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Chapter 9, Part 3

Medical Science Publication No. 4, Volume II

OBSERVATIONS ON PRISONERS OF WAR IMMEDIATELY
FOLLOWING THEIR RELEASE*

MAJOR HENRY A. SEGAL, MC

Introduction

From the psychiatric viewpoint, Operations Little Switch and Big Switch presented an unusual challenge. Not only did they present an opportunity to apply the knowledge gained through the handling of repatriated prisoners of World War II, but also to augment that knowledge and, particularly, to evaluate the enemy's tactics and technics in the war to control men's minds.

The psychiatric literature contains many references to the deleterious effects of enemy imprisonment (1-14). Follow-up studies of former POW's strongly suggest that the problems have not been self-limiting and that many men continue to experience difficulty in readjusting to their non-prison environment. Often, failure to resolve these problems has caused the individual concerned to become an emotional cripple, unable to accept or discharge responsibility in the military or civilian setting. To a large measure, the difficulty lies not only with the former prisoner himself, but with the environment to which he returns following repatriation. Wan, beaten, and sometimes maimed, the former prisoner serves as a vivid, visual, guilt-producing stimulus to the civilian population and often to the military as well. How better to assuage this feeling than to "do everything possible for those poor men?" Hence, there follows an unreal, often protracted period of adulation beyond belief with free giving, total permissiveness, and absent need for responsibility. This veritably universal relief from guilt has an opposite effect upon the repatriate. For him, it may very well be guilt-inducing by reminding him anew of his capture and his prison camp behavior. Under such circumstances it is not unusual to find men unconsciously expressing the desire to remain helpless and pitied. Quite often repatriates who had been relatively asymptomatic throughout the course of their imprisonment developed psychogenically determined symptoms after repatriation. These symptoms are tenaciously maintained for purposes of secondary gain. ("If I am sick like this because of my


*Presented 30 April 1954, to the Course on Recent Advances in Medicine and Surgery, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington,
D. C. The views expressed in this paper are those of the author and do not necessarily reflect official opinion of the Department of the Army.


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imprisonment, how can I be expected to perform the duties of a soldier?")

It was amply evident, even before Little Switch had begun, that public opinion was unshakably fixed. The hue and cry to "bring those poor boys right home" had already been sounded throughout America. Civic-minded organizations had already planned their heroes' parades. Radio, television, and the press were vying with each other to provide the most complete coverage. We had lost the battle for time-time in which to carry out the essential prophylactic measures aimed at forestalling the appearance of the POW syndrome seen amongst World War II repatriates. What remained for us was only the opportunity to work briefly with the returnees and to define and delineate for them the unreal atmosphere to which they had returned and the problems confronting them should they fail to recognize them as such.

Problems of Readjustment

What were the specific problems facing the men at the time of their return to friendly hands? We have already touched upon one in the preceding paragraphs. Our World War II knowledge suggested others. They were confirmed by our findings in both Little Switch and Big Switch (15, 16).

1. Reintegration

For the most part, the repatriates tended to view their families and themselves as they were at the time of capture rather than in terms of the present time. They might fail to recognize that with the passage of time and the lack of common experiences, their interests and their family's interests may have become divergent.

2. Financial

The large sum of back pay which was made immediately available could be foolishly squandered thereby creating future financial difficulty. The group in general appeared to be potentially easy targets for vigorous salesmen. The temptation would exist to spend it all in an effort to prolong the period of "unreal" living they would encounter on their return home.

3. Return to a Disinterested Environment

Prisoners of war, many of whom had spent up to 36 months in captivity, would find it exceedingly traumatic to return to an environment where the Korean War had not always been a popular one, where public interest was not always high, and where some disinterested individuals might even refer to them as "foolish" for having taken a part in the war.


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4. Communication

During the period of prolonged imprisonment a distinct system of idiomatic communication amongst groups of fellow POW's was created. In this system there are often striking condensations, displacements, and references so that one not thoroughly familiar with the system is hard put to understand its real meanings. Hence, the repatriates upon their return to ordinary civilian and military life could find a strange lack of understanding between themselves and those who had not been former prisoners. This might create for them a feeling of rejection, helplessness, and frustration in not being able to make satisfying human contacts. They might then find the greatest comfort for some time to come in meeting and talking to old fellow former prisoners who, alone amongst all others, would respond with some understanding of the pressing and non-explicit difficulties which they found.

5. Curiosity Seekers and Patronizers

Individuals who approached and questioned repatriates regarding their experiences, not out of genuine interest or concern, but rather through curiosity, would present a challenge to the returnee's ability to control hostility. Similarly, people who evidenced an overly sympathetic or overly solicitous attitude could evoke considerable anger.

6. Indoctrination

This did not constitute a problem for any previous group of repatriated prisoners. Throughout the Korean War considerable concern existed about the enemy's propaganda and indoctrination tactics. A warning note was sounded by Edward Hunter in his book, "Brain Washing in Red China" (17) in which he detailed the Communist's coldly calculated, highly systemized plan to alter men's basic attitudes and beliefs. The overconcern on the part of the public and press was heightened by Communist threats to Big Switch returnees that they would be severely punished by our Government upon their return to America. The unnecessary focusing on this area (indoctrination) diverted attention from the important therapeutic task of aiding in readjustment.

