Franklin D. Jones

Sanctioned Use of Drugs in Combat

Since World War I the appropriate use of the principles of forward treatment has resulted in the return of 60 to 90% of combat stress casualties back to their units• Modern high- technology, sustained, and possibly nuclear warfare raises serious barriers to the practice of these principles which require rest from combat in a safe place near the battle fronts followed by return of the soldier to his own small (squad or platoon sized) unit. Great mobility and dispersion of forces will impede return of the soldier to his unit and technology capable of identifying any agglomeration of soldiers due to an infra-red “signature” will interfere with application of forward treatment. Prevention of psychiatric casualties through strengthening cohesion appears to have definite limits as seen in Israeli psychiatric casualties of 23 per 100 wounded-in-action casualties in the 1982 Lebanon War despite thorough preventive efforts (Belenky, Jones 1983).

Psychiatric Casualties (Battle Shock) in Israeli Defense Forces in the War in Lebanon June-September 1982

The 1982 war in Lebanon differed qualitatively and quantitatively from the 1973 Arab-Israeli War. The 1982 conflict was fought at the time and in the manner chosen by the Israelis. It engaged only a portion of the IDF, and did not stress its logistic support. Intense military operations were conducted from 6 June 1982 until the initial cease fire on 11 June 1982, and during a further period from 21-26 June 1982, when the IDF cut the Beirut- Damascus Road. The majority of IDF casualties, including psychiatric casualties, were sustained during these periods of intense fighting. Overall, for the IDF in Lebanon during the period of June-December 1982, the ratio of psychiatric casualties to wounded has been cited as 23:100 (Shipler 1983). During the 1973 Arab-Israeli War, the ratio was higher, probably over 30:100 (Noy, personal communication). It appears that for an equivalent degree of combat stress, indicated by the relative number of wounded, psychiatric casualties in the IDF were lower during the 1982 war in Lebanon than during the 1973 war.

Lessons of War for Psychiatry

Like generals who have failed to learn the lessons of prior wars and lost decisive battles, military medical leaders have failed to learn or apply the psychiatric lessons of prior wars with disastrous results. A chart summarizing these lessons is available elsewhere (1).

Applications of Military Psychiatry in Civilian Disturbances: Disasters, Terrorism, Hostage and Refugee Situations

The premise of this paper is that some aspects of disasters, terrorism, hostage and refugee situations are comparable to military combat and that the treatment principles of combat psychiatry can be usefully applied in these situations. Furthermore, since the military is often requested to aid in these situations, it is incumbent upon the military physician and especially the psychiatrist to understand the dynamics and modes of treatment pertaining. Such knowledge may be gained by reading the extensive literature, by experiential courses such as that of the US Federal Bureau of Investigation (1) or through educational programs on videotape (2).

Neuropsychiatric Casualties of Chemical, Biological and Nuclear Warfare

Spurred by recent reports that Soviet and Vietnamese forces have waged chemical warfare in Afghanistan, Laos and Cambodia, the United States has attempted to increase its defensive and offensive chemical capability. This has created a vocal opposition which claims that the use of chemical, biological and nuclear weapons is unthinkable. However, an exhaustive study by a Stockolm group (SIPRI 1973) of all instances of chemical warfare from 1914 to 1970 revealed that there have been over two dozen conflicts since World War I in which chemical or biological agents usage has been documented or claimed. The usage has usually occurred when one group had a superior chemical warfare capability. During WW II the Germans had such a superior capability in the form of the nerve agents; but, believing the Allies to have a similar capability, they did not use them. There is, therefore, a compelling argument in favor of the deterrant effect of parity in chemical warfare capability.

Psychiatric Casualties in Modern Warfare: I Evolution of Treatment

Shaped by the struggle for survival, man is the highest form of thinking animal. He is astonishingly adaptable in the service of survival. Survival for a group on the battlefield may require the sacrifice of some of its members. Thus group survival and individual survival may be mutually exclusive events creating a conflict between the individual’s instinctual urgings for personal survival and the emotionally conditioned and rational urgings for sacrifice in the interests of group survival. Such a conflict may result in severe anxiety or the development of compromise symptoms which remove the soldier from combat as a medical casualty. This may particularly occur when the rational powers are weakened by fatigue or the emotional ties to the group are weakened by poor bonding with the group and by loss of some of its members, by poor leadership or by adverse circumstances which emphasize the potential for diminished individual survival.

Warfare and the US Military Family

Although it had been recognized since WWII that a disproportionate number of combat psychiatric casualties came from the ranks of those with family obligations, the relationship of this finding to the development of combat stress was not fully realized until studies were made of Israeli casualties in the 1973 Arab-Israeli War. Noy (1982) and others found that most of these casualties occurred in soldiers undergoing some form of current social, usually family, stress. Such stress might be negative such as marital disharmony, parental problems or illness; but, it might also be positive such as pregnancy, birth of a child or other good news. A peculiarity of the Arab-Israeli Wars has been the ready communication between the Israeli soldier and his family. Noy observed that the overconcern of some Israeli mothers or grandmothers conveyed to the soldier in a telephone conversation before or after a battle could be the precipitant of combat breakdown.