The Veterans and the Community
"A GREAT RESPONSIBILITY RESTS ON THE PUBLIC"
By MAJ. GEN. NORMAN T. KIRK, Surgeon General of the United States Army
Delivered before The New York Times Conference, New York City, October 12, 1944
Vital Speeches of the Day, Vol. XI, pp. 62-64.
THE American public should be told the truth about what war does to its fighting men. It should know that some of our men are struck down by disease, that they lose arms or legs and that they come home nervous invalids.
The public should also know that in no war have soldiers been given more scientific, painstaking medical care and more human understanding. They will continue to get that care and understanding wherever they are.
On my recent tour of the European battlefronts I was particularly interested in finding out how long it took for medical aid to reach a wounded man. Soldier after soldier told me that he had received medical aid within minutes after he had been hit. The medical soldiers are right alongside of those boys who are fighting in the front lines. They are prepared to give them first aid and get them back for medical and surgical treatment in the shortest possible time.
The evacuation of the wounded may be compared to a long conveyor belt. It starts when the wounded man is picked up by the medical soldiers, given first aid and carried to the battalion aid station for emergency surgery and medical care often under artillery fire. From there he is taken to collecting stations which prepare the men for transportation and to the clearing stations which have complete surgical equipment. He then goes to the evacuation hospital and from there to the general hospital far removed from the combat zone. If he cannot be returned to duty within a limited time, he is sent to a general hospital in the United States.
The man who reaches the general hospital in the United States and is discharged from the Army, is the one which I want to talk to you about today.
He may have lost an arm or a leg. He may have lost both arms or both legs. His face or head may be disfigured. He may be a nervous wreck from battle fatigue and labeled psychoneurotic or psychotic. But no matter what his condition is I want to assure you that he will get the best care that medical science can provide.
Spirit Has Been Developed
All along the line of this medical conveyor belt he has received treatment. His spirit has been developed. He has put his dependence upon the doctors and the nurses. He has seen others with possibly more serious wounds get well. He learns to take the loss of an arm, leg, eye or disfigurement in his stride. He believes he will soon be well to do a job and has complete confidence in what the doctors and nurses tellhim. That this confidence is not misplaced is shown by the fact that 97 per cent of those wounded who reach Army hospitals get well.
The amputee is happy with others like himself. He is furnished a prosthesis and taught how to use it. The blinded man is taught to be self-reliant. Plastic surgery takes care of the facial disfigurement. His morale is high. He is ready to face the world. And then what happens?
When he sees his mother, she breaks down and cries. When he walks down the public street he is a subject of morbid curiosity. When he boards the street car someone tries to help him. These are the things that destroy his self-confidence and the work of months is sometimes undone in minutes.
The wounded soldier does not want sympathy. Neither does he want charity. Legislation and the grant of funds, embellished by ballyhoo, is not the answer to making him a useful citizen. He wants to be self-supporting and self-reliant. It is only humanitarian to subsidize him in accordance with his handicap but he does not want pity, gratuities or sob-sister aid. Many of these men when properly trained have a higher earning power than when they entered the Army. They are normal beings and they want to be treated as normal human beings.
Clarifies Term Psychoneurotic
Now let us take a look at the psychoneurotic case. First of all the term is widely misunderstood. The public confuses the term with psychosis and immediately labels him crazy.
There is nothing mysterious about psychoneurosis. It does not mean insanity. It is a medical term used for nervous disorders. It manifests itself by tenseness, worry, irritability, sleeplessness, loss of self-confidence or by fears or over-concern about one's health.
A great many of those symptoms are manifested by people in civilian life, to greater or lesser degree. You are all familiar with the chronic complainer. Nearly everyone has some idiosyncracy about health. In spite of all this the psychoneurotic in civilian life is not labeled nor does he have difficulty in carrying on his business. Some of our most successful business and political leaders were psychoneurotics.
But put that successful, psychoneurotic businessman into the Army and the doctors immediately have a problem on their hands. Our Army is for the most part a civilian army. The majority of our soldiers have had no previous military training. Our citizens have not been regimented. They are used to a Beautyrest mattress, a private bath and all of the other conveniences that have made our American way of life so desirable. Some of these men are pampered by over-indulgent mothers and co-workers from early morning till late at night.
