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CLINICAL
FORUM
325
THE
TRAUMAS
OF
WAR
In
1945-1946,
the patient population of theWelchConvalescent
Hos-
pital consistedof some5,000battle casualties, one half orthopedic cases,
one half psyehoneurotic.These men were transferred from emergency
centers in the EuropeanTheater upon determination that they could not
be sufficientlyrehabilitated tobe returned to combat.Theyhad ”broken
down” during the Africancampaign, the Italian and Siciliancampaigns,
the h z i oBeachhead, and the invasionof France.Theirperiod of combat
stress varied widely, ranging from a day or
two
to more than a year of
continuous fighting. Physical illness was minimal, but psychological
damage was severe.
Thebattle scenesof trauma and horror that these soldiershad experi-
enced were almost indescribable (and barely comprehensibleby those
mental health professionals who had not personally experienced com-
bat). Ambrose
(1997),
of all currentwriters,most closely depicts the kind
of personal stories that we in the Welch Hospital heard from those
GIs
who were admitted to our unit.
Most of these patients had experiencedsometype of brief, supportive
therapy at intermediate stations when their conditions were acute. At
that time, they were generallymotivated to rejoin their outfits, because
among combat soldiers there
is
a strong attachment to “buddies.”
How-
ever, some arrived at Welch Hospital several months later with a
well-structured neurosis and considerable resistance to treatment. By
this time, the motivation for many of them had changed to a strong
desire for discharge and a return home.
Many of these veterans manifested hysterical paralyses and other
dissociativereactions, as well as depressivereactionsand phobic disor-
ders. However, the majority were given a diagnosis of anxiety reaction,
severe, (with the symptoms listed). Also included was an estimate of
predisposition (mild, moderate,or severe)based on
an
evaluation of the
patient’s preservicelife,back to childhoodwhen possible. Someof these
men had indeed suffered severe abuse as children, more often neglect,
but the majority were simply normal young Americans with at most
only amild predisposition that couldbe consideredrelevant to their pre-
senting condition.
Precipitatingstress related not only tobattle fatiguebut also included
stresses encountered during induction, training, shockat change of life-
style, and transfer to the battle zone.
A
prognosis was also recorded
based on the examiner’s estimate
of
motivation, ego strength, and psy-
chological test data.
Initially,
I
was assignedto the first treatment team, consistingof apsy-
chiatrist, psychologist, and psychiatric socialworker. This team trained
new mental health personnel who were transferred to our hospital to
form additional such teams. Each new treatment team was then
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