Further conflict within the Surgeon General's Office
To make matters worse and in direct conflict with existing War Department directives, The Surgeon General issued the following letter, on 11 September 1945:
On the basis of detailed surveys recently completed of all convalescent hospitals, both by military and civilian consultants, the following clarification is offered concerning the disposition of patients:
a.Type of Disposition: No patient should be returned to duty unless he is general duty.
b. Method of Discharge: All patients with residual medical disabilities should be discharged on Certificates of Disability Discharge.
c. Individuals who have no residual medical disabilities but who are considered inadaptable for further service should be disposed of under the provisions of AR 615-369, if their record of service warrants honorable discharge.
This, in effect, constituted an open invitation to CDD practically every patient who was evacuated from overseas since "general duty" implied "combat duty," and practically none of this group could be so classified because of some limitation-physical or psychological.
The "military and civilian consultants" referred to in the letter did not include any member of the Neuropsychiatry Consultants Division, nor any of the service command neuropsychiatric consultants, all of whom had on many occasions voiced opposition to such a policy.
The subject was brought up at a meeting of the War Department General Council on 5 November 1945.
On 23 November 1945, a representative of G-1 informed The Surgeon General that the matter of abuse of CDD's in convalescent hospitals had been discussed at the meeting of the General Council, and 6 days later, The Surgeon General's letter of 11 September 1945 was rescinded.
It was not until 29 December 1945, 4 months after the war had ended, at a time when the matter had ceased to be important, that the final chapter was written. On that date, WD Circular No. 391 was issued, with the following instructions:
1. Enlisted personnel hospitalized in the United States will be disposed of in accordance with the provisions of this circular. Every effort will be exerted to return to duty all enlisted hospitalized personnel who can be expected to render effective military service of any type.
2. a. Enlisted personnel physically unfit for further effective service in the Army will be discharged in accordance with the provisions of AR 615-361 after maximum benefit from Army hospitalization has been obtained.
b. Enlisted personnel physically fit for return to limited assignment or general
service duty (see WD Cir. No. 217, 1944, and WD Cir. No. 196, 1945) but who are eligible for separation from the Army under existing provisions of age, points, service, dependents, etc., will, as soon as maximum benefit from Army hospitalization has been obtained, be transferred on a duty status, direct from the hospital to the separation center, nearest his home.
c. Enlisted personnel physically fit to return to an appropriate duty assignment (general or limited service in accordance with the provisions of WD Cir. No. 217, 1944, and paragraph 4, WD Cir. No. 196, 1945) and who are not eligible for discharge under current directives will be disposed of as follows:
(1) Those likely to render effective service upon return to duty will be returned to an appropriate duty assignment.
(2) Those unlikely to render effective service upon return to duty by reason of likelihood of early recurrence of incapacitating symptoms as a result of continued military service, but who can be returned to civilian life without likelihood of such recurrence, will be transferred to the detachment of patients if not already so assigned, and ordered, on a duty status, to the separation center nearest their homes for discharge under the provisions of AR 615-365, and this circular. This procedure will not be utilized to discharge those individuals who should be discharged under the provisions of AR 615-368 or AR 615-369.
Psychiatric nomenclature which was barely adequate for civilian psychiatry was totally inadequate for military psychiatry. Use of the generic term "psychoneurosis" for all types and severity of neurotic disorders placed all individuals so labeled in a single category, the variations of which were never appreciated by line officers.28 Unfortunately, the term "psychoneurosis" was often confused with the term "psychosis," and many individuals diagnosed as psychoneurosis were looked upon with suspicion of insanity by their associates and officers since both words contained the basic syllable "psycho" which is, and was, a commonly used lay colloquial term for designating a major mental disorder.
Adding to the difficulties of nomenclature were such blanket statements29 as "there is no classification duty for patients with neuropsychiatric disorders" and "greater care will be taken * * * to prevent all individuals predisposed to or suffering from psychoneurosis * * * or having a proven history of such from entering the military service."
As stated previously, the criteria for the diagnosis of psychoneurosis were not uniform. The Inspector General found in a survey of many medical installations both in the Zone of Interior and overseas that the diagnosis of psychoneurosis was being abused by medical officers-that it was being applied to cases of transient situational maladjustments and of character and behavior disorders.
