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Appendix C

Contents

APPENDIX C

Meeting of Neuropsychiatric Consultants, Office of The Surgeon General

21 APRIL 1945

REPORT OF THE COMMITTEE ON PERSONNEL 

Committee Members

Lieutenant Colonel Thom, Chairman

Colonel Porter

Doctor Zabriskie 

Major Berlien

Captain McClung

The committee made the following recommendations:

1. That Service Commands make an effort to equalize medical officer personnel with patient load within their commands.

2. That the Service Command Consultants submit the names of officers who should be selected for early rotation and the names of officers who desire oversea service.

3. That in making reports of station visits, the consultants give a review of the neuropsychiatric personnel with their MOS [military occupational specialty] numbers and any recommended change in MOS.

4. That the consultants select candidates for MAC [Medical Administrative Corps] OCS [Officer Candidate School] from enlisted psychiatric social workers (SSN 263) within their commands.

5. That no key personnel be moved from a command without notification of the command headquarters.

6. That Service Command consultants select candidates for training at the School [School of Military Neuropsychiatry] from among officers who have returned from overseas and officers who are unfit for oversea service.

REPORT OF THE COMMITTEE ON HOSPITALIZATION

Committee Members

Colonel Bleckwenn, Chairman

Doctor Parsons

Lt. Colonel Brill

Lt. Colonel Dunn

ADMINISTRATIVE PROBLEMS

1. Enforce administrative discharges in theaters. Avoid evacuation and medical channels.

2. Work-up of psychopaths only-return to duty. Send psychiatric report with recommendations to line officers for future reference.

3. Expedite transfer of patients interhospital by telegram to regulating officer and direct emergency transfer when permitted.

4. Eliminate abuse of channels for separation of individuals with diagnosis "Psychoneurosis."

a. Differentiate between illness and attitude.
b. Stop prostitution of professional judgment.


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c. NP [Neuropsychiatric] Department not a CDD [certificate for disability discharge] mill.

5. Recommend fusion of [AR] 600-500-CDD Boards.

6. Recommend recovered acute psychotics to duty.

7. Recommend paroxysmal disorders (occasional attack) be retained on duty status.

8. Request clarification AR 615-368 on homosexuals.

9. Request reinstitution of AR 615-365 for special cases (recovered psychotics, etc., not fit for further duty).

10. Hold Service Command meeting for psychiatrists and psychologists when minutes of this meeting are made available.

CONVALESCENT HOSPITALS

1. Dearth of personnel.

2. Deficiency of supplies and equipment (acceptance of gifts and utilization).

3. Immediate organization of receiving center (initial screen helps NP group).

4. Set out sights at 50-60% return to duty of NP casualties.

5. NP Division should have own CDD, Disposition, 368, 369 Boards.

6. Establish necessary machinery geared up to process 50 dispositions per day (units with 2,000 NP patients).

7. Use of psychologists and social workers in group therapy.

8. Men should go to duty from NP Division without advanced reconditioning if marked for limited service.

REPORT OF THE COMMITTEE ON PREVENTIVE PSYCHIATRY

Committee Members

Lt. Colonel Smith, Chairman

Lt. Colonel Brosin

Doctor Gregg

Major Appel

The Committee concluded that the most effective means by which service command psychiatrists can prevent psychiatric disorders are as follows:

1. By formulating opinions and advising the command on matters of administrative policy and procedures which affect the mental health of military personnel. Top priority at present should be given to:

a. Ensuring that emphasis is being placed on providing adequate treatment at the dispensary level.
b. Ensuring that ineffectives who are primarily attitude or morale problems are handled administratively rather than disposed of through medical channels.
c. Ensuring that psychiatric opinion is available to command on the most effective means of handling redeployment, problems of classification, training, discipline, furloughs and providing incentive for effective behavior.

