Psychosomatic Medicine 7:257-272 (1945)
© 1945 American Psychosomatic Society

Psychological Factors in Combat Fatigue

With Special Reference to Hostility and the Nightmares

The combat fatigue syndrome of anxiety, irritability, startle, insomnia and nightmares represents a common nucleus which can be distinguished from the innumerable individual differences of reaction which result from the individual differences in the personalities. This common nucleus is the emergency physiological mobilization for fight or flight with its psychological concomitants. This produces persisting symptoms rather than merely aiding fight or flight when it becomes intense enough to upset the man's psychological equilibrium of emotional forces.

The intensity of the reaction depends upon the external precipitating circumstances--nature, duration, suddenness, opportunity for action, etc., and upon the internal make-up of the man--intensity of his hostility, severity of his conscience and inhibitions, toleration for effort, demands and deprivations.

The control of the reaction depends upon external factors--living conditions, boredom, training, understanding of war goals, confidence in officers, feelings of being valued and treated fairly, etc., and upon internal factors such as the man's adaptability, strength of will, tolerance for hostility and anxiety.

Once symptoms appear, secondary reactions to them develop--minimizing the symptoms, struggling to control the giving in to them, exploiting them and so on. This secondary reaction must be clearly distinguished from the causes of the symptoms. The essence of the combat fatigue syndrome is that the man's experiences stimulate and mobilize emotions which have always been important in the personality, and which overwhelm and strain his forces of control. He is then unable to digest these experiences: i.e., regain control of the emotions which have been aroused by them. Chief among these emotions is hostility and violence. In seeking to control the hostility the commonest mechanism is to project it and turn it against the self, i.e., experience the impulse to fight and attack as being attacked. The conscience is generally of importance in this.

This view of the dynamics of combat fatigue bases the clinical picture upon the physiological mobilization for fight or flight, explains the symptoms, including the catastrophic anxiety dreams, and shows the relationship of the condition to the anxiety states of civil life, from which they differ chiefly in the intensity of the precipitating experiences which stimulate emotions which might otherwise have remained under control.

Note:
The views expressed in this paper are those of the author and do not necessarily reflect those of the Navy Department.

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