It appeared that, once a soldier was placed on limited duty or recommended for limited assignment because of an emotional disorder, it was unusual for him to ever revert to general service, because of the possibility
28One could add: Also not understood or appreciated by medical officers, including psychiatrists.-A. J. G.
29War Department Memorandum No. W600-39-43, 26 Apr. 1943.
of a recurrence of his difficulty. A prevalent misconception was that psychoneurotic disorders would develop in all such predisposed individuals whenever they were exposed to any stressful situation.
Psychoneurosis became practically a household word, and there was hardly a soldier who was unfamiliar with the word "psycho." To differentiate between cases of chronic psychoneurotic disorders and those which developed as a result of the stress of operational or combat flying, to minimize the stigma of a psychiatric diagnosis, and to emphasize the situational aspects and lack of permanence of the disorder, the Air Forces adopted the terms "operational fatigue" and "flying fatigue" for those cases of psychoneurosis which resulted from the stress of hazardous or combat flying. This concept was quickly and widely adopted by Ground and Service Forces combat units where the term "exhaustion" and later "combat exhaustion" and "combat fatigue" were used for those emotional disturbances which resulted from the stress of combat.30
The use of these terms was remindful of the term "shell shock" which became the wastebasket for neuropsychiatric diagnosis in World War I. Before long, the terms "operational fatigue," "flying fatigue," "combat exhaustion," and "combat fatigue" were applied to cases other than those which were combat incurred. In many instances, it was applied to men who had never been in combat and even to men who had never left the continental limits of the United States. Other difficulties encountered were: According to an official ruling, Air Forces personnel hospitalized for "flying fatigue" could receive flight pay, while hospitalized, similar to personnel with physical injuries or disease. However, if the diagnosis was psychoneurosis, they were not eligible to receive flight pay-on the assumption that it was not the result of an injury or disease.
To effect some standardization in the use of such terms and to dispel the existing confusion, The Surgeon General issued the following directive in October 1943:31
In certain theaters it has been found that the term "psychoneurosis" produced in the patient's mind the idea of war causation and incurability and thus materially interfered with recovery. The term "exhaustion," on the other hand, implied to the patient nonspecific etiology, natural occurrence, and speedy recovery. It was also in a measure true, in that in the majority of cases this exhaustion was a strong contributory factor. If it is found expedient to use the term "exhaustion" as a preliminary diagnosis for combat neuropsychiatric casualties, the term should be employed only on the emergency medical tag and the case rediagnosed with the proper diagnostic term on the field medical record. The use of the term "exhaustion" for psychoneurosis will be confined to cases developing under enemy action. Cases of exhaustion free from
30The term "exhaustion" was first used in a II Corps directive issued in April 1943 to designate combat psychiatric casualties. Later, NATOUSA (North African Theater of Operations, U.S. Army) directives continued to direct the use of this diagnosis. In the same sense, the Marine Corps utilized "fatigue" and "combat fatigue" for the psychiatric casualties of the Guadalcanal fighting. A full discussion of the origin of the term "exhaustion" is contained in "Medical Department, United States Army. Neuropsychiatry in World War II. Volume II. Oversea Theaters" [in preparation].-A. J. G.
31Circular Letter No. 176, Office of the Surgeon General, U.S. Army, 20 Oct. 1943.
psychiatric components and essentially "physical in nature" will be qualified with an appropriate term in addition to the word "exhaustion," for purposes of differentiation.
Change of psychiatric nomenclature.-In September 1944, the Deputy Chief of Staff requested the Assistant Chief of Staff, G-1, to study the entire problem of psychoneurosis (p. 102) for the purpose of "determining what improvements could be made in Army procedures and publicity in the handling of psychoneurotics." He stated:
A competent authority has expressed the fear that in their enthusiasm the psychiatrists within the Army are overdoing their diagnosis of psychoneurosis and are overdoing the publicity on this subject. If the War Department builds up a clinical record and a diagnosis that a soldier is a psychoneurotic it will probably impair the individual's future civilian usefulness and may greatly increase the number of men dependent upon Government disability allowance. In many of these cases the individual became a psychoneurotic because he was unable to adjust himself to his position in the Army. Many of these individuals will have no difficulty in returning to their former civilian environment and will be normal in every respect in continuing a way of life to which they were accustomed and adjusted prior to their induction in the Army. If they are labeled as psychoneurotics their former employers will be reluctant to take them and the individual concerned will become convinced that he cannot readjust himself to his previous civilian environment. It is understood that the Navy is now diagnosing these cases as "No disease. Temperamentally unqualified for Naval service." It is suggested that the Army may well use a similar diagnosis.
