It was recognized early in the war that psychiatric casualties would require treatment as well as soldiers who had been physically wounded. No. 1 Neurological Hospital was established in September 1940 near Basingstoke in Hampshire with 200 beds. Often simply referred to as “Basingstoke”, this hospital also handled plastic surgery. In the Mediterranean theatre, 1st Canadian Infantry Division appointed a divisional psychiatrist, and a Base Neuropsychiatric Centre was established at No. 15 General Hospital in North Africa. Treatment included sedation, rest, psychotherapy, and drug and electro-shock therapy. Work served as another form of therapy, Special Employment Companies being used to load supplies of ammunition and fuel for the battlefield among other tasks. Battle exhaustion casualties apparently responded well to being given something meaningful to do.
Although significant strides had been made compared to the First World War, when stress casualties were lumped together under the rubric of “shell shock”, attitudes towards such men did not reflect the modern notion that “each soldier has a limited reserve of fortitude which runs out sooner or later” (Bill Rawling, Death Their Enemy: Canadian Medical Practitioners and War, 2001, p. 189). Many exhaustion cases were ultimately labelled “chronic”; psychiatrists reported that such men, inherently unsuited for combat, should have been weeded out before going overseas. In Northwest Europe, senior officers took a harsher attitude to psychiatric casualties, perhaps influenced by a deepening reinforcements crisis that left many units understrength at one of the war’s most critical stages. In the cases of 2nd Canadian Corps and 2nd Canadian Infantry Division, commanders refused to integrate psychiatric services into their medical organizations, instead emphasising stern disciplinary measures to deal with potential malingerers (Rawling, p. 199). Treatment of exhaustion cases was perhaps least satisfactory in the air force, where many aircrew suffering from battle-related traumatic stress were labelled as “Lacking in Moral Fibre”, or LMF, and treated as disciplinary problems.
The typical symptoms of exhaustion are described by Terry Copp, who notes that 90% of diagnosed cases were among infantrymen, a statistic no doubt influenced by air force attitudes concerning the “moral fibre” of its personnel. Copp writes: “The large majority of individuals diagnosed as suffering from Battle Exhaustion exhibited what the psychiatrists described as acute fear reactions and acute and chronic anxiety manifested through uncontrollable tremors, a pronounced startle reaction to war-related sounds, and a profound loss of self-confidence. The second largest symptomatic category was depression with accompanying withdrawal” (J. Terry Copp, “Battle Exhaustion and the Canadian Soldier in Normandy”, in Marc Milner, ed., Canadian Military History: Selected Readings, 1993, p. 240). The incidence of battle exhaustion casualties in First Canadian Army reached crisis levels during the battles south of Caen in July 1944. In an infantry division of about 18,000 men, only a much smaller proportion, approximately 4500, served as front-line infantry. It was these men who sustained the great majority of the 200,000 Allied casualties in the Battle of Normandy. Casualty replacement schemes had been based on statistics derived from the Italian campaign which proved inapplicable to the nature of the fighting in Normandy. The result in the summer of 1944 was that sufficient reinforcements to support the periods of “double-intense” combat then taking place were not available. A dwindling number of infantrymen thus had to bear the task of driving the Germans out of the occupied territories. Many inevitably snapped under the strain. The crisis was only alleviated with the German defeat in Normandy, and although exhaustion casualties continued to occur, they did not do so in the same overwhelming numbers that had been seen in the aftermath of the assault on Verrières Ridge, for example.