The Setting

Because of the importance of environmental factors opera ting upon the men at the time of their return, it is essential that the initial environment into which the men were placed be discussed in some detail.

In Operation Little Switch all of the repatriates were regarded as hospital patients and their care and subsequent transfer to America was entirely through medical channels. They were maintained for the first day and night of freedom at an Army Evacuation Hospital


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near Seoul, Korea. Here they received needed emergency medical care and were given a brief, initial physical examination. On the following day they were air-lifted to the two Tokyo Army Hospitals designated to provide their care. In these hospitals special wards were reserved for them. The former prisoners were not given the freedom of the hospitals or the city, ostensibly to conserve time in order that essential medical and administrative processing could be carried out. The regular hospital complement was augmented by additional medical and administrative personnel. The POW's were given certain unusual privileges such as a free telephone call home, short-wave bedside radios, special PX ward carts. Above all else, they were given copious quantities of that special nursing care known as "t. l. c." (tender loving care). The imposition of restrictions and limitations concerning their behavior and movements undoubtedly served as a reminder to them that they were, as before, still members of our country's fighting arm. Their Tokyo hospital stay was, unfortunately, all too brief and did not permit necessary psychotherapeutic intervention. At the end of 3 days the men were air-evacuated to America via Hawaii to Army hospitals nearest their homes, where their processing was completed.

In Operation Big Switch only the sick and wounded were regarded as medical patients and evacuated through medical facilities. The remainder, and by far the overwhelming majority, were accorded a status most closely resembling that of the rotatee who has completed his Korean tour of duty and is en route to the Zone of Interior. They were maintained at an Army Replacement Depot in Inchon, Korea, in an area specially set aside for them. It was obvious that all concerned had taken great pains to insure their comfort. The area was freshly painted and equipped. New shower units had been installed. A splendidly staffed Red Cross unit was in continuous operation. A PX was installed solely for the use of repatriates and was elaborately stocked with expensive radios, cameras, etc. In contrast to the ordinary rotatee they were given bunk-type beds with fresh linen. The entire area was decked out with such incongruous signs as "Howdy Partner," "Long Time No See," "Times Square and Broadway," "The Little Golden Gate."

The Replacement Depot, which was still charged with its customary function of processing normal rotatees, was understaffed and hard put to discharge its added difficult mission. Despite the fact that the repatriates were quartered in an Army Replacement Depot, there was little if anything to suggest to them that they were still members of the Armed Services. Discipline was extremely lax. Initially there were no formations. Retreat ceremony was never held. Saluting, either between prisoners or cadre was seldom seen. The repatriates


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were asked, rather than told, to keep appointments. As is so often the case, men who fail to be treated as soldiers fail to act like soldiers. Fully 30 to 40 percent of them failed to keep necessary appointments and could be found instead lounging in the PX, the Red Cross Recreation Room, the barber shop, shoe shine parlor, or simply lying on their beds. An increasing number of men jumped over the fence at night for an evening of drinking and play.

It soon became apparent to all concerned that a semblance of discipline was needed. The institution of two formations each day proved somewhat helpful. There was a mild "tightening up" by the cadre. Needless to say, no harmful effects by the change in policy could be detected. In fact, the author overheard one repatriate saying to another, "Boy, that Captain sure did chew me out." "Yeah," replied the other, "how did you feel about it?" "Boy, it sure felt great."

Aboard the troop ships carrying the men to the United States their "special treatment" continued. In addition to the POW's these ships also carried a large number of normal Korean rotatees (men who had completed their Korean tour of duty and were en route to the United States for reassignment or separation). The allocation of troop space differed between the two groups, with the repatriates being given additional living space. They were segregated from the other troops aboard as well as from the ship's complement. This did much to foster in them a feeling of being different and precluded a satisfactory group reintegration which we considered so necessary. An excellent narrative of the conditions and work performed aboard these ships may be found in an article by Lifton (18).

The Method

In Operation Little Switch the Department of the Army prescribed minimum standards to be met in the examination of prisoners of war, including a complete medical and physical examination. It was determined in the Far East Command that the psychiatric examination would consist of a psychiatric interview of at least 1 hour's duration, a complete psychological test battery (Wechsler-Bellevue, Rorschach, TAT, Miole-Holsopple and DAP Tests) and, where time permitted, a psychiatric social history. The men received their psychiatric evaluation in Tokyo within 24 to 48 hours of their arrival.

