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Chapter IV



Education and Training

William C. Menninger, M.D. 


Three factors led to placing a major emphasis on the educational and training aspects of the neuropsychiatric program in the Army-the insufficient number of specialists in neuropsychiatry in the Army, the persisting nationwide shortage of psychiatrists, and the inadequacy of training in psychiatry in civilian medical schools.

The Regular Army had a minimum of trained men in the field of neuropsychiatry (p. 41), only four of whom had been certified by the American Board of Psychiatry and Neurology, and two of these were approved by credentials because of age.1 With the exception of a few previously mentioned (p. 18), most of the Regular Army psychiatrists were used in administrative capacities, though some of these assignments were related to psychiatry. To direct its wartime psychiatric program, the Army had to recruit specialists from an already insufficient number of civilian specialists. In civilian life, psychiatrists had never constituted more than 2 percent of the practicing physicians, and approximately 80 percent of these were concerned with institutional work, mainly in State hospitals. The corresponding type of work in the Army, namely, with psychotic patients, constituted less than 10 percent of the total psychiatric service, although the incidence of psychosis was not greatly different from that in civilian life. One might conclude that psychiatric practice in the Army was proportionately 10 times as extensive as in average civilian community practice, if limited to institutional work. Consequently, even initially, there was an acute shortage of neuropsychiatrists, and this was more of a problem in view of the comparatively large number of physicians whose experience had been limited to work with psychoses.

A second factor, inseparably linked with the shortage of psychiatrists, was the very rapid increase in psychiatric casualties. Within the first year of the war, the job of providing care for these casualties grew to extensive proportions and, as the magnitude increased, the relative shortage increased also.

A third factor resulted because of the inadequate training in psychia­

1Col. Cleve C. Odom, MC, and Col. William C. Porter, MC.


try in the average medical school. It is an admitted fact that the majority of medical students, at the time, graduated without any clear understanding of the anatomy, the physiology, and the pathology of the psyche. Consequently, it was impractical merely to assign younger medical officers or general practitioners to the overworked neuropsychiatric sections in hospitals, although necessity required this in many instances. It was not uncommon to find a surgeon or an obstetrician who had had a year of State hospital work immediately after graduation, followed by training and the practice of his own specialty for 10 years or more, assigned to the psychiatric section of the hospital. Furthermore, it was recognized that, even though a man might be a well-qualified psychiatrist, an important aspect of his Army psychiatry necessitated his learning the administrative aspects concerned with the field, such as Army regulations dealing with psychiatry, methods and procedures in dispositions, testimony before boards, courtsmartial testimony, and current policies as given in circulars and manuals.

Just as in all other phases and aspects of psychiatry, no prewar plans had been made for psychiatric indoctrination or education. The evolution of the educational efforts again illustrates the struggle in which each step taken was an attempt to meet an emergency and a very critical problem. Many of the eventual progressive moves could not have been planned, even at the onset of the war, and, in almost every instance, there was only manpower and time to attack the most acute and immediate problem. It probably will be repeated here and elsewhere that the lessons learned in World War I and recorded for posterity2 went unheeded. This indictment cannot go unchallenged because the actual interpretations of the lessons learned varied with the individual who interpreted them. So, heeded or unheeded, the problems that arose had to be solved when they presented themselves in World War II.

Within 6 months after Pearl Harbor, the Neuropsychiatry Branch (later the Neuropsychiatry Consultants Division), SGO (Surgeon General's Office), became aware of the national shortage of trained psychiatric potential for the Army and of the need for intensive training in this field. Consequently, after investigating this aspect of military manpower, the chief of the branch submitted a memorandum to the chief of the Professional Service, SGO, recommending that training courses in military neuropsychiatry be established.3 This memorandum brought out several pertinent points of reasoning. First, it brought out the increase in neuropsychiatric disorders already recognized at this early date. Second, it focused on the inexperience of newly recruited medical officers to the "mental disorders peculiar to military life." Third, it recognized the difficult transi­

2The Medical Department of the United States Army in the World War. Neuropsychiatry. Washington: U.S. Government Printing Office, 1929, vol. X.

