On Killing

Killing and Combat Trauma:

The Role of Killing in Psychiatric Casualties

Nations customarily measure the “costs of war” in dollars, lost production, or the number of soldiers killed or wounded. Rarely do military establishments attempt to measure the costs of war in terms of individual human suffering. Psychiatric breakdown remains one of the most costly items of war when expressed in human terms.

— Richard Gabriel

No More Heroes

CHAPTER ONE The Nature of Psychiatric Casualties: The Psychological Price of War

Richard Gabriel tells us that “in every war in which American soldiers have fought in this century, the chances of becoming a psychiatric casualty — of being debilitated for some period of time as a consequence of the stresses of military life — were greater than the chances of being killed by enemy fire.”

During World War II more than 800,000 men were classified 4-F (unfit for military service) due to psychiatric reasons. Despite this effort to weed out those mentally and emotionally unfit for combat, America’s armed forces lost an additional 504,000 men from the fighting effort because of psychiatric collapse — enough to man fifty divisions! At one point in World War II, psychiatric casualties were being discharged from the U.S. Army faster than new recruits were being drafted in.

In the brief 1973 Arab-Israeli War, almost a third of all Israeli casualties were due to psychiatric causes, and the same seems to have been true among the opposing Egyptian forces. In the 1982 incursion into Lebanon, Israeli psychiatric casualties were twice as high as the number of dead.

Swank and Marchand’s much-cited World War II study determined that after sixty days of continuous combat, 98 percent of all surviving soldiers will have become psychiatric casualties of one kind or another. Swank and Marchand also found a common trait among the 2 percent who are able to endure sustained combat: a predisposition toward “aggressive psychopathic personalities.”

^{The Relation of Stress and Development of Combat Exhaustion to the Combat Efficiency of the Average Soldier}

^{Source: Swank and Marchand, 1946}

The British in World War I believed that their soldiers were good for several hundred days before inevitably becoming a psychiatric casualty. But this was only made possible by the British policy of rotating men out of combat for four days of rest after approximately twelve days of combat, as opposed to America’s World War II policy of leaving soldiers in combat for up to eighty days at a stretch.

It is interesting to note that spending months of continuous exposure to the stresses of combat is a phenomenon found only on the battlefields of this century. Even the years-long sieges of previous centuries provided ample respites from combat, largely due to limitations of artillery and tactics. The actual times of personal risk were seldom more than a few hours in duration. Some psychiatric casualties have always been associated with war, but it is only in this century that our physical and logistical capability to sustain combat has completely outstripped our psychological capacity to endure it.

The Manifestations of Psychiatric Casualties

In his book No More Heroes Richard Gabriel examines the many historical symptoms and manifestations of psychiatric casualties.[8] Among these are fatigue cases, confusional states, conversion hysteria, anxiety states, obsessional and compulsive states, and character disorders.

Fatigue Cases

This state of physical and mental exhaustion is one of the earliest symptoms. Increasingly unsociable and overly irritable, the soldier loses interest in all activities with comrades and seeks to avoid any responsibility or activity involving physical or mental effort. He becomes prone to crying fits or fits of extreme anxiety or terror. There will also be such somatic symptoms as hypersensitivity to sound, increased sweating, and palpitations. Such fatigue cases set the stage for further and more complete collapse. If the soldier is forced to remain in combat, such collapse becomes inevitable; the only real cure is evacuation and rest.

Confusional States

Fatigue can quickly shift into the psychotic dissociation from reality that marks confusional states. Usually, the soldier no longer knows who he is or where he is. Unable to deal with his environment, he has mentally removed himself from it. Symptoms include delirium, psychotic dissociation, and manic-depressive mood swings. One often noted response is Ganzer syndrome, in which the soldier will begin to make jokes, act silly, and otherwise try to ward off the horror with humor and the ridiculous.

The degree of affliction in confusional states can range from the merely neurotic to the overtly psychotic. The sense of humor exhibited in the movie and television series M*A*S*H is an excellent example of individuals mildly afflicted with Ganzer syndrome. And this personal narrative provides a look at a man severely afflicted with Ganzer syndrome:

“Get that thing out of my face, Hunter, or I’ll feed it to you with hot sauce.”

“C’mon, Sarge, don’t you want to shake hands with ‘Herbert’?”

“Hunter, you’re f***ed up. Anybody who’d bring back a gook arm is sick. Anybody who’d bring one in the tent is begging for extra guard. You don’t know where that thing’s been. QUIT PICKING YOUR NOSE WITH IT! OUT, HUNTER! OUT!”

“Aw, Sarge, ‘Herbert’ just wants to make friends. He’s lonely without his old friends, ‘Mr. Foot’ and ‘Mr. Ballbag.’”

“Double guard tonight, Hunter, and all week. Goodbye, sicko. Enjoy your guard.”

“Say good night to ‘Herbert,’ everyone.”

“OUT! OUT!”

Black humor of course. Hard laughs for the hard guys. After a time, nothing was sacred. If Mom could only see what her little boy was playing with now.

Or what they were paying him to do.

— W. Norris

“Rhodesia Fireforce Commandos”