Psychiatry Up Front

Alongside its totals for dead and wounded from October's battles for the Kumwha ridges, the Eighth Army in Korea was checking another figure last week: manpower losses caused by mental illness. From just behind the front, Psychiatrist Robert J. Lavin sent in an encouraging report on the 7th Division. Of 250 men who had shambled into his tent during the month, said Captain Lavin, he had been able to send no fewer than 247 back to duty. The great majority went back to combat within four or five days, and most of the others got service (e.g., as stretcher bearers) in the forward area. Only three cases did Lavin send to a rear-area hospital in Seoul, and one of them soon returned to duty.

Reports trickling in from the other divisions along the frozen front followed the same general pattern. Clearly, the Army's up-forward treatment of psychiatric cases (TIME, Nov. 5, 1951) was paying big dividends.

Hot Potato. After years of backing & filling, the Army at last has a policy that seems to satisfy both the generals' cries for manpower and psychiatrists' pleas for enlightened treatment of battlefront emotional cases. The policy began to emerge early in World War II. The Army swung away from the practice of treating every case of "combat fatigue" like a hot potato, sending the soldier back to rear-area hospitals, and often to a medical discharge which helped to make him a psychiatric case for life. The new idea was that most war neuroses do not originate in childhood fears but in a normal, understandable fear of being wounded or killed. And the aim was to get the men back into combat, on the double.

But the Army's policy pendulum swung too far. By 1944, battle-weary men were being browbeaten into going up front after insufficient psychiatric care, and they were being separated too long from their own units. Yet there was real progress in the fact that a psychiatrist was assigned to nearly every division; in the later stages of World War II about 60% of psychiatric cases went back to combat, while 30% more were fit for some kind of military duty.

"You've Had It." Soon after the fighting began in Korea, the Army put its new doctrine, now well polished and better balanced, into practice. Every man is treated as close to the front as possible. He spends a minimum of time away from his own unit. He must never be encouraged to think that his upset may help him to escape from combat. On the contrary, he is told that he has just "had a bit too much," and should be back in there pitching in a day or two. Treatment centers bear no resemblance to hospitals, look like front-line units with tents and chow lines.

The Army sets up three levels at which psychiatric cases are treated. First is the battalion aid station. There, the battalion surgeon (though no psychiatrist) is supposed to single out the simple cases of fatigue and treat them on the spot with a day or two of rest, plenty of good hot food, and a few words of reassurance. It helps, too, to remind a soldier that his buddies are still up there, taking it, and need him. Usually, the patient hates the idea of letting them down.

The next level is the division clearing station which has a psychiatrist. He may do no more than the battalion surgeon does, simply handling the battalion's overflow if there is a rush of cases. Or he may keep the patient a couple of days longer; his interviews are more searching, and he may have time to treat moderately severe cases with a "truth drug" and let the patient act out the battle experiences and emotions which bedevil him. Finally, there is the Eighth Army's hospital in Seoul, camouflaged under the name of a "holding company." Even there, patients from the front lines stay only a few days. If the psychiatrists are satisfied that a man cannot be fixed up then & there, they order him evacuated. But now such cases are rare indeed.

Hot Shower & Shave. Far more typical is the case of George, a 22-year-old private first class from New England. He had been in the line for six months and was beginning to suffer from shaking spells.

Then, when his patrol was caught by enemy mortar fire, he saw two of his buddies killed. He collapsed. A corpsman found George shaking and crying, trying to dig a hole in the rocky Korean ground with his bare hands. At the division clearing station, when he heard friendly artillery fire, he jumped under his cot and clawed the ground. Sodium amytal and a firm but friendly psychiatrist helped George to relive his troubles, and to see them for what they were. Within a week he was back with his outfit.

To the time-honored symptoms of "shell shock" and "combat fatigue" a new complication has been added: "rotation fever." Tom, 19, a draftee from the Midwest, was checking off on a pocket calendar the days before he would go home. Then the Communists struck. Tom was not hurt, but he got sick. He vomited, ached all over and shook like a leaf. He was soon passed back to Psychiatrist Lavin of the 7th Division.

Tom was half ashamed, but half hoping that he had something to save him from more front-line duty. Captain Lavin, an ex-sergeant (medical corps), knew the signs. He told Tom: "I used to be an enlisted man myself." But he went on: "There's nothing the matter with you--all you need is rest." Hot food, a hot shower, hot water for shaving and a night under blankets worked wonders. After listening to other men who had had it worse than he had, and another friendly chat with Lavin, Tom went up front again.

Captain Lavin sums up the Army's current policy in crisp G.I. language: "Nobody is going to chicken out if I can help it." Roughly four-fifths of Korea's psychiatric cases now go back promptly to combat. Nearly all the rest get forward duty in service companies. And the system works: of the men returned to duty after up-forward psychiatric care, only 10% have to come back for more.

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