2. By education of military personnel in psychodynamics. Top priority at present should be given to:

a. Education of commissioned and noncommissioned officers in the psychiatric aspects of leadership.
b. Mental Hygiene instruction of enlisted men. Advice and criticism on techniques in public speaking should be given to psychiatrists who present the TB MED 21 type of information to enlisted men.

c. General medical officers-instruction in psychiatry.

d. Instruction of the public in the nature of the military psychiatric problem.

3. By collaborating in the formulation of information and orientation programs designed to influence attitudes and beliefs of military personnel. Top priority at present should be given to the content of programs planned for returnees during redeployment.


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REPORT OF THE COMMITTEE ON REDEPLOYMENT

Committee Members

Lt. Colonel Barnacle, Chairman

Lt. Colonel Farrell

Dr. Strecker

Major Goldman

I and E [Information and Education] Division is working on this problem and has a large responsibility. However, it is recognized that there are medical and psychiatric implications. Therefore, the following recommendations are offered:

1. Prevent hospitalization if possible.

2. Full utilization should be made of consultation service and outpatient departments of hospitals where redeployment is located.

3. Strengthen existing neuropsychiatric personnel with overseas men, if possible, and establish new Consultation Services in those camps where none exist or utilize the Division Neuropsychiatrist in this capacity.

4. Orientation projects recommended:

a. Movies.
b. Modifying TB MED (12 and 21) or production of a new TB MED for psychiatrists and enlisted personnel and officers stressing the need for "continuing the job."

5. It is recommended that no psychiatric screening as such be utilized at Redeployment Camps. Advise that any physical examination to be done be made before furlough and that statement be signed by soldier prior to furlough. Cooperation of the line and medical officers needed. A psychiatrist should be available for consultation only as indicated above.

6. Free use of sick-in-quarters in lieu of hospitalization except where there are definite indications for special care.

7. Maintenance of unit identification in redeployment. Officers and men should remain with their old units.

8. That dispensary care be utilized in medicine and surgery in treating the redeployed men.

9. Consideration should be given to the education of the families of the men who are being redeployed.

REPORT OF THE COMMITTEE ON CONSULTATION SERVICES, CLINICAL PSYCHOLOGISTS AND PSYCHIATRIC SOCIAL WORKERS

Committee Members

Colonel Ebaugh, Chairman

Lt. Colonel Seidenfeld

Major Guttmacher

Captain Goldberg

A. CONSULTATION SERVICES

1.  These units should be designated as "Consultation Services" throughout the Army.

2. The personnel in them should be based on the established trainee strength. There should be per 10,000 trainees:

a. One psychiatrist.
b. One clinical psychologist.
c. Three social workers (SSN 263).
d. Two personnel consultant assistants (SSN 289).
e. Three clerks.

3. Functions of the Consultation Services are well formulated in the pending TB MED on Consultation Services.

4. It is recommended that the Replacement and School Command and the Office


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of the Surgeon of the Army Ground Forces consider the advisability of assigning a psychiatrist to the staff of Replacement and School Command. The psychiatrist should have had experience on the staff of a Consultation Service.

5. Consultation Services should be established in redeployment centers. They should be preferably staffed by overseas personnel.

B. CLINICAL PSYCHOLOGISTS

1. A goal of at least 200 commissioned psychologists should be established.

2. Consideration should be now given to the advisability of training selected enlisted men to prepare them to serve as assistant psychologists.

3. In installations where patients are receiving vocational guidance, as part of the treatment program, the interpretation of such counseling should be left to the direction of the psychiatrist and the psychologist rather than to separation counselors.

C. PSYCHIATRIC SOCIAL WORKERS

1.  Every possible avenue should be explored to discover enlisted personnel who through civilian experience in correlated fields are capable of being trained as military psychiatric social worker assistants.

2. The commissioning of selected, well-qualified social workers is advocated.

3. The appointment of a commissioned psychiatric social worker to each Service Command Headquarters is recommended.

4. It is estimated that there should be two psychiatric social workers to every psychiatrist, for all types of installations where the latter are used.