Shortly afterward, the Air Surgeon requested The Surgeon General to call a conference for the purpose of standardizing nomenclature and defining terms which were then in use.
In connection with the request of the Deputy Chief of Staff for a report on the problem of psychoneurosis, The Surgeon General made the following comments in a comprehensive report to G-1:
It has been suggested that the word psychoneurosis be changed to something else that is less imposing and frightening. This office has consistently maintained that the word is an accepted medical term with a specific meaning and that if a new word were substituted, it would soon carry with it all the associations of the present one. Any stigma which is attached to the diagnosis would carry over to any other word used in its place. Cancer or syphilis called by any other name would still be the same. The difficulty is not with the term but rather with the attitude toward and understanding of the term. Furthermore, much of this existing confusion and misunderstanding can be traced to the fact that psychoneurosis was called "shell shock" in the last war. To introduce still another misnomer at this juncture could not but lead to even further misunderstanding. The solution is believed to be in education rather than evasion of the term.32
On 25 January 1945, The Surgeon General called a conference which was attended by the civilian consultants in neuropsychiatry to the Secretary of War and by representatives of the Veterans' Administration, the
32In retrospect, the repeated defense of the term "psychoneurosis" by the psychiatrists in the Surgeon General's Office was an error as demonstrated later by the successful effort of Menninger et al. (p. 232) in introducing a new psychiatric nomenclature in which two new categories, the "transient personality reactions" and the "immaturity reactions," made unnecessary the wholesale usage of the term "psychoneurosis." These new categories have now been used successfully for years, including the Korean War period.-A. J. G.
Air Surgeon's Office, the Bureau of Medicine and Surgery of the U.S. Navy, the U.S. Public Health Service, and the Surgeon General's Office. It was the consensus of the conferees that, whenever possible, a psychiatric diagnosis should include four parts:
1. The type of disturbance or disorder.
2. The external precipitating stress which caused the disorder.
3. The extent of the predisposition.
4. The degree of impairment of functional capacity resulting from the disorder.
It was also agreed that the term "psychoneurosis" should be regarded as an inclusive term which could be omitted from the more specific diagnoses, such as anxiety reaction or conversion reaction.
These recommendations were included in The Surgeon General's memorandum to G-1 on the subject of psychoneurosis and were later adopted by the War Department33 and appropriate instructions issued to the field (see "Medical Disposition," a, b, and c, p. 225).
The method of recording the diagnosis of psychoneurosis was elaborated upon in a later publication34 which outlined the criteria to be used in describing the severity of stress, the degree of predisposition, and the amount of incapacity.
War Department Technical Bulletin (TB MED) 203.-The final step in the modernization of psychiatric nomenclature was taken when a markedly revised list of standard diagnoses was published in TB MED 203 and issued on 19 October 1945. The new nomenclature was the work of General Menninger over a period of 14 months. He personally solicited the opinions and recommendations of over 100 of the outstanding psychiatrists in the country and made numerous revisions until the final draft was accomplished. The dynamics of psychopathology was chosen as the basis for the classification of the psychoneuroses.
A new group was added-the transient personality reactions to acute or special stress. It included such disorders as combat exhaustion and acute situational maladjustment. The term "psychopathic personality" was eliminated and replaced by "character and behavior disorders" which were subdivided into: (1) Pathological personality types, (2) addiction, and (3) immaturity reactions. The term "somatization reaction" was also introduced. It included all of the so-called "organ neuroses."
All of the needed changes were thereby brought about. No longer did the diagnosis of psychoneurosis appear with annoying frequency. The four-part diagnosis permitted individualization and, in effect, represented a brief description of the case. A more dynamic system was substituted, and some of the undesirable categories were eliminated.