3Memorandum, Col. Roy D. Halloran, MC, and Maj. Malcolm J. Farrell, MC, for Brig. Gen. Charles C. Hillman, 1 Sept. 1942, subject: Training Courses in Military Neuropsychiatry for Medical Officers.


tion of many psychiatrists from civil to military life "without assistance." Fourth, it heralded the need to amalgamate the varied thoughts of psychiatrists and psychiatric schools of thought into a uniform, single, acceptable form of military neuropsychiatry. Fifth, it anticipated the advent of "more serious problems of forward combatant areas, for which many will have no preparation."

The memorandum contained the proposal that Col. William C. Porter, MC, then Chief, Neuropsychiatry Section, Walter Reed General Hospital, direct this teaching and training program at the Walter Reed Army Medical Center, Washington, D.C. The course was to last from 4 to 6 weeks and was to be established primarily to orient those psychiatrists who had come from civilian life to the peculiar military aspects of psychiatry so that they could promptly function more efficiently and in a uniform manner. The memorandum further spelled out the required staff of the school which was a modest estimate of four instructors, including the director. It also presented the novel idea that the teaching team could later move to various Army centers to instruct medical officers in the surrounding areas. Supplementation of the team by service command consultants and prominent civilian specialists was also recommended.


With only tentative approval gained, plans were started for the development of a 4-week course in military neuropsychiatry, limited to those medical officers who had at least 1 year's training or experience in psychiatry or neurology, or both. Colonel Porter, as recommended, was designated director of "The School of Military Neuropsychiatry" and was to remain in this assignment throughout the war. However, prior to this assignment, Colonel Porter was actively engaged in the training of psychiatrists at Walter Reed. Official approval was eventually obtained from The Adjutant General,4 and the school was organized and began functioning on 20 December 1942 at Lawson General Hospital, Atlanta, Ga. Here, Brig. Gen. William L. Sheep, a Regular Army psychiatrist, was the commanding general, and Lt. Col. Joseph S. Skobba, MC, was the chief of the Neuropsychiatric Section. Their active and gracious collaboration greatly facilitated the teaching program of the school. The first nine courses, including, on an average, 30 students each, were conducted at Lawson General Hospital, and the course was specifically planned to orient the trained or experienced psychiatrist and neurologist to the practice of military neuropsychiatry.

4War Department Memorandum No. W350-134-42, 4 Dec. 1942.


Later Changes

In October 1943, the school was moved to Mason General Hospital. Brentwood, Long Island, N.Y. Mason General Hospital had been designated as a specialized treatment hospital for neuropsychiatric casualties, and it was believed that the training program could take advantage of the increased clinical facilities. As indicated previously, the initial plan was to orient psychiatrists who came into the Army directly to their military assignment. Over 400 of the psychiatrists coming into the Army from civilian life had the advantage of this course. In the spring of 1944, it was apparent that the acute shortage of trained psychiatrists would continue so the general program of the school was reoriented to provide a 12- instead of a 4-week course for intensive training of medical officers who had had no previous psychiatric experience. With the exception of the two "fill-in" courses of 6 weeks, this latter plan was continued at Mason General Hospital until 22 December 1945, when the 23d and last class graduated.

The inclusive dates of the last 12 courses and the number of graduates are listed in the following tabulation:

Inclusive dates

Number of graduates

20 December 1943-15 January 1944


17 January 1944-12 February 1944


14 February 1944-11 March 1944


13 March 1944-8 April 1944


15 April 1944-8 July 1944


10 July 1944-30 September 1944


2 October 1944-11 November 1944


20 November 1944-10 February 1945


19 February 1945-12 May 1945


21 May 1945-30 June 1945


9 July 1945-27 September 1945


8 October 1945-22 December 1945





Since 308 students had completed the first 11 courses and 692 the last 12 courses, exactly 1,000 students were trained.


Program of Instruction

The approved master schedule for the 600 hours (12 weeks' course) and 300 hours (6 weeks' course) included the following subjects:


12 weeks' course

6 weeks' course

Basic military training



Review of neuroanatomy, physiology, and pathology



Clinical neurology



Clinical psychiatry (emphasis on borderline and minor psychiatric deviations)



Special Army problems



Psychological testing



Reserved by commandant for special speakers






In carrying out the training, an absolute minimum number of didactic lectures had to be given in order to meet the requirements as approved by the War Department.5 Applicatory exercises in the form of clinical clerkships and critiques were the important features of the course. In addition, demonstrations were freely used, and conferences consisting of roundtables, forums, and informal discussions were irregularly included.


