 He intimately understands the stresses. He as an officer, if he establishes a reputation for fairness and consistency, his word will be heeded, his explanations and reassurances accepted. His encouragement of the man in coping with his fears, resentments and griefs can provide stronger psychological support than any other medical officer in the division. There is not much the individual battalion medical officer can do to keep men from injury and battle. There is much he can do to prevent important loss of manpower from psychiatric causes. At first day I wasn't thinking much about my contribution to the prevention of any casualties, except perhaps myself. I was uneasy. I didn't know what to expect. Look, Doc, there's your battalion. Look here, here, Doctor. All of one of the corpsmen take care of it. Okay, Chief. Let's go meet the old man. Look, Peter, he was a good battalion medical officer. Though not a psychiatrist, he seemed to have been quite sold on the subject. He reported into the division and just got here. Oh, Doc Orvillean's replacement, huh? Yes. Glad to have you aboard. We're getting into one of the best outfits on the line. It's Major Barton, my exec. Glad to know you said that. We've got a good bunch of men here, Doctor. I guess I thought a CO in an exec in combat would be rather taut and brass-bound. But these men, and in fact most of the officers I was to meet, I learned to respect for many reasons. They were top professional soldiers, highly competent and assured, but friendly and receptive to any sensible ideas we had to offer. Yeah, the other day we were talking about this combat fatigue problem, and the surgeon says to me, without batting an eye, Colonel, there's a direct relation between the quality of leadership and the number of NP casualties in any battalion. Of course, I knew that there was nothing personal in it. As a matter of fact, I agree with him completely, although I'd never looked at it in those terms before. And what's more, he's been keeping a lot of the men we thought had gone psycho on, I mean, NP cases, and returning them to the line. Yeah, the old professor showed us that some of these Marines that looked like they couldn't take it were really good stuff. It's surprising what a night's sleep, a little encouragement, and getting them back front, what we'll do for most of them. Well, we'll see you, Colonel. Right. Well, by the way, sir, Able Company may have some rough going tomorrow. They lead the attack. Jump off at 0630. Thanks, Major. The word's out. We'll probably have a few extra customers at sick call tonight. Well, you know how to handle them, sir. Yeah, before Dark Peters joined the battalion, Sick Bay unloaded too many good men to their rear. He can probably give you some good pointers on this stuff, and we need all the men we can keep. Well, glad to have you with us. Thank you, sir. Thanks. So this is it, huh? Say, why all the emphasis on NP casualties? How about Marines were rugged? They are, more than most. But any man can develop symptoms that make him temporarily or, in a few cases, even permanently ineffective in combat. The old man knows that. He's pretty much on the ball with this problem, and that helps. Hi, Doc. Hi, Andrews. How are you? Fine. Hi, George. This is Dr. Yoast, Lieutenant Eastman R. Adjutant. Doctor? How do you do? This is Sergeant Major, Dr. Yoast. Glad to know you, Doctor. I do. I'll bet Dr. Overland was glad to see you. You've been grasping about rotation for a long time. Yeah, I expect waiting for me was beginning to get him down. I guess so. By the way, Sergeant Major took care of that kid you sent in. The one it was all shook up. Yeah, thanks a lot. Just saw him scooting out of here. Well, you said we could all use an extra hand around the CP after you sort of convinced us. Well, so long. That's all it took for most of them. I didn't realize it at first, but the Sergeant Major and the Adjutant gave us some wonderful help. Sometimes I couldn't decide what to do with a man. A couple of days around the CP gave me a chance to keep my eye on him. Most of them went back to duty on their own when they were rested. Some needed a little encouragement. Many men were kept at duty who would have been lost to the rear. We had to be careful not to clog up the CP or have sick bay known as an easy out from duty. You've got to have cooperation from the line offices. I never miss a chance to keep them informed about their medical problems concerning their men and getting their angle on them, particularly on P-cases. It pays off. Incidentally, what's all this about Dr. Oberlin? He was a hard charger and a damn good doctor. But lately the job seemed to be getting him down. He was getting a bit moody and let it influence the handling of his patients. What do you mean? Well, sometimes he'd evacuate everybody and sometimes he wouldn't evacuate anyone. I don't get you. Sometimes it almost seemed to be if I can't get out, nobody will attitude. And other times it was if I can't get out, at least you can. I'm sure he didn't think it out that way, but it's one of those things you got to watch in yourself. Getting used to it after a while. Nobody likes this stuff. But it does become tolerable. How about some chow? Huh? Oh, yeah. I wasn't very hungry. And I didn't understand yet that this was one of those opportunities Peters had spoken of. I was meeting some of the company officers for the first time. A