War and prisoner psychopathologies: stages of panic, collective violence, medical interventions
The term ‘war psychopathology’ in psychiatry and psychology refers to all pathological psychic manifestations, both individual and collective, with immediate or delayed onset, and with transient or long-lasting evolution, that have a direct, if not exclusive, relation to exceptional events of war
War psychopathologies, clinical and pathogenic aspects
Psychopathological disorders normally occur in conjunction with combat.
They may appear either at the beginning of the conflict, when the tension accumulated during waiting becomes intolerable, or while the conflict is in full swing.
Of great importance in this respect is the role of the accumulation of emotions, which in particular cases can explain the delayed appearance of certain reactions: the latency time may last for months or years, depending on the traumatic modality.
The individual manifestations of war psychopathologies
Similar to physiological reactions, individual manifestations are considered as reactions to particular states of acute deconstruction of consciousness.
Four elementary forms can be identified schematically, listed below:
1) Anxious forms
Considered as an irrational phenomenon, anxiety is all the more intense the more unfamiliar the threatening danger is.
Experience from previous fights does not always allow it to be overcome, and the opposite phenomenon can often occur.
Anxiety may disappear or diminish in the course of the conflict, as a better assessment of the situation allows the subject to regain his cool.
If this is not the case, anxiety can lead to extremely serious behavioural disorders, such as airlessness and uncontrolled motor discharges.
In the first case, a framework of inhibition is established with immobility, stupor, muteness, muscle rigidity and tremors.
In the second case, the subject, screaming and with a distraught face, flees haphazardly, sometimes forward towards enemy lines, or seeks illusory shelter, neglecting elementary safety precautions.
Anxiety can also trigger extremely aggressive behaviour characterised by violent agitation, similar to epileptic rage.
The latter can be the cause of violence and injuries towards officers or fellow soldiers, or can lead to self-mutilation, suicidal raptures and raging homicidal insanity against prisoners.
Such states are normally accompanied by a darkening of consciousness and amnesia phenomena.
An excessively prolonged period of anxiety can result in a negative stress condition that can lead to suicide.
2) Confusional and delusional forms
This syndrome may be reduced to simple disturbances of attention, or it may result in a true state of mental confusion with spatio-temporal disorientation, inhibition behaviour towards reality and agitated states with terrifying content and psychosensory sensations.
The German psychiatrist K. Bonhoeffer (1860) distinguished three types of fright psychosis: an initial superficial form with disturbances of the motor and vascular system, a form with emotional stupor, and a final phase in which consciousness tends to remove certain memories.
Mental confusion due to war has been studied in many countries, as it is a very frequent syndrome.
During the Second World War and subsequent conflicts, this war confusion gave way to acute delusional psychoses; however, it was seen that during the last world war some of these psychoses had a more disturbing schizophrenic aspect. They normally regress very quickly.
All these acute clinical pictures are accompanied by somatic manifestations of exhaustion and are followed by more or less important amnesia.
3) Hysterical forms
They have been abundantly described since the First World War.
“It can be said, that the clientele of the neurological centres consisted mainly of subjects suffering from functional disorders. This large number of cripples, of impotent perseverers, greatly astonished the neurological doctors of war, who were unaccustomed to the presence of hysterics in hospitals’.
(Psychologist André Fribourg-Blanc, from Hysteria in the Army )
In modern conflicts, hysterical forms tend to be replaced by psychosomatic afflictions.
4) Depressive forms
Normally, depressive forms occur at the end of an active combat period, which is why they are more easily observed in troops at rest.
There are many causes, including fatigue, insomnia or a sense of grief due to the loss of comrades.
States of melancholy with the risk of suicide are not uncommon, especially in soldiers who lose a comrade in war with whom they did not have a good relationship.
Such depressive forms can also occur in an officer who holds himself responsible for the death of a subordinate soldier, whom he had exposed to fire.
War psychopathologies, collective manifestations: panic
Panic is defined as a collective psychopathological phenomenon, which arises on the occasion of mortal danger and due to the uncertainties of battle; it has always been a part of the combatant’s world and leads to the phenomena of the soldier losing control of his emotions and obscuring his thoughts, often causing catastrophic reactions.
The study of this phenomenon has moved from simple historical description to objective scientific research.
Panic arises from an inaccurate perception (most often intuitive and imaginary, or in relation to archaic mental representations), of a frightening and impending danger, against which it is impossible to resist.
It is highly contagious and leads to disorganisation of the group, disorderly mass movements, desperate escapes in every direction or, on the contrary, to total paralysis of the group.
Sometimes, there is unnatural behaviour that goes in the opposite direction to the instinct of preservation and survival, such as mass suicides in situations judged to be desperate: during the First World War, after the torpedoing of the French ship Provence II, nine hundred soldiers, who could have been saved, jumped into the sea and drowned.
The four phases of panic
The evolution of the panic phenomenon unfolds in a stereotypical manner.
