This was my dissertation submitted for my degree of MA (HISTORICAL STUDIES) at the University of Lincoln 2010. I recently rediscovered a copy and thought it was worth sharing.

You can also read my article: ‘A ‘Lack of Moral Fibre’ in Royal Air Force Bomber Command and Popular Culture’, British Journal for Military History, 6.3, 2020, pp. 42-65 https://journals.gold.ac.uk/index.php/bjmh//article/view/1425/1538

Abstract.

This dissertation examines the treatment of neuropsychiatric casualties from RAF Bomber Command during the Second World War, and how those who were deemed to be LMF, or lacking in moral fibre, were dealt with. A contentious and taboo subject, the aim of this dissertation is to fill gaps in the historiography and examine some of the myths surrounding LMF and the treatment of neuropsychiatric casualties by the RAF.

Utilising some previously unused or unavailable sources, by conflating an ‘across the grain’ re-examination of official sources with a ‘bottom up’ examination of veterans’ memoirs, published and unpublished, and with reference to wartime medical journals, it attempts to answer three main questions: How did station medical officers treat emotional casualties and maintain the efficiency of aircrew during a tour? How did the RAF treat those removed from flying at Not Yet Diagnosed Neuropsychiatric (NYDN) centres and hospitals? What actually happened to airmen who refused to fly and were judged to be lacking in moral fibre after they “disappeared” from their squadron? 

The RAF made every effort to extend the efficiency of aircrews to keep them flying, and the medical beliefs behind the RAF’s policy towards “waverers” and neuropsychiatric casualties are discussed. The prophylactic treatment by squadron and station medical officers through counselling and drugs, together with more intensive remedial treatment by neurologists and psychiatrists combining traditional psychotherapy, drug treatment and more experimental interventions at RAF hospitals are examined. Arguably the stigma associated with the LMF policy was effective in persuading many aircrew members to continue to fly operations, but aircrew found to be lacking in moral fibre and posted away from their squadrons experienced tedious monotony caused by bureaucracy rather than deliberately callous punishment.

Introduction.

No one who saw the mask of age which mantled the faces of these young men… is likely to forget it. Their pallor, the hollows in their cheeks, and beneath their eyes, and the utter fatigue with which they lolled listlessly in chairs about their mess, were eloquent of the exhaustion and frustration which they felt. In ten hours they seemed to have aged as many years.^[1]

Focusing on the Royal Air Force Bomber Command in Europe during the Second World War this dissertation will examine what happened to men who were removed from flying duties or who refused to fly. Among the Allied forces, bomber aircrews statistically suffered the greatest casualty rates during the Second World War; from the aircrew in RAF Bomber Command who were posted to an Operational Training Unit (OTU), 63% were killed, 12 % became prisoners of war and only 24% were physically unharmed.^[2] However an official report in July 1942 found that

the number of flying personnel who since the beginning of the war have ceased to fly because of nervous disorders is roughly equivalent to 4% of the flying personnel. This figure includes 1 ½ % who have become unfit through genuine flying stress.^[3]

A report in 1941 showed that from 265 operational aircrew who reported to their medical officer and were diagnosed with a psychological disorder, 65% were engaged in night bombing.^[4] It was found that one third of aircrew who were referred to a neuropsychiatrist during the twelve month period ending in February 1944 were from Bomber Command.^[5] Approximately 125,000 aircrew flew with Bomber Command during the war; over 55,000 were killed,^[6] and potentially between five and six-thousand became emotional or psychiatric casualties of some kind. Although the RAF admitted that some emotional casualties had genuine medical reasons for their inability to fly, many were seen to have a weakness of character. The term “Lack of Moral Fibre” (LMF) was first recorded as being used by the RAF in March 1940 after a meeting to discuss the treatment and disposal of men, without a medical reason to explain their actions, who openly admitted they did not intend to fly. It was felt that the RAF needed to “institute some procedure for dealing with cases of flying personnel who will not face operational risks.”^[7] A letter drafted by Air Vice-Marshall E. L. Gossage, Air Member for Personnel (AMP) after the meeting was concerned with:

a residuum of cases where there is no physical disability, no justification for the granting of rest from operational employment and, in fact, nothing wrong except a lack of moral fibre.^[8]

A significant proportion of autobiographies published by veterans of the RAF bomber campaign mention a squadron member who was judged LMF, but usually such memoirs mention only an individual refused to fly and mysteriously disappeared from the squadron.^[9] The story of what happened to emotional casualties treated by station medical officers, by specialists in hospitals used as Not Yet Diagnosed Neuropsychiatric (NYDN) centres, and those designated LMF has largely remained untold, and forms the basis of this dissertation.

In the main, popular history of World War Two narrates the heroic actions of individuals and focuses on their courage, and the tale of the RAF in the Second World War has become the story of ‘The Few’, of Fighter Command who flew in the role of defence rather than offensive operations. After the war the Lancaster became a synecdoche for Bomber Command but today the only remaining airworthy Lancaster in the UK is maintained by the RAF as a memorial as part of the Battle of Britain Memorial Flight based at RAF Coningsby. The bomber aircraft performed an offensive role but by being included in the BBMF the aircraft has gained connotations to the Battle of Britain. Much of the historiography examining Bomber Command discusses the effectiveness and morality of area bombing in the context of the meta-narrative of the Second World War and the concept of total war; however this study will avoid joining these debates. Relatively few historians discuss LMF and fewer consider neuropsychiatric casualties. 

In a short section of his book Bomber Command entitled “Courage”,journalist and popular historian Max Hastings maintained that morale never became a major problem for the RAF,^[10] and saw the LMF policy as a punitive deterrent. In common with many memoires of ex aircrew, Hastings described how men who were pronounced LMF vanished from RAF stations, but also touched on many points discussed in greater detail by later historians.^[11] LMF was first examined in detail by John McCarthy in 1984. He attempted to “sketch the origins of the concept, to account for its existence, to observe its application and to assess its incidence”.^[12]  In a ‘top down’ approach, largely using the official sources open at the time, he examined the RAF aircrew selection process, tour length and the odds against survival. He highlighted the belief in the RAF that LMF was contagious and that men were predisposed to cowardice. In the chapter entitled “Moral Fibre” in his book The Right of the Line, John Terraine discussed the conception of LMF and aircrew morale equating LMF to cowardice and desertion, but he concluded the numbers involved were “trivial.”^[13] Terraine also employed a ‘top down’ approach using official sources; he discussed the length of a tour and the few instances of courts martial, but unlike other authors he also investigated the number of aircraft interned in neutral Switzerland and Sweden.^[14] Seeing the RAF as occupying “the vanguard”, “the place of honour” and “the place of greatest danger” during the war,^[15]  it is understandable that Terraine understates the numbers of men he defines as cowardly.^[16] However he does make the important point that the RAF was “largely dependent on the maximum of self discipline as far as members of aircrew w[ere] concerned.”^[17]

Using both official sources and individual accounts of the air war in perhaps the most comprehensive study of this topic to date, Courage and Air Warfare: The Allied Aircrew Experience in the Second World War, Mark Wells compares the RAF to the USAAF. He describes in detail the stresses and dangers faced by airmen of both forces, and also discusses quantitative aspects of LMF, both air force’s selection and training procedures, and their initial treatment of emotional and psychiatric casualties. Wells suggests that unlike American psychiatric specialists who, aided by the volume of manpower available to the United States, sought to identify the best candidates for aircrew selection, the RAF doctors concentrated on eliminating the worst.^[18] He concludes that “the RAF’s “combat stress philosophy was based on two fundamental beliefs… that courage was a function of character… [and] the strong conviction that LMF was contagious.”^[19]   Wells is a Colonel in the United States Air Force, and the Senior Military Professor and Deputy Head of the Air Force Academy’s Department of History; unsurprisingly he stresses the importance of a strong espirt de corps in both bomber forces, and includes a chapter on the importance of leadership. However this was arguably more important in the USAAF when bombing in formation during daylight hours the leader’s aircraft could be seen, and Wells admits that within the RAF “each bomber’s crew considered itself, in many ways, a separate and individual unit.”^[20]   

Examining the development of psychology and psychiatry, and concentrating on Bomber Command, Allan English also traced the origins of LMF, but from a direction informed by the social sciences. He focused “on the development of clinical aviation psychology and psychiatry as they relate to the diagnosis and treatment of aircrew suffering from combat stress, particularly in Bomber Command,”^[21] and discussed the medical theories used to support the policy. He maintains that emotional casualties were regarded as a “medico-military problem”^[22] and their treatment by the RAF was influenced by civilian psychologists and “technocratic elites.”^[23]  Their theories, based on research carried out during the inter war period, included the concepts inspired by Freud and genetic science that people were predisposed to cowardice and that cowardice was contagious.^[24] Seeing the LMF policy as “an amalgam of bureaucratic expediency, psychological theories, and operational imperatives”,^[25] English points out that the LMF process was a simple and effective alternative to a court martial and an easy way of “weeding out bad characters.”^[26] In his book based on his doctoral thesis, The Cream of the Crop: Canadian Aircrew 1939 – 1945, he investigates how members of the Royal Canadian Air Force were selected for aircrew, trained, and treated by the RAF once operational. However, writing from an almost Post-Colonial perspective, he becomes embroiled in contemporary debates about how Canadians were treated by the RAF,^[27] and is influenced by modern psychological concepts such as Post Traumatic Stress Disorders (PTSD) and theories concerning Combat Stress Reaction (CSR).^[28] As Simon Wessely highlights, the social, moral, pragmatic and psychological theories used to attempt to understand motivation and the lack of motivation during conflict constantly change,^[29] and as a historian it may be a mistake to privilege one particular psychological paradigm over another.^[30] Sydney Brandon examined the topic from the angle of the use of psychiatrists and neurologists in the RAF in the selection of aircrew, and concludes “that the use of the LMF label was neither necessary nor effective.”^[31] From a similar perspective, Ben Shephard examines the armed forces treatment of war neurosis in the context of psychiatrists expectations based on their experience of Shell Shock during the First World War and the then prevalent medical theories including Freudian analysis.^[32] Shephard sketches the characters of Dr. Charles Symonds, the Consultant Neurologist and R. D. Gillespie, the Consultant Psychiatrist to the RAF during the war. He highlights that it was felt that neurosis was not caused by trauma and indeed a neurosis only followed a traumatic event if the patient gained an advantage through it.^[33] Casualties were treated harshly as a deterrent to preserve the fighting force,^[34] and also in order to avoid expensive pensions.^[35] In his book The Flyer: British Culture and the Royal Air Force 1939 – 1945, Martin Francis examines the place of the airman in popular culture of the time. Chiefly concerned with concepts of gender, the study includes a chapter “The Flyer and Fear”^[36] and discusses the concepts of courage and cowardice and how fears impacted on their masculinity.

