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LONG-TERM STUDY OF COMBAT AREA SCHIZOPHRENIC REACTIONS Preliminary Report
HERBERT S. RIPLEY; STEWART WOLF
Am J Psychiatry 1951;108:409-416.
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Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington.

Department of Medicine, Cornell University Medical College, New York, New York.

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Abstract

1. One hundred patients with schizophrenia or schizophrenic-like reactions occurring in a combat area have been investigated.2. Follow-up data over a period of 5 to 8 years after the initial hospitalization were obtained through records, questionnaires, and personal interviews.3. There was a high incidence of psychopathologic symptoms prior to the illness developing overseas.4. The most common precipitating factors appeared to be traumatic incidents in combat, family problems, sexual conflicts, prolonged overseas service, difficulty in accepting responsibility, dissatisfaction with the army assignment, and problems in interpersonal relationships with others in the organization.5. Eighty percent of the patients were evacuated to the United States within 2 months of the hospitalization.6. On reaching the United States, one- fifth had shown marked symptomatic improvement. After two months of hospitalization, over a third of the patients had been discharged. Only four were continuously hospitalized for more than a year.7. Comparison of the prewar and postwar adjustment revealed that the general health, ability to function at work, family relationships, and social adaptation were all poorer, and the sexual adjustment was essentially unchanged.8. There was a gradual trend toward decrease in disability, though personality deviations characteristic of schizophrenia persisted. After 5 or more years severely handicapping symptoms were present in one- fifth of the patients. Eleven had had further hospitalizations.9. Although the amount of disability compensation had been gradually reduced, over three-fourths of the patients were still receiving some benefits.10. The long-term course of the patients studied indicates that schizophrenia in the military service does not differ essentially from that occurring in civilian life.11. Some schizophrenics functioned in the army for long periods prior to the acute episode despite psychopathologic symptoms.12. Vulnerability in civilian life to the types of stress similar to those encountered in the armed forces indicates that such individuals should not be accepted for military duty.13. A proper evaluation of the assets and deficiencies may lead to better military assignment and lessen the number of psychiatric hospitalizations.14. A policy of returning soldiers to the United States after a definite period of service overseas may be of use in decreasing the number of psychiatric casualties.15. The physician with an understanding of psychiatry may be of great help in preventing and treating psychiatric casualties. Since personality illnesses are a major problem in the military services, whenever it is feasible special courses or orientation periods in psychiatry should be offered for medical officers.16. There has been too much emphasis on granting disability compensation and too little on rehabilitation. Continuous treatment efforts can help many with schizophrenia to reach or maintain their best level of adjustment.17. This report has been based on a preliminary evaluation of the data and will be followed by a more definitive communication in which the findings among schizophrenics will be compared with carefully selected controls from the same military units.

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