The Fashions in Trauma

In articles that appeared in the American Journal of Psychiatry in 1969 and 1971, three army psychiatrists boasted that the policy of embedding psychiatrists in Vietnam’s combat units had been a wonderful success. And so the army’s statistics seemed to show. Peter Bourne, who headed the army’s psychiatric research team, announced that henceforth “psychiatric casualties need never again become a major cause of attrition in the United States military in a combat zone.” It was an assertion that provoked fury among many of those who had been sent to fight in the jungles of Southeast Asia. Soon enough, that anger had tangible consequences of a profound sort.          Bourne was not the first psychiatrist to claim that his profession had the capacity to ward off the effects of war on the troops. As entry into the Second World War loomed, American psychiatry mobilized. It persuaded Washington that if it wanted to avoid the epidemic of shell-shock that had disabled so many soldiers in the First World War, the government should allow it to screen out the psychiatrically vulnerable. In that way, the damage to morale and to the army’s ability to fight could be avoided, as could the waste of resources involved in training soldiers incapable of enduring combat.           One and three quarter million potential recruits were rejected on psychiatric grounds. It was a triumph of science and forward planning. Except that once combat began, it swiftly became apparent once again that modern industrialized warfare was not ideally suited to the maintenance of mental health. Placed under sufficiently appalling stress, the soldiers of the greatest generation broke down between two and three times as often as those who had fought in the First World War. At war’s end, fifty thousand veterans, not all of whom had actually faced combat,

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