In performing the psychiatric examination, the psychiatrist usually began by introducing himself to the patient with the explanation, "I am a psychiatrist and I am interested in talking with you about any problems which may have arisen as a result of your imprisonment in order that I may be helpful not only to you, but also to your buddies." The examinee was then asked to discuss in detail the events leading up


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to capture. In so doing, the majority of men interviewed developed the story of their capture, their period of captivity, and their attendant feelings. Specific areas of interest which the psychiatrist investigated in detail were: Circumstances surrounding capture; attitude toward capture; narrative of prison experiences; attitude toward fellow prisoners; attitude toward captors; motivation and future plans. In addition, a minimal amount of background information in terms of family, schooling, religious preference, and siblings was obtained.

Psychological testing was performed in two separate testing periods. These tests were administered at varying times in the course of the POW's stay. The results of these tests are currently under analysis and will be reported at a future date.

At the time of the arrival of the first group of Big Switch returnees at Inchon, seven psychiatrists were available to carry out psychiatric examinations. When it became evident that only a minimal amount of time would be available for this task, because of the pressing need for administrative processing, additional psychiatric personnel were made available. The personnel selected for this task came from both the Far East Command and the Zone of Interior. Army, Navy, Marine Force, and Air Force personnel participated. A considerable number of the psychiatrists and psychologists received their initial briefing at the U. S. A. H. 8167 A. U. where the Big Switch sick and wounded had been evacuated. Many of the men were assigned briefly to the hospital on temporary duty in order to work with the prisoner patients.

A second briefing session was held at Inchon in which the author made full use of the experiences gained in Operation Little Switch. The psychiatric personnel then undertook the difficult task of interviewing the repatriates while they awaited ship at Inchon. The men thus seen were examined at periods ranging from 5 hours to 96 hours after their return to friendly hands. A minimum of 20 and a maximum of 80 returnees were seen daily. It was believed that the experience gained was responsible for making a coordinated well-integrated team of the psychiatric personnel assigned to the ships returning the repatriates to America. Each ship carried a psychiatric team consisting of senior psychiatrist, three psychiatrists, clinical psychologist and clinical psychology technicians or psychiatric social work technicians.

Group Therapy

The psychiatric evaluation as well as the initial clinical psychology impressions confirmed our initial impression that the Little Switch returnees could not be considered "normal." The men appeared not only to have no awareness of the specific problems of readjustment


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facing them, but also to lack the capacity to handle them. There was a clear and definite need for vigorous psychotherapeutic measures. With the pressure of time and personnel limitations under which we operated it was quite obvious that individual psychotherapy was not feasible. The group psychotherapeutic approach appeared ideal. Not only would such an approach conserve time and personnel, but it also would enable former prisoners to utilize the support of that group with which they appeared most comfortable in working through their problems. Accordingly, two pilot groups were organized, but met only twice. In general, the group of 8 to 10 men remained silent and appeared somewhat hostile toward the therapist. They failed to respond to a non-directive approach. When the session was structured by the therapist's introduction of specific problems facing the entire group they became more active and appeared capable of discussing these difficulties. While no one would be presumptuous enough to state flatly that these pilot groups were helpful to the participants, we nonetheless believed that with more time and more meetings such an approach would yield beneficial results.

It was therefore recommended most strongly during the planning phase of Operation Big Switch that all returnees who had been held captive for over 6 months be seen in group therapy. There was no time for this to be carried out at Inchon. However, all of the members of the psychiatric teams had been briefed regarding the need for and rationale of group therapy to be carried out aboard ship en route to the United States. It was felt that the 14-day voyage would enable the psychiatrists and clinical psychologists to hold at least six group therapy sessions of a reasonably structured nature. No effort whatsoever was to be made at delving into the past. Guilt uncovered in such a technic would have proven most difficult to deal with. Instead, the focus was to be on the "here and now" situation. Unfortunately, the press of administrative and other processing was so great that on some ships no group therapy was performed while on others only a few sessions could be held.

An appraisal of the effects of group therapy is contingent upon a carefully executed follow-up study utilizing controls. Such a study will be undertaken in the future.

Accomplishments

A total of 149 United States military personnel repatriated in Operation Little Switch received their complete psychiatric evaluation (including psychological testing) at the two Army hospitals in Tokyo. The comprehensive medical evaluation performed on 68 repatriates at the United States Army Hospital, 8167th Army Unit is reported elsewhere. Included is a brief survey of the psychiatric findings (15).


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In Operation Big Switch a total of 1,301 repatriates received their psychiatric examination (exclusive of psychological study) at Inchon. Two hundred and fifty sick and wounded repatriates, evacuated through medical channels, received complete psychiatric and psychological work-ups in Tokyo. Of the men seen in Inchon, 30 were considered overtly psychotic, pre-psychotic or severely neurotic. They were transferred to the Neuropsychiatric Center in Korea (the 123d Medical Holding Company) for interim care and ultimate transfer to the Neuropsychiatric Center in Tokyo. Ninety-three former prisoners were considered sufficiently disturbed and tense to preclude interview by the press or television reporters. Twelve repatriates, though obviously emotionally disturbed, were considered capable of returning to the Zone of Interior via ship with supportive care.