33War Department Circular No. 81, 13 Mar. 1945.
34War Department Circular No. 179, 16 June 1945.
LINE-OF-DUTY DETERMINATION OF NEUROPSYCHIATRIC DISORDERS
Because of the chronic nature of most neuropsychiatric disorders, peacetime criteria for LD (line-of-duty) determination were continued during the early days of the war. They were based on the knowledge that "in many chronic diseases and degenerative conditions, symptoms appear only after many months or even years, and that in such conditions incapacitating defects may arise as a natural consequence of the disease and not as the logical incident or probable effect of duty in the service."35
All cases of dementia praecox, manic depressive psychoses and psychoses of a similar nature, and psychoneurosis developing within 6 months after entry into active military service were to be regarded as having existed prior to service. Cases developing after 6 months' active duty were to be regarded as having been incurred in line of duty "* * * when a careful review of the past history fails to elicit evidence of mental abnormality or functional nervous disorder before the original entrance into active military service or during the first six months of such service."36 It was permissible to use medical judgment in making the LD determination.
In May 1944, to conform with Veterans Regulations No. 1 and to facilitate the adjudication of claims for pensions, the criteria for determining line of duty were revised. The new criteria were based on the assumption that, lacking evidence to the contrary, a disease or injury was service connected and, therefore, in line of duty-unless it resulted from misconduct or neglect, or occurred while absent without official permission or out of activities not connected with the service.
The Veterans Regulations provided:
Every person employed in the active military or naval service shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of enrollment or where clear and unmistakable evidence demonstrates that the injury or disease existed prior to * * * enrollment and was not aggravated by such active military or naval service.37
Under this regulation, length of service per se was no longer to be a decisive factor. The important considerations were (1) what was written down in the findings of the induction physical examination and (2) clear and unmistakable evidence concerning the disease or disorder.
All cases of psychosis and psychoneurosis were, therefore, to be con
35Army Regulations No. 40-1025, Changes No. 1, 21 Aug. 1942.
37Veterans Regulations No. 1 (a), pt. 1, par. 1 (b), as amended by Public Law No. 144, 78th Cong.
sidered "in line of duty" except where there was clear and unmistakable evidence that the disorder existed prior to entry into the service and that it was not permanently aggravated by service.
When these guides were incorporated in AR 40-1025, 12 December 1944, upon the recommendation of the Neuropsychiatry Consultants Division, the following addition was included with reference to neuropsychiatric disorders:
Whenever "permanency" of aggravation must be established, as in determination of eligibility for retirement benefits, an aggravation (of a psychiatric disorder) will not be considered permanent if it is purely situational and if it is evident that it will be removed, with reversion of the disorder to its previous degree of severity, within a reasonable time upon return to civilian life.
Defects of revision.-While in many induction stations, great care was exercised in performing and recording the results of the medical histories and examinations, there were other stations where, because of the large volume of work and shortage of medical officers, the psychiatric portion of induction physicals was performed in a perfunctory fashion. For example, in one induction station, it was necessary to process 600 men each day and, with just 1 psychiatrist, approximately 30 seconds were devoted to the neuropsychiatric portion of the examination. Here, thorough and intensive study of each man was not possible, neuropsychiatrically or any other way. (This was in contrast to other induction stations located in metropolitan areas where availability of psychiatrists permitted much more careful evaluation.) Therefore, to assume that complete and careful examinations could be performed on every man entering the service during wartime was unrealistic.
In many instances where men related histories of epilepsy, nervousness, headaches, and weakness, but were unable to supply "proof" that these conditions existed before acceptance into the service and no objective evidence of these conditions were apparent on examination, the men were inducted often without notation being made on their induction records. When these men were later discharged and applied for pensions, there was no clear and unmistakable evidence (if the individual chose to change his story) to prove that the condition existed prior to induction, and nothing to contradict a claim of aggravation.
The effect of a law (Veterans Regulations) which placed the responsibility on the Government for any illness which occurred in military personnel during wartime was (1) to increase the rate of rejections and (2) to cause the Government to pay pensions to men whose conditions existed before entry into the service and were not truly aggravated by service.
