Psychosomatic Medicine 9:124-130 (1947)
© 1947 American Psychosomatic Society

Psychosomatic Medicine in an Army Hospital in India

The author reviewed the charts of 1266 consecutive patients treated by him in a year on a General Medical Section of an Army hospital in Assam, India. Nine hundred and twenty-eight patients (73.3 per cent) had organic, somatic diseases; 104 (8.2 per cent) had full-blown psychoneuroses; 234 (18.5 per cent) had a combination of the two: psychosomatic illnesses. In other words, one out of every four general medical patients had a large emotional component to his illness.

The soldier's life in India was detailed to illustrate how poor military objectives, monotony, homesickness, and subtropical physical discomforts over long periods of time can constitute sufficient stress in a non-combatant area to lead to psychological breakdown.

The characteristics of the soldier-patient overseas were anlyzed, with emphasis on the secondary gains of his illness. In contrast to civilian medicine, the Army doctor's goal in war time is not the complete cure of the individual patient as much as keeping as many soldiers on duty status as much of the time as possible.

The nature of the patients' illnesses was analyzed. The organic cases were primarily acute infections: bacterial, virus and parasitic. The psychoneuroses exhibited anxiety elements in 85 per cent, both with and without conversion symptoms. The commonest anxiety syndromes of functional headaches, vasomotor instability and hyperventilation were detailed. The psychosomatic disorders included independent organic and emotional syndromes; emotional overlay secondary to an organic disease; and a large group of borderline cases which were presumptively of emotional etiology.

The treatment program for the emotional illnesses was outlined. Only 10 per cent of the patients, who had deep-seated personality disorders, were transferred to the Neuropsychiatric Service. The rest were treated on medical wards by superficial psychotherapy, including true reassurance, suggestion and group psychotherapy.

The basic conflict between group military objectives and the soldiers' personal incentives was presented in the Discussion as the fundamental cause for the many emotional illnesses. This conflict produced a chronic state of tension (anxiety) which was evident in most of the neurotic and psychosomatic patients. The relationship of environmental stress to individual predisposition in emotional illness was discussed. The role that the internist can play in adjusting these stresses, and giving the patient some insight into the nature of his emotional illness in the form of superficial psychotherapy, was outlined.

Suggestions for better prophylaxis and management of psychosomatic illnesses in the overseas Army were made. These included group mental hygiene lectures for both soldiers and their commanders, an effective rotation policy, orientation of general duty medical officers to the diagnosis and treatment of emotional illness, the increased use of group psychotherapy, and a plea for closer liaison between Medical and Neuropsychiatric Services in Army hospitals.

Note:
Presented at the Annual Meeting of the American Society for Research in Psychosomatic Problems, Inc., New York, May 12, 1946.