When this type of person is put into the Army he has a lot of adjustments to make. He becomes part of a vast machine that is regulated like clockwork. His job becomes an important part of an over-all job. He is not always in a position to know the ultimate objective of his work. So he starts to worry about it.
Adjustments Are Difficult
He has other adjustments to make. There is mass feeding. Oftentimes he is on K rations. Sometimes he has no rations and he has to shift for himself. There is mass sleeping. The man next to him snores. Unfamiliar sounds disturb his sleep. On maneuvers he has to sleep on the ground and on the battlefront he may not get any sleep for hours at a stretch. These are all disturbing elements to him.
Under all of these conditions it is difficult for him to adjust. It's hard enough for a rugged, hardy individual to adjust, let alone a man with psychoneurotic tendencies. Therefore the nervously inclined individual, who was a success in civilian life, fails in the Army and receives a discharge.
We also have the moron, the mental defective and the constitutional psychopath to deal with. We get the alcoholic, the pathological liar and the pre-criminal in the Army. We have the boy who has been a failure all his life. He is a problem child at home and his school and occupational records have always been poor. Very few of these men ever make good soldiers.
Then we have the nearly normal individual who cracks under combat. Everyone has his limit of mental and physical endurance. A man can stand just so much. Put him in combat and under prolonged shelling and bombing, combined with poor rations, sometimes none at all, he becomes a casualty.
It's not the first time strong men have broken down after giving what it takes!
We may have as many of this type of casualty as we do physically wounded, and the cycle of medical care for him starts immediately.
If he does not return to active duty within a reasonable time after treatment he is brought back to the United States and after reconditioning may be discharged.
Reconditioning Has 3 Phases
Reconditioning is a new term in this war. Previously the Medical Corps officer has been interested in the hospital treatment and recovery of his patients. But a soldier patient is of no use to his organization until he is returned to active duty. The sooner he is returned, the greater the manpower of the Army. In addition, the sooner his hospital bed is released, the sooner another casualty can be cared for. For discharged veterans there is a definite responsibility to returnthem to civilian life in the best state of physical and mental health possible.
Reconditioning consists of three phases—physical, educational and occupational. All patients in the Army Service Forces hospitals are included in the program except those acutely or seriously ill. The bed patient is given orientation and education in addition to physical bed exercises or occupational bed handicraft. As he increases to a ward ambulant stage these activities are intensified. The program is progressive through all stages of convalescence and balanced so that no one phase is overemphasized. Thus, if he is to be discharged, he is ready to undertake the occupational training offered by the Veterans Administration or go into his former job.
The most important thing which friends and relatives of the disabled veterans can do is to treat them naturally—treat them as normal men. Attention should not be forced upon them. People should not shudder at their afflictions and they should not be gushed over. These men are hypersensitive. If they have lost an eye or an arm or a leg they may feel, if friends or relatives unwittingly encourage that feeling, that the bottom has dropped out of the world they knew. But that isn't true. We all know men and women who have successfully overcome grave disabilities and have lived useful lives.
Sympathy Is Needed
Give him some sympathy, sure. The injured man needs to know that his family and friends care for him. That is very important. But they must also know that this soldier is no longer a "boy," except to his mother who will always think he is, and he should not be so treated.
Through training and leadership he was, when wounded, a soldier—a soldier who could give and take—lick the best the enemy could offer. In other words he was a courageous, mentally and physically fit man. Don't ever let him lose this fighting spirit.
The wounded soldier must be allowed to do things for himself. If he finds he can tie his own tie or lace his own shoes, it is much better that he do it than it be done for him. He must discover that despite his handicap, he can do these and other things to give himself confidence and self-respect.
Parents, relatives and friends should not attempt to minimize the result of his injury. They must be realistic and honest. They should not tell him he looks fine, when he doesn't. But they can tell him he will soon be as good as new. These wounded and disabled service men have no desire to be martyrs. They don't want to be treated as heroes. They want to lead normal lives and be treated as normal human beings. They have rendered a great service to our country. They have made a great sacrifice. So a great responsibility rests on the public. Public behavior has got to be adjusted so that by ill-considered actions additional handicaps are not placed upon the disabled soldier.
On the other hand, by intelligent understanding of their problems and needs, the public can help them along the road to success and happiness.