The Heavy-Laden

Soldiers' frayed battle-nerves are the subject of much concern among service doctors and the people at home. Last week, before the Brief Psychotherapy Council in Chicago, Lieut. Colonel Roy Richard Grinker gave his candid opinion of the psychiatric methods now used to get war-sick soldiers back into battle.

Colonel Grinker divides military neuroses into four types: 1) those occurring before exposure to military life can have any effect; 2) those caused by the restrictions of military life; 3 ) those caused by foreign service with its homesickness and poor living conditions; 4) true war neuroses caused by actual combat. Men suffering from the first three types, says the Colonel, were not normal in the first place and have a poor chance of being completely cured. But men with true war neuroses are not "weak and useless characters, and deserve active help."

Forget It. The Army now uses two ways of treating such cases -- the old, "suppressive," "forget-it" treatment of World War I, and the newer "catharsis" in which, by means of persuasion with or without drugs, the despairing soldier is made to spit it out. Still most common, because it takes less time, is the old-fashioned method. The anxious soldier is given rest, sedatives, food and psychiatric pep talks. These are usually given so that all the ward may hear -- only the most personal part of the discussion is sotto voce. The question is asked repeatedly: "You want to go back and try again, don't you?" The man is led to think that giving up is dishonorable, "that family, friends, comrades and country expect him to return and finish the job."

This treatment works only on a soldier whose ego is still pretty much in command of his cosmos. About 60% of the selected cases on which the Army uses it are improved enough to return to battle. Colonel Grinker admits the necessity of this slapdash technique, but he thinks that speed is the only thing in its favor. He says it is hard to tell whether the returned troops are effective in combat, that the end result in many cases of repressed anxiety will be a mental problem after the war, if not before.

Tell It. The timeconsuming, thorough, "uncovering" type of psychotherapy is ordinarily given only to men who do not respond to simpler treatment, and to men whose neuroses appear serious at the out set. Colonel Grinker says that this treatment can be used only at base hospitals or psychiatric station hospitals. But many conscientious, front-line psychiatrists use some of the uncovering techniques. For this treatment, a soldier is given food, rest and some drug (e.g., sodium pentothal by vein) to loosen his tongue. Beside him in a darkened room the psychiatrist persuades him to describe the horrors he has endured, relive the episodes that hurt his inner being.

These treatments can be given only by a hardy doctor with plenty of moral courage of his own. Every case of war neurosis presents a picture of heart-rending insecurity -- the patient is convinced that the whole world is hostile and that nothing can make it right again. "He sobs, weeps violently, throws himself into the psychiatrist's arms as he tells how he was deserted by every semblance of a protective, supporting or kindly figure. Officers, other soldiers, friends and buddies all suddenly become impotent in the face of the ever-present enemy fire and activity.

He is an isolated individual in the darkness . . . like a child in a dark room with the door shut and no human voices audible. ... It is now apparent why so much gratification and affection must be given these men. They have . . . given far beyond their capacities and the overdraft on their psychic banks must be replenished before they can reassume their resemblance to the adult."

Toward Independence. When such a patient begins to depend on the psychiatrist and accept him as a "supporting presence," he is likely to lose the outward signs of his neurosis--a stiff leg, deafness, forgetfulness, phobia. But if the psychiatrist neglects him or ships him off too soon to another station where he gets some thoughtless rebuff, the neurotic symptom will return. Bad news from home sometimes causes a relapse. "Time is necessary for the patient . . . to test the human environment's sincerity. . . . The Army is not conducive to such testing."

A few interviews usually start a patient toward recovery. If they do not help, some kind of shock treatment is used; but patients requiring shock are unlikely to recover completely. Then begins a longer period, probably months, of making the patient independent of the psychiatrist. Best way to do this is by occupational therapy--not basketry, but useful jobs around the hospital.

The long treatment, Colonel Grinker is convinced, is the best in the long run. But, says he: "We do not have enough psychiatrists." Fortunately, Army doctors who are not psychiatrists are becoming converted to the method and are demanding training; "they have seen how little value there is in diagnostic labeling, persuasion, suggestion and authoritative forcing."

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