In the most recent article on this subject, Edgar Jones views LMF as the ‘stick’ wielded by the RAF command to persuade crews to risk their lives. He highlights the use of Not Yet Diagnosed Neuropsychiatric (NYDN) Centres and attempts to discover the impact of LMF on morale and performance, and why such a draconian “policy of deterrent was needed to keep aircrew in their aeroplanes.”^[37] He points out that LMF was not a medical condition it was a military definition,^[38] and that it “was not the bureaucratic response of a civil servant but came from senior RAF commanders.”^[39] Jones agrees with Wells in that the main motive behind the RAF’s policy of LMF was their concern that increasing numbers of aircrew may refuse to fly; and that perhaps the concept of LMF was coined to discourage aircrews, all of whom were volunteers, from refusing to fly missions.^[40]

Max Hastings estimated that around ten percent of operational aircrew were lost from bomber command for morale or medical causes from operational squadrons and training units.^[41] John McCarthy believed that there were around 148 cases of LMF each year from Bomber Command,^[42] while Mark Wells concludes that from Bomber Command there were approximately 1000 temporary and permanent emotional casualties per year and 200 per year were designated LMF.^[43] Hastings reached his conclusion by extrapolating hearsay evidence,^[44] and English calculated the number of Canadian casualties with similar statistical convolutions.^[45] The sources required to give a definitive answer do not appear to exist. Tantalizingly the lost Lawson Memorandum quoted in Terraine tells us that 4,059 cases of LMF were submitted and 2,726 were classified as LMF,^[46] but Terraine fails to specify the time frame. In April 1945 Whittingham recorded that: 

Each year there are about 3000 cases of nervous breakdown in aircrew and about 300 cases of lack of confidence. A third of the cases occur in Bomber Command, and a third in Flying Training Command.^[47] 

Despite the USAAF treating their neuropsychiatric casualties differently, Wells believes that the incidence of LMF was similar in both forces.^[48]  Perhaps most tellingly after the war a note on German military neuropsychiatry from January 1946 underlined that:

The incidence of neurosis in the Luftwaffe of 5% is the same as our own… the return of 30% of cases of neurosis to flying duties is also pretty close to our own figure.^[49] 

As may be deduced by the above examples, with the evidence available to historians today an accurate assessment of the total number of aircrew who were found to be LMF throughout the war remains unlikely. The definitions of both LMF and medical diagnosis altered over the course of the war, the size of Bomber Command fluctuated, and amongst other variables, the stresses the men were under altered with the weather, the type of operations they flew, the type aircraft they were flying in and the opposition they came up against. Until the Lawson memorandum is found or individual service records are released to researchers only estimates of the numbers involved can be calculated.

The historiographical consensus is that, informed by their medical consultants, it was believed by the RAF that most airmen broke down due to an underlying predisposition to mental weakness, rather than their exposure to traumatic experiences, and that LMF was contagious. Historians comment on the difficulties of assessing the numbers of men involved, and agree that as the diagnosis of such problems was subjective, many potential cases of LMF or neurosis were dealt with by station medical officers and went unrecorded. Although other motives, such as patriotism or the unwillingness to let their comrades down are discussed, arguably the fear of being killed or maimed during a sortie was partially balanced by the fear of being branded as lacking in moral fibre. With the exceptions of Brandon, and Kevin Wilson, who utilises oral testimony in his Men of Air: The Doomed Youth of Bomber Command, the majority of these works concentrate on a largely ‘top down’ approach. A controversial and originally taboo subject,^[50] historians have tended to concentrate on the formation of the policy of LMF, on calculating the numbers of men who found themselves unable to continue to fly, and the effectiveness of the RAF’s attempts to reduce these numbers by the initial selection of aircrew, by training, and by the deterrent of LMF itself; few discuss in detail how squadron medical officers managed to keep crews flying, and there are no accounts of what happened to emotional casualties once they were removed from their squadrons.

It is accepted that “the heavily weeded official files… leave many questions unanswered”,^[51] however previous studies have attempted to answer quantitative questions and queries about changing RAF policy towards LMF. This dissertation will use many of the available official sources examined by others previously, including Air Ministry reports and minutes, squadron records and unit records at the National Archives. Reports by RAF medical consultants, contained in the archives at Kew and published in 1947, contain numerous useful case studies.^[52] However for this project these sources were approached and interrogated in order to obtain qualitative rather than largely quantitative material and administrative details. All the sources must be approached carefully, it may be a mistake to read what was supposed to happen officially and to accept it at face value, and often published decades after the war, veteran’s memoires should be considered equally assiduously due to their subjective perspective. Such sources may be coloured by the intervening time and the author’s needs to tell their stories in the context of the historical debate about the morality and effectiveness of the bombing campaign.

Since the majority of the historiography was published more sources have become available. AIR 19/632, containing private office papers concerning LMF, ‘waverers’ and the disposal of members of aircrew who forfeited the confidence of their Commanding Officers was not opened to the public until August 2005;^[53] previously only Edgar Jones was able to use it as a source.^[54] Similarly there has been a large number of veteran’s autobiographies and memoires published over recent years, including via the internet, that have as yet not been by historians. Conversely since some of the earlier research was undertaken certain documents have become unavailable. The memorandum on LMF from 1945 by Wing Commander Lawson, quoted extensively by Terraine and most recently by Wells appears to have been lost by the Air Historical Branch.^[55]   Oral Testimony was considered; but it proved to be difficult to find people willing to discuss such a contentious topic from among the ever dwindling number of surviving bomber aircrew. Men branded as LMF are unlikely to become members of squadron associations, and without finding someone who spent time at a NYDN centre or who was designated as LMF, at best interviewees could recall anecdotal evidence of a squadron member who vanished from their station. Medical journals proved to be an invaluable resource. Where an anecdote or an official document mentioned a medical procedure or a drug used in the treatment of RAF personnel, sources such as the British Medical Journal and The Lancet have been examined. It was also found that RAF medical officers occasionally published their observations and findings in articles in such journals, and often gave their opinion on contentious issues such as military “malingerers” through the journal’s correspondence pages.^[56]       

The Air Ministry were prepared for neuropsychiatric casualties and a flow chart disseminated to all station medical officers in 1939 diagrammatically represented how the RAF medical services expected to treat psychological casualties. (See FIG 1) This flow chart remains a good illustration of their treatment through out the war.

FIG. 1. Flow Chart Diagram showing the movement of neuropsychiatric aircrew. ^[57]

The Special Diagnostic Centres became known as NYDN centres, the Special Treatment Hospitals were the hospitals at Matlock and Torquay, and other NYDN centres with long stay Neuropsychiatric wards, such as Rauceby. However it must be remembered that despite the fact that many aircrew regarded LMF as a medical condition, officially it was an operational military term rather than a medical diagnosis.^[58] This explains why on the above schematic there only three outcomes, Duty, Convalescence or Invaliding. In practice a fourth outcome, accessible from all nodes, was executive action, downgrading due to LMF via Reselection Centres such as Eastchurch and the Air Crew Disposal Unit.     

The following chapter discusses the medical beliefs that informed the RAF policy on emotional casualties. It will explain the official policy on ‘waverers’, those termed LMF or NYDN as laid out in the “waverers letter” and Air Ministry Pamphlet 100, and discusses the role of the station medical officer. Chapter Two will examine the treatment of aircrew personnel by station medical officers and examines NYDN centres, focusing on the RAF hospitals at Matlock, Torquay and Rauceby. The treatment of patients using psychiatry, electro convulsion therapy, narco-analysis, insulin therapy and occupational therapy is also discussed. The RAF made a concerted effort to diagnose and treat those with neuropsychiatric symptoms in order to maintain efficiency. From a NYDN centre aircrew could be returned to their squadron, regraded on medical grounds or posted as LMF. The final chapter examines the treatment of those found to be lacking in moral fibre. Officially aircrew could not be classified as LMF if a medical condition for their inability to fly could be found; tests such as decompression tests and ECGs were carried out in order to eliminate physical causes. Among other locations, LMF aircrew were posted to relocation centres such as at Eastchurch or the Air Crew Disposal Unit at Keresley Grange. This chapter will consider the conditions experienced by personnel while they awaited their final disposal by the executive. Arguably those found to be LMF experienced boredom, anxiety and uncertainty due to bureaucratic delays rather than any deliberate punitive persecution.       

