Dividend from Viet Nam

During World War II, U.S. Army field commanders discovered that they were losing more troops to combat stress than to the enemy. One man in ten was knocked out of action by battle-induced mental disorder; in 1943, more men were discharged because of psychiatric reasons than were inducted. Moreover, such casualties were usually eliminated permanently from the war; they were shipped home and discharged. Today in Viet Nam, the psychiatric casualty rate is down to one man in 100. And most of the victims rejoin their units within two days.

One reason for this dramatic reduction is a considerable improvement in the fighting man's lot. Hot meals almost daily, swift evacuation of the wounded by helicopter, regular periods of R and R (rest and recreation) far from the battle zone, steady troop rotation--all these, by contributing to the soldier's peace of mind, have helped prevent mental wounds. But the major reason for the improvement lies in psychiatry's new understanding of and approach to battle stress.

In Viet Nam, the fighting man is seldom out of reach of a psychiatrist; each combat division has its own. There are also two fully staffed mental health clinics that accept the disturbed patient in a most unmartial atmosphere. Military ceremony and the rule book are dropped at the door. Says Colonel Thomas Murray, chief Army psychiatrist in South Viet Nam: "Some of our psychiatrists are the most improbable military guys: soft, flabby, unexercised." In this deliberately demilitarized ambience, the soldier's recovery begins.

It is there, too, that combat therapy radically and abruptly departs from its civilian equivalent. "Our aim is not to please the patient," - says Murray. "At home, the psychiatrist's orientation is toward kindness, consideration, tender loving care. Here, to be kind would be to send your patient home." The purpose of military therapy, however, is not cure but amelioration. It is to get a disabled fighting man back on the line--or, if possible, to keep him on the line.

Stress Syndromes. Techniques are being tried that might not be approved by the American Psychiatric Association. In Korea, for instance, captured American soldiers who were subjected to brainwashing showed more stubborn loyalty to their military outfit than to their own moral values or even their country. In Viet Nam, this knowledge is being applied by treating the battle-shocked man not as an individual but as part of his unit. Men like Major Joel Kaplan, 33, who heads the U.S. Army mental hygiene clinic in Nha Trang, recognize a number of stress syndromes that can tear the unit apart --and, in so doing, generate individual psychiatric casualties.

One of these is known as the f.n.g. (for "f -- g new guy") syndrome. Because of the twelve-month troop-rotation policy, each combat unit gets periodic transfusions of "new guys" unannealed by fire. The raw arrival is greeted with naked suspicion and hostility by a fighting force whose very life depends on group solidarity. Field commanders are now encouraged to prepare the new man for his chilly reception so that he will know what to expect. To abbreviate the period of distrust, the most seasoned veteran in the outfit is often made the new man's mentor and supervisor.

Another group crisis threatens when the fighting unit undergoes a change of command. This evokes feelings of rejection and anger that can, and frequently do, engulf the new commander. Discipline plummets, and sometimes the departing officer may himself hasten the process by shucking his role as leader, accepting his troops as equals, granting extra privileges and even hinting that the next commander might be something of a martinet. Such crises can be averted, or at least ameliorated, if the departing officer is made aware of the problem and advised to tighten discipline and control before he leaves.

New Breed. This approach, first used during World War II, helped establish one of psychiatry's newest methods: group therapy. If the efficacy of such treatment needs any further proof, psychiatrists in Viet Nam feel that they have provided it beyond any doubt. But the value of their experience may go well beyond that.

Combat psychiatrists see the battlefield not so much as a special environment but as a kind of telescoped, infinitely more stressful version of ordinary life. For this reason, and to get the men back to duty as quickly as possible, the Army is creating a new breed of lay therapist, from the battalion surgeon to the squad sergeant to the commanding officer. All these men stand on the line with the soldier. If they are taught to understand and deal with the factors that can cripple a fighting man without visibly injuring him, they can provide an effective, on-the-spot countermeasure against this elusive enemy. In Viet Nam, the lessons are being learned.

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