few of them were down from briefing and had stopped by the mess area before going back to their men. Any Marine officers come out with you, Doc? I'm expecting my relief any minute now. No, sorry. Quit kidding yourself, Milt. Your relief just graduated from grade school. How are the women making out in the states these days? Do they miss me? Oh, they sure do. Hey, Serge, you've still got one of my boys. The one with the sprained ankle. How's he doing? Well, we've had him sitting around the supply tent making out forms another few days, and he'll be good as new. What about that fella I sent down with the drizzly runs? We caught him up. It's probably more of an emotional thing than infectious. Another 48 hours around the CP, and he'll be okay. You better keep your eye on him, though. I'm not sure he can take much more. Oh, why not evacuate him? We've got fighting to do up here. Hey, cool, Jack. Anybody can get a belly full, some sooner than others. So what? He won't be any good to you, even if you do get him back on the line. Now, wait a minute. Pete sent us back plenty of men I never thought we'd see again. They performed, too. That's soulmate. The equivalent of a couple of platoons, the CO said. Makes a hell of a lot of difference. I haven't noticed too many of these characters returning to my platoon. Maybe there's a reason. Say, Pete, what percentage would you say if all our casualties are sent back to your division psychiatrist? Depends on the situation. In heavy prolonged combat, and where we're getting crowded or have to move out quick, maybe one out of six or seven wounded. Well, I suppose you have the time and space. Depends. Practically all of the men who are shook even before they get into battle are sent back to duty promptly. Those men who do break in battle and need a little more time, we hold for a day or two. Most of these men get back on the lines, too. What about the division psychiatrist? They send back well over half of the men we do have to evacuate. Yeah, but how many of them only crap out again? Believe it or not, only a very small percentage. See what I mean? Look out for competition, doctor. Seems like we're all turning into a bunch of psychiatrists. You know, that's very interesting. Because whether you realize it or not, you hit it right on the head. Platoon leaders can be our biggest help for this whole problem. Hell, I'm not trying to be a chowder head about this thing. I'm open-minded. And only slightly spastic. Well, anybody who's been out here long enough is likely to notice some changes in himself. Goes off his feet a bit, gets a little sour, irritable. How long have you been out here, Jack? Okay, okay. Get off my back. Time for sick call. Don't you get squared away and I'll see you there. Finish your coffee, though. Okay. Well, Doc, what about that ammo carrier I sent down with the weebs? One who said he got pooped out carrying ammo on the hill. He looked kind of shook. Murphy? Yeah, I thought he was genuine enough. Not a very rugged type, a bit immature. We gave him a little rest and a pep talk. Told him you might be able to make him a rifleman. Okay, Doc, thanks for the referral. Thanks for the referral. The line seemed to have picked up the lingo. But I'd begun to see that it went a good deal deeper than that. Peters was getting cooperation by proving that there could be an unnoticed and unnecessary leakage of manpower if company officers didn't understand the problem of combat anxiety in its many and varied forms. In its many and varied forms. In its many and varied forms. I didn't know then that combat anxiety might show up as a a sprained ankle that stayed lame a sprained ankle that stayed lame a well healed wound broken glasses toothache. Peters got right at the core of things. I told you business would be up tonight. The truth is, many if not most of these men wouldn't be here if we weren't attacking in the morning. Their symptoms are real. But they're scared, just plain scared. And most of them don't connect. Their symptoms with being scared. It's normal. Look, I'll lead off and you can take hold when you feel like it, huh? We'll do. A doctor? Yeah. A tenant and I have sent this man in since he wants to see you. His name's Johnson. Oh, yeah. What's the trouble, Johnson? Well, Doc, my stomach's all fouled up. How does it bother you? It feels lousy all the time. All the time? Well, on and off for a couple of weeks. I feel sick when I wake up. Off my feet. Then belching rotten eggs. Quivery feeling all the time. Any pain? Well, man, everyone out here starts belching rotten eggs after a while. It's a sign of an old salt. Put your head back. With that first sick call, I started to understand the various signs and symptoms of anxiety that are common to all men who have been in combat for any length of time. I was to find that there were many men and officers whose stomachs acted up or had headaches, palpitation, loose bowels, frequency, irritability, tremors, or whatnot, yet who were completely effective in their jobs. It's not the symptom. It's the man, his capacity for adapting to the stress of combat despite his anxiety. Nothing unusual, fella. Most of the men get the same feeling from time to time. You ever play football? Well, you know the feeling you get just before the game? This is the same thing only a hell of a game. The corpsman will give you something to ease the belching. You'll be okay. I hope