The aim of this dissertation is to fill the gap in the historiography and examine some of the myths surrounding LMF and the treatment of neuropsychiatric casualties by the military. Utilising some previously unused or unavailable sources, by conflating an ‘across the grain’ re-examination of official sources with a ‘bottom up’ examination veteran’s memoirs, published and unpublished, and with reference to wartime medical journals, it attempts to answer three main questions: How did station medical officers treat emotional casualties and prolong the efficiency of aircrew during a tour? How did the RAF treat those removed from flying at Not Yet Diagnosed Neuropsychiatric (NYDN) centres and hospitals? What actually happened to airmen who refused to fly and were judged to be lacking in moral fibre after they disappeared from their squadron? 

Chapter 1: Predisposition to Psycho-Neurosis and the Role of the Medical Officer.

Before the treatment of psychological casualties and those accused of LMF are examined, the theories and beliefs underpinning their treatment should be considered in the context of medical and military opinion formed during and after the First World War and in the Second World War itself.^[59] This is made more complicated by the lack of standardisation in the classification of diagnoses. It was argued that:

the tendency to invent new terms for neurosis in flying personnel [wa]s due largely to the desire… to avoid for the man who has… done his best, any appellation which would class him as “neurotic”.^[60]

The terms concerning flyers included “flying stress”, “aeroneurosis” and “aviator’s neurasthenia,”^[61] and even the semiotic differences between bravery, courage and fearlessness were open to debate.^[62] In the RAF Lack of Moral Fibre was a “bureaucratic euphemism for the accusation of cowardice” and not a medical diagnosis,^[63] but other terms were also used or  suggested, including “waverers”, “lacking in confidence” and “lack of courage”. All such expressions carried an element of stigma with them; arguably aircrew preferred the acronym LMF and the euphemism the “wind up”.^[64] This chapter will examine the contemporary medical knowledge that informed the RAF about psychoneurotic disorders, the role of station and squadron medical officers and some of the executive decisions taken regarding the treatment of emotional casualties.

The concept of Shell Shock enabled doctors of the relatively new practice of psychiatry to legitimate their profession within industrialised nations and it became accepted that as well as ‘hysterical’ females, males could also be prone to neurotic symptoms.^[65] Shell Shock was explained by Freudian concepts of neurosis,^[66] and although other diagnoses such as Disordered Action of the Heart (DAH) were harder to explain, such conditions were often also thought to be psychosomatic in origin.^[67] Many war neuroses were explained by the Freudian theory of conversion hysteria; conflict within a patient between his instinct for self preservation and his wish to perform his duty, between his subconscious and conscious, resulted in the suppression of emotional energy. It was felt that this force eventually “expressed itself in disorders of the viscera and the autonomic nervous system, on one hand, and, on the other, in mental changes shown in anxiety and distress.”^[68] The treatment and any hope of a cure was for “absolute rest” and a good diet in a quiet environment, and for the patient to express their repressed emotion “in the form of abreaction, either in the waking state or under hypnosis.”^[69] However, perhaps influenced by the Government’s reluctance to pay pensions to such casualties in future wars, research in the interwar period found that constitutional and environmental influences predisposed some people to psychoneuroses.^[70] Although in Britain it became the responsibility of the individual to prove that their disability was war related,^[71] after the First World War almost 66,000 servicemen drew a pension for functional disorders of the nervous system alone, and 29,000 were still drawing their pension in 1938.^[72] By 1939 the RAF planned that patients with neurosis should remain in the service for as long as possible to avoid their having to be invalided and paid pensions for attributable neurosis.^[73]            

By the beginning of the Second World War the term Shell Shock was no longer part of the official nomenclature, and much medical knowledge based on observations from the trenches in the Great War was either ignored, discounted or forgotten by the military.^[74] While it was still published in some peer reviewed medical journals that “nobody, however phlegmatic, was really immune from anxiety”,^[75] and even that “systematic research on… predisposition… gave inconclusive results”,^[76] arguably the military were selective as to whose opinion they chose to accept. Although as Jay Winter argues, the term ‘Shell Shock’ came to occupy an important place in British culture and the memory of the First World War,^[77] it was felt by the military that the best way to deter war neurosis “was to suppress all mention of quasi-medical terms like ‘shell shock’, pay no pensions and make it impossible for ‘neurosis’ to be used as grounds for getting discharged”^[78] The RAF retained the concern that such neuroses were contagious; any malingerers were to be treated harshly and stigmatised as an example to others.^[79] They were convinced that having undergone extensive selection processes and intensive training, a volunteer force would be almost immune to neuroses.^[80] However, even before the end of the ‘phoney war’ and the retreat from France, the rising number of emotional casualties in what was at the time a small professional force, led the RAF to consider their treatment of neuropsychiatric casualties. A copy of the first version of the ‘waverers letter’ was disseminated to all commands in April 1940.^[81]

The RAF employed medical consultants to organise and research the treatment and hopeful prevention of neuropsychiatric casualties. Chief of these were Charles P. Symonds, a neurologist who had served in the First World War and the psychiatrist, Robert D. Gillespie.^[82] However neurology took precedence over psychiatry and became dominant within the Air Ministry,^[83] as can be seen in the creation of the compound noun “neuropsychiatry.”^[84]  Although, like Symonds, Gillespie was convinced that people were predisposed to break down, he was more open to the view that the aetiology of neuropsychiatric symptoms were traumatic events,^[85] and the view endorsed by the USAAF that everyone will break down eventually if exposed to sufficient stress.^[86] A proponent of Pavlov, Freud and American schools of thought, Gillespie believed that, rather than requiring repeated training, a conditioned response could be established by a single experience if it was intense enough.^[87] Symonds was unsure of the effectiveness of Freudian psychotherapy;^[88]  throughout the war he maintained a harsher stance towards emotional casualties. He concluded from his research that only the weak and predisposed to neuropsychiatric symptoms broke down and that “the inherent quality of the man [w]as the most important single factor concerned in his ability to succeed in the operational effort.”^[89]

Symonds argued that in the inter-war period the term “flying stress” incorrectly became a clinical diagnosis, and there was no more warrant for this than there was for shell shock, or other terms such as “aeroneurosis” or “aviator’s neurasthenia.” He believed that all such diagnoses were “founded upon error, and might well… become a danger to morale.”^[90] “Flying stress” he argued “should only be used to denote the load which air-crews have to carry.”^[91] He defined flying stress as the normal effects of the cold and altitude, the weather, the length of trips and the nature and intensity of the enemy defences; exceptional flying stresses included personal losses, crashes experienced and crashes witnessed.^[92] He felt the anticipation and the stress of cancelled operations was as great a load as a raid itself.^[93] Symonds argued that “the idea of danger either in reflection or anticipation may be a more potent stimulus to evoke fear than the actual presence of danger.”^[94] He believed that as well as many neuropsychiatric patients suffering from conversion hysterias and anxiety neuroses explained by traditional Freudian theory, an equal number were suffering from a fear neurosis, “a morbid state of fear”.^[95] How a patient dealt with their own fear was more important to a medical prognosis than the amount of flying stress endured. However, although he admitted fear neuroses were obviously more common at times of war, and often most affective disorders were mixed states,^[96] Symonds conformed to the view held by many psychiatrists that “as far as symptomatology [was] concerned, the war neuroses possess no distinctive features differentiating them… from the various psychoneurotic and psychotic states which prevail in time of peace.”^[97] Syndromes were defined by “phenomenology and not psychopathology.”^[98] Towards the end of the war RAF doctors were encouraged to limit their diagnoses to Anxiety, Hysteria, Fatigue syndrome, Depression and Lacks confidence.^[99]

FIG 2.

^[100]

Symonds’ beliefs were founded on research he and Williams carried out during the war, by interviewing medical officers, squadron commanders and squadron leaders, and by collecting data from cards returned by unit medical officers and neuropsychiatric specialists at the Central Medical Establishment (CME) and NYDN centres.^[101] (See FIG 2) The cards required the MOs and specialists to record the patient’s details and diagnosis, their symptoms, flying stresses, and any causes of stress not associated with flying, any predisposing factors, the treatment given to them, disposal and prognosis.^[102] The level of predisposition was discerned by investigating the patients past record and family history during interviews.  When the data was collated distinctions were made between operational and non-operational flying, predisposition and non flying stresses were recorded as “Nil”, “Mild” or “Severe”, and there were five stages of flying stress from “Nil” to “Exceptional.”^[103]

The results from these surveys confirmed many of their preconceptions. It was found that the 67.7% of individuals who broke down were predisposed to neuropsychiatric illnesses,^[104] and there [was] an inverse relationship between the severity of the predisposition and the degree of flying stress to which the patients… [were] subjected.”^[105] The most predisposed broke down soonest with the least amount of stress, many whilst still in training, at OTUs or at the early stages of an operational tour. It was found that 42% of the cases were from Bomber Command, of which 54% were Air Gunners or Wireless Operators/Air Gunners and 31% were pilots.^[106]  The survey also found that, within Bomber Command, only a quarter of the patients were officers, and 42% were married.^[107] “Domestic worries” such as marriage during the tour, pregnancy, and financial worries were felt to be important factors contributing to the non flying load.^[108]

