We've briefly quoted Karl Menninger, M.D., before, here. But in scouring a book he wrote almost 50 years ago, we came across this extensive retelling of what he observed with World War II veterans and combat stress -- what we know today as PTSD.
It's interesting to read because there is both not much material readily available before the Vietnam War brought post-traumatic stress disorder into the common awareness, and also because the phenomenon of PTSD does seem to slightly "mutate" over time, perhaps because of the difference in the types of combat with each significant war. Menninger, a world-famous psychiatrist, brings up many important points in this passage -- and we wonder how many of them would still be considered true today.
(The context for the original work that he's citing here was performed when he was a member of a commision to study combat exhaustion in World War II veterans, appointed by the Surgeon General and his brother, Brigadier-General William C. Menninger.)
“In our studies of reactions to combat stress in World War II previously referred to, we were very much impressed with the way in which a set of forces began a phase of great stress and simultaneously aroused certain opposing forces which helped to maintain a balance. Then came more stress and more defense. Gradually the stresses seemed to become greater than the defenses, so that there occurred a lowering of achievement level, a partial retreat, the employment of emergency regulatory devices, evidences of threatened disorganization, and then, usually a recourse to medical aid.
With sedation and a few hours of rest many of these individuals were able to resume their former efficiency and return to the battle. Heroic and admirable as it was, this was not too difficult to explain. But other individuals had the same treatment and were not able to return to the front lines. Their symptoms persisted. This too we could understand. More time was required, more rest, more recuperation, further removal from the imminence of renewed combat stress.
But now comes the enigma. Many of these patients were sent back to the base hospital for care, nursing, protection, rest, and treatment. We saw some of them there, later. Many had improved or were improving; some had returned to duty (but usually not to combat duty). What impressed us most was that some of them were not better; they were under treatment of sorts, but they were worse. There was, for them, no more battle stress, no more physical exertion and prevail, no more threat of death. There was not even any considerable probability of further duty assignment. Bright, or at least safe and comfortable, situations lay ahead for them. Why did not the symptoms disappear?
In analyzing the nature of the stress they had undergone, we began to realize this was different from what would appear on the surface. In the beginning these men had experienced fear, fatigue, resentment, hunger, cold, and other things. But they were sustained, there, by many things, too: self-respect, pride-idealism, courage, devotion to duty, training, and habituation to routine. Moreover, there was a strong support from relations with comrades and officers and units. The sudden increment of stress which precipitated these symptoms was frequently the loss of one of these human supports by death or transfer. In other instances cumulative fatigue seemed to be the most important factor.
For these men, then, who did not respond to battalion aid-station treatment, the nature of the stress had changed; but it did not diminish quantitatively as the casual observer might have assumed. The threat of danger was gone, true, but so were the excitement and the routine activity. The weariness was gone, true, but so was the companionship of fellow soldiers. The unpleasant physical conditions were corrected, but in their place was the guilt feeling of abandoning one’s comrades and the fear of accusation of cowardice. Painfully disturbing was the dilemma that if one mastered his distress he would be sent back to duty, but if one admitted it he would be retired. A retirement could be cleared of all tincture of suspected cowardice only if it took the form of something called sickness. Efficient warfare and humane medical science are antithetical and sooner or later the antithesis shows up in the individual.”
-- Karl Menninger, M.D., “The Vital Balance: The Life Process in Mental Health and Illness.” New York: The Viking Press (1963).
Editor's note: The photo illustrates Polish soldiers involved in the Warsaw Uprising.
