NEEDLING BATTLE JITTERS (Jun, 1945)

I just read a somewhat similar article in Wired last month. i09 also had an interesting piece on the history of PTSD this week.

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NEEDLING BATTLE JITTERS

by R. A. Montherlant

NARCOSYNTHESIS—medicine’s newest and most effective method of reclaiming from their mental hells the pitiful “combat fatigue” cases.

MEDICINE’S newest and most streamlined method of fighting the battle jitters was perfected during the Tunisian campaign under the nerve-wracking conditions of a combat zone.

In a base hospital at Algiers, where air raids were as much an accepted part of the day’s routine as chow, Army doctors, working under the direction of Lieut. Col. Roy R. Grinker and Captain John P. Speigel, U. S. Army psychiatrists, established the scientific use of hypnosis-producing drugs in the treatment of “combat fatigue” cases. Until recently the dramatic story could only be mentioned in the daily press, but now that the technique has become widely known and adopted by practicing psychiatrists, the complete details can be given to the public.

Most “combat fatigue” cases present the same disheartening picture. They are all terror-stricken, hardly able to speak except in a gasping stutter, and their bodies are periodically seized by uncontrollable fits of nervous shaking. Their faces are drawn and mask-like, full of anger or fear. Sudden spasms of laughing or crying will wrack them for no apparent reason.

Somewhere, somehow, in his battle ex- perience, the normal anxiety that every soldier feels under enemy fire has been intensified beyond human endurance for these pitiful cases. Usually it centers around some catastrophic event, like the sudden and horrible death of a close buddy or the mass destruction of many other soldiers by a single bomb. Then his nerve snaps, his mind becomes confused and foggy, and he is what this war calls a “psycho-neurotic” casualty. But, whatever the cause, in one respect all psychiatrists agree: get the patient to remember his terrible experience without damage to an already weakened nervous system, and his cure can be quite easily accomplished.

Here is where the drug-produced hypnosis plays its almost miraculous role. It gets the patient to forget his inhibitions, throw off the suffocating burden of inner tension and tell in detail everything that bothers him. Drs. Grinker and Speigel call the new method, “narcosynthesis,” because, while under the hypnosis, the soldier-patient re-experiences the horrible event that caused his breakdown—that which doctors in their esoteric lingo call the “traumatic episode”—and then rebuilds or “synthesizes” the memory thus obtained, with the help of the doctor.

The drug Drs. Grinker and Speigel used was sodium pentothal, one of the growing legion of barbiturate drugs which has a sleep-producing and heavily depressant effect on the central nervous system. For soldiers in the steel grip of nervous tension, such a soothing drug has an immediate and good effect. Moreover, in the light of the most recent medical research, it seems that an even more beneficial effect is that which it has on the hypothalamic region of the brain, that region controlling the sympathetic nervous system. Excessive sweating and pronounced body tremors, both common to “combat fatigue” and due to the action of the sympathetic nervous system, soon disappear after the drug is given.

Yet the most dramatic result is gotten through the so-called truth-telling properties that the drug contains. There is nothing mysterious or magical to medical science about this power. The simple explanation is that all of us are reticent and have secrets which we do not readily “get off our chests.” And a person in a highly nervous state, like a “combat fatigue” case, is trebly inhibited. He is very much like a spring that has been wound too tightly, vainly trying to unwind again. To get him to relax, to talk, to loosen the bunched-up psychic coils, the drug reduces his nervous activity through sedation, and sets him free from the intolerable burden of anxiety and tension.

