Nostopathy--a study of pathogenic homecoming.

Abstract

The following findings were characteristic of the group we have been studying as illustrating the problem of nostopathy in the returning veteran. The adjustment in the premilitary life was not free from neurotic episodes but they did not lead to disabling results. Many of the homes were described as being cold, and a lack of affection was a frequent complaint of our patients. None of the homes could be described as having a good relationship between the parents and the children, and between the siblings themselves. A better than average adjustment to the rigors of combat conditions was observed in the entire group. It was early noted that nostopathy occurred in those men who had had extensive combat experiences without any early clinically diagnosed breakdowns and who had often exceeded the amount of time spent in combat as contrasted to others in similar circumstances. In other words, the superego control in this special situation was unusually strong, and these men did not give up and request to be returned but rather kept on until they were ordered to return. The severe traumatic experiences the soldiers went through without any demonstrable symptomatology at the time may still have caused damage to their adaptability. We certainly found a history of traumatic war experiences in all our cases. However, only a few showed evidence of traumatic neurosis. The changes in the home situation, including even minor ones, had meaning for the veteran and, if one studied his life history, one could understand how that situation was of pathogenic importance. The group under investigation is an exception to the usual psychiatric experience that the civilian neurotic individual is a poor military risk. Ordinarily, we would expect that ability to adjust in war would be more or less correlated to civilian adjustment; yet in our group, all functioned much better in war than they did in their civilian lives. The result is that the predictability of psychiatric breakdown in war based on civilian history is made more difficult. It cannot be stressed enough that such individuals may be of great value in the military setting during times of national emergency. It should be our responsibility not to overlook the potential excellent serviceman among the neurotic population. Pathological reactions to return home are not limited to the veteran returning from war but can also be found among those who return from a long absence due to prolonged hospitalization or imprisonment. Cases have been observed in state hospital work where the patient would do well until the moment that his discharge was contemplated and then without any obvious reason there was a return of his illness. Often it is not recognized that the return home was conceived by the patient as a danger to him. The major difference between the returnee from victorious war and from humiliating institutionalization is the increase or decrease in self-esteem. However, in some of the returning veterans, a sense of guilt predominated and they could therefore not accept any narcissistic reward for their participation in the successful war. A study of our own patients has shown to us the pathogenic significance of the return home as an important factor in their illness.