Their theories to explain these findings fitted the paradigm of predisposition. Pilots were felt to have a greater occurrence of neuroses because of the extra “psychological strain of the responsibility for the aircraft and its crew”,^[109] and gunners because they had more time to observe their own symptoms.^[110] David Stafford-Clark suggested that aircrew sergeants, especially air gunners and engineers, were more prone to neuropsychological illness because the motive behind their volunteering for aircrew was often “simply glamour and promotion, their attitude to flying and its risks unconsidered.”^[111] Although Symonds and Williams admitted that NCOs endured greater hardships in their dispersed living quarters,^[112] and that as “an officer hesitates to intrude” into an NCO mess, it was harder for MOs to recognise the early signs of distress,^[113] the accepted view was that NCOs broke down more frequently because of “inherent qualities which are fixed:”^[114] they broke down because they were not gentlemen. A squadron commander commented to Symonds that “If a man is slovenly on the ground the odds are that he will be slovenly in flying. You can see this in the way they keep their rooms and the way they fly.”^[115] Their report was based on a series of interviews with senior officers;^[116] the opinions of the airmen themselves were not sought and many of its conclusions were subjective. Finally, with little more than hearsay evidence, it was still believed that cases of LMF were contagious and often occurred in “epidemics”,^[117] which “easily infect several members of the same crew.”^[118]

The RAF’s consultant’s methodology, results and conclusions were fundamentally flawed. Predisposition was found in patients because the doctors expected to find it. If during interviews with the patient no predisposition was found they assumed it was there but hidden. While station MO’s found predisposition to neurosis in 45% of the cases, neuropsychiatric specialists found it in almost 75%.^[119] It was felt that this may have been due to the MO’s lack of training, or the limitations of the interview.^[120] Predisposing factors included “nightmares as a child”, introspection, “timidity” psychological illnesses in the patient’s family, “headaches and ‘eyestrain’”, or numerous other clues that would show the MO that the patient was “a slightly unstable type”.^[121] Ultimately the amount of predisposition recorded for any given patient was dependent on the subjective opinion of the doctor and the questions he asked.  Although LMF was not a medical diagnosis, the theory of predisposition was also at odds with the concept that a lack of confidence was contagious. However by the end of the war some of these flaws had been acknowledged. The view held by American doctors that everyone has their limit and would break down eventually became more accepted in the RAF. As a correspondent to the British Medical Journal highlighted in April 1945, individuals with a bad family history or neurotic disorders were decorated for bravery, and that the theory of predisposition was “largely assumption and… not justified in the present state of our knowledge.”^[122] In America it was noted that although breakdowns were frequently related to faulty childhood traits, growing evidence showed that a proportion of normal and healthy servicemen also succumbed.^[123] Perhaps most famously, Lord Moran, Churchill’s person physician, wrote that “a man’s will power was his capital and he was always spending… When their capital was done they were finished.”^[124]

Throughout the war the RAF’s specialists suggested that more attention should be paid during the aircrew section process to candidates’ predisposition to neuroses.^[125] However, due to the dearth of doctors trained in neuropsychiatry able to supervise the selection process, and the need for large numbers of aircrew from a relatively small population, this was impossible.^[126] In attempting to prevent aircrew succumbing to illness, either physically, perhaps through the hazards of flying at altitude, or emotionally, by developing a neurosis caused by a traumatic experience or facilitated by their own inherent weakness, the role of the medical services within the RAF was often “preventative rather than curative.”^[127] Informed by the results of the research undertaken by officers such as Symonds and Williams, one of the most important roles of a station MO was to prevent aircrew developing neuroses severe enough to warrant their removal from flying duties.

While medical officers were required to deal with all accidents and emergencies on their station, and the day to day health of the ground-crew and WAAFs, it was felt that their most important role was to maintain the physical and mental wellbeing of the aircrew and their efficiency whilst on operations.^[128] Research had shown that a large number of aircrew were predisposed to psychoneuroses; it was expected that aircrew would break down for genuine medical reasons as well as refusing to fly due to a lack of moral fibre.  The prevention of neuroses among airmen and the treatment of the early symptoms were crucial to the role of the MO as, once a neurosis was established, if a patient “required more than the most superficial psychotherapy, he was unlikely to return to flying duties and to remain efficient.”^[129] In one study it was found that as many as 70 % of cases of neuroses were treated on the station by the MO without further assistance from NYDN centres or specialists.^[130]     

Station medical officers were guided by the Air Ministry pamphlet 100, Notes for medical officers on the psychological care of flying personnel,^[131] by the revised pamphlet 100A,^[132] and by lectures for new MOs held weekly at the Central Medical Establishment and at local NYDN centres.^[133] Pamphlet 100 outlined the prevalent Freudian theories concerning psychoneurosis, their causation and symptomology.^[134] The warning signs of a “pre-neurotic state” indicating the need for a period of rest, leave or change of duty were described as:

Any changes noted in the general behaviour, habits, or efficiency of an individual call for investigation. Abnormalities commonly met are:-

1. Fatigue
2. Increased indulgence in alcohol or tobacco.
3. A tendency to become unsociable or irritable.
4. Loss of interests, disinclination for effort.
5. Emotional crises-loss of self control.
6. Falling off in flying efficiency.
7. Physical symptoms such as loss of appetite, of sleep or of weight, the presence of tremors and tachycardia, and typical anxiety facies.^[135]

All of theses signs were observed by station MOs, but others sought help on their own volition. Malingerers, men at first reporting to the MO with an unfounded trivial complaint often later confessed they were afraid. A smaller group who exaggerated slight disabilities such as boils, catarrh, or sinus troubles, in an attempt to be taken off flying, were also likely to be suspected of LMF.^[136] Medical officers must have often had to make moral judgments on such personnel based on experience and subjective opinion. It was felt that a “Frank admission of fear when it is associated with self-reproach or over-whelming anxiety is evidence in favour of illness. A grudging admission, especially if associated with attempts at justification, is evidence against illness.”^[137] However a refusal to fly almost always led to disposal as lacking in moral fibre. Medical officer David Stafford- Clark felt that men who “faltered” during a tour came into two groups, temporary and permanent failures. (See FIG 3)

FIG 3.

^[138]

The temporary group included the subsets “8^th to 12^th trip waverers” and “early fatigue cases” who had flown at least 24 operations. With these groups, given the correct treatment by the station MO, Stafford-Clark believed that prognosis for completing their first tour and even a second tour was good. The permanent failures consisted of “essentially unsuitable types”, who broke down in the early stages of their first tour, and those who broke down after “exceptional strain.” Of those who had suffered exceptional strain he felt that after treatment by the MO or at a NYDN centre only a few would return to flying duties, but of those in the other group “almost all of these cases require[d] executive and not medical action.”^[139] Stafford-Clark also identified the periods of a tour when the neuroses were likely to be the most severe for bomber crews,^[140] and his observations were confirmed by the more empirical investigations into the weight lost by aircrew members over a tour.^[141] The most stressful times for aircrew were found to be at the first and last few operations, together with several operations towards the middle of a tour.^[142] In order to spot the symptoms of the onset of neurosis it was recommended that the MO:

should mix with [aircrew] in the mess, drink with them and go on parties with them. In duty hours he should spend time in the crew rooms and hangars, and during operations should be present at briefing, take-off, return and interrogation.^[143] 

The problem of assessing how MOs treated aircrew is complicated by the fact treatment varied considerably between stations according to the individual medical officers. Their differences of opinion can be clearly discerned in the British Medical Journal correspondence pages. One doctor felt that recourse to a neuropsychiatrist was “the refuge of the diagnostically destitute,” admitting he referred “more and more cases to the executive for disciplinary action,^[144] while others were far more sympathetic, citing cases where those invalided from the services were still “seriously incapacitated after months of civilian life.”^[145] Other MOs persisted in searching for organic causes for a patient’s symptoms, frequently referring patients to other specialists before consulting a neuropsychiatrist.^[146] Undoubtedly some MOs were more astute than others, and tried to win the confidence of the aircrews. At Wickenby the MO played piano and drank with the men in the officer’s mess,^[147] some doctors even flew on operations,^[148] and a navigator at Elsham Wolds recalled that the station’s doctors never seemed to sleep.”^[149] However, within the culture of the RAF it was hard for doctors, as officers, to associate with sergeant aircrew. Although, in order to interact with NCO aircrew, each day one medical officer arranged for a different bomber crew to visit the station sick quarters for ultra-violet light treatment,^[150] others regarded themselves as part of “the community of brother officers”.^[151] As part of the officer elite, many MOs conformed to the social and cultural preconceptions prevalent among the upper echelons of the RAF of the importance of a public school education; combined with the accepted theories of predisposition for psychoneurosis, they may have expected air gunners who were once tradesmen, or even “the eleven plus scholarship boys” who constituted the backbone of Bomber Command aircrew,^[152] to be more susceptible to a lack of discipline and low morale.   

It was advised that liaison between the MO and commanding officers should be as “intimate as possible” while keeping extent of their partnership “outside the knowledge of the crews.”^[153] Although medical officers could only advise commanding officers on matters effecting morale,^[154] to an extent, however unwillingly, they became part of the RAF’s disciplinary machine. It was suggested that officers should explain problems to aircrews at all costs, even if the explanation was incorrect,^[155] as discipline and leadership were felt to be vital to helping the man to accept and carry the load of operational flying.^[156] Symonds and Williams reported that the squadron leader should fly on an operation when morale was low, and recorded the opinion that when it became known on one squadron that the commander wouldn’t fly operationally there were five cases of lack of confidence within a fortnight as a direct result.^[157] However, while Harry Yates recorded that his squadron was “not the sort of outfit in which senior officers picked the easy trips,”^[158] and that the “quality of a Commanding Officer’s leadership was a crucial factor in squadron morale”,^[159] arguably what commanding officers did in the air was irrelevant. Recalling an operation where his regular pilot was replaced by the CO, Frank Musgrove pointed out:

There was… no sense in which the Wing Commander was leading the raid or even his squadron… he was anonymously embedded somewhere in the scrum… he gave no order or signal to other aircraft… [and he was] an example and inspiration to no one.”^[160] 

Perhaps it was a CO’s disciplinary treatment of the men on the ground that was more important. Bomber Command were concerned with “Fringe Merchants”, crews who bombed short of the target, and “Boomerangs”, crews who aborted sorties for various reasons.^[161] In November 1943 4 Group recorded 69 ‘early returns’ from a total of 804 despatched; most were for reported mechanical failures, but 5 aircraft returned because of a sick crew member.^[162] These men were examined by medical officers and were found to be “approximately half illness and half neurotic”.^[163] It was ultimately the responsibility of the CO to decide whether a man should be treated as a coward or not.^[164]

The medical officer and the commanding officer were informed how to treat individual aircrew by the so called “waverers” letter, “Memorandum on the disposal of members of air crews who forfeit the confidence of their commanding officers.”^[165] Aircrew found to be unable to stand up to the strain of flying were to be placed in one of three categories.   

