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Menninger cites as the important factor in combat exhaustion, failure on the part of the ego to control the unconscious aggressive impulses. In order to bear the new pressures of army life, the soldier must establish a positive father relationship to the leader of his group, and in addition, an esprit de corps. Finally, he must regress to an earlier developmental stage in order to accept a dependent, passive rôle.
Menninger then goes on to describe the development of what he calls a 'neuropsychiatric' reaction in combat. In discussing the psychodynamics of combat exhaustion, he states that combat dreams do not relieve the traumatic neurosis because the dream process is unconscious and is not permitted physical expression. Thus 'what was originally stimulated by an external threat becomes internalized, and without help may become an insoluble vicious cycle'.
The author states that his paper is oversimplified and condensed. The rôle of aggression is the only factor emphasized. The rôle of external danger, deprivation and guilt feelings are hardly mentioned.