During the World War every army had its cases of functional nervous disorder which incapacitated soldiers for duty. [Harry Levi] Hollingworth has published an account of a large number of American cases hospitalized at Plattsburg, N.Y., in his Psychology of Functional Neuroses. One of his most interesting observations was that there were significant differences in the types of nervous breakdown suffered by enlisted men and by officers. The men inclined strongly to the ailments which we have described as hysteria. They showed much more tendency than officers to develop paralyses and anesthesias, or to simulate disease symptoms or epileptic attacks. Their officers more often exhibited “nervous indigestion,” states of anxiety accompanied by nightmares and loss of appetite, an inability to make decisions, periods of quickened pulse and heightened blood pressure.
Why is it that more officers fell into such states than enlisted men? Hollingworth’s answer is undoubtedly the correct one. He gives two reasons. The first is that officers carry a much heavier responsibility than the common soldiers. The second is that officers were as a group more intelligent and better educated than the men.
An enlisted man in the the army has comparatively few important decisions to make. These are made by officers. The private does not have to choose what he will wear, what he will have for breakfast, the hour at which he will rise, or how he will spend his time on duty. He lives under orders which prescribe not only what the shall do but the manner in which he shall do it. Such decisions as he must make are the decisions of immediate action…. Most of the elaborate organization and discipline of an army is aimed at the prevention of any need for decision by the enlisted man. The officer, on the other hand, must look to the provisioning and quartering of his command. He must decide how the orders of his superior are to be carried out and how objectives are to be reached. Failure of attack or of defense is blamed not on men but on officers. In addition, the officer must deal with the varied personalities of his command. All responsibility requires deliberation and choice. Decision, when high stakes are involved, takes much energy.
There is also some evidence that differences in intelligence and training affect the type of neurotic response to intolerable situations. The hysterical tricks by which the enlisted man escapes duty are not open to the more intelligent person who can see through them. In order that a paralysis that keeps a man from duty shall be classed as hysterical and not as a case of malingering, the device must be inarticulate and unplanned like the cat’s escape from the puzzle box. Education and intelligence reduce the possibility of inarticulate and uncontrollable tricks of escape. The more intelligent man not only realizes how others will react to a paralysis that has no basis in physical injury; he must also face himself. The tricks of the hysteric are recognized as not consistent with the stage directions for his role.
With the naive (or cynical) solution of the hysteric not open to him, the officer does not find a way out. His distress, which is the result of prolonged conflict, is unrelieved and at this stage his symptoms are those which we have described as anxiety. Tensions keep him from sleep or trouble his sleep with fearful nightmares. He has periods of rapid pulse. The well-known effects of excitement on digestion are in evidence. … An added source of anxiety is the necessity of keeping his state from the notice of his men and brother officers. …Prolonged and unrelieved tension makes him incapable of decision. He begins to extend his worries into the past and the future. He worries over yesterday’s troubles as well as today’s…. Obsessions interfere with his attempts at deliberation….All exertion demands tremendous effort….
…One failure or one reprimand may break up the attitude of confidence that is essential in commanding men or in making plans and carrying them out.
Edwin R. Guthrie (1938)