Psychiatric Findings

The initial psychiatric evaluation carried out in Operations Little Switch and Big Switch must be regarded as objectively cross-sectional rather than conclusive. The majority of repatriated prisoners of war observed manifested a moderate to marked degree of blandness, retardation, and apathy. These features had been previously noted amongst repatriated World War II prisoners of the Japanese and the term, "Zombie Reaction" was applied (19). In general, Big Switch returnees appeared more interested in their environment and somewhat less "Zombie"-like than did the Little Switch group. In most cases the blandness and apathy cleared spontaneously 3 to 4 days after repatriation and was then replaced by a mild degree of euphoria (happy "Zombies"). Talk was very shallow, often vague, and with definite lack of content.

The majority of men examined spoke with little coaxing or prompting by the interviewer. None of the Little Switch returnees appeared reluctant to submit to psychiatric evaluation. In some instances Big Switch personnel expressed opposition to psychiatric interview on the grounds that they "might violate security." It was believed that the Big Switch group were more guarded and suspicious during interview and demonstrated evidence of overt anxiety and concern regarding their future treatment by military and civil authorities. It appears reasonable to ascribe this anxiety to Communist statements of impending prosecution on their return to America as well as the avid interest shown by our press and television reporters regarding Communist indoctrination efforts (brain-washing).

In both groups of returnees it was strikingly evident that details of the events leading up to and immediately following capture were missing. In many cases their behavior when captured suggests a


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panic reaction with concomitant dissociative state and loss of memory for specific events. Many of the men spent painstaking hours with fellow prisoners in an effort to reconstruct the situation at the time of their capture. Virtually all of the men interviewed described an initial fear that they would be put to death by the enemy. They expressed considerable surprise at the treatment accorded them by the Chinese who gave every appearance of being friendly and helpful when taking them prisoner. Many prisoners openly expressed gratitude for the "good treatment" which they received. Actually, the "good treatment" merely meant that the Chinese did not torture or kill them as they had anticipated. Although most repatriates could clearly recall earlier fantasies of death or maiming, none remembered having fantasies of being taken prisoner of war prior to the time they were captured. Most said simply, "I never considered being captured as a possibility."

In discussing the "Death Marches" considerable resentment was expressed by some senior officers toward junior officers and noncommissioned officers whom they accused of selfishness, poor discipline, and failure to comply with orders. On the other hand, some junior officers and noncommissioned officers stated with considerable anger that senior officers defected, refusing to take command and to accept responsibility.

In the early stages of the war, particularly the period from July 1950 to April 1951, atrocities and stories of atrocities were rampant. Many of the men had personally witnessed, prior to capture, the results of North Korean atrocities. This undoubtedly exerted a strong "conditioning" effect so that when captured they believed they too would be torture victims; however, even after no further positive evidence of widespread atrocities existed, men, when captured, continued to be fearful and to anticipate torture and death.

Both the Little Switch and Big Switch repatriates demonstrated an incredible tolerance toward the medical and administrative processing. There was evidently no burning desire to return home immediately. Many were consciously aware of the anxiety engendered by their imminent return home and asked for additional time in which to "get on my feet." Others, perhaps through an unconscious attempt at delay, asked for leave or exaggerated minimal physical complaints in order to gain access to the less hurried medical channel of evacuation.

Little and Big Switch returnees during their brief period of observation in Korea and Japan appeared to be highly non-cohesive and isolated. The group identifications maintained prior to capture were, in several cases, absent. The repatriates often referred to themselves as, "The Americans" or "American Forces." It was not uncommon


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for men to respond to the question, "What unit were you with?" with the reply, "Camp number so and so."

A large number of the men examined appeared "suspended in time." They had a highly idealized picture of themselves and their family and had failed to take into consideration that both their families and themselves had changed during the period of imprisonment. There was little, if any, talk of future plans. Such plans for the future as were discussed appeared poorly conceived, of a short-term nature, often conflictual and highly unrealistic.

"Give-Up-Itis"

American medical officers held prisoner of war by the enemy have commented upon this "syndrome" which they observed at first hand amongst their fellow prisoners.

Symptoms and Course

Men who developed this syndrome were observed to abstain gradually from physical activity. They remained supine within the confines of their prison hut. With the passage of time, they withdrew more and more from all contacts and became mute and motionless. They refused to eat unless given large amounts of cold water. Eventually, they completely refused to eat and developed what amounted to an obsession for cold water. Finally they "turned their faces to the wall" and died. From the onset of first symptom to demise took a period of 3 weeks, "almost to the day."

Incidence

In units with poor morale and poor unit identification, this condition was responsible for a large number of deaths. "Give-up-itis" alone was considered the primary cause of 25 to 50 percent of all the prison camp deaths. In conjunction with exposure, "give-up-itis" accounted for 75 percent of the deaths, while in almost 100 percent of the cases a combination of "give-up-itis," exposure, and malnutrition was considered the cause of death. The condition was most prevalent amongst single, young, immature enlisted men from broken homes. It was rarely noted amongst noncommissioned officers or officers. In the 25-35-year-old age group regardless of rank, the condition was uncommon. It was rare amongst psychopaths. The syndrome is said to have been nonexistent amongst other Allied prisoners of war.