The pressure to obtain a greater number of embryonic neuropsychiatrists at a faster speed resulted in arrangements to institute a similar course in civilian installations. The director of the Neuropsychiatry Consultants Division was given authority to contact four medical schools in New York City, and arrangements were satisfactorily made with Columbia University and New York University to provide the 600-hour, 12 weeks' course. Both of these universities did conduct three such courses.

The first class was conducted from 15 April 1944 to 8 July 1944, with 39 officers completing at Columbia University and 28 at New York University; the second class was from 18 November to 10 February 1945, with 34 officers completing at Columbia University and 29 at New York University; the third class was from 1 September to 24 November 1945, with 47 officers completing at Columbia University and 50 at New York University. Dr. Nolan D. C. Lewis was directly in charge of the classes at Columbia Uni­

5The list of the instructors at Lawson and Mason General Hospitals with rank held at time of assignment is as follows: Col. William C. Porter, MC, Director, 15 Dec. 1942-31 Dec. 1945; Lt. Col. M. Ralph Kaufman, MC, 15 Dec. 1942-30 Aug. 1943; Maj. Joseph Fetterman, MC, 15 Dec. 1942-11 Mar. 1944; Maj. William H. Everts, MC, 17 Dec. 1942-1 Oct. 1943; Maj. James L. O'Leary, MC, 10 Oct. 1943-22 Dec. 1945; Maj. Jackson M. Thomas, MC, 6 Sept. 1943-4 June 1944; Lt. Col. Baldwin L. Keyes, MC, 1 May 1944-11 Nov. 1945; Lt. Col. Ralph T. Collins, MC, 10 Apr. 1944-22 Dec. 1945; Capt. (later Maj.) Herbert Spiegel, MC, 28 Aug. 1944-22 Dec. 1945; Maj. Henry A. Davidson, MC, 26 Feb. 1945-15 Dec. 1945; Capt. Leonard R. Sillman, MC, 10 June 1944-1 Mar. 1945; Maj. William H. Dunn, MC, 5 June 1944-30 Aug. 1944; Maj. Benjamin H. Balser, MC, 18 Nov. 1943-9 Apr. 1944.


versity, and Dr. S. Bernard Wortis was in charge at New York University. Instruction was provided by the faculties of these two universities. Maj. Norman Reider, MC, was placed on temporary duty by the Medical Department to serve as coordinator for these classes and to give the lectures on strictly military subjects. He was assisted by 1st Lt. (later Capt.) Bernard J. Lamb, MAC, in the first two classes.


The value of this training in neuropsychiatry was inestimable. The schools, at Lawson and Mason General Hospitals combined, graduated 1,000 men. The university schools graduated 227. At least two-thirds of the total number had no previous psychiatric training, other than the minimal lecture courses given in medical schools. Although they could only be classified as "D" specialists (in a ranking A, B, C, and D classification), they tremendously augmented the neuropsychiatric staffs of the medical installations throughout the Army. There is abundant evidence, obtained from observation by experienced psychiatrists, that these men did a very creditable job and that the relatively short training did give them a functional orientation which permitted them to do good psychiatry on their assignments. Since the majority had been general practitioners in civil life, they not only maintained a trained eye on possible organic disturbances, but also became acutely aware of the existence of psychological concomitants as well as purely psychological illness. By their recent alliance with medicine, their eagerness to learn, and the judicious application of their learning in a field quite new to them, they materially assisted in mounting liaison between psychiatry and the other fields of medicine. This training program was regarded as one of the most important and successful achievements during the war to meet the overwhelming neuropsychiatric problem in the Army. After the war, many of these men had become so interested in the specialty, that they entered psychiatric residencies and thus swelled the ranks of psychiatrists, so sorely needed throughout the country.

Recognizing that the School of Military Neuropsychiatry had been such an essential training project, the Training Division, SGO, when asked to reduce to a minimum the training activities following V-J Day, recommended continuation of this school indefinitely among the very few medical training units to be preserved. Looking forward to the postwar Regular Army training program, the school was officially moved to Fort Sam Houston, Tex., on 1 June 1946, to be associated with the Brooke Army Medical Center at that post, in orders issued from the Headquarters of the Second Service Command, 10 January 1946.



