The Royal Navy of World War Two prided itself on the superior psychiatric health of its men. Because it had its pick of recruits, it assumed that it always got the best and most emotionally stable men.
This rather complacent view was to be challenged as the war went on and even the toughest of sailors began to show unmistakable signs of battle fatigue and stress.
At first these were dismissed as nothing more than a state of anxiety. Only from 1943 did the Royal Navy admit that it’s seamen might be suffering from “fatigue”. This term was chosen deliberately to avoid the stigma of mental breakdown and to suggest that once a man had rested he could rapidly return to duty.
Stress related disorders were especially common among crews serving in the Arctic convoys. Many ships’ surgeons noted that the prolonged and repeated stress and strain of daily bombing attacks led to an increase in the number of men attending sick parade, accompanied by increased apathy and listlessness among the crew in general.
There were even occasions when men were too stressed to abandon a sinking ship even though they were physically capable of saving themselves.
Morale was even more difficult to maintain among survivors of a sinking. This was mainly because they had nothing to do on the rescue ship but indulge in self-pity and criticism of their opposite numbers on the new ship.
Part of the problem was that from having been members of a small, tightly disciplined and closely organised community they had lost the comradeship of the mess and a sense of purpose.
Men of the Royal Navy generally dealt with this challenge much better than merchant seamen who were under looser discipline and had less of a sense of social cohesion.
Even so it was important for officers to ensure that steps were taken quickly to deal with the trauma of Royal Naval survivors by stressing routine and a sense of normality.
Doctors were warned against asking leading questions about the mental health of the men they were examining to minimise self-pity and promote increased confidence.
After 14 days’ survivors’ leave , survivors were reintegrated into a new ships’ company. In many instances, these were made up of other survivors with the unfortunate result that men suffering from “anxiety” were concentrated in one ship and battle fatigue and satisfaction could become ingrained in a company.
Wartime conditions with long periods at sea exacerbated neurotic illnesses in the navy caused by a cold and damp environment, the vibration and excessive noises of the ship, sleeplessness, long periods without shore leave, boredom resulting from lack of recreation and the want of outlets for sexual frustrations.
Men worried about their families ashore, especially those living in the heavily bombed naval ports. Many men reported to the sick bay with minor complaints after receiving a worrying letter from home.
Medical officers at sea were advised to watch for such signs of neurosis as unreliability, slipshod work, a slovenly appearance, excessive consumption of alcohol and cigarettes, and surliness.
Minor illnesses could also be signs of psychiatric disturbance, including headaches, indigestion, dizziness, palpitations, tremor, diarrhoea and excessive micturition.
It was one thing to observe the signs of battle fatigue, it was another to offer effective treatment.
The fighting efficiency of the ship came first and could not be compromised. Disturbed men were kept on duty not only so that they would be too busy to think about their problems but so that the work of the ship could be carried on with a full complement of crew.
Only in advanced cases of neurosis was a man to be admitted to the sick bay for treatment or, if in port, to a hospital. In most cases shore leave was seen as the solution to all problems.
Ralph Ransome Wallis, the surgeon on HMS London, recognised the limits of what he could do despite being aware that most of his shipmates displayed psychiatric symptoms to some extent.
His view was that there was no option but for them to cope with their own problems and get on with their jobs. In his experience, “a few sharp words from the sick berth chief petty officer accompanied by a No. 9 pill containing a powerful purgative worked wonders”.
Even Desmond Curran, the chief psychiatric consultant to the Royal Navy was reluctant to admit that ‘operational strain’ might be a cause of neurosis and mental breakdown. It was easier to blame the inherent psychological weaknesses of the men themselves. It was his belief that hypochondria and psychosomatic disorders could be encouraged by acknowledging them as a problem.
Before the war the Royal Navy had not employed any specialists in psychiatric health. By 1943 it had 36 psychiatrists, all but three of them based in the United Kingdom, compared with the 227 in the army.
Whereas the army could offer forward-deployed psychiatry to its forces treating men with combat neuroses based in forward areas as quickly as possible after battle, this was impossible for the Navy with its psychiatrists all being shore-based and far from naval action.
There was a feeling of insouciance among naval psychiatrists concerning the good state of naval mental health, yet psychiatric casualties were far from negligible. The number of officers and ratings referred to psychiatrists from warships rose rose from 5,000 in 1940 to 6,141 in 1943, representing one per cent of all naval personnel.
The true numbers of men suffering from battle fatigue may have been much higher as many naval doctors believed that referral to a psychiatrist would only make the man’s condition worse by branding him as a “loony” and resulting in invaliding out of the service.
It was widely believed that the best way of helping a man recover from battle stress was to ignore the illness and its psychosomatic origins, avoiding the stigma of mental illness and getting the man back to efficient to winning the war.
If telling ratings to “take a grip on themselves” was the best way of doing this, then that was how the doctor approached the problem. The efficiency of ship was all that really mattered.
Kevin Brown has written and lectured widely on the history of medicine, especially naval medicine. He is Trust Archivist to Imperial College Healthcare NHS Trust and Alexander Fleming Laboratory Museum Curator at St Mary’s Hospital, London, a museum and archives which he set up. Fittest of the Fit is his latest book published by Pen and Sword.