Treatment

In attempting to cope with this condition our captive medical officers at first made use of a sympathetic approach with exhortations to "remember the family," "the girlfriend," "wife," "friends." When


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this approach failed to yield results, the doctors then employed a stern, strict regimen in which they attempted to provoke hostility from the afflicted individual. They persisted in their anger-producing tactics until a positive hostile response was produced. When the individual was forced into this response early in the course of his syndrome he recovered completely and did not relapse in the future; however, the use of such a technic is most difficult for the anger thus induced is both profound and protracted. One physician employed the technic of forced eating to prevent deaths from "give-up-itis." He and his trained enlisted personnel supervised the prisoners' eating habits. Any prisoner who refused to eat was choked until he consented to take food. If the food was spit out it was re-fed to the individual.

Indoctrination

During the period prior to the entry of the Chinese Communist Forces into the Korean War, no indoctrination attempts were made by the enemy. The North Koreans proved themselves totally barbaric and ruthlessly cruel captors. The Chinese Communists, on the other hand, appeared more interested in indoctrination than in death and torture. This is not to say that they were the epitome of kindliness for their brutality too is well known. There was evidently no distinction between Chinese or Korean by our soldier when captured, since he regarded both as intent upon torturing and ultimately killing him.

At the time of capture, the Chinese, by word and deed assured the new prisoner that he would be unharmed and well treated. Most often he was offered a "friendly" cigarette. Though poorly fed, to be sure, the enemy was quick to point out, "We are feeding you the same food we eat-for we are your friends." To the soldier anticipating torture and death such treatment produced a considerable emotional confusion. How could he help but feel some gratitude to his new-found "benefactor" for having spared him from death itself? The silent removal of leaders from time to time during the course of imprisonment served as a constant reminder that one must continue to fear the future. Compliance and cooperation were achieved by subtle hints at torture, occasional physical mistreatment, chiefly in the form of slapping or the maintenance of uncomfortable positions for protracted periods, solitary confinement, deficient diet, dummy firing squads, and perhaps worst of all, threats of exile to Siberia and eternal non-repatriation. On the other hand, "good" behavior was rewarded by improved diet and living conditions. In some cases the enemy hinted at "early repatriation" and referred to a group of American Marines they had released in December of 1950, after a brief period of indoctrination.


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The Chinese utilized every possible method to deny the prisoners internal leadership. The relative absence of organized food, escape, disciplinary committees within the camp membership bears testimony to their success in this regard. Results were obtained first by segregating all officers into a special camp. The noncommissioned were similarly removed. This deprived the bulk of prisoners of their leaders with resultant deficient discipline, leadership, and morale. Into this leaderless group the Chinese injected the English-speaking Chinese Communist squad leader. He was responsible for the group's discipline, indoctrination, and for constant informing. Whenever natural leaders emerged amongst the prisoner group they were removed silently and expeditiously by the Chinese usually with subtle hints that they would never return again.

Before the group could adopt a new identity and pattern of behavior, it was essential that the old one be dissolved. This was achieved in part by denying that the prisoners were soldiers. They were addressed by their last name only and told that since they were now prisoners and war criminals they no longer had any rank. By adroitly regulating mail from home, the enemy made use of an insidious and ingenious method of cutting the home ties. Letters from home of a pleasant or at least neutral nature were deliberately withheld. Those of a complaining or pessimistic type were delivered uncensored to the men. Because of the depressing effect of such letters, many ceased to look forward to mail from home and tended to lose their identification with home.

The autobiography required of each prisoner presented the enemy with a powerful club to wield over their heads. Obvious misstatements were quickly discovered and employed as evidence that the prisoner had failed in his duty to "always tell the truth." One also paid a price for honesty and accuracy since it was not difficult to show that at least one member of the prisoner's family had committed a crime against the people and was an enemy of the people-a crime for which the prisoner must recant by good behavior. To the Communists there were no crimes against individuals-only crimes against the people. Hence the theft of a single turnip by a prisoner was a crime against the poor people of North Korea and the culprit a war criminal whose punishment could be exile to Siberia.

Isolation was nurtured also by the enemy's insistence upon the need to confess (inform) which was constantly stressed even though it implicated one's self, family, friends, or country. To fail to do so constituted a criminal act against the people, for which punishment was frequently given. Close relationships between fellow prisoners became virtually impossible under such conditions. Not only could one's own friends not be trusted, but no one could even be sure that


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he himself would not be the informer. To tell the truth once meant to tell the truth always. ("Why are you not telling us the truth this time? Have you changed and become an enemy of the people?")