Four phases are normally observed:
- An initial period of preparation or ‘alertness’, characterised by fears and a feeling of vulnerability, combined with other factors (fatigue, demoralisation). False news is spread, fuelled by agitators, creating ambiguous and ill-defined situations in which everyone is in search of information. Critical capacity is absent in both those who transmit it and those who receive it.
- A second phase, of ‘shock’, brutal, rapid and explosive, but brief, due to the eruption of anguish, which becomes terror, in the face of the danger that seems to be specifying itself. The capacities of judgement and censure are inhibited, but without affecting the readiness to act.
- A third phase, of ‘reaction’ or panic proper, during which anarchic behaviour of astonishment and flight manifests itself. A realisation begins to emerge that can lead to a feeling of the futility of life and give rise to individual or collective suicidal reactions.
- A fourth phase, of ‘resolution’ and interaction. The storm calms down, fear diminishes, the first mutually supportive behaviours appear and efforts to restore order are organised; leaders are designated, and consequently scapegoats on whom revenge and blame are fixed. The emotional tension can sometimes vent itself in forms of violence and vandalism. This violence manifests itself in proportion to the anguish felt, executions and atrocities.
The phenomenon of panic develops among soldiers when the troop is in a state of forced alertness and fear, with scarce supplies, deprived of sleep, tried by losses suffered, bombardments, night vigils and defeats.
Often, a simple noise or the cry of a fearful soldier is enough to unleash dismay and terror, causing fatal misunderstandings.
The use of hitherto unknown weapons, surprise, poor visibility conditions, and the sound atmosphere can precipitate terror. Psychological warfare techniques use the effect of panic as a weapon to induce enemies to flee.
More specifically, in N.B.C. (nuclear, biological and chemical) warfare, terror is used as a deterrent.
This is because panic occurs more frequently in rear-guards, as troops engaged in the action have more of a tendency to fight than to flee.
It appears that panic is best observed at the level of small group units, where the regulation of such behaviour is closely linked to individual interactions.
It is at the level of this, in fact, that motivations are determined; their existence is verified in everyday life, in the face of immediate needs that require recourse to leaders and comrades.
On an anthropological level, the uncertainties brought about by individual anxiety must be prevented through the revalorisation of human factors, the reinforcement of solidarity and the identification of individuals with their group; to do this, both individual and collective measures must be applied.
We will then recall the notion that fear plays a role as a social stimulus, which explains why this emotion is extraordinarily transmissible.
Contrary to the traditional view, it is not the externalisation of fear by certain individuals that contaminates others: if they in turn experience it, it is because they have learnt to interpret the visible signs of fear as indications of the presence of a dangerous situation unknown to them.
They feel nothing but their own fear, due to a previously acquired conditioned reflex that determines the reinforcement of action.
Forms of psychopathologies induced by collective violence
Many phenomena of collective violence, such as war and conflict, have been shown to cause very serious forms of psychopathology.
We can identify some of them:
- Intentional traumas are induced by human beings on other human beings. Here, malign intentionality is central in causing severe psychic suffering: in extreme cases, severe trauma emerges with hallucinogenic forms, traumatic memories and delusions of persecution or influence. Due to the extreme violence and ferocity of conflicts, these forms of psychic violence are increasingly frequent.
- Schizoid or schizophrenic states occur after a deprivation phenomenon. In the scientific literature itself, schizophrenic forms are described as ‘total sensory deprivation’. Due to the harsh conditions and forced rhythms that war imposes, cases of depersonalisation, dissociation and identity confusion occur among soldiers; they give up their own identity to defend themselves against annihilation.
- Psychosomatic disorders include, for example, muscular and skeletal disorders due to the inhuman and violent rhythms of war.
General sociological conditions have been particularly studied in combatants
Morale is the determining factor here, linked to patriotic enthusiasm and an ideal for which one is prepared to die if necessary.
Clearly, soldiers will present less risk of psychological breakdown, depending on how well they have been selected and trained.
On the contrary, one can see how a pessimistic state of mind, the absence of motivation and the lack of preparation of the soldiers create favourable conditions for individual and especially collective breakdowns, as in the phenomenon of panic examined above.
It is by analysing these factors that US psychologists have explained the numerous psychiatric disorders that occurred in the US army during the Second World War.
These disorders occurred in such large numbers because the US young men had not received adequate psychological training.
Having never been incited and accustomed to living in danger, convinced that war was about the civilian rather than the military, the young recruits were convinced that they had nothing to do but help the chosen troops (riflemen).
In these cases, the group will be influenced in a more or less direct way by socio-cultural models, ideological tendencies and all those conditioning factors that are the fruit of a long upbringing.
The causes of war psychopathology
The causes leading to the appearance of psychopathologies are many; among them, a general attitude that is far too sympathetic, not to say permissive, towards mental disorders is considered a priority.
