One Question Predicted Emotional Breakdown Better Than Any Other – SDP#34

PODCAST-A WWII field psychiatrist found that infantry soldiers in the 5th Army survived a maximum of 238 aggregate combat days (ACD) before a fate of (1) physical casualty, (2) prisoner of war, or (3) psychiatric casualty. For the first time, it was realized that every soldier had a “finite voltage” and sooner or later would break – even if they appeared to have held up magnificently under incredible stress. This understanding demarked a sharp change in thinking that previously held that soldiers that “broke” under pressure did so only due to some psychological flaw.

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CHANGING PTSD to PTSI

In order to bring greater awareness to the issue of posttraumatic stress disorder (PTSD), the United States Senate designated June 27th as National PTSD Awareness Day. President George W. Bush in 2014 championed a campaign to change how we think about PTSD. In a very moving discussion on Good Morning America, he stated, “We’re getting rid of the D,” he said. “PTS is an injury; it’s not a disorder. The problem is when you call it a disorder, [veterans] don’t think they can be treated.” This is part of the George W. Bush Institute’s Military Service Initiative

PSYCHIATRIC COLLAPSE VIEWED AS INTRA-SOLDIER FLAW DURING & BEFORE WWII

A soldier’s mental health was viewed much differently 75 years ago. An important lesson that came out of military psychiatry in WWII. In that war, looking at psychiatric collapse of individuals primarily along the Western front, the conventional view was that there was something wrong with them before they even showed up in the Army and that a healthy individual could endure combat essentially indefinitely and then people referred to “Shell Shock”, what was later called “Combat Fatigue.” Doctors were saying it’s a manifestation of a pre-existing condition in a military context

WHY WE FIGHT VIDEOS & MOTIVATION PROGANDA. The belief was that a “weakling” soldier (who hadn’t been screened out) perhaps just needed more motivation. Dr. Appel, military psychiatrist, shared wrote that as psychiatric liaison to the Information & Education (I&E) Division, he took on my first project helping make movies in a series entitled Why We Fight to be shown to recruits. (You can view these unsettling Frank Capra videos on YouTube – each are 40-50 minutes in length). Appel recalls discussing id, superego, and ego with the experts making the films: a Harvard professor of sociology, a professor of psychology from Yale–and Ted Geisel, or “Dr. Seuss.”

THE ONE QUESTION THAT WAS AN EXCELLENT PREDICTOR OF A SOLDIER’S BATTLE ENDURANCE

Later studies determined that that single question, asked at induction, “Do you want to be in the service?” predicted actual emotional breakdown better than any other. Negative responses heralded subsequent mental disorder.

WHAT HELPED?

Surprisingly, extra pay to combat soldiers didn’t make a difference. Steps that made a difference included setting a completed Tour of Duty at 180 ACD and providing line infantry soldiers with special blue arm patches. Such measures boosted morale & decreased psychiatric collapse.

SUMMARY

Per Appel, from a medical viewpoint, the most exciting event had been that discovery that every man has a breaking point. This had not been known previously to psychiatry or to anyone.

FOLLOW

David will respond to discussion thread comments or questions & also to emails.  The Safety Doc Podcast is hosted & produced by David Perrodin, PhD.

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