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The Merchant Marine is a sufficiently unique body of men to merit a brief sketch of their characteristics before entering upon a discussion of their war neuroses. Most of the men are seafarers with whom the sea is the occupation of choice. Often it is even more—a refuge from the competitive life ashore. Since the onset of war this group has been augmented by others who look upon it as the branch of service in which they prefer to fight the war. In many ways, members of this latter group are much like those recruited into the Army and Navy.
During the war it is the duty of the psychiatrist in the service to get the patient back to active duty as soon as possible, or when this is impossible, to discharge him so that someone else may be treated in his place. Because of the resultant rapid turnover, it becomes difficult to pry deeply into the psychopathology. For other reasons it also seems unwise to do so. To evolve practical working concepts, we must rely to some extent upon the ideas advanced by those who analysed chronic cases in detail during the years following the last war. These ideas are put to the test as a working basis and either built upon, revised, or disproved.
To define a traumatic war neurosis is not an easy task. The definition must be broad and flexible to include the many and varied aspects of this condition. A traumatic war neurosis exists when, as the result of war-time experiences, an adaptation takes place in the absence of, or not in consonance with, organic changes, which results in a reduction of the individual's resources.
We have observed in our cases several distinct types of adaptation. (1) Highly emotional (or terror state). This is characterized by narrowing of consciousness, amnesia, confusion, vertiginous attacks, often loss of consciousness, with or without convulsions. (2) Sensory and motor phenomena. These are quite variable, the sensory phenomena often being hallucinatory reproductions of the traumatic episode. Motor ph