Communist propaganda was disseminated largely by formal "classes" held under the supervision of the Chinese squad leader. The propaganda initially presented was not totally unreasonable or hostile so as to arouse the group's ire. So successful was the enemy at stimulating the anger of the prisoner group that there were very few evidences of organized or spontaneous resistance. The material consisted, in part, of questions as to "Why South Korea Had Invaded North Korea?" "America's Imperialistic Aims in Asia," "The Role of the Communists in Fostering Peace," "The Maldistribution of Wealth in America," "Racial and Class Discrimination," and "The Need for Peace." In addition to the squad leader, each group had an enemy-appointed monitor selected from amongst the group membership. He often proved sympathetic towards the Communists and worked with the squad leader in indoctrinating the men. A check on the squad's attentiveness in the classroom was maintained by questions about each day's lessons. The need for cooperation was stressed and subtle hints made at non-repatriation. The enemy made full use of defectors amongst our prisoners. Officers who confessed to germ warfare atrocities were taken on tours of the camps to tell the men of "the barbaric American germ warfare efforts." These presentations were evidently highly effective, for the majority of returned prisoners interviewed appeared quite convinced that we had employed such tactics.

The majority of our captured personnel did not have access to secret information; however, the Chinese repeatedly questioned them about Tables of Organization and Equipment, Field Manuals, and Training Manuals. The Chinese would often openly exhibit these documents to show that they already possessed the information but insisted nonetheless that the prisoner reveal all he knew of their contents. Many men tried to deceive the enemy by submitting false information. This was dealt with sternly and the prisoner threatened with the brand of "enemy of the people." Often, the Chinese would take the information and throw it in the waste basket with the enjoinder "Write it over again." When the second document was submitted the first would "reappear" and the two would then be compared. Any difference, no matter how slight, formed a basis for the accusation, "You are not telling the truth." Having once entered into this business, the prisoner could never turn back but must, perforce, produce more and more of the desired material ultimately betraying some bit, even though seemingly insignificant, of security material.


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There appears to have been considerable confusion amongst the prisoner group as to how they were to deport themselves in captivity. Hence, some believed that they were to "give name, rank, serial number only." Others maintained that their instructions had been "give name, rank, serial number and nothing else-unless the enemy looks like he really intends to get what he wants." Some understood their instructions to be to give the enemy anything he wanted to know except security information. In retrospect, it would appear that no compromise was possible. One either told absolutely nothing or was eventually maneuvered by the enemy into telling everything.

The Chinese divided prisoners into two categories: "Progressives" and "Reactionaries." These two terms, long associated with American political life, in the short period of months have now taken on an entirely different meaning. One has become an epithet synonymous with "Communist;" the other has become a badge of honor awarded anti-Communist. Within the prison environment and, as used by the enemy, the words have still different meanings.

The term "Reactionary" was given to those prisoners of war who for whatever reason either actively or passively opposed Communist ideology or who acted in violation of prison camp regulations. Amongst the group so labeled we find the "true heroes"-men who actively resisted all indoctrination efforts and who refused to impart any information whatsoever to the enemy. These men maintained their identity, integrity, and honor throughout the period of imprisonment. In general, they were ill-treated by the enemy, often subjected to torture, and most spent considerable time in solitary confinement. A very small number of prisoners who were psychotic during their incarceration were labeled "Reactionary" for, in their psychotic behavior, they defied the enemy by spitting, hurling invectives or rocks, etc. Also to be found within the "Reactionary" group were some men with life-long personality disorders. These men had a virtually life-long history of inability to accept authority and of constant rebellion thereto. In prison camp their continued course of aggressive behavior earned for them the label "Reactionary." They may be considered "Reactionary" by accident rather than by design.

Although the "Reactionary" group appears reasonably specific and capable of definition, the "Progressive" group is a confusing one by reason of its heterogeneousness. In general we may say that the Communists regarded anyone who accepted their views or at least did not actively or passively oppose them, as a "Progressive." Yet, this distinction on pseudo-political grounds breaks down quite readily. Amongst the group labeled "Progressive" by the Communists and their fellow prisoners we find a group of men with apparently little


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ability to withstand stress who early reacted to enemy threats, real or implied, by giving military information or by confessing to germ warfare charges. Although labeled "Progressive" by the enemy and the public, this group does not profess any sympathy whatsoever for Communism or its tenets and these men regard themselves as "Americans." Many are quite outspoken in their hatred of the Communists.

Informers have been labeled "Progressives." These men, during imprisonment, informed upon their fellow prisoners to curry favor for themselves in the form of better creature comforts. They do not regard themselves as Communists, nor is there anything to suggest that their behavior was politically determined. These men behaved no differently in prison camp than they had prior to imprisonment out of camp. They had and have no sense of loyalty or identification with any group. They act only for what they consider to be their own best interests. Nothing suggests that their behavior was contingent upon indoctrination. On the contrary, many were not sufficiently endowed intellectually to grasp the indoctrination material.

The largest group of "Progressives" were those prisoners who elected, in their words, "to play it cool." This group felt that the best method for survival during imprisonment was at least superficial cooperation with the enemy by not vigorously opposing the indoctrination program. Enemy petitions signed by these men were regarded by them to be relatively benign. There was a strong tendency to set limits for they consistently refused to sign what they considered to be traitorous allegations.

