Forward psychiatry was not effective in returning combat troops to fighting units but, by allocating soldiers to support roles, it prevented discharge from the armed forces. Uncertainties remain about relapses, including other routes that servicemen used to escape from a combat zone.
Mild or intermittent respiratory disorders in the post-war period supported beliefs about the damaging effects of gas in the three somatic clusters. By contrast, the neuropsychiatric group did not report new respiratory illnesses. For this cluster, the experience of gassing in a context of extreme danger may have been responsible for the intensity of their symptoms, which showed no sign of diminution over the 12-year follow-up.
During the Second World War, controversy surrounded not the inevitability of psychiatric casualties but the extent to which they could be minimized by selection, training, morale, and leadership. By early 1944, when planning for the D-Day landings was advanced, the problem of the psychiatric battle casualty was considered manageable by careful preparation and clinical understanding. The campaign to liberate Europe offered the newly formed Directorate of Army Psychiatry an opportunity to demonstrate its effectiveness. Psychiatric services were deployed to Normandy to maximize the return of front-line troops to duty. Commanders, however, entertained doubts about the value of military psychiatrists. By offering a sanctioned escape route from battle, some believed that their mere presence undermined the fighting spirit of combat troops. The records of 32 General (Psychiatric) Hospital have been analysed to discover categories of troops most vulnerable to breakdown and to assess the impact of front-line treatments. Infantry soldiers, those most likely to be killed, were disproportionately represented amongst admissions. Senior non-commissioned officers were also at elevated risk of breakdown, some being war weary from earlier campaigns. Probably 36 per cent of admissions returned to combatant duty, and 53 per cent were evacuated to the UK. The scale of psychiatric casualties revealed failures in pre-deployment screening.
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