A great deal of publicity had been given to the cost of caring for the many neuropsychiatric casualties of World War I, and those psychiatrists who were impressed with the figures undoubtedly rejected many men who were borderline cases, but who might well have made good adjust-
ments in the Army, in order to avoid the possibility of their becoming responsibilities of the Government. They did this in compliance with directives which were written with those same considerations in mind.
A trial period of duty with administrative discharge for preexisting defects which are discovered during that time would have had the effect of allaying the fears of examining psychiatrists and would have decreased the number of rejections at induction. Further, by such a trial period, the Government would have been spared the responsibility for illnesses which were not truly service connected.38
The problem of bed wetting has bothered armies for time immemorial. Bed wetting subjects the individual to the taunts of the others, results in some loss of sleep, introduces the complication of increased linen and bedding requirements if malodorous situations are to be avoided, increases the possibility of exposure to cold or inclement weather when in bivouac, and makes for difficult situations under crowded housing conditions, such as on troop transports.
Traditionally, the Army attitude toward nocturnal enuresis (which was not the result of organic disease) was that of an "undesirable habit" and handled such cases in several ways. One method was to turn the individual over to a proverbial tough sergeant who by such techniques as having the man awakened every hour throughout the night or pitiless ridicule was supposed to cure him. This, however, was by no means the usual manner of dealing with cases of nocturnal enuresis.
Another method was developed at Camp Abbot, Oreg., where the post commander, in September 1943, established an enuresis tent near the post stockade under the supervision of the provost marshal for all military personnel suffering from enuresis, cause undetermined.39 Its purpose was for "training in self-regulation and self-discipline." Company commanders upon learning of repeated bed wetting of any member of their commands were required to report the individual to the post inspector who, if the facts so warranted, would refer the individual to the provost marshal. The individual continued in training with his organization but was not permitted to drink "cokes," beer, or soft drinks at any time, was permitted coffee only for breakfast, and received no pass or furlough privileges except in cases of emergency. He was delivered to the provost marshal one-half hour after the evening mess call and was permitted no fluids from supper to reveille. He was awakened every 2 hours during the night and
38This describes the common Navy philosophy and practice of administrative separation of noneffective trainees during the initial training phase (boot camp.-A. J. G.
39Administrative Memorandum No. 25, Camp Abbot, Oreg., 16 Sept. 1943.
taken to the latrine. Or, discharge for undesirable habits might be recommended and separation from the service effected with either "blue" (without honor) or "white" (honorable) discharge, depending upon the individual commander's discretion.
As time went on, the attitudes toward and the management of enuresis became more medically and psychiatrically oriented. Thorough medical workup was given in most posts to exclude the possibility of organic genitourinary or nervous system disease. In some stations, medical discharges were given even when no organic disease was found.
Policy and procedures for dealing with enuresis were not uniform until 1 January 1944 when section VIII, AR 615-360, was modified by changes No. 18, as follows:
It is now a generally accepted medical and psychiatric opinion that enuresis is not necessarily a habit, but rather may be a symptom of some underlying mental or physical condition. Underlying causes of enuresis may be organic disease, psychoneurosis, psychosis, mental deficiency, psychopathic personality or lack of proper juvenile training.
Generally, if the case is studied completely, one of the above diagnoses will be established. Therefore, in each case a complete mental and physical evaluation of the person afflicted will be done by qualified medical officers and a decision made as to disposition. If the individual is to be discharged, decision will be made as to the appropriate section of these regulations to be utilized. The type of discharge should also be decided solely on the merits of each individual case and governed by the nature of the determined underlying cause rather than by the resultant enuresis.
When the conduct of an enlisted man was such as to render his retention in the service desirable except for his enuresis, an honorable discharge was to be given. Relatively few cases of enuresis were found to be due to physical or mental disease; a majority were considered to be due to "lack of proper juvenile training"-but the practice of penalizing this unhappy group with "blue" discharges was discontinued.
