As the United States entered World War II and began to prepare for a long conflict, there was a lack of planning regarding the medical treatment of psychiatric casualties that would occur during the war.
Spurred by the experience of World War I, whereby it was thought that an emotional weakness in a soldier predisposed him to “shell shock,” policy makers were already making plans in 1940, prior to the outbreak of World War II, to weed out the weak. Based on a plan created by psychoanalyst Henry Stack Sullivan in 1940, the Selective Service program required psychiatric screenings for the young American men who would be fighting the war.
These initial screenings were supposed to eliminate soldier collapse; therefore, combat fatigue was not taken seriously early in the war. A soldier who broke down emotionally was given the bare minimum of care in a battlefield hospital. Military leaders were unprepared for the large number of men who suffered from war neurosis; estimates are that it was double the number of World War I cases.
Not surprisingly, combat fatigue was highest in the Army infantry units, followed by the Marines. The Navy (excluding Marines) and Coast Guard had lower rates, the exception being sailors whose ships had been successfully attacked by Japanese kamikaze. Gen. Omar Bradley, commander of the 12th Army Group in Europe, finally in 1943 required a seven day holding period for a soldier diagnosed with psychiatric exhaustion.
Time Magazine on May 24, 1943, gave news coverage to an American Psychiatric Association meeting where the Commander of a Naval Hospital in California described a new disorder called “Guadalcanal Neurosis.” Cmdr. Edwin Smith described “a group neurosis that has not been seen before and may never be seen again that occurred after prolonged warfare on Guadalcanal. He [Smith] had treated over five hundred Marines from that killing island and he described their physical and mental strain as combining the ‘best of Edgar Allan Poe and Buck Rogers. … Rain, heat, insects, dysentery, malaria all contributed – but the end result was not bloodstream infection nor gastrointestinal disease, but a disturbance of the whole organism, a disorder of thinking and living, of even wanting to live.’ Symptoms displayed by these hard-bitten Marines were ‘headaches, sensitivity to sharp noises, periods of amnesia, tendency to get panicky, tense muscles, tremors, hands that shook when they tried to do anything. They were frequently close to tears or very short-tempered.’ Smith felt that it was doubtful these men could go back to the type of combat they had been exposed to on Guadalcanal.”
With the evidence that elite troops like Marines were susceptible to combat exhaustion, the military thinking changed from over-reliance on screening to the understanding that every man was susceptible after prolonged combat.
Screening for mental defect before enlistment was abolished by Gen. George Marshall in 1944, since the process had not reduced the incidence of nervous exhaustion among the World War II warriors. The Army’s slogan then became “every man has his breaking point” and the terminology utilized to describe psychological injury was battle or combat fatigue.
Regardless of the comprehension of the breaking point of the combat soldier, many with battle fatigue were sent back to the front lines after a period of rest away from combat, unless the soldier remained nonfunctional. In the 1940s the assumption was that once a soldier was removed from combat, his trauma would disappear. The preferred treatment was to have the traumatized soldier treated close to the war zone in order to facilitate a quick return to the front. More severe cases were taken out of action and often discharged and sent home. More than forty percent of medical discharges during the World War II years were for psychiatric reasons, the common diagnoses being psychoneurotic disorder and/or personality defects. The large number of discharges for neuropsychiatric reasons belies the common assumption that the World War II soldier did not suffer the same degree of war trauma as those of later wars. Only the most severely affected were discharged; so the actual rate of combat/battle fatigue may have been underreported in World War II.