1. Those who though medically fit… come to forfeit the confidence of their Commanding Officers without having been subjected to any exceptional flying stress…
2. Those who are given a permanent medical category lower than A1B or A3B… solely on account of nervous symptoms and without having been subjected to any exceptional flying stress…
3. Those not included in (ii) above who are given a medical category lower than A1B or A3B, as appropriate.^[166]

Officers in category (i) were to loose their commission and leave the RAF, while airmen were to loose their aircrew badges, be removed from aircrew duty, reclassified AC2 for at least three months and remustered.^[167] The memorandum highlighted the importance of the role played by medical officers, as the “individual, though medically fit must be proved to be lacking in moral fibre.” Medical officers had “to eliminate any possibility of a medical disability before a member of an air crew [was] placed in category (i)”^[168] Where a medical officer was in doubt whether a case should be regarded as one of sickness or lack of confidence the individual concerned was to be sent “to the Specialist in Neuro-psychiatry at the nearest N.Y.D.N. centre.”^[169]

The Director General Medical Services, Air Marshal H. E. Whittingham agreed that it was important to remove suspected LMF cases from operational stations as soon as possible,^[170] as it was believed that “any air crew personnel not actually employed on flying for any reason have an adverse effect on others if left for too long on the station”.^[171] Medical officers on operational stations were under pressure to come to a quick conclusion regarding aircrew who refused to fly. Although they were cautioned that pilots or members of aircrew were frequently “taken off flying with the label “psychoneurosis” without adequate investigation or assessment of their symptoms”,^[172] perhaps it is unsurprising that throughout the war far more aircrew were diagnosed with a neurosis or sent to NYDN centres than disposed of by the executive as LMF. However, although station medical officer’s diagnosis may have been accurate, their role as far as the RAF was concerned was to keep as many men flying as possible, and functioning as efficiently as possible. Of those referred to a NYDN centre in 1944 72% were grounded.^[173] As Gillespie pointed out it was felt that “if you provide beds for psychological disorders you will get them filled.”^[174] Arguably Medical officers were in the unenviable position of attempting to reconcile their Hippocratic Oath with their duty to the RAF and the war effort.  It is likely that a patient reporting to the MO with psychoneurotic symptoms, who was found to have moderate or severe predisposition to neurosis and who withstood a high degree of flying stress and non flying stress, would be diagnosed psychoneurotic and treated medically, either in the station sick quarters or at a NYDN centre. However if the MO could find no evidence of predisposition and only mild stresses, his diagnosis may be less favourable, and it would then be for the CO’s to decide how they were to be treated.    

Chapter 2: Not Yet Diagnosed Neuropsychiatric.

“The… medical officer… inspires with an Aesculapian touch”.^[175]

Reading official sources, reports and station records across the grain, together with the testimony of veterans published in their memoirs and reference to wartime medical journals, this chapter will examine the immediate and prolonged treatment of potential and actual neuropsychiatric casualties by the RAF. It will examine the prophylactic treatments employed by station medical officers in order to maintain the efficiency of aircrews, and the treatment of those posted to NYDN centres. In particular this chapter will examine the NYDN centre at Rauceby, and the hospitals at Matlock, which dealt with NCO patients, and Torquay, where officers were treated. The treatments that men underwent at these hospitals will be described. Based on the findings of First World War treatments of neuropsychiatric patients it was believed to be most beneficial if patients were treated as near as possible to the front, in an endeavour to stop them seeing themselves as casualties.^[176] For members of Bomber Command this meant at least initial treatment in the SSQ.  In common with accepted practice, the treatments available included 48 hours rest and sleep, often assisted by drugs, reassurance using a “common- sense approach to the psychology of aircrews,”^[177] and short periods of leave.^[178]

In anyone reporting to the MO with anything suspected as more than mild neuropsychiatric symptoms, organic causes had to be ruled out before any executive decision could be made.Concerned about one of his pilots, in the novel Fibre, the CO asks his medical officer to examine a pilot he is concerned about, to try to find an organic cause for his lack of confidence and to explain his series of bad landings.^[179]  At altitude a mild cold could become severe sinus trouble and a nagging toothache could become “blinding pain.”^[180]  In a diving aircraft the rapid change in air pressure could lead to a mild Eustachian obstruction becoming painful “Otic barotrauma” and burst ear drums.^[181] In some instances air tests were used in an attempt to replicate symptoms. A sergeant flight engineer reported sick after returning from leave when he had been urged to give up flying by his family.  He reported experiencing abdominal pain and throbbing headaches at altitudes between 15,000 and 20,000 feet. He had suffered severe flying stress during training and his seven operational sorties, when his aircraft ditched and members of his crew were killed. However he was found to have no predisposition and was not displaying any symptoms of anxiety or nervous tension. Accompanied by the MO, he was taken on a cross country flight and was kept unaware of the altitude at which the aircraft was flying. Although he reported some pain and discomfort it was not associated with the heights he had claimed and there was no correlation to barometric pressure. His reasons for ceasing to fly were not considered medical and he was disposed of by the executive.^[182] Arguably the gap between his last traumatic experience and flying again was too long; he had been given too much time for “rumination over the dramatic occurrence.”^[183] Some medical officers believed that no member of an aircrew should be allowed leave following an accident before he had returned to full duties without symptoms.^[184] Following the maxim if someone was thrown from a horse they should remount as soon as possible,^[185] pilots were encouraged to have test flights after a traumatic experience “just to show there’s no ill feeling with air-craft in general.”^[186] Flying tests were also used as part of the psychological treatment. After a crash which killed several members of his crew, a sergeant pilot “lost his confidence… and… was so shaky that even his circuits and landings were hopeless.”^[187] He was accompanied on a ninety minute test flight by the MO who endured several poor landings as the aircraft “kangarooed” on the runway, until the pilot became “competent and relaxed”.^[188]    

However, the station MO also played a more routine part in aircrew’s lives. For those flying night sorties, drugs such as caffeine and Benzedrine were regularly given to the men to help keep them alert. Jack Currie recalls the MO at Wickenby handing out caffeine tablets; although Currie heard about Benzedrine tablets being issued he did not see them.^[189]  However, at RAF Methwold, Miles Tripp’s preferred “wakey-wakey” pills contained 5 to 10 milligrams of Benzedrine and they were available after every briefing.^[190] To counteract these, on their return there was an issue of rum, and “white blockbusters” were “dished out by the medical orderly”to help them sleep.^[191] Treatment by ultraviolet light was widely used for its “general tonic value” for aircrews on night time operations,^[192] and Hyoscine was prescribed to prevent airsickness.^[193] As well as these regular prophylactic treatments, the MO was on the look out for symptoms that individuals were suffering from the stress of operations, and the degree of a patient’s psychoneurosis was judged against the intensity of symptoms of others who continued to fly.^[194]  In their studies Symonds and Williams discovered that 46% of aircrew with psychological disorders received physical treatment on their station.^[195] Although related physical symptoms such as dyspepsia may have been treated by antacids,^[196] or a placebo,^[197] often patients were admitted to the station sick quarters where drugs such as Nembutal or Medinal were administered.^[198] An average SSQ had accommodation for up to thirty-five patients, usually a male ward of twenty beds, with separate rooms for officers, W.A.A.F.s and observation or isolation cases. It was staffed by the station’s doctors, a dentist and about ten medical orderlies.^[199] In their study Symonds and Williams cited the instance of “Case 87”, a Sergeant Air Gunner who reported sick after only three operations in Lancasters. During an interview with the MO he was found to have a predisposition for psychoneurosis and he was admitted to the SSQ for 48 hours rest. He was given 3 grains of Nembutal at night and 15 grains of Sodium Bromide three times a day, and along with “encouragement” from the MO, his captain and other officers, he went on to complete 22 sorties before he was killed.^[200] Drug treatment combined with a psychological “pep talk”,^[201] using “explanation, persuasion, or suggestion,” was employed in almost 80% of cases.^[202] 

Although aircrew had an inherent suspicion of “Trick Cyclists,”^[203] as they called psychiatrists, a great deal of emphasis was placed on the MO’s interview with patients.^[204] MOs were advised to approach someone they suspected of the patient “tactfully” and “unofficially”,^[205] as it was thought that some patients would be relieved to openly discuss their difficulties.^[206] In the early stages of a psychoneurosis “abstruse or mysterious therapeutic procedure” was not necessary. A “budding psychoneurosis” could be relieved by reassuring the patient that in certain circumstances fear was not to be ashamed of, it was natural, and had to be coped with.^[207] Despite the above air gunner’s admitted fear and obvious anxiety state, he was effectively treated by the MO, the gunnery officer and his pilot. However, others who did not openly admit to psychoneurotic symptoms were also treated for them. It is possible that many were not aware that the MO was treating them with “psychotherapy of a simple kind”.^[208]

