although The Surgeon General was responsible for the activities of the Medical Department and the health of the Army, he was unable to exert any command functions beyond a limited sphere because these had been given to the General Staff; to Headquarters, Army Service Forces; to Headquarters, Army Ground Forces; to Headquarters, Army Air Forces; and to the service commands. Until late in the war, The Surgeon General did not have direct access to the Chief of Staff or the General Staff. Consequently, it was not until 1945 that policies and practices for the best care of the troops were able to be published and implemented.
In view of these difficulties, all personnel associated with the Medical Department can be proud of its achievements under adverse circumstances. Their loyalty and devotion to duty has to be recognized by the other services and combat arms who always found medical personnel at their side
wherever they might be. Both the Regular Army and civilian physicians earned these tributes and deserve commendation for their efforts.
HENRY W. BROSIN,
Colonel, MC, USAR.