Another sub-group consisted of those having a rather naive desire to learn. These men displayed an avid, possibly sincere, interest in Communist teachings and literature. They were encouraged in this by the enemy who emphasized the need for them to "learn the truth." It need not be presumed that this group was of necessity indoctrinated. For the most part, these men were immature, insecure, and highly susceptible to the flattering interest shown in them by the enemy.

The smallest sub-group are those who were truly indoctrinated and in some cases at least, there is evidence to show that their indoctrination took place long before their capture in the Korean War. These individuals, as a result of the enemy's indoctrination efforts and their own personality deficits, radically altered their political beliefs and at the time of repatriation openly and unqualifiedly subscribed to Communism and its teachings. This small group considered themselves the elite "Peace-fighters." They have no doubt about their future plans. They will return to America and teach Communism! It is predicted, however, that for many their indoctrination will not


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last long and upon return to America they will once again alter their beliefs in order to conform with the majority. Many in this group are hysterics, schizoid personalities and psychopathic personalities. The total number or truly "indoctrinated" returnees is very small (20).

Areas for Future Investigation

1. Adequate counter-measures to employ against the enemy's psychological warfare efforts cannot be devised until we first become thoroughly conversant with his technic and rationales. To achieve this, a vigorous, scientifically objective dissection of the Communist indoctrination and propaganda efforts must be performed. There has been a growing tendency to regard the Communist enemy as supermen. Their program of brain-washing has been viewed, in some circles at least, as being so fiendishly diabolical that no one could possibly withstand its pressures. Yet, there are many amongst the returnee group who successfully withstood all of the enemy's indoctrination efforts. We would do well to study this group in an effort to learn what traits of character, personality types, mechanisms of defense, degree of intellect, etc., are needed to emerge victorious from the war designed to destroy basic loyalties and beliefs.

2. It may well be that the enemy's results have far more to do with our "weaknesses" than with his "strengths." One of the major forces sustaining a soldier during periods of combat stress is his close identification with his unit and, particularly, with his fellow soldiers. Many prisoners captured by the enemy in the early months of the Korean conflict showed a striking lack of identification and unit pride (esprit). The initial tactical situation in Korea necessitated the commitment to battle of large numbers of unseasoned troops. Urgently needed replacements were thrust into the breech without an opportunity to become acquainted with their leaders or fellow soldiers. Under such conditions it is not surprising to find that during their period of imprisonment they lacked a sense of "belonging," and had poor identifications. These men conceivably proved more susceptible to the enemy's indoctrination tactic of isolation.

Soldiers of other United Nations held prisoner of war by the enemy are reported to have remained cohesive and to have actively opposed the enemy's indoctrination efforts. No cases of "give-up-itis" are reported amongst this group.

These findings may be due to the fact that they were not subjected to as severe an indoctrination program by the enemy as were our forces. The explanation may lie, at least in part, in the fact that their men had strong unit identification, knew their fellow soldiers and leaders thoroughly and, above all, possessed a high degree of


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esprit and discipline. Without exception, these nations employed unit, rather than individual, rotation. When committed to battle, their combat units were well integrated and the men had a strong sense of "belonging" with friends who could be thoroughly trusted and relied upon. Under such conditions enemy efforts to cause loss of identification and subsequent isolation were hampered.

While it cannot be definitely concluded that unit rotation is one of the needed counter-measures to block enemy indoctrination efforts, there appear to be reasonable grounds for investigating this possibility.

3. In Operation Little Switch and Operation Big Switch stress was placed upon prophylactic psychiatric measures in an effort to forestall the so-called "POW Syndrome." An evaluation of the results of our planning can be gained only through a follow-up study of the repatriates. Similarly, the effects of Communist imprisonment cannot be measured merely by a study carried out immediately following repatriation. Further evaluation performed at varying time intervals are needed.

4. The potential combat soldier undergoes rigorous, thorough, detailed training so that he will be capable of properly deporting himself upon the battlefield. Yet, this same soldier receives only minimal, highly generalized information regarding his behavior if captured. He learns little about enemy tactics of interrogation and indoctrination. He may know nothing of the enemy's political system, his way of life, aims, and intents. Often, unfortunately, he knows very little about his own country, about Democracy and its true meaning and working. He is, at best, ill-equipped to withstand political discussion and indoctrination efforts. Although he has heard that it is important to resist the enemy and, indeed, to resist capture, he has been told little about how to accomplish this. His misapprehension of death and torture at the hands of the enemy remains uncorrected so that on capture he becomes emotionally confused by the enemy's seeming kindliness and benevolence. He has been told to "give name, rank, serial number . . . and nothing more" and when this avails him not, he is confused as to what to reveal and what to conceal. He has not been apprised of the enemy's specific weaknesses and of how to utilize them to disrupt his program. A revision of our current training regarding capture appears warranted. Admittedly, such a program is most difficult to devise for it is incumbent upon our Army not to discuss defeat (capture), but to stress victory (non-capture). Nonetheless, reality dictates that some men will be captured in battle. With proper training they will remain, even though prisoners of war, American soldiers, disciplined, loyal, and capable of constantly opposing their captors.