5. Schools for the training of qualified and potential psychiatric social workers, already in the Army, should be promptly established.

6. It is recommended that the Service Command Neuropsychiatric Consultant, in cooperation with the Personnel Consultant of the Service Command, should exert his efforts to insure the full utilization of psychologists and social workers in their respective professional specialties. 

REPORT OF THE COMMITTEE ON PROBLEMS OF THE MILITARY OFFENDER

Committee Members

Lt. Colonel Schroeder, Chairman

Lt. Colonel Bloomberg

Major Hilger

Captain O'Kelly

1. It is assumed that the basic philosophy of the Correction Division is:

a. Restoration to duty of as many men as possible.
b. Maintain the deterrent value of incarceration of offenders as it related to potential offenders in the population.
c. Protection of society as long as possible from those who cannot be rehabilitated and whose crimes consist of offenses against property and/or persons.

(Note: In carrying out the previously mentioned functions, punishment will not be considered as the primary aim of the Correction Division. This does not exclude the temporary needs for punishment for maintenance of discipline.)

2. Resocialization of military offenders constitutes the primary objective of Rehabilitation Centers.
 

3. Role of psychiatrists in Rehabilitation Center.

a. Primary function is diagnosis and treatment of the individual.
b. Since treatment involves manipulation of the environment, the psychiatrist should serve in a staff advisory capacity to aid in the proper modification of training program and doctrines.
c. He should be a member of the classification board.

4. Qualifications of staff personnel in Correction Centers:


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a. The psychiatrist should have experience and/or training in penology, or at least related experience such as in criminal or juvenile court work.
b. The administrative and training staff should have experience and/or training in penology and this pertains especially to those serving on P and S [Psychiatry and Sociology] Boards.
c. It is advisable to have members of the P and S Board as members of the classification board and in fact a single board could cover the functions of both.

5. Psychiatric knowledge should be brought to bear on the problem of military offenders in the following order of decreasing importance:

a. AWOL [absent without leave] and other less serious violations.
b. Expert testimony when requested in court-martial cases.
c. Rehabilitation center psychiatry.
d. United States Disciplinary Barracks psychiatry.

6. Concurrence is given to the 12 points listed below as psychiatrically important in "The Conference on Rehabilitation of Military Prisoners," Fort Leavenworth, Kans., 14-16 November 1944. Specifically it is recommended that in testimony for the P and S Board a diagnostic label not be made but in lieu of such a diagnosis the individual under consideration should be stated to be "not deemed restorable on NP grounds" or "deemed restorable on NP grounds," followed by a pertinent statement as to the essential psychiatric and personality characteristics of the individual concerned.

a. Establish a classification board to plan and periodically review the rehabilitation program for each individual and the total rehabilitation program. Psychiatric evaluations should contribute to the board decisions.
b. P and S Board should contain complete records on each man, including the findings, claims, dispositions, recommendations, etc.
c. The practice of giving a diagnostic label should be discontinued.
d. Group psychotherapy should be fully utilized.
e. Special types of cases causing problems in detention should be the subject of special psychiatric investigation with a view of making general recommendations as to their care and disposition.
f.  A scientific "Follow-up System" should be instituted to determine the degree of success or failure of our methods with cases returned to duty.
g. A manning guide should be prepared to include personnel assistants to the psychiatrist in detention centers.
h. Standards of qualification of all personnel working with prisoners should be formulated.
i.  A training program should be instituted for personnel working with prisoners.
j.  Means should be provided for the exchange of ideas, methods, and policies between psychiatrists and psychologists doing this work.
k. Technical libraries dealing with criminology, penology, psychology and mental hygiene should be provided.
1. Studies should be undertaken to determine and formulate methods of preventing military violations.

7. A TB MED should be prepared on the subject of psychiatric testimony in matters pertaining to legal responsibility.

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