By force of necessity, neuropsychiatrists were trained in all the major oversea theaters. In some locations, formal training courses in specific medical units were established and trainees were assigned on orders. Some training, because of the exigencies of the tactical situation, had to be done on the job; sometimes, under enemy fire; and at times, meetings or "bull sessions" served to exchange experience procedures and methods in psychiatric care. The training in the oversea theaters is detailed in the sections relating to these various areas.

European theater.-Two special efforts of many, one in the European theater and one in the South Pacific Area, are worthy of mention. In the European theater, the 312th Station Hospital (NP) made training one of its major activities. This was largely organized through the efforts of the theater Senior Consultant in Neuropsychiatry, Col. Lloyd J. Thompson, MC (fig. 10), with the help of the commanding officer of the hospital, Col. Ernest H. Parsons, MC (fig. 11). A school of military neuropsychiatry was organized under the immediate direction of Maj. (later Lt. Col.)

FIGURE 10.-Col. Lloyd J. Thompson, MC, Senior Consultant in Neuropsychiatry, Office of the Chief Surgeon, European Theater of Operations, U.S. Army.


Jackson M. Thomas, MC (fig. 12), who was later succeeded by Maj. Howard D. Fabing, MC. Training for general medical officers was also given at th 36th Station Hospital (NP) in June and again in November and December 1943.

The training program for general medical officers of combat units was given continuously at the 312th Station Hospital (NP) from 27 December 1943 to 15 July 1944. The prepared course was of 1 week's duration, and during this time interval, 768 general medical officers attended the school. Again and again, the officers assigned began the course with skepticism and indifference and almost invariably ended with enthusiasm and appreciation. The primary aim was to instruct these officers in the recognition and first aid management of psychiatric battle casualties, since the majority of the group were to serve with combat troops. The effort of this school in orienting, psychiatrically, this large number of medical officers was probably one of the most significant factors in the low rate of evacuation of psychiatric casualties from the European theater.

South Pacific Area.-In the South Pacific Area, two formal schools were held, one for the 27th Infantry Division and one for the 81st Infantry Division. The school for the 27th Infantry Division was held from 1

FIGURE 11.-Col. Ernest H. Parsons, MC, Commanding Officer, 312th Station Hospital (NP), European Theater of Operations, U.S. Army.


FIGURE 12.-Maj. (later Lt. Col.) Jackson M. Thomas, MC, Director, School of Military Neuropsychiatry, European Theater of Operations, U.S. Army.

January 1945 to 31 January 1945 at Espíritu Santo in conjunction with the 25th Evacuation Hospital and the 122d Station Hospital. The courses were organized under the direction of Lt. Col. (later Col.) M. Ralph Kaufman, MC (fig. 13), and Lt. Col. (later Col.) Edward G. Billings, MC (fig. 14). In addition to providing the instruction for 32 medical officers, 13 chaplains were given psychiatric orientation, 99 selected line officers attended five lectures, and all officers of the division, totaling 225, attended one general session.

The school for the 81st Infantry Division under Colonel Billings was held from 12 February 1945 to 10 March 1945 and utilized the 8th and 29th General Hospitals. Sixty-seven medical officers and seventeen chaplains were given training at these courses. One session was held for all officers of the division, totaling 300 men.


The training of nurses, psychologists, psychiatric social workers, neuropsychiatric technicians, and aids is detailed in respective chapters


FIGURE 13.-Lt. Col. (later Col.) M. Ralph Kaufman, MC, Neuropsychiatric Consultant, South Pacific Base Command.

dealing with these paramedical personnel, and likewise, oversea efforts at training are described in the respective theater histories.


There is little doubt that the psychiatric casualty rate both in combat and in noncombat conditions reflected in some degree misunderstanding between the line and medical officers. A fair percentage of line officers had no understanding of psychopathology. They did not want to be bothered with noneffective soldiers. They learned that one of the convenient methods of getting rid of these soldiers was to refer them to the Medical Department. On the other hand, comparatively few medical officers had had field duty, either combat or otherwise. They did not always clearly understand the problems confronting the line officer. When this factor was combined with lack of knowledge and understanding of psychiatric casualties because of faulty medical education, there is little doubt that the Medical Department contributed its share of disposing of psychiatric casualties who might have performed adequate duty.


