PSYCHIATRIC OBSERVATIONS IN A COMBAT AREA IN THE SOUTH PACIFIC

In this brief comment upon the insistent problems of the neuroses of war, I shall dwell chiefly upon the entity of combat fatigue-a condition so aptly named, now so well defined by others, and daily better understood by psychiatrists, medical men in general and the military personnel as a whole. The current emphasis upon this most prevalent of all psychiatric war disabilities is well deserved, in view of the tremendous toll from the standpoint of casualties that can be attributed to this single illness alone. On the combat front, it is important to arrive at an early diagnosis and there is a growing unanimity of opinion that treatment instituted early is the sine qua non of recovery and the instrument to a favorable ultimate outcome. For all practical purposes, it is well to bear in mind as the diagnostic criteria of combat fatigue (previously labeled psychoneurosis, war or traumatic neurosis) that we are dealing with a neurosis developing acutely under experiences of extreme threat to ego-security in individuals previously well integrated. Objectively, startle reaction is to some degree universal in the acute stage. Anxiety, tremors, sleeplessness, battle dreams and some degree of confusion or temporary amnesia are usually all presentat least in the early stages of the condition. The conditioning factors which predispose to this profound personality disintegration may vary in intensity and duration. Usually, physical and emotional exhaustion are present to a degree sufficient to prepare a fertile field for a neurotic catastrophe. Then comes some terrifying life-threatening episode, unendurable to the psyche, which allows for only one response: an acute psychoneurosis.