The Treatment of Psychoneurosis in the British Army1

An account of the treatment of psychoneurotics under military conditions in the Army may serve a useful purpose at this time of transition. Under new and fast-changing social conditions similar methods may come to be applied to the civilian population. It is essential to get a clear idea as to what has been achieved, and what is beyond those methods which I shall call 'manipulative psychotherapy'. This account will show that the methods applied are in a certain sense the opposite to the psycho-analytical approach, aiming as they do at a change in the patient through manipulation of his external environment.

I shall not deal with Army Psychiatry as a whole. Army Psychiatry has many branches of which treatment is not the most important. It aims at preventing neurotic breakdowns by assisting in the selection of candidates for special employment, e.g. as officers, and also helps in the assessment of the aptitudes of the ordinary soldier before he is sent to a unit. Further, there is the question of raising morale. These aspects of Army Psychiatry lie outside the scope of this paper, and the student interested in Army Psychiatry as a whole finds a complete survey in J. R. Rees's book, The Shaping of Psychiatry by War. I confine myself to the treatment of psychoneurotics in which I have personal experience, and which is the natural interest of the psycho-analyst who is practising as a therapist.

The treatment of psychoneurotics is not necessarily the same as the treatment of psychoneuroses. This leads to the important point of the aim of treatment. Under civilian conditions we often find that treatment drags on for a long time, because both the patient's and the analyst's ambitions rise as the patient improves. The treatment is prolonged beyond the time when the initial symptoms disappear. The aim of treatment in the Army is naturally much more restricted. At best we aim at restoring the patient to his previous health, 'previous' meaning as he was before enlist