so, doc. What's his temperature? Normal, doctor. Doctor, would you take a look at Jasper down here? Had a headache the last few weeks, he says. I'll go. This is the man, doctor. Jasper? You want me to get your thyloscope, sir? Yeah. I think it would somehow get him off the lines. I didn't realize that at the time because in the beginning I was inclined to spend too much time trying to rule out unlikely organic causes. That's a luxury of civilian practice. Later, I'm afraid I may have become a little too casual in a diagnostic sense. The best approach, of course, is to take the man and his complaints seriously, whether psychogenic or not, and to conduct a sufficient or physical examination this time permits, even if some conscious elaboration is suspected. It's not only good medical practice, but to do otherwise provides the man with a convenient basis for his resentments and a rationalization for any reluctance to carry on. You stand by, I'll be back in a minute. There, that should fix it up. Thanks, doc. Say, I've got a man here who says he's had headaches for a couple of weeks. I can't find anything, except a little nasal congestion. Think we ought to send him back for some ENT studies? What's his name? Dr. Jasper again, huh? Able Company. Let's see if we can get some more dope on him. We'll give him a ring. Able Six? Let me talk to your company commander. Hello, Jack, this is Peters. Look, Jack, I got one of your men down here. His name's Jasper. Do you have any scoop on him? Yeah, I know him, Pete. A rabbit-y sort of character, but kind of surly. He keeps to himself, sloppy with the details. I think he's a foul ball. How long has he been with you? Oh, about ten days. Say, look, Jack, I've talked with this guy before, and he's not a bad sort, basically. Among other things, he's been worrying about home matters. He's new, and he's not the sort who adjusts to a new crowd very quickly. Give him a chance. How about getting Sergeant Gray to show a little interest in him? A word from you would help, too. Oh, brother. What's the Marine Corps coming to? Okay, okay. Send him back. We'll do what we can. They'll cooperate. Will it work? As before in similar cases, once a new man starts feeling he's a welcome member of the organization, he doesn't feel so scared and unhappy. But you have to act before the thing's out. What do we do now? Give him some explanation about these headaches, a few APCs to take with him, and send him back to duty. We'll do it firmly. And don't get involved in any arguments. What's up, man? I think I got the pile, Doc. Well, let's take a look, huh? Just a few tags. We can fix that up for you for the time being, anyway. I should rather go to the hospital. Hell most, sir. It ain't that bad. I can't leave the outfit now. We're jumping off in the morning. Can't you just put something up there? Okay. The corpsman will give you something to ease it. That group spirit is the most powerful support the doctor has in keeping men at duty. Some men you just can't evacuate even though you know it's medically sound. And some won't even turn in when they should, as long as the fighting's going on. Well, I guess that's all of them for sick call this evening. The corpsman will take care of anything else that comes up. And if they can't, the chief will let us know. Okay. We sure have a good bunch of corpsmen. We do. But that matter the aid men out with their companies take care of most of sick call right on the spot. Well, I expect they know how to help with organic troubles, but are they of any value with these combat fatigue cases? Oh, they sure are. Now you take those corpsmen over there. When they report for duty, I always give them a briefing on the NP problem. The necessity for preventing the leakage of manpower and at the same time spotting the occasional anxiety cases, becoming useless and a danger to his outfit. But who just won't call it quits? Above all, I emphasize the company aid man's great value in providing observant information on all the referred cases. They help us make a fair decision about this position. You'll see what I mean in the morning when the real show starts. I need two sutures. One of them grenades landed right next to me. Didn't get you, though. No, but a wing went to tomb sergeant. I started hollering them. I guess I got excited for a while. Good God, Doc, I don't know. I guess I can't take it. Corpsmen, let's have that coffee here. The man was alert, responsive, exhausted. The reaction was relatively superficial and transient. To evacuate him to the rear, might have sent up a guilt reaction that he would have had to justify by the development of further symptoms. He'd been thrown off balance by a sudden shaking experience. We gave him a chance to get his bearings, offered him some firm reassurance and sent him right back. How about some water, huh? I just crapped out. Hot all day on patrol yesterday. I was pooped. Scared like I never been before. But even get my breath. I guess I just passed out. I could just sleep. I can't. I doze off like... and I jerk awake. Get easy, fella. How about racking this man out near Sick Bay? I don't expect him moving the next 12 hours. What if he doesn't snap out of it by then? Well, we can always send him back to Regimental Aid and have them hold him for another 24 hours. We send a note along indicating we expect the man back shortly. We've got a good working relationship with Regiment on these