War Psychiatry

INTRODUCTION

War, with its lesser elaborations such as competitive sports, has been an enduring aspect of human existence. Survival for the prehuman individual and the species was largely dependent on the evolution of physical attributes until fairly late in human development. The ability of prehumans and humans to organize into groups resulted in the supplanting

of biological evolution with social evolution. Social evolution was so powerful an agency that while modern humans are less well developed physically than their human and prehuman ancestors, they are nevertheless more capable of survival. Social evolution has necessarily been accompanied by psychological evolution such that the two cannot be separated. In modern wars, beyond a minimal level of physical fitness and technical learning of how to fight, the soldier’s most important training is in social-psychological reaction patterns, particularly the handling of fear and aggression and the bonding with a group for accomplishing the military mission.

While wars differ along many dimensions ranging from ideology to technology, the human element remains the same. After millions of years of evolutionary molding, the human organism is reasonably well equipped physically to fight the solitary or group combat that our Stone-Age ancestors endured. This physical development alone, however, would never have allowed humans to achieve dominion over the natural world. This dominion resulted from the development of implements of combat and a social structure that facilitated cooperation in battle. Part of this social structure included the ability of protomen to band together on hunting expeditions as well as their ability to discover and then propagate the knowledge of how to make and use weapons. It is a striking observation that men through all periods of recorded history have fought ultimately as small groups consisting of from 2 to 20 or 30 persons.(1)

The same cultural evolution of groups that maximized

warrior skills in the past, however, has increasingly prepared homo sapiens for peace rather than war. Individual psychology, reflecting family and cultural influences, often hinders rather than facilitates successful adaptation to combat. This can be seen, for example, in religious prohibitions against violence, which when internalized

by any of a variety of processes, may even overcome

near-instinctive behaviors for self-preservation. 2(p512)

Contents

Foreword by The Surgeon General

Frontispiece Plates

Preface

Patient Flow in a Theater of Operations

1. Psychiatric Lessons of War

2. Traditional Warfare Combat Stress Casualties

3. Disorders of Frustration and Loneliness

4. Neuropsychiatric Casualties of Nuclear, Biological,

and Chemical Warfare

5. Psychiatric Principles of Future Warfare

6. A Psychological Model of Combat Stress

7. U.S. Army Combat Psychiatry

8. U.S. Air Force Combat Psychiatry

9. U.S. Naval Combat Psychiatry

10. Combat Stress Control in Joint Operations

11. Debriefing Following Combat

12. Postcombat Reentry

13. Behavioral Consequences of Traumatic Brain Injury

14. Disabling and Disfiguring Injuries

15. Conversion Disorders

16. Chronic Post-Traumatic Stress Disorder

17. The Prisoner of War

18. Follow-Up Studies of Veterans

19. Summation

Acknowledgements

Acronyms

Index

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