As the man who would spark a revolution in the treatment of combat stress in the American army, Capt. Frederick R. Hanson had two things going for him. The first was that he was a trained neurologist and neurosurgeon. The second was that he had volunteered to go along with the Canadian troops who took part in the disastrous Dieppe raid in August 1942. The second was probably more important, both in shaping his own ideas about what happens to men under fire and in establishing his credibility with fighting men.
At the time of America’s entry into the war, the standard way to deal with men who cracked up at the front was to evacuate them as quickly as possible, in part to keep them from “infecting” others. Even so, psychiatric casualties were rapidly becoming an epidemic. During the early fighting in North Africa and the Pacific, as many as 30 or 40 percent of battlefield evacuations were due to psychiatric reactions. Affected soldiers bore blank, expressionless faces and shook and wept uncontrollably, curled up in a fetal position, staring through unseeing eyes.
Lt. Gen. George S. Patton was far from the only commander who thought such men were just cowards; other generals may not have slapped and threatened to shoot soldiers whom they found lying in evacuation hospitals with psychiatric diagnoses, as Patton did on two notorious occasions, but they largely agreed that these men were unfit for military service. So in their own way did the army’s few psychiatrists, who, applying their Freudian training, assumed that a man’s breakdown in combat was due to some underlying psychiatric disorder reaching deep into his childhood.
As Albert E. Cowdrey relates in his superb history of American military medicine in World War II, Fighting for Life, Hanson decided to try an entirely different, and utterly pragmatic, approach when he found himself deluged with hundreds of victims of battle stress following the American army’s disaster at Kasserine Pass. As Hanson explained at a groundbreaking army medical symposium in February 1943, “even the most normal of soldiers” may become a psychiatric casualty as a result of prolonged exposure to the cataclysms of war. “To discuss combat neuroses in terms of civil life is to invalidate the inquiry,” he insisted.
Hanson’s first step was to emphasize the normality of such reactions. He ordered psychiatric cases to be termed “exhaustion.” The term was not just a euphemism: Hanson found that a significant number of cases were no more than the result of men being driven past their limits of endurance through lack of sleep during days of frontline fighting. He had them put to bed and shot up with huge doses of barbiturates, and allowed them just to sleep. More than half of his cases were able to return to their units within 48 hours.
More subtly, Hanson observed that the very process of evacuating psychiatric cases made their “mental” diagnoses self-fulfilling. It came down to reward and punishment: A soldier who suffered from a genuine anxiety complaint under combat—tremors, sleeplessness, gastrointestinal upsets, racing heartbeat—and who found himself removed to a place of safety as a result would tend to perpetuate those symptoms, until he truly did become a hopeless hypochondriac. And the patient convinced not just the doctors but himself that he really was sick, in order to perpetuate and justify the comfortable position he found himself in, and rationalize the abandonment of his buddies.
So Hanson’s innovative next step was to keep all psychiatric casualties in a hospital close to the front—preferably where they could still hear bombs and shells falling. The men had to maintain military routine, march to meals, dress in uniform, and none were allowed to remain more than three days. “Rest and recovery were possible,” as Cowdrey summarized Hanson’s approach, “but escape from the war was not.” Soon more than two-thirds of combat stress casualties were regularly returning to effective combat duty after this brief treatment.
Hanson’s ideas for treating psychiatric cases at the front were adopted throughout the army by the War Department in November 1943, with a psychiatrist appointed to serve at each division level. The aim, as Hanson explained, was not to seek “perfection for the patient” but to serve the manpower needs of the army. Yet his compassionate pragmatism did as much, or more, for individual men as it did for the army as a whole.
Originally published in the November 2009 issue of World War II. To subscribe, click here.