WAR PSYCHIATRY IN RETROSPECT
B. H. MCNEEL
The principal points emphasized in the foregoing discussion are as follows:
1. In assessing and dealing with psychiatric problems at induction, in training and in action the army psychiatrist deals fundamentally with behaviour patterns which have been built up over a long period and which he can do little to change in a short time. This is less true in action where acute breakdown occurs causing apparently sudden changes in the behaviour patterns of previously well adjusted individuals or where prolonged stress causes a gradual decline in efficiency of adjustment.
2. The symptoms in a large percentage of psychiatric casualties are superficial and for the most part are readily removed by simple methods of treatment. Though superficial they require satisfactory resolution to prevent fixation and persistent disability.
3. The techniques of individual treatment necessarily vary with the individual's reqùirements. The aim is to help the man to understand himself and to help him do something about it. Some men need the opportunity to relive traumatic experiences as in "abreaction." However, in many cases it is the general adjustment and not the traumatic experience which needs to be "talked out." Removal of symptoms is desirable if not essential but the crucial point is the man's deliberate and determined choice of a course of action.
4. The disposal and the final outcome are largely dependent on the personality make-up which we have expressed in terms of constitution and character, and on personal morale.
5. Character may be modified by prolonged retraining but the most hopeful approach to either preventive or therapeutic psychiatry in the Army is in the direction of improving personal morale by efforts in the individual case to build up confidence and to give guidance in self-management, and by general morale measures which are the responsibility of the command rather than of the medical officer.
6. The greatest hope of success in reducing psychiatric casualties lies in attention to preventive aspects and in the institution of early treatment as far forward as possible. For this reason it is important that officers and N.C.Os. receive thorough indoctrination in the principles of mental health which are applicable and that medical officers receive adequate instruction in the fundamentals of personality adjustment, psychogenic disorders and psychosomatic medicine. If such principles are clearly understood much of the responsibility for management and treatment can be left to those who are constantly in contact with the men.