When Don Charlwood was almost halfway through his tour he mentioned his increasing airsickness to his MO at a final briefing one night. He was immediately given some pink powders “for the tummy”, “vitamins to take the place of last night’s sleep” and caffeine to get him through the operation; and he was told to report to the sick quarters when he woke up the afternoon after the raid. He reported to the SSQ to find a fellow navigator and the bomb aimer from his crew were also there. He was ordered to bed and slept through the night and the next day, not waking until the following evening. While there he heard a rumour that “high-altitude work was taking more out of the men than had been anticipated” and he was also visited by a friend.^[209] At the end of his 48 hours rest Charlwood asked the MO to go back to duty because he didn’t want his crew to fly without him.^[210]  Perhaps as well as drugs and rest in the SSQ he had received the MO’s subtle psychotherapy. Such temporary grounding does appear quite common, Tripp tells of an Air Gunner who was temporarily grounded with ear trouble,^[211] and “Tubby” the flight engineer who flew with Harry Yates was also grounded for forty-eight hours when he went to see the MO as he “had been experiencing a mild recurrence of his air sickness.”^[212] 

However, the treatment aircrew received varied between stations and with different medical officers.^[213] A Bomb-aimer with the symptoms of jaundice reported to his MO and was told that he was frightened of flying and that was why he had gone yellow.^[214] Discussing ground crew as well as flying personnel, medical officer, Wing Commander Perkins maintained that many saw the neuropsychiatrist as “the escape route… for anything distasteful,” and believed that those who asked at sick parades to see the nerve specialist had learnt “all the correct answers to the neuropsychiatrist’s questionary well in advance.”^[215] The jaundiced Bomb-aimer managed to complete his tour and as Tripp points out the MO had “achieved a financial saving to the country’s exchequer by not taking [him] off flying duties.”^[216] A Medical officer with the rank of Squadron Leader felt that:

the first duty of the Service medical officer [wa]s to consider the efficiency of the Service which employs him, and then the individual… Surely the uncontrolled neurotics… [were] better out of the Service, which they merely hinder.^[217]

In more obvious cases of psychoneurosis caused by the exceptional stress of single traumatic events, drug treatment, narcosis and psychotherapy were practised on operational stations. Charlwood himself was asked by a junior medical officer to talk to a fellow Australian in the sick quarters; a rear gunner who had been pulled “unscathed” from a Wellington which had crashed killing the rest of the crew. The gunner’s eyes were dilated and he was talking “rapidly and sometimes incoherently” before he fell asleep.^[218] After such an event it was felt that “prolonged sleep, advice and encouragement, a further trip or two and then leave” could give good results.^[219] 

On the advice of the MO around a third of crews treated on their station were given leave of between 48 hours and ten days.^[220] The benefits of leave depended on where the leave was spent and with whom, and there was always the problem where commonwealth crews could go.^[221] After a problematic eighth operation the CO gave Yates and his crew a weeks leave. He believes that the CO probably “saw a crew that was tired and susceptible to error.”^[222] As Dr. Robert Maycock, a Wing Commander who carried out research into the physical effects of flying on aircrews lamented:

It is perhaps a pity there is no clinical record of the beneficial and restorative effects of those ‘forty-eights’ in the ‘Big City’ on those who temporarily have had enough.^[223] 

Treated with psychology, drugs, rest and leave by the MO on operational stations, many aircrew who could be considered neuropsychiatric casualties, if albeit temporary ones, were not recorded.^[224] Some aircrew “showing signs of strain and anxiety” were awarded a temporarily reduced medical category, and remained on their station,^[225] and although NCOs who refused to fly were treated harshly by the executive, officers were sometimes found a non flying role within the squadron.^[226] As in the example of “Case 87” on pages 43 – 44, many more who were persuaded to continue flying with the assistance of the MO were subsequently lost on operations.^[227] With the agreement of the CO,^[228] patients of unsure diagnosis, who exhibited more developed psychoneurotic symptoms,  or failed to respond to the MO’s treatment were referred to NYDN centres.     

Nine of the twenty-six general RAF hospitals had neuropsychiatric wards,^[229] but with the exceptions of Rauceby and Halton, “psychotic” patients were transferred to Army Mental Hospitals.^[230] There were eleven NYDN centres in England and Scotland, four of which were for operational personnel, and provision for long term neuropsychiatric patients at RAF Matlock and Torquay. (See FIG 4) In 1943 there were 37 medical officers engaged in neuropsychiatric duties within the RAF, and twenty of these served at NYDN centres.^[231] Between June and December 1942 an average of 293 aircrew outpatients per month were seen for the first time at NYDN centres, and in December 432 old outpatients attended.^[232] In a twelve month study of one NYDN centre, from 2,000 neuropsychiatric patients just under 15% (300) were aircrew.^[233]

FIG 4.

^[234]  

The average stay for neuropsychiatric in patients was found to be 30 days for officers and 94 for airmen.^[235] In the last two months of 1942, from among both in and out patients at NYDN centres, under one quarter of pilots were returned to full flying duty, and around 3% were recommended for executive action.^[236] Among other aircrew only approximately one sixth returned to full duty and around 5% received an executive decision.^[237] As other categories include temporary grounding and invaliding, it can be assumed these were disposed of as LMF. Around one fifth of the patients either continued to be treated at the NYDN centre or were transferred to the Central Medical Establishment and other hospitals.^[238] Some of these were sent to the convalescent homes at Torquay (for officers) and Matlock (for airmen). These homes treated others convalescing from wounds and illnesses too and while it was agreed that while:

the presence of nervous cases retards the recovery of others… the benefit to the nervous cases of contact with other patients who are mentally normal is considered to outweigh this disadvantage.^[239]   

In December 1939 Torquay had almost 250 beds available for officer patients,^[240] and when the RAF hospital at Torquay was attacked by four Focke-Wulf 190s in October 1942 a report shows that from 206 patients there were 19 “NYD”N”” patients.^[241] At Torquay, after the day’s programme airmen were free to go out, subject to a 10.30 p.m. curfew, although some were entitled to late passes or sleeping out passes.^[242] At Rauceby a new NAAFI building was built with a supper room and two rest rooms, and the lighting, internal decorations and furniture were intended to create an “artistic and “non-barrack room atmosphere.””^[243] Men were encouraged to mix with WAAFs and there was “something on” every night of the week. Outdoor activities included “Games and organised parties”, while indoor events included dances, concerts, lectures and discussions and occupational therapy,^[244] and there were visits by the ENSA concert party.^[245] Occupational therapy was “fully utilized” and proved “most beneficial and popular,”^[246] At Rauceby patients were given instruction in handicrafts such as leather work, clay modelling, rug making, book binding and model-plane making. However encouraged to make soft toys, hand bags and things of a similar nature, some aircrew “were apt to sneer at the femininity of such an occupation and felt they were not doing a worthwhile job.”^[247] Studying the benefit of occupational therapy at Torquay,^[248] Wing Commander Phillipi discovered that of the few that failed to respond to occupational therapy the majority were “neurological” patients.^[249] Although ostensibly for orthopaedic and medical patients, neuropsychiatric patients were encouraged to participate in physical activities, as the “enthusiasm” and “high morale” of physical training instructors was thought to exemplify “deportment and zest”.^[250] At Torquay, as well as “General P.T.”, activities included golf competitions, cycle rides, football, bowls, volley ball, basket ball, swimming and afternoon or all day rambles.^[251]  It was felt that such a regime of “carefully graduated exercises, games, and physical training” would reinforce the psychotherapy that was an important apart of their treatment.^[252] 

It was found that “conversations lasting only half an hour to one hour two or three times a week could achieve good results.”^[253] Treatment was mainly analytical and abreactive, and included case history and Freudian dream analysis. After careful history taking, and a “lucid explanation” of the origin of the patient’s symptoms, he was “sooner or later confronted with the need to drop his symptoms or his interest in them and face the prospect of return to duty.”^[254] Gillespie attempted to break the conditioned Pavlovian responses to stimuli such as smells which reminded a pilot of burning flesh from an accident he had been involved in, or “unresolved infantile conflicts” such as an air gunner’s childhood claustrophobia.^[255]  Gillespie believed that neuroses caused by “normal” fears were likely to be successful treated this way; however he felt that unless the patient was “sufficiently intelligent” the prognosis was bad for a patient with a “constitutional” fear due to a faulty upbringing.^[256] If after normal analysis the patient’s repressed memories could not be penetrated the use of narco analysis was indicated,^[257] and often seemed to achieve results faster than hypnosis.^[258] Various barbiturates were slowly injected to render the patient “drowsy” but without “reaching the stage of incoherence,”^[259] and once “reduced to a semihypnotic state… the man [wa]s forced to re-live the frightening experience which precipitated breakdown.”^[260] The treatment was also used to help patients recover lost memories and to remove panic states and recurring nightmares with little demand on the doctor’s time.^[261] Using similar drugs, continuous sleep treatment or “Prolonged Narcosis”, aimed to “procure 20 hours of sleep out of the 24… and to see that during the 7 to 10 days the treatment is being continued the patient receive[d] 3 to 4 full meals a day.”^[262] Based on the treatment of the previous war’s shell shock patients, this treatment aimed to give the patients a distance from their traumatic experiences and to replace the weight they lost through stress.^[263] For this RAF doctors used the drugs Nembutal and Sodium Amytal.^[264] In some hospitals in order to treat both a patient’s weight loss and as an alternative method of prolonged narcosis therapy, Insulin therapy was experimented with. Insulin was given to patients on an empty stomach “to produce a light coma”, which was interrupted by giving sweet tea followed by 12 ounces of potatoes.^[265] The insulin increased the appetite of the patient and further helpings of potatoes were often eaten as well as a full lunch. The treatment was successful in improving the appetite of neurotic subjects and they often gained a stone or more in a few weeks.^[266] However as Gillespie highlighted, this treatment was unsuccessful in curing long standing neurotic traits, anxiety or depression.^[267] 

