Falklands war 25TH anniversarY - Boekje Pienter

FALKLANDS WAR 25th ANNIVERSARY
Rate of British Psychiatric Combat Casualties Compared to
Recent American Wars
HH Price
Division Psychiatrist, Headquarters, 8th Infantry Division (Mechanised), US Army, Europe
Summary
This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the
Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World
War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars.
The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of
combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite
and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands
War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention
rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of
various diagnoses are also presented.
The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of
American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function
in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular
constellation of factors may not recur.
Introduction
The Falklands war is described by Surgeon Commander Scott-
Brown, as one of the Navy psychiatrists involved, as a 20th
century reincarnation of the Afghan Wars or the 1896 Sudan
Expedition 1 . Despite the technological advances of naval and air
warfare in this conflict such as Exocet missiles and Harrier jets,
the land war was fought without many of the weapons used in
recent wars. There was little use of heavy armour or helicopter
gun ships. General Thompson, the land force commander, said
“The only difference between Hannibal and us is that he went
by elephant and we are going to walk” 2 . And walk they did,
carrying most of their supplies, due to the poor road system on
East Falkland.
During the course of the war which lasted a total of 74 days
with a 25 day land campaign from the landing at San Carlos
Water to the capture of Stanley, the British lost 237 men killed,
777 wounded with 446 receiving significant hospital treatment.
The rate of evacuated psychiatric casualties was 2% of all
wounded with 16 declared cases evacuated from the hospital
ship, Uganda. This rate compares favourably to the American
experience in recent wars i.e., 23% of medical evacuees were
psychiatric casualties in WWII, 6% in Korea and 5% in the
early stages of the Vietnam War, reaching a high of 60% during
the drug epidemic of 1972 3,4 . The Falklands produced a low
rate of psychiatric casualties. This paper will examine the factors
which the American experience suggests affects psychiatric
casualty rates, two of which were not present in the Falklands
and six factors which were.
Factors not Present
The low psychiatric casualty rate in the Falklands is significant
in that two factors believed to have decreased psychiatric
casualties in American experiences were not present in this
campaign, i.e. the presence of psychiatric personnel in line units
and psychiatric screening of all evacuees.
Due to the psychiatric disaster in the American Army during
the Tunisian Campaign in 1943, psychiatrists were sent to corps
level, then further forward to evacuation hospital level during
the Sicily invasion. On 9 November 1943 the War Department
re-established the position of division psychiatrist with the first
division psychiatrist reaching a division at Anzio in March
1944. The increasing forward assignment of psychiatrists
during World War II coincided with, and perhaps led to, a
decrease in psychiatric casualties. However, even as late as
August 1945, only seven out of 17 divisions in the Southwest
Pacific had division psychiatrists 5 . During Korea, within 6-8
weeks of the onset of fighting, division psychiatry became
operational 6 . By the time of Vietnam, there were more
psychiatrists in the theatre per Army troop strength than in any
previous war. 3 Though Abraham has written extensively on the
treatment of battleshock (the British term for psychiatric
combat casualties) and has proposed the development of
Battleshock Rehabilitation Units at division level supported by
Field Psychiatrist Teams, these have not yet been fully
organised 6 . There are no behavioural science teams attached to
British line units corresponding to the division psychiatrist,
psychologist, social worker, and enlisted behavioural science
technician (91G) in the U.S. Army. No Royal Army Medical
Corps psychiatrists were invited to the Falklands.
Psychiatric screening of medical evacuees has also been found
to decrease rates of psychiatric casualties in the American Army.
During the New Georgia Campaign in the Pacific during July
and August 1943 no screening of evacuees occurred in the 43rd
Infantry Division. This division had large numbers of
psychiatric casualties as well as medical evacuees subsequently
found to have psychiatric disorders at base hospitals 7 . This
division lost 10% of its strength during one month to N-P
casualties. It is reported that men actually “tagged” and
58 JR Army Med Corps 153(S1): 58-61