FIGURE 14.-Lt. Col. (later Col.) Edward G. Billings, MC, Neuropsychiatric Consultant, South Pacific Area.

It was obvious to many thoughtful individuals that two major educational efforts should be made relating to psychiatry: First, to teach medical officers psychiatry and the most expeditious methods of providing psychiatric care to both combat and noncombat casualties; and second, to give the line officers a better understanding of the Medical Department's attitudes and aims toward these types of patients.

It would be impossible to portray adequately the extent of the educational effort that was put forth toward both of these aims. Most of it had to be done through personal and individual contact. Every consultant regarded these objectives as among his most important functions and, undoubtedly, spent a large proportion of his time in educating individuals in groups, through personal contact, conferences, meetings, and schools.

Efforts to indoctrinate general medical officers were a part of the efforts of the Surgeon General's Office and the service commands. The most tangible results were probably evident in the mental hygiene con-


sultation services and in each basic training camp through the office of the psychiatrist in charge of the mental hygiene consultation service. Six hours of psychiatric instruction were given to students at the Medical Field Service School, Carlisle Barracks, Pa., although this was never very satisfactory for lack of a suitable instructor. Because of the demand, WD (War Department) Technical Bulletin (TB MED) 94, "Neuropsychiatry for the General Medical Officer," was issued on 21 September 1944 and was widely disseminated. It was used as the basis for staff meetings, medical meetings, and seminars, and presumably a copy was given to every medical officer.


Formal Program

The desirability of giving all Army officers some understanding of mental hygiene concepts was recognized, particularly as it pertained to leadership and in the hope that such knowledge would reduce the number of psychiatric casualties. On this basis, the Neuropsychiatry Consultants Division was able to include in WD Circular No. 48, issued on 3 February 1944, the provision that 6 hours of lectures in mental hygiene be given to all Army officers. This circular also prescribed 3 hours on the same subject for all enlisted men. The publication of this circular was followed shortly by an outline of these prescribed lectures, the one for officers in TB MED 12, issued on 22 February 1944, and the one for enlisted men in TB MED 21, issued on 15 March 1944. The inclusion of these lectures moved so rapidly that the circular had to be written and printed before the Neuropsychiatry Consultants Division could complete the lecture outlines.

In obtaining approval for the program, much preliminary discussion was held with various echelons in the War Department as to terminology and number of lectures. Initially, the Neuropsychiatry Consultants Division recommended 10 hours for officers and 5 hours for enlisted men. For such a radical innovation, it was finally determined that 6 hours should be recommended for officers and 3 hours for enlisted men. In order to overcome prejudice, instead of using the term "mental hygiene," the title of "Personnel Adjustment" was used for the officers' lectures and "Personal Adjustment" for the enlisted men's lectures. Concurrence was readily obtained from the Army Ground Forces. It was delayed in being acted upon by the Army Service Forces and actually was approved by G-3 (operations and training) before final concurrence was obtained from the Army Service Forces. Both of these medical technical bulletins were entirely rewritten after the end of the war.


Problems Encountered

These lectures undoubtedly contributed to the mental health of the Army by removing some of the mystery connected with psychiatry and by properly explaining many of the misconceptions commonly connected with this specialty. It was, however, impossible to know just how extensively the lectures were actually used because no system of checking had been instituted. Many personal letters from all over the world indicated that they were being given. Consultants stressed their importance in every unit visited. The AGF (Army Ground Forces) headquarters and ASF (Army Service Forces) headquarters6 sent specific instructions to all basic training camps to insure that the lectures would be given. Much of their effectiveness depended upon the amount of time the busy psychiatrist could spare in meeting the demands for these lectures and upon the ability of the psychiatrist to present such material in an impressive and instructive manner.