Gillespie was the chief psychiatrist at Matlock throughout most of the war,^[268] and he found that over half the patients admitted to Matlock had had their symptoms for over a year.^[269] Hastings believed that “the most fortunate, who were sensitively treated” were sent for a “spell” at Matlock,^[270] but as Francis recently highlights, the lives of the aircrew treated there “remains, even now, highly obscure.”^[271] However, in his account published in 2000 and previously unused as a source by historians, Denis Wiltshire, a flight engineer on Lancasters, tells how he was admitted to RAF Matlock after a traumatic event on a raid in which his bomb aimer was killed.^[272] Although physically uninjured he was admitted to his station sick quarters in a catatonic fugue state where he remained, probably sedated, for four days before he was transferred to Matlock. Between 1940 and 1945 Matlock usually had between 100 and 150 inpatients,^[273] and was referred to as the “Hatter’s Castle” by the airmen.^[274] The nickname has connotations of the Mad Hatter from Lewis Caroll’s Alice’s Adventures in Wonderland, but perhaps more tellingly the 1942 film The Hatter’s Castle, starred Robert Newton as James Brodie, a more sinister mad hatter, who lived in a pretentious crenellated house not dissimilar to the old Rockside sanatorium at Matlock.^[275] In the film Brodie drinks to excess and suffers a mental breakdown before committing suicide. It is possible that the patients saw the film as an apt metaphor for their time at Matlock as well as a nickname for the hospital.  It is likely that Wiltshire underwent continuous sleep treatment and psychotherapy at Matlock and, after tests to rule out organic causes,^[276] he was treated with Electroconvulsive therapy (E.C.T.).^[277] All Wiltshire remembers of his ECT was being taken to a room in a wheelchair and, wearing only a sleeveless gown, lying on a bed with rubber sheets and pillow. A gum shield was inserted, gel applied to his temples, and the pads were clamped to his head, before he was anaesthetised by an injection.^[278] (See FIG 5)

FIG 5.

^[279]

Reference to wartime medical journals can determine details which Wiltshire was unwilling to recount. Typically the resistance of the patient’s head was measured first by a small DC current before voltages between 90 and 145 AC at up to 2,000 milliamps were applied for one to two tenths of a second.^[280] The fit produced could last fifty seconds, during which the patient sometimes passed urine or faeces,^[281] and there was a slight risk of fractures.^[282] Afterwards the patient could experience a “retrograde amnesia reaching back for several hours.”^[283] Such a treatment could be repeated twice a week for up to six weeks.^[284] After weeks of treatment, dressed in hospital blues as all his kit and uniform had been lost, Wiltshire attended a medical board and a discharge board after which he was invalided from the RAF.^[285]    

The prevalent theory of predisposition led the doctors at NYDN centres to conclude that “few were likely to become operationally fit again, – for the reason that, in a sense they never fully were.”^[286] In the case of patients predisposed due to a “constitutional timidity or anxiety” it was felt impossible “for medical treatment, in or out of hospital, to supply what years of training in courage have failed to do.”^[287] Those returning to full flying duties do not seem to have been more prone to being lost on operations, but although the sample sizes were very small there was some evidence that they were more prone to accidents, and after nine months it was discovered that those returning to full flying were three times more likely to break down.^[288] However it seems that by immediate treatment, station and squadron medical officers managed to prolong the operational effectiveness of many aircrew. While in their autobiographies and memoires, few veterans admit to coming close to breaking down, several mention being grounded for forty eight hours for physical ailments such as ear trouble and air sickness, arguably the MO may have considered some of their complaints to have been symptoms of a burgeoning psychoneurosis. In an article in the British Medical Journal the medical profession were informed that every new patient at a NYDN centre was “reviewed completely and anew from the neuropsychiatric angle… since in many cases it is necessary to counter previous medical opinions suggesting organic disease,”^[289] but in secret reports to the Air Ministry, the importance of the reports from an airman’s MO and CO were stressed. They were regarded as of equal importance to a good clinical history as “the sheet anchor of judgement” in making a “final opinion.”^[290] In at least some instances an airman’s treatment was dependent on the original diagnosis of an individual medical officer and the whim of his CO. Medical officers had to decide whether a man’s inability to fly was “his fault or his misfortune,”^[291] and Dr. Alan Gregg wrote in the British Medical Journal in 1944, “it is sometimes hard to separate psychiatric symptoms from immorality.”^[292] Difficult cases were passed from the specialists at NYDN centres to the CME for the consultant in Neurology to give the final decision whether “it is a medical or non-medical case.”^[293] In a percentage of cases no recognised illness or medical reason to avoid flying was found, and as a consequence, some NYDN patients were labelled LMF by the executive. Their treatment, together with those who refused to fly, will be discussed in the next chapter.

Chapter 3: LMF and Aircrew Disposal.

“there’s not much future in Bomber Command”^[294]

The typical narrative of LMF is that an example was set “pour encourager les autres;” the men were paraded before the squadron, their previously loosened wings were ripped off, and they were marched away, never to be seen again.^[295] Using rare personal testimony this chapter examines where they were sent and what happened to them, however it will be shown that not all those accused of LMF were treated in such a fashion. It was policy to remove suspect aircrew from their squadron as quickly as possible, but an often lengthy process had to be undergone before a man could be officially designated as LMF. As was the case of Denis Wiltshire discussed in the previous chapter, it is possible that, after medical investigation a proportion of men posted to NYDN centres or Eastchurch grounded or invalided from the service rather than being disposed of by the executive as LMF. Following the procedure defined by the ‘Waverer’s letter’, the medical board had to ensure that there was no medical reason for the man not to fly, and this could entail lengthy testing. An airman must have been found to have no physical illness, few or no neuropsychiatric symptoms, and have suffered from little or no stress, either from flying or domestic influences, before they could be designated as LMF. The final stage was a letter from the Air Ministry officially reducing the airman in rank and withdrawing his entitlement to wear his air crew badge.^[296] While disciplinary centres such as the glass house at RAF Norton in Sheffield do not come under the scope of this chapter, the Air Crew Disposal Unit (ACDU) and the infamous and enigmatic Air Crew Reselection Centre at RAF Eastchurch on the Isle of Sheppey will be discussed.

The RAF policy towards waverers, those who were LMF, or indeed any “odd-ball types” not suited to life in the forces,^[297] was inconsistent and altered throughout the war. Sent to Brighton, Blackpool or Uxbridge in the early days of the war, and officially only to Uxbridge by the summer of 1942,^[298]  this was found to be unacceptable as these were the RAF’s main recruit selection depots and LMF personnel were felt to have a detrimental effect on the morale of recruits. There was a neuropsychiatric specialist at the reselection board at Brighton to advise on the suitability of cases among air crew for alternative employment,^[299] but from early 1943 Eastchurch combined the duties carried out by Brighton, Blackpool and Uxbridge as the main reselection centre.^[300] However the problem of recruits and training aircrew seeing LMF and NYDN patients remained.  Paraded at Eastchurch, air gunner J. Green saw “flights of aircrew with all badges of rank missing from their sleeves.” He believes recruits were briefly sent to Eastchurch “to witness and possibly be intimidated by the treatment… [of] these unfortunates.”^[301] By the end of July 1943 1407 cases had been dealt with by the reselection boards at Eastchurch,^[302] and it was quickly found that Eastchurch needed more than one medical officer because the:

combination of the rapid turnover and the high proportion of unfit, mentally and physically, among the suspendair [sic] personnel, mean[t] a disproportionate amount of work for the Medical Section compared with the strength of the Station.^[303]

Accused being “unfit to captain an aircraft”,^[304] Flight Sergeant Roy Larkins was posted to Eastchurch in February 1945, and was briefly given the job of cleaning his barrack block and painting posts around the parade ground white.^[305] Not realising his career was “marked” as if he was “branded on the forehead,”^[306] he was told to hand in his flying kit, and did so still thinking he would fly again.^[307] Larkins felt there was a “conspiracy” to demoralise aircrew; he was put on a charge for being late which was later dropped,^[308] and he felt humiliated by the lack of a Sergeants’ Mess. At Eastchurch life was “down market” compared to other stations.^[309] Eastchurch was a typically cold and damp widely dispersed site. A correspondent of Miles Tripp remembered there were “hundreds of aircrew milling about and the farmers used to pay a shilling an hour to work in the fields.”^[310] Two-hundred personnel were in tented accommodation in the late spring and early summer of 1944,^[311] and the following year the Senior Medical Officer complained about:

the old and dilapidated condition of the billets on the Station. These are not proof against the worst type of weather experienced on this island, and are now in a state when they are beyond repair with the facilities and material available.^[312]

The camp was also plagued by mosquitoes from numerous pools of stagnant water,^[313] and compared to what he was accustomed to in the Sergeant’s Mess, Larkins found the food “dreadful”. Birds sat on the beams of the large dinning hall, and “there was a constant drop on to the tables below… occasionally some poor individual had his meal ruined”.^[314] At Eastchurch in 1944 a NYDN patient in the SSQ attacked a WAAF corporal nursing orderly and he had to be placed under escort until his transfer to a Military Hospital. A report stressed the need for separate sick quarters for NYDN cases waiting for disposal.^[315] The problem of LMF and NYDN patients mixing with other aircrew members was still prevalent during the later half of the war. Posted to Eastchurch for remustering after a physical illness, Sergeant, navigator Frank Lund remembered:

many of the fellows there were halfway round the bend. They were the Bomber boys who had been through hell and back. They would wake up in the middle of the night screaming.^[316]

