On Killing: The Psychological Cost of Learning to Kill in War and Society by Dave Grossman Page A
Authors: Dave Grossman
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Whatever the physical manifestation, it is always the mind that produces the symptoms, in order to escape or avoid the horror of combat.
Anxiety States
These states are characterized by feelings of total weariness and tenseness that cannot be relieved by sleep or rest, degenerating into an inability to concentrate. When he can sleep, the soldier is often awakened by terrible nightmares. Ultimately the soldier becomes obsessed with death and the fear that he will fail or that the men in his unit will discover that he is a coward. Generalized anxiety can easily slip into complete hysteria. Frequently anxiety is accompanied by shortness of breath, weakness, pain, blurred vision, giddiness, vasomotor abnormalities, and fainting.
Another reaction, which is commonly seen in Vietnam veterans suffering post-traumatic stress disorder (PTSD), years after combat, is emotional hypertension, in which the soldier's blood pressure rises dramatically with all the accompanying symptoms of sweating, nervousness, and so on.2
Obsessional and Compulsive States
These states are similar to conversion hysteria, except that here the soldier realizes the morbid nature of his symptoms and that his fears are at their root. Even so, his tremors, palpitations, stam-mers, tics, and so on cannot be controlled. Eventually the soldier is likely to take refuge in some type of hysterical reaction that allows him to escape psychic responsibility for his physical symptoms.
48 KILLING AND COMBAT TRAUMA
Character Disorders
Character disorders include obsessional traits in which the soldier becomes fixated on certain actions or things; paranoid trends accompanied by irascibility, depression, and anxiety, often taking on the tone of threats to his safety; schizoid trends leading to hypersensitivity and isolation; epileptoid character reactions accompanied by periodic rages; the development of extreme dramatic religiosity; and finally degeneration into a psychotic personality.
What has happened to the soldier is an altering of his fundamental personality.
These are only some of the possible symptoms of psychiatric casualties in war. Gabriel notes that "The mind has shown itself infinitely capable of bringing about any number of combinations of symptoms and then, to make matters worse, burying them deep in the soldier's psyche so that even the overt manifestations become symptoms of deeper symptoms of even deeper underlying causes."
The key understanding to take away from this litany of mental illness is that within a few months of sustained combat some symptoms of stress will develop in almost all participating soldiers.
Treating the Mentally Maimed
Treatment for these many manifestations of combat stress involves simply removing the soldier from the combat environment. Until the post-Vietnam era, when hundreds of thousands of PTSD cases appeared, this was the only treatment believed necessary to permit the soldier to return to a normal life. But the problem is that the military does not want to simply return the psychiatric casualty to normal life, it wants to return him to combat! And he is understandably reluctant to go.
The evacuation syndrome is the paradox of combat psychiatry.
A nation must care for its psychiatric casualties, since they are of no value on the battlefield — indeed, their presence in combat can have a negative impact on the morale of other soldiers — and they can still be used again as valuable seasoned replacements once they've recovered from combat stress. But if soldiers begin to realize that insane soldiers are being evacuated, the number of THE NATURE OF PSYCHIATRIC CASUALTIES
49
psychiatric casualties will increase dramatically. An obvious solution to this problem is to rotate troops out of battle for periodic rest and recuperation — this is standard policy in most Western armies — but this is not always possible in combat.
Proximity — or forward treatment — and expectancy are the principles developed to
Anxiety States
These states are characterized by feelings of total weariness and tenseness that cannot be relieved by sleep or rest, degenerating into an inability to concentrate. When he can sleep, the soldier is often awakened by terrible nightmares. Ultimately the soldier becomes obsessed with death and the fear that he will fail or that the men in his unit will discover that he is a coward. Generalized anxiety can easily slip into complete hysteria. Frequently anxiety is accompanied by shortness of breath, weakness, pain, blurred vision, giddiness, vasomotor abnormalities, and fainting.
Another reaction, which is commonly seen in Vietnam veterans suffering post-traumatic stress disorder (PTSD), years after combat, is emotional hypertension, in which the soldier's blood pressure rises dramatically with all the accompanying symptoms of sweating, nervousness, and so on.2
Obsessional and Compulsive States
These states are similar to conversion hysteria, except that here the soldier realizes the morbid nature of his symptoms and that his fears are at their root. Even so, his tremors, palpitations, stam-mers, tics, and so on cannot be controlled. Eventually the soldier is likely to take refuge in some type of hysterical reaction that allows him to escape psychic responsibility for his physical symptoms.
48 KILLING AND COMBAT TRAUMA
Character Disorders
Character disorders include obsessional traits in which the soldier becomes fixated on certain actions or things; paranoid trends accompanied by irascibility, depression, and anxiety, often taking on the tone of threats to his safety; schizoid trends leading to hypersensitivity and isolation; epileptoid character reactions accompanied by periodic rages; the development of extreme dramatic religiosity; and finally degeneration into a psychotic personality.
What has happened to the soldier is an altering of his fundamental personality.
These are only some of the possible symptoms of psychiatric casualties in war. Gabriel notes that "The mind has shown itself infinitely capable of bringing about any number of combinations of symptoms and then, to make matters worse, burying them deep in the soldier's psyche so that even the overt manifestations become symptoms of deeper symptoms of even deeper underlying causes."
The key understanding to take away from this litany of mental illness is that within a few months of sustained combat some symptoms of stress will develop in almost all participating soldiers.
Treating the Mentally Maimed
Treatment for these many manifestations of combat stress involves simply removing the soldier from the combat environment. Until the post-Vietnam era, when hundreds of thousands of PTSD cases appeared, this was the only treatment believed necessary to permit the soldier to return to a normal life. But the problem is that the military does not want to simply return the psychiatric casualty to normal life, it wants to return him to combat! And he is understandably reluctant to go.
The evacuation syndrome is the paradox of combat psychiatry.
A nation must care for its psychiatric casualties, since they are of no value on the battlefield — indeed, their presence in combat can have a negative impact on the morale of other soldiers — and they can still be used again as valuable seasoned replacements once they've recovered from combat stress. But if soldiers begin to realize that insane soldiers are being evacuated, the number of THE NATURE OF PSYCHIATRIC CASUALTIES
49
psychiatric casualties will increase dramatically. An obvious solution to this problem is to rotate troops out of battle for periodic rest and recuperation — this is standard policy in most Western armies — but this is not always possible in combat.
Proximity — or forward treatment — and expectancy are the principles developed to
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