There was much dissatisfaction in some units because of the time involved in giving the lectures. In all the training camps, the training schedule was so full that it was with difficulty that they were included, and in a few instances, they had to be given in the soldiers' off-duty period. The circular as well as the medical technical bulletins also served the extremely important purpose of calling the attention of high ranking commanding officers to the War Department's recognition of the importance of this subject. In a few places, as illustrated by the schools in the South Pacific, the line officers en masse were exposed to psychiatric orientation. War Department Circular No. 48 came out over 2 years after the war began, and, during those 2 years, no official, centrally sponsored, psychiatric or mental hygiene orientation was given. Even after the circular and bulletins appeared, a large number of officers and troops were in forward areas and certainly never put the directive into effect. No psychiatric lectures were ever included in the Infantry Officers' Training School at Fort Benning, Ga. Consequently, this circular could only be partially effective, and it is to be regretted that an early systematic approach could not have been provided throughout the War Department. There seems little doubt, however, that this effort, even though late, was one of the signal achievements of the Surgeon General's Office in the field of psychiatry.


During the first 2 years of the war, the limitation of manpower in the Neuropsychiatry Consultants Division, SGO, and the pressure of other immediate tasks resulted in inadequate attention being given to the devel­

6Army Service Forces Circular No. 215, 11 July 1944.


opment of training films. No one doubted their great value but the expense and the time required for the development of such, plus the difficulties in arranging for such films to be made, led to the postponement of any active planning in this direction. The result was that four of the first films to be made were initiated and carried through either in the theaters or in the service commands. Two additional films were adopted from the Navy and still two others were adopted from British films.

The experience with these films, however, was so satisfactory that a general program was outlined, setting forth the specific needs for various films, and a military psychiatrist, Maj. George S. Goldman, MC, was placed on full-time duty to develop this program.

The division had cooperated with many other officers in the planning and production of psychiatric films and reviewed films produced by other agencies, making recommendations as to their adoption and utilization. Later, it had instituted and collaborated in the production by the Information and Education Division, ASF, of an educational film dealing with the reactions of fear, regimentation, deprivation, discipline, resentment, emotions, and bodily changes.

The first step in the development of an adequate psychiatric film library was to survey the total needs for psychiatric films and to draw up a list of all desirable films. The purpose and the audience for which each was intended and a brief summary of their content was given in the preliminary list and against this was checked the films already adopted by the Army, those which could be adopted, and those in production or already proposed. While it would have been desirable that one film be planned for one specific purpose and a specific audience, for reasons of practicality it was necessary that each film perform as many functions and reach as wide an audience as possible.

At the time Major Goldman undertook this program, a number of films had been adopted and were being distributed.7 Others were later developed and in the process of production.8

7PMF (Professional Medical Film) 5011, "Psychiatry for the General Medical Officer," originally developed by the British and redeveloped by the U.S. Army, 1945. FB (Film Bulletin) 184, "Psychiatric Procedures in the Combat Area," developed in the Mediterranean theater by Lt. Col. Frederick R. Hanson, MC, Maj. Calvin S. Drayer, MC, and Maj. Stephen W. Ranson, MC. TF (Training Film) 8-1402, "Introduction to Combat Fatigue," developed by the Navy, 1944. PMF 5012, "Combat Exhaustion," developed in the 312th Station Hospital in England by Col. Lloyd J. Thompson, MC, Col. Ernest H. Parsons, MC, and Maj. Howard D. Fabing, MC, 1945. TF 8-1428, "Care of the Sick and Injured-The NP Patient," developed by the Navy, Lt. Comdr. Howard P. Rome, 1945. TF 8-2090, "Ward Care of Psychotic Patients," developed in the Ninth Service Command by Col. Lauren H. Smith, MC, and Col. Olin B. Chamberlain, MC, 1945. Special Film, "Hypnosis-Okinawa" developed by Lt. Col. M. Ralph Kaufman, MC, and Maj. Lindsay E. Beaton, MC. Miscellaneous Film 1133, "The New Lot," developed by the British. PMF 5019, "Let There Be Light," developed at Mason General Hospital with actual patients and personnel, 1946-a famous actor, Walter Huston, was the narrator; his son, Maj. John Huston, was director and producer. Later, in 1948, this film was remade with professional actors and retitled "Shades of Gray," PMF 5047. "Your Job and the Psychiatric Patient," a three-part film, was not completed until after V-J Day and then released in 1947-Part I: The Psychiatric Patient; Part II: How the Patient May Affect the Attendant; Part III: The Attendants Help the Patients.

8Department of the Army Special Regulations No. 110-1-1, Index of Army Motion Pictures and Film Strips, 5 Jan. 1950, pp. 111-112.