Like all scientific advances, the discovery of the “truth-telling” drug has come almost simultaneously to eager experimenters in widely separated parts of the world. In England, at almost the same time that Drs. Grinker and Speigel were telling the Army in a confidential monograph of their wonderful success with sodium pentothal, Dr. J. Stephen Horsley published a book entitled, Narco-analysis, that advocates the identical technique in the treatment of mental cases. In fact, Dr. Horsley may be called the father of the method, inasmuch as he began his experiments back in 1931. His curiosity in drug-hypnosis and its possibilities was first aroused when, as a young medical student in the maternity ward of a London hospital, he assisted at an investigation in the use of nembutal to produce amnestic or “painless” childbirth. He noticed that the patients, upon awaking from the narcosis, gave many indications that reminded him of a subject coming out of a hypnotic trance. On the basis of this, he followed through his experiments, proving step by step that narcotic hypnosis could be a valuable aid to short-cut psychotherapy. But how does the drug work its wonders? Drs. Grinker and Speigel found that it was best administered by hypodermic injection. The soldiers they treated were takan to a semi-darkened room and told that they were going to receive an injection that would make them sleepy. While the injection was being made at a very slow rate so the doctors could watch its effects, the soldier was told to count backwards from 100. Shortly after the counting became confused and just before actual sleep was produced, the injection was discontinued.

At this point many soldiers would begin to speak spontaneously. And if a soldier chose to talk about his battle experience, the doctor permitted him to continue. In a number of cases, however, the doctor had to prompt the patient to talk.

For those who needed more stimulation, a typical battle scene would be described. The doctor would tell of mortar shells crashing nearby, enemy planes roaring overhead, and enemy tanks rumbling in a column. The ones who needed the most stimulation were those severe anxiety cases who had lost almost all contact with reality. When their resistance proved hard to crack by any other method, the doctor would adopt an all-out tactic.

Each patient, on the basis of his individual experience at the front, would re-enact a totally different scene. Some would climb out of bed and wander about the room looking for a slit trench or a lost friend. Others would re-live the scene verbally as though they were telling a very realistic story.

All of them showed great terror. Their eyes would widen enormously, their faces would be covered with perspiration, and their bodies would become rigid. When the emotional pitch reached unbearable limits, each would sink back exhausted and remain still for a number of minutes, and then would take up the story at a less dramatic point.

Most spectacular of all is the suggestive power of drug-hypnosis. Drs. Grinker and Speigel treated many soldiers who had such crippling neurotic symptoms as the inability to hear, to talk; and paralysis of arms or legs. With such cases they would assume a dictatorial tone, commanding the patient to talk, hear, or move his limbs. In every instance, if the “talking-out” method had not, already removed the underlying anxiety responsible for these physical disabilities, the stern commands of the doctor would complete the job.

Now the most crucial point in the treatment had been reached. As the soldier crossed the borderline between the nightmare reality of his battle experience and the comparatively safe environment of a rear-area hospital, the doctor had his best opportunity to rehabilitate the soldier’s shattered ego. In the soldier’s confused and fright-clouded mind, there was no difference between the hospital and the menacing, dangerous world of the battlefield. Every sound, even the sudden snap of a match, was taken for a danger signal and made the soldier jump and start.

The drug had already lessened a great deal of the emotional pressure, however, and the next task of the doctor was to help the liberating process further by convincing the soldier that the danger was in the past—finished, done with once and for all—that it would not be repeated. When the patient accepted this, he was on the threshold of recovery.

In the interviews that followed, the soldier was constantly led back to the story he told under narcosis. He was asked to tell it over and over again until he understood clearly every detail. This also is a vital phase in the treatment, for if the patient wishes to get well, he must ferret out all the subtle reasons for his original fear and try to understand them. Paradoxically, cures are achieved in psychiatric therapy by harping on the causes of anxiety rather than avoiding or skirting around them. The sooner the patient becomes masterful in handling his fear and anxiety with objectivity, the quicker the cure.

To get a graphic picture of the process, the story of a twenty-two year old radio operator sent back from the front with a relatively mild case of anxiety, will serve to illustrate.

On admission to the hospital he complained of moderate anxiety, apprehension and headaches. He had difficulty in concentrating and his memory was poor. He was particularly concerned because he could not remember the names of men in his own outfit, Every night he had dreams accompanied by great fear and anxiety, dreams where he saw himself being attacked by great swarms of dive bombers.