No differentiation was made before 1944 between enuresis as a habit reaction-symptomatic of immaturity-and enuresis as a symptom of some organic disorder (s). Therefore, no data for admissions for enuresis (in its psychiatric connotation) are shown in table 6, dealing with neuropsychiatric admissions in World War II, for the period before 1944. However, if all types of enuresis were taken into account, some 20,000 persons were admitted with such a diagnosis during World War II, indicating an admission rate of 8 per 10,000 mean strength per year.40
There was a similar evolution in the disposition of homosexuals. Initially, all cases of homosexuality who were not tried by courts-martial (where offenses were involved) were given "blue" discharges. A man on his own initiative or because of noticeable difficulty in adjusting might
40For further details, see footnote 1 to table 6, p. 216.
visit or be sent to a psychiatrist for consultation. When it was ascertained that the basis of the maladjustment was homosexuality and this was reported to the individual's commanding officer, the subject usually received a "blue" discharge. Objections to this harsh practice were raised by many homosexuals whose attempts to receive help from a medical officer resulted in their being discharged "without honor." Further, confidence in medical officers was undermined by the Army requirement that these officers report even those confidential statements given in a professional consultation. The homosexual was being singled out as a result of irrational prejudices, even though he was no more responsible for his aberration than the mental defective was responsible for his central nervous system pathology. World War II data indicate that some 5,500 persons were admitted to hospitals with a diagnosis of "pathological sexuality," primarily "homosexuality."41
Col. Roy D. Halloran, MC,42 who was chief of the Neuropsychiatry Consultants Division in the early part of the war, while feeling that the problem of homosexuality had not created serious difficulties, attributed some progress in the handling of the problem to the publication of WD Circular No. 3, issued on 3 January 1944. This directive permitted the giving of a "blue" discharge to an offender who was not deemed reclaimable, in lieu of court-martial, and provided for hospitalization of those who were deemed reclaimable. Included in the reclaimable category were those who were guilty of first offenses, those who acted as a result of intoxication or curiosity, or "those who acted under undue influence, especially when such influence was exercised by a person of greater years or superior grade."
The commanding officer of the hospital at which such an individual was hospitalized was required to transmit to The Adjutant General (and to theater headquarters, if overseas) a full report of the diagnosis, treatment, results of treatment, and recommendation as to disposition, to be kept on file. Depending upon the results of treatment, the individual was returned to duty or separated from the service or tried by court-martial, this decision being made by higher authority. If returned to duty, the reclaimed offender was then assigned to a different organization so that he could start anew.
Actually, there was little in the way of individual intensive treatment that could be given to such men in a military setting.43 Adequate evaluation was possible, however. It is not known just how many homosexual offenders were salvaged for further duty under this system, but probably less than 1,000. The fact that any were salvaged is significant.
41In regard to statistical data on homosexuality, one can agree with Menninger that such data "are probably of little if any importance as an indication of either the true incidence or significance of the problem * * * Probably for every homosexual who was referred or came to the Medical Department, there were 5 or 10 who never were detected." (Menninger, William C.: Psychiatry in a Troubled World. New York: The Macmillan Co., 1948, pp. 226-227.)-A. J. G.
42Halloran, R. D.: Problems of Neuropsychiatry in United States Army. M. Ann. District of Columbia 13: 17-23, January 1944.
43In all fairness, it should be recognized that few homosexuals were or are given individual intensive psychiatric treatment in civil life.-A. J. G.
Neither Army regulations nor WD Circular No. 3 specified the method of disposition of a homosexual who was not guilty of any offense. It was common practice, however, to give "discharge without honor" (blue) to any individual discharged because of homosexuality, on the premise that homosexuality constituted an undesirable trait of character.
To correct this practice, the Surgeon General's Office recommended a change in Army regulations44 to indicate that only those homosexuals who were guilty of sexual misconduct in the service should be considered for "blue" discharges. Further, that those who were not guilty of any sexual offense and who had a satisfactory record of service should be given an honorable discharge. Concurrence in this, however, could not be obtained from other War Department agencies because it was feared that many adjusted homosexuals would seek to be discharged and that others might claim to be homosexual for the purpose of being separated from the Army with honorable discharges.