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Summary

1. Repatriated prisoners of war are confronted with specific problems of readjustment following repatriation. In the past, failure to resolve these problems has resulted in emotional "crippling" of an incapacitating degree. In Operations Little Switch and Big Switch group psychotherapy was prophylactically employed to forestall the "POW Syndrome" described following World War II.

2. The planning and method of the psychiatric evaluation performed on all repatriates of the Korean War is discussed. The initial findings, based on examination of 149 Little Switch returnees and 1,551 Big Switch returnees, showed the men to be retarded, disinterested in their environment, apathetic,and with carefully modulated affective display.

3. American medical officers held prisoner by the enemy noted a large number of prison camp deaths apparently caused by the "loss of the will to live." Men suffering from "give-up-itis," as it was termed by our captured doctors, died within 3 weeks of the appearance of the first symptom. Treatment of a palliative nature was not successful. The patients responded satisfactorily to an approach aimed at evoking strong hostility from them.

4. The Chinese Communists employed a technic of isolation and indoctrination, which has been termed "brain-washing," upon our prisoners. The technic and an initial appraisal of its effects are discussed in some detail.

5. Several areas for future study are suggested by the author:

    (1) Followup studies to measure the effects of imprisonment by the Communists and also to evaluate the results of prophylactic group psychotherapy.

    (2) A study of the traits of character, personality types, and mechanisms of defense of repatriates who successfully withstood the "brain-washing" program.

    (3) A change in information given combat soldiers with regard to their deportment should they be taken prisoners of war. Better knowledge of the enemy's weaknesses and methods of exploiting them as well as increased knowledge of the true meaning and working of Democracy.

    (4) A consideration of unit vs. individual replacement in an effort to foster strong identification with combat unit and fellow soldiers.

References

1. Arntzen, F. I.: Psychological Observations of Prisoners of War. Am. J. Phych. 104 : 446, 1947.


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2. Bettelheim, B.: Individual and Mass Behavior in Extreme Situations. J. Abn. Soc. Psychol. 38 : 417, 1943.

3. Bluhm, Hilde O.: How Did They Survive? Mechanisms of Defense in Nazi Concentration Camps. Am. J. Psychother. 2 : 3, 1948.

4. Brill, N. Q.: Neuropsychiatric Examination of Military Personnel Recovered from Japanese Prison Camps. Bull. U. S. Army Med. Dept. 5 : 429, Apr. 1946.

5. Bondy, C.: Problems of Internment Camps. J. Abn. Soc. Psychol. 38 : 453, 1943.

6. Cochrane, A. L.: Notes on the Psychology of Prisoners of War. British M. J. 1 : 282, Feb. 23, 1946.

7. Dearlove, A. R.: A Study of the Activities of Officer Prisoners of War. Brit. M. J. (pp. 406-409), March 24, 1945.

8. Greenson, R. R.: The Psychology of Apathy. Psychoanalyt. Quart. 18 : 290, 1949.

9. Jones, M., and Tanner, J. M.: The Clinical Characteristics, Treatment and Rehabilitation of Repatriated Prisoners of War with Neurosis. J. Neurol., Neurosurg., & Psychiat. 11 : 53, 1948.

10. Kirman, B. H.: Mental Disorders in Released Prisoners of War. J. Ment. Soc. 92 : 808, 1946.

11. Kral, V. A.: Psychiatric Observations under Severe Chronic Stress. Am. J. Psychiat. 108 : 185, September 1951.

12. Nardini, J. E.: Survival Factors in American Prisoners of War of the Japanese. Am. J. Psychiat. 109 : 241, October 1952.

13. Sitter, S. C.: Psychiatric Reactions Observed on Corregidor and Bataan in Japanese Captivity. Proc. Neuropsychiat. Conf. Sixth Serv. Command (pp. 5-9), 1945.

14. Wolf, S., and Ripley, H. S.: Reactions among Allied Prisoners of War Subjected to Three Years of Imprisonment and Torture by the Japanese. Am. J. Psychiat. 104 : 180, 1947.

15. Gibson, H. C., Schlichter, J., and Segal, H. A.: Repatriated American POW's with Special Reference to Avitaminosis, Tuberculoses and Intestinal Parasites. The Medical Bulletin of the United States Army, Far East 1 : 154, August 1953.

16. Segal, H. A.: Initial Psychiatric Findings of Recently Repatriated Prisoners of War. Read at Annual Meeting of the American Psychiatric Association, St. Louis, 3-7 May 1954.

17. Hunter, E.: Brain Washing in Red China. Charles E. Tuttle Co., Vanguard Press, Inc., New York.

18. Lifton, R. J.: Home by Ship: Reaction Patterns of American Prisoners of War Repatriated from North Korea. Am. J. Psychiat. 110 : 732, 1954.

19. Peterson, D. B.: Personal communication.

20. Peterson, D. B.: Prisoners Swayed-Didn't Fall. Interviewed by U. S. News and World Report, p. 28, 28 Aug. 1953.