When he was questioned by the doctor, he showed a fair remembrance of his battle experiences, but whenever he concentrated upon them, they became confused in his mind. They were like nightmares, distorted and shadowy. During the Battle of Maknassy, he had been stationed near an airfield which was being constantly dive-bombed, but he stuck at his post throughout the day, working his radio from a deep foxhole. At the close of the day he felt feverish and had a severe headache, so his Commanding Officer sent him back to the aid station at Gafsa to rest that night.

From that moment on, the events became confused and jumbled in his mind. He remembered only isolated happenings, and only fragments that seemed to have no relation to anything else. He remembered wandering back to the aid station after spending the night in a cave. He was surprised that morning to find that overnight he had become deaf. His mind was in a turmoil; he felt dizzy and weak; he couldn’t concentrate on one subject for any period of time. Seeing his condition, the Medical Officer had sent him back to the hospital and then Drs. Grinker and Speigel gave him the narcosynthesis treatment.

He accepted the injection quietly and, as soon as a satisfactory level of narcosis had been reached, the doctor told the radio operator that he was in Gafsa. He reacted instantly, screaming, “Gafsa?” and sitting stiffly up in the bed, his eyes filled with terror. He was so overcome with terror and fear that he was unable to talk. Calmed and reassured by the doctor, he lay back in bed and started to talk about his experiences in battle.

Crying and sobbing bitterly, he said: “Those dirty Nazi b-! They killed those two boys right in front of my eyes. They were nice boys. They weren’t doing anything—just laughing— when they were killed. I told them to dig a deeper hole. They laughed at me. I guess they thought I was yellow. They were lying in a shallow slit trench. I told them to dig it at least six feet deep and reinforce the sides, so they wouldn’t fall in. They laughed and said a Stuka couldn’t hit the side of a barn from two inches away. A minute later a dirty Nazi Messerschmitt came over strafing, and killed those two boys in their trench; they couldn’t get me—I was in too deep. I want to go back and get those dirty Nazi b—.

I want to show them that we’re not yellow. They think we’re just playboys. I don’t know what to do; I told the Captain yesterday I wanted to go back to the front, but I don’t know if I can take it. Shelling and bombing, bombing and shelling, all day long and all night long. After those two boys were killed, I didn’t feel good. I threw up the rations we had just eaten together. I had a headache and felt hot all over. The Major said, ‘Boy, you’ve got a fever. I’ll send you back to the Medics at Gafsa for the night.’ I went back in a jeep, and when I got there, I was standing in front of the Medic’s tent, talking to a Corporal, when I heard a plane. I knew by the sound of the motors that it was a German plane, so I said to the Corporal, ‘Blow your whistle!’ Then we saw a single-motor German plane, like a sea gull. A Stuka! I jumped into the foxhole with the Medic, and the plane flew around and around and dumped its bomb load right over us. I started to feel bad and began to shake all over, and then everything blacked out. Later I heard the Medic say, ‘Stop crying, stop laughing! It’s all over.’”

Then he told how he had been sent to the hospital, and when he reached this point, he sat up and opened his eyes, fully aware of having been under narcosis. As you can see from the above verbatim record, the gaps and missing parts of his story were all filled in, giving the doctors all the material they needed to hasten his recovery. During the next few days, this patient improved very rapidly. His headaches disappeared, his battle dreams stopped, and he was in good enough condition to be sent back to limited duty.

1 comment
  1. Randle McMurphy says: April 5, 20126:16 pm

    I last performed Amytal interviews (narcosysthesis) in the late 1970′s, not for PTSD but with patients admitted to a psychiatric emergency service with psychogenic amnesia. We also used it to distinguish between catatonic schizophrenia and psychotic depression.

    The article is a remarkably good description of the technique developed during WWII by American psychiatrists for rapidly returning traumatized troops to their units. One technical correction: the barbiturate would have been administered intravenously, not intramuscularly as it appears in the staged photos. A reminder of the time when psychiatry was a dynamic, creative discipline instead of the timid, literal minded husk it has become in the U.S.

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