cases. They know how to handle the occasional man we send them. Well, if you think there's a chance for a fairly quick recovery, you should use the Regimental Aid Station. One you can't hold the man here. He gets back on the job quicker, than the rest of the government of the division. And he doesn't get the feeling of being a hospital case. I see. Peter's was hitting upon the basic principle of combat psychiatry. Treat as far forward as reasonable and return to duty as quickly as possible. In that way, you don't lose the great advantage of the man's identification and pride in his own fighting group, and you minimize the opportunity for symptoms to develop and persist as unconscious justification for escape. Take that, boy. Looks much worse than the others. Yet most of this is due to physical exhaustion and lack of sleep. Two factors which can often mislead you into a bad prognosis. He's from Able Company. They've really been kept jumping lately. We'll give him just enough sedation to knock out the anxiety and permit him to sleep. That may do the trick. Dr. Yos! The news, son. Grenade bounced off my helmet. Went off. Knocked me dizzy. You remember the sound of the explosion? The flash? Yeah. Never forget it. I must have passed out right after. Headache? Dizzy? Let's have an otoscope, hmm? Blast concussion, huh? I don't think so, but we'll see. That hurt you, Tom? A little. It was not blast concussion. I gradually discovered that the familiar symptoms of headache, transient dizziness, and various acute anxiety manifestations after a man had been shaken up by a nearby explosion were usually best understood and treated in psychological terms. In most cases, brain injury due to concussion was minor or absent. There was no true retrograde amnesia, no hemorrhages, no tympanic perforation, no neurological findings. That hurt? No. We'll give him a mild sedative stat and get Regiment to keep him for a few days before sending him back to his outfit. We can't keep him here because we might have to move out. Nothing at all serious, fella. Nothing wrong with your head. You'll be okay in a few days, but you do need and deserve a couple of days of rest and sleep. Carmen? This is in a back to Regiment only. Well, you looky going through the rear and sleeping in the sack all day. Somebody bring your child to you? Boy, that's for me. I won't even have to do my own laundry. Yeah, you follow if you don't, it breaks. What is your last name? Decker. First name? Kill of the face. Any spreaders? No. What's the story, Corporal? Corporal, do you hear me? What's the story? I'm good at Carmen. We always get useful information from him. That's some coffee, Corporal. I left him. Thank God. You need a rest, Corporal. You'll go back, but you need a rest. I crept out. Send me back. Send me back. I don't belong here. I'm not sick. They need me up there. They need me. You'll go back with them in a few days, son. Carmen, get this man to med the tide. Not much left. More than you might think. I know that man. Been out here for a long time. Had just about all he can take. For a while. Funny. I always thought a man would be glad to get out of this mess. Not that one, apparently. That's just it. When they can't keep it up any longer, why are they feel guilty of letting their buddies down? Well, we can tell them what good guys they are, but what do we do to treat them? Well, we reassure them as best we can. Most of the men we see have these feelings to some degree, but in extreme cases like that one way. The guilt-relief business has to wait until it calms down. Back at the medical company with division psychiatrists. Oh, Doctor, we need some help. Better do a cut down. I don't want to waste time. Be clean. Ship them out. All right, Doctor. Say, Doc, my feet are killing me. Your feet? How long? Ever since I've been here. I'm four months now. See, you got a new pair of boots. They give you any support? They did it first. Then the pain came back. Well, let's have a look. Pretty good-looking pair of dogs. But they hurt, Doc. Uh-oh. Certainly, this man looked bad. Yet not all such cases are irretrievably lost in combat duty. Although he had to be evacuated to division there were some favorable indications. He had performed well before. His disturbed behavior was precipitated by a sudden shocking experience. He still had a good fighting grip on his weapon. Most shaken men are sent to duty by the BMO or the division psychiatrist. But there are a few who, for the safety and welfare of the group should never be returned to a front-line unit. The panic prone, the grossly immature, the profoundly apathetic, the faltering non-com who has lost the confidence of his men and severe hysterical reactions when not precipitated by some sudden trauma. Hey, Dr. Hi, Tony. You still here? Mr. Zucca man is out there. So his top was telling me last night. Mr. Zucca man, huh? Yes, sir. Good Zucca man's hard to get. Look, I know your feet bother you, but you can carry on, can't you? I don't know. Look, why don't you come and see me when we're in reserve? Then we can get a specialist to look at you. I don't think there's anything serious. Stay loose, huh? Okay, sir. Okay, son. We'll take that stitch out tomorrow. Dr. Peters? Yeah. 1,800, sir. Thanks, sir. If you hurry, you can catch your buddies. They need a man up there who can handle a Zucca. We're moving up at 1,800. Yeah, I know. Hey, Tony, come on. Let's go.