Conversion hysteria can occur traumatically during combat or post-traumatically, years later. Conversion hysteria can manifest itself as an inability to know where one is or to function at all, often accompanied by aimless wandering around the battlefield with complete disregard for evident dangers. Upon occasion the soldier becomes amnesiatic, blocking out large parts of his memory. Often, hysteria degenerates into convulsive attacks in which the soldier rolls into the fetal position and begins to shake violently.
Gabriel notes that during both world wars cases of contractive paralysis of the arm were quite common, and usually the arm used to pull the trigger was the one that became paralyzed. A soldier may become hysterical after being knocked out by a concussion, after receiving a minor nondebilitating wound, or after experiencing a near miss. Hysteria can also show up after a wounded soldier has been evacuated to a hospital or rear area. Once he is there, hysteria can begin to emerge, most often as a defense against returning to fight. Whatever the physical manifestation, it is always the mind that produces the symptoms, in order to escape or avoid the horror of combat.
These states are characterized by feelings of total weariness and tenseness that cannot be relieved by sleep or rest, degenerating into an inability to concentrate. When he can sleep, the soldier is often awakened by terrible nightmares. Ultimately the soldier becomes obsessed with death and the fear that he will fail or that the men in his unit will discover that he is a coward. Generalized anxiety can easily slip into complete hysteria. Frequently anxiety is accompanied by shortness of breath, weakness, pain, blurred vision, giddiness, vasomotor abnormalities, and fainting.
Another reaction, which is commonly seen in Vietnam veterans suffering post-traumatic stress disorder (PTSD), years after combat, is emotional hypertension, in which the soldier’s blood pressure rises dramatically with all the accompanying symptoms of sweating, nervousness, and so on.[9]
These states are similar to conversion hysteria, except that here the soldier realizes the morbid nature of his symptoms and that his fears are at their root. Even so, his tremors, palpitations, stammers, tics, and so on cannot be controlled. Eventually the soldier is likely to take refuge in some type of hysterical reaction that allows him to escape psychic responsibility for his physical symptoms. Character disorders include obsessional traits in which the soldier becomes fixated on certain actions or things; paranoid trends accompanied by irascibility, depression, and anxiety, often taking on the tone of threats to his safety; schizoid trends leading to hypersensitivity and isolation; epileptoid character reactions accompanied by periodic rages; the development of extreme dramatic religiosity; and finally degeneration into a psychotic personality. What has happened to the soldier is an altering of his fundamental personality.
These are only some of the possible symptoms of psychiatric casualties in war. Gabriel notes that “The mind has shown itself infinitely capable of bringing about any number of combinations of symptoms and then, to make matters worse, burying them deep in the soldier’s psyche so that even the overt manifestations become symptoms of deeper symptoms of even deeper underlying causes.” The key understanding to take away from this litany of mental illness is that within a few months of sustained combat
Treating the Mentally Maimed
Treatment for these many manifestations of combat stress involves simply removing the soldier from the combat environment. Until the post-Vietnam era, when hundreds of thousands of PTSD cases appeared, this was the only treatment believed necessary to permit the soldier to return to a normal life. But the problem is that the military does not want to simply return the psychiatric casualty to normal life, it wants to return him to combat! And he is understandably reluctant to go.
The evacuation syndrome is the paradox of combat psychiatry. A nation must care for its psychiatric casualties, since they are of no value on the battlefield — indeed, their presence in combat can have a negative impact on the morale of other soldiers — and they can still be used again as valuable seasoned replacements once they’ve recovered from combat stress. But if soldiers begin to realize that insane soldiers are being evacuated, the number of psychiatric casualties will increase dramatically. An obvious solution to this problem is to rotate troops out of battle for periodic rest and recuperation — this is standard policy in most Western armies — but this is not always possible in combat.
Proximity — or forward treatment — and expectancy are the principles developed to overcome the paradox of evacuation syndrome. These concepts, which have proved themselves quite effective since World War I, involve (1) treatment of the psychiatric casualty as far forward on the battlefield as possible — that is, in the closest possible
Limited chemical treatments have been used in recent years to assist in the recovery process. According to Watson, “the so-called truth drugs have also been used near the front line to ‘abreact’ soldiers who are shell- shocked.” Such drugs have reportedly been used with some success by the Israelis to induce psychiatric casualties to “talk through the circumstances leading to their reaction, an activity which appears to prevent their fears being ‘bottled up’ and so causing some other, long-term syndrome.”
But the use of chemicals in combat may not be quite so benign in the future. Gabriel, a retired intelligence officer and consultant to both the House and Senate Armed Services Committees, provides a chilling note on the future of the treatment and prevention of combat psychiatric casualties. He believes that the armed forces of both the West and the East are searching for a chemical answer to this problem. Gabriel warns that the perfection of a “nondepleting neurotrop” to be given to soldiers prior to battle would result in “armies of sociopaths.”
Gabriel concludes from his research that “one can but marvel at the inventiveness of the human psyche in its efforts to escape its surrounding horror.” Similarly, we must marvel at the inventiveness of modern armies and nations in their efforts to ensure that they get full value from their soldiers. And we cannot help but come away with an image of war as one of the most horrifying and traumatic acts a human being can participate in. War is an environment that will psychologically debilitate 98 percent of all who participate in it for any length of time. And the 2 percent who are not driven insane by war appear to have already been insane — aggressive psychopaths — before coming to the battlefield.
CHAPTER TWO