Without prior knowledge of the Surgeon General's Office, a change to AR 615-368 was issued about a month later to the effect that "the mere confession by an individual to a psychiatrist that he possesses homosexual tendencies will not in itself constitute sufficient cause for discharge * * *."45 Provision was made for hospitalization upon the recommendation of the psychiatrist for the purpose of determining if the individual should be restored to duty or separated from the service. The implication was that if separated it would be with a "blue" discharge.
After a series of conferences with representatives of the major forces of the Army, a memorandum was forwarded in July 1945 by The Surgeon General to the Assistant Chief of Staff, G-1, expressing the opinion that "personnel who were inadaptable for service by reason of homosexuality were entitled to honorable discharges providing they were guilty of no offense and their service had been honorable and faithful." It was pointed out that when an individual voluntarily sought medical assistance and this resulted in a "blue" discharge, faith in medical officers was lost, and in effect, such an individual was given the same consideration as one who had committed homosexual offenses and whose services had not been satisfactory. It was suggested that a person with homosexual tendencies was no more responsible for his condition than was one with mental deficiency. Men in the latter category were given honorable discharges when released because of inaptness.
This memorandum resulted in the preparation of a confidential letter, in the Adjutant General's Office, on the disposition of homosexuals. This letter, dated 31 October 1945, was addressed to all commanding officers
44Army Regulations No. 615-368, 7 Mar. 1945. (Section VIII, AR 615-360, was replaced by AR 615-368-Undesirable Habits or Traits of Character, Enlisted Men, Discharge, dated 20 July 1944; and AR 615-369-Enlisted Men, Discharge-Inaptness, Lack of Required Degree of Adaptability or Enuresis, dated 20 July 1944.)
45Army Regulations 615-368, Changes No. 1, 10 Apr. 1945.
having general court-martial jurisdiction.46 From the psychiatric standpoint, it represented great progress in the solution of this highly charged problem. It provided for honorable discharges (under the provisions of AR 615-369) of enlisted personnel who were released because of lack of adaptability resulting from homosexual tendencies, and who had committed no sexual offenses while in the service. It did not imply that all confessed homosexuals should be discharged merely on the basis of a confession of homosexuality. Officers who were found to be inadaptable for service as a result of homosexual tendencies were permitted to resign for the good of the service. A report of medical examination, including psychiatric examination, was required to be forwarded with the letter of resignation. Where no sexual offense had been committed and where record of service justified an honorable discharge, upon review, the qualification "for the good of the service" would be disregarded and resignation under honorable conditions accepted.47
The subject of malingering48 comes to the foreground in every war-but perhaps less in this war than others because of greater understanding of the dynamics of human behavior.49 Certain line officers and tough first sergeants would from time to time insist that most individuals with functional disorders were fakers or cowards and initially handle them accordingly. Many others may have had similar opinions but did not translate their thoughts into words or actions. Never during the war did there develop a witch hunt for malingerers. There are no reliable medical statistics available on the frequency of malingering since it was not included as a medical diagnosis. Where an individual was suspected of malingering, a diagnosis of "No Disease" was usually entered on the clinical record. It was then left to that person's commanding officer to prefer charges, if he so desired. If charges were preferred, the ultimate decision concerning the existence of malingering was resolved by court-martial.
The following figures on the number of cases tried for malingering (excluding self-inflicted wounds) and the number found guilty during the war were obtained from the Office of the Judge Advocate General:
46This came out on 23 March 1946 as WD Circular No. 85.
47The achievement of a more enlightened management of the homosexual problem during the end phase of World War II was rapidly lost in the postwar years. A revision of AR 615-368, issued on 14 May 1947, deleted any reference to or procedure for reclaiming homosexual offenders and made it increasingly difficult to obtain an honorable-type discharge for the confessed homosexual who had committed no offense in the service. However, the last chapter on Army policy for dealing with homosexuality (AR 635-89, 8 Sept. 1958) provided that self-confessed homosexuals or other homosexuals with no provable offense in the service (so-called Class III) were required to be given an honorable-type discharge.- A. J. G.
48This subject (with others in this chapter) is comprehensively reviewed by William C. Menninger, in Psychiatry in a Troubled World. New York: The Macmillan Co., 1948.
49Halloran, R. D.: Problems of Neuropsychiatry in United States Army. M. Ann. District of Columbia 13: 17-23, January 1944.