In the army of the Third Reich in the Second World War and in totalitarian countries, on the contrary, soldiers who manifested hysterical reactions, personality disorders or depression were subjected to strongly punitive measures, because it was thought that they could demoralise and contaminate the group itself.
When their disorders became more pronounced, they were treated in the same way as organic diseases and considered only with reference to the individual subjects, and not to the general psychological conditions, which could not be questioned.
In particular, German psychiatrists were obsessed with the intentional aspect of the disorder, insofar as the illness frees man from his duties and responsibilities.
In America, by contrast, disorders doubled compared to the years of the First World War, no doubt because more attention was paid to psychological aspects and perhaps because the less rigid US military organisation allowed soldiers to express themselves more freely.
To explain the scarcity of mental disorders in the German armed forces, German psychologists refer to the positive action of movement warfare.
In fact, war of movement, especially when victorious, is less psychogenic than positional or trench warfare.
Contrary to what one might think, certain violent and very harsh actions that took place in a climate of defeat do not always result in great disruption.
During the encirclement of Stalingrad during the Second World War, for example, despite the appalling conditions of combat, the men could not allow themselves to succumb to illness: this would have separated them from the group, with the consequence of being abandoned to the cold, imprisonment and certain death.
Like wounded animals, they mobilised their last energies to survive. In critical conditions, therefore, it can happen that ‘cold-bloodedness’ and the survival instinct allow situations to be resolved that would otherwise be lost, or dominated by fear.
As far as particular sociological conditions are concerned, there are differences in the frequency and symptomatology of mental pathology of individuals subjected to the stresses of war, depending on the epochs, nations and modes of combat.
To this end, comparative studies have been done in an attempt to specify the types of disorders and pathologies within the various sociological frameworks.
War psychopathologies: mental disorders of prisoners
In addition to a number of known pathologies, certain clinical pictures have been particularly studied as they are more specific:
- Nostalgic psychoses in which anxiety is centred on separation from family and country of origin. They mainly affect certain ethnic groups that are particularly attached to their countries and traditions.
- Reactive states of liberation, which manifest themselves in the form of melancholic or manic outbursts (‘return mania’).
- The asthenic states of captivity, observed after repatriation, characterised by rebellious asthenia, hyperemotionality, paroxysms of anxiety, somatic symptoms and functional disorders.
Obsessive conduct manifests itself as obsessive behaviour for life. By adjusting to life outside prison, these individuals end up forgetting the years they spent in prison and the other people who left or died there. In these cases, the only remedy is to act on the ex-prisoner’s great feeling of guilt.
These states, from an evolutionary point of view, heal slowly and can also manifest themselves on individuals without a psychiatric history; however, they can reoccur periodically or on the occasion of traumatic events (so-called ‘traumatic neurosis’ ).
The psychopathology of concentration and deportation camps deserves a place of its own. Characterised by nutritional and endocrine disorders, the after-effects of exceptional deprivation, torture and physical and moral misery, it left indelible traces in the psyche of its victims.
Prisoners subjected to prolonged detention in a prison display disorders such as intellectual asthenia, abulia, reduced resistance to social contacts and a whole series of functional symptoms, among which it is not always possible to distinguish organically based disorders. In particular, readjustment to family, social and professional life is extremely difficult for these subjects because the practical and psychological conditions are compromised by the torture suffered in the camps.
In this sense, the ‘late paroxysmal ecmesia syndrome’ (observed mainly in former deportees) is described, which consists of painfully reliving certain scenes of their existence in the atrocious reality of the concentration camp.
The subjects who were rescued from the concentration camps, despite appearing to be in good condition, on closer inspection, behind their ‘calm and courteous’ behaviour, hid worrying phenomena of neglect in clothing and body care, as if they had lost all notion of hygiene.
All spontaneity had disappeared and their sphere of interests was reduced, including, in particular, interest in the sexual sphere. In particular, 4,617 men were examined who had endured thirty-nine months of imprisonment under very harsh conditions.
It was only through their great personal courage that these subjects managed to beat death and survive.
Similar observations were made, by the Americans, about their prisoners repatriated from Korea or Indochina.
They had particular difficulty, even when they returned apparently in good health, in reconnecting their previous emotional ties and creating new ones; instead, they manifested a pathological attachment to their former fellow prisoners.
In these returnees, the consequences of ‘brainwashing’ are studied.
In the hours following release, the ‘zombie reaction’ is observed, characterised by apathy; in these subjects, despite gentle and affable contact and appropriate expressions of affection, conversation remains vague and superficial, especially regarding the conditions of capture and the ‘march to death’.
After three or four days there is an improvement characterised by greater cooperation: the subject expresses, in a stereotyped and always very vague manner, the ideas received during indoctrination. His anxious state is due to the new living conditions, administrative formalities, press comments on ‘indoctrination’ and a general fear of being rejected by the community.
Some armies, e.g. the US Army, have begun to prepare their soldiers, even in peacetime, for the conditions of captivity, so that they become aware of the risk of suffering and psychic manipulation they might possibly incur.