An air gunner who refused to fly after ten operations remembered that a Warrant Officer pilot shot himself and the atmosphere was “ghastly”; at Eastchurch aircrew were stripped down to AC2 and “dumped”.^[317]  The RAF recognised the delay in processing waverers and LMF aircrew. Executive reports on individual cases were frequently “not forthcoming or delayed, with the result that when cases d[id] go to the Medical Board they ha[d] to be deferred.”^[318] At Eastchurch it was recognised that there was also a “medical delay” in processing reselections. It was found there was: 

1. Necessity for hospital investigations of numerous psychiatric cases sent [to Eastchurch] as purely executive cases, and of psychiatric cases recognised as such previously, who have deteriorated & require further investigation, hospitalization, or invaliding.  
2. Necessity for investigation, hospitalization, & regrading of cases of physical illness which have not been dealt with at previous units.
3. Delay in obtaining Specialists’ appointments prior to convening medical boards under Group arrangements.^[319] 

Theoretically the medical papers of all cases to be reduced in category due to a nervous illness were to be reviewed by a consultant in Neuropsychiatry.^[320] Perhaps due to such official delays and the of numbers men there, Larkins found that it was only necessary to attend the parade for the Daily Routine Orders (DRCs) in the morning; usually if a man was not required to report for any specific duty he was free for the day.^[321] Lund recalled “bureaucracy at Eastchurch was not of the most effective kind… so long as you kept out of everyone’s way and you had a kit bag on your back and looked as though you were going somewhere… no-one would bother you!”^[322] It was common practice for aircrew to leave the camp and catch the train into Sittingbourne. The train stopped by a hole in the perimeter fence 200 yards short of the main gate, and those on guard “watched happily, being well aware of the procedure.”^[323]  Larkins even managed to go Absent Without Leave (AWL) for a weekend without being missed.^[324] However for many Eastchurch was not their last posting. Stripped of their rank, NCOs were often posted to new stations as AC2, while many officers and airmen were sent to the Air Crew Disposal Unit.^[325] The available evidence suggests that conditions at ACDUs were similar to Eastchurch, although arguably it was harder to for officers to go AWL. The records show that in the beginning of October 1944 Flying Officer W— reported to a nearby airfield for an air test and then went absent without leave. He reported back to Keresley Grange towards the end of the month and in December he relinquished his commission.^[326] Larkins recalls visiting the camp cinema at Eastchurch,^[327] while at Keresely Grange, a Flight Sergeant used to read books from the “moderately decent library” all day before thumbing a lift to the theatre or cinema in Coventry in the evening.^[328] Examining the records of the Air Crew Disposal Unit, McCarthy was concerned with the numbers who passed through,^[329] however more than quantitative information can be gleaned from these sources.   

Aircrew from ACDU Chessington visited places such as the zoo, St Paul’s and Madame Tussauds.^[330] Lecture on topics such as “What shall we do with Germany?” were also held.^[331] Jones highlights that the records reveal that servicemen “saw patriotic films and played in cricket matches in an attempt to win back their self-esteem and commitment to the war effort.”^[332] However perhaps such entertainments were reserved for officers; finally posted to Keresley Grange, Flight Sergeant John Wainwright recalled that “sheer boredom was the last weapon they tried.”^[333] Aircrew were frequently sent from Air Crew Disposal Units to NO.1 CMB for medical assessment and several were invalided on medical grounds.^[334] Several officers relinquished their commissions at ACDU Usworth including a Wing Commander,^[335] and many more from Keresley Grange.^[336] Before their disposal Australians were “granted an interview at Kodak house” the headquarters of the RAAF, while British aircrew suspected of LMF were interviewed by Wing Commander Lawson at the Air Ministry.^[337] The unit record books only detail the specific movements of officers, and in the absence of Wing Commander Lawson’s memorandum and papers, it can only be surmised that sergeant aircrew were also interviewed. However the station records show that many aircrew were sent to different medical stations for tests before a decision about their final disposal could be made. A sergeant reported to RAF Benson in Oxfordshire for decompression tests,^[338] and a flying officer visited RAF Station Hospital Uxbridge to be seen by an ENT specialist.^[339]

There was a permanent decompression chamber at the RAF Physiological Laboratories at Farnborough,^[340] and mobile decompression chamberswere towed from station to station to allow aircrew to experience the effects of a lack of oxygen. At 20,000 there is a feeling “of a mild elation, not dissimilar to that experienced after one or two well mixed gin and vermouth.”^[341]  At altitude without oxygen it was felt that a man “reverts to elementary type”, first forgetting the things he learned last.^[342] At the altitudes flown by some aircraft towards the end of the war aircrew could also suffer from the bends. This was caused by the formation off gas bubbles in the tissues; the symptoms are pain in the joints which varies from “a slight ache to an agony which is incapacitating.”^[343] In the safety of a decompression chamber a rapid descent of 7,000 feet per minute could also be simulated to test for aural pain from blocked Eustachian tubes,^[344] and tests were carried out to see if those suspected of LMF were more than usually susceptible to either the bends or anoxia.^[345]  In cases of suspected “hysteria or malingering” the pressure could be altered unknown to the patient, and their reaction to suggested ascent or descent could be observed.^[346] It was also discovered that the effect of altitude was exacerbated when aircrew hyperventilated due to their fear. As well as unconsciousness this could cause “tetany, paraesthesia, confusion and faintness.”^[347] Others were tested in a centrifuge for their resistance to ‘g’ force, as it was also well recognised that neurosis was associated with a cardiovascular instability and a subsequently diminished tolerance to ‘g’.^[348] In a study of a hundred aircrew who lost consciousness (over three quarters while on an operations) the most frequent cause was found to be an anxiety state or neurosis caused by fear.^[349] Failure to reproduce such symptoms in tests on the ground, where fear was not present, may have suggested to the doctors that the patient was physically fit, and led eventually to their being found LMF. These tests were in addition to a complete physical examination, and an interview following the usual psychiatric lines,^[350] sometimes using narcosis or hypnosis, and questioning the patient about their history and family background in an attempt to discover any predisposition.^[351] Some patients were also investigated by electro-encephalography (EEG) to discount epilepsy before executive action was taken.^[352] 

Originally anyone who refused to fly were to be treated the same, regardless of whether they had completed a tour or were still undergoing training.^[353] An aircrew member who had done well on a first tour, but through strain or exhaustion was unable to complete a second tour, was not to be submitted under the procedure outlined in paragraph 10 of the waverers letter,^[354] although defining an acceptable amount of strain was dependent on the subjective discretion of the executive. By 1944 some commanding officers were reluctant to instigate the “W” procedure and to sign the metaphorical “death warrant” of aircrew who had given good service but by being “jittery” had forfeited the confidence of their CO.^[355] Rear gunner Flight Sergeant John Wainwright refused to fly after recovering from being wounded on his seventy-third operation.^[356] He was forbidden from contacting anyone in his squadron and “quizzed and questioned” for three months. He believes that “they” could not comprehend the “nerve required” to face the threat of LMF and refuse to fly, and maintains that had he been interviewed by “just one flyer… somebody who knew”, he may have been persuaded back to operations.^[357] However those accused of LMF were deliberately segregated from other aircrew and everyone they knew. Wainwright maintained that if someone who had completed numerous operations made a conscious decision to stop flying, there was nothing that could persuade them to change their mind.^[358] However, although there are some discrepancies in their narratives and they lack proper referencing, Brandon, Shephard and the journalist and author Wendy Holden all cite the case of a bomb aimer who was accused of LMF but who was persuaded to return.^[359] After freezing shortly after take off on an operation his aircraft returned early. He was initially examined by the MO who could find nothing physically wrong with him, and was called a coward by his CO. He was driven from the station to an unidentified unit where he was interviewed by a psychiatrist. The doctor rationalised his fears and explained the stigma of LMF. Although his CO and crew needed to be talked into accepting him back, he was persuaded to return to duty and was back on the station before most of his squadron had landed. Arguably he had not made a conscious decision to stop flying but was suffering from a normal advanced fear anxiety. Theoretically there was to be a twenty-four hour cooling off period, and aircrew were entitled to write a statement in their defence to be submitted with the other official reports.^[360] In contrast Wainwright refused to cajoled; for three months he was transferred from one “square peg establishment” to another and interviewed by four separate psychiatrists. Although Symonds, Williams and Gillespie stressed the importance of fear on aircrew, the Freudian psychiatrists who interviewed Wainwright did not seem to understand the importance of emotions caused by terror and continued to place too much emphasis on their patient’s sexuality.^[361] In 1943 it was recommended by one of the consultant neuropsychiatrists that: 

a man who has permanently ceased flying solely because he has lost his nerve for it, should lose his badge whether his loss of nerve is considered a medical disability or not, unless he is qualified to retain it by adequate service in the past.^[362]

At his final board, before a “trip of greying patriarchs” Wainwright was reduced to Leading Aircraftman (LAC) and posted; in deference to the number of operations he had flown LMF was “out of the question”, and he was allowed to keep his wing.^[363] In such cases the final board was to consist of a representative of personnel services as chairman, one or more officers with operational experience, a consultant in neuropsychiatry and any other medical consultant deemed necessary.^[364] Towards the end of the war the RAF became more lenient towards aircrew who had completed at least one tour.^[365] Denis Wiltshire admitted to still being confused when he was invalided at his final medical board at Matlock, but remembers sitting before three senior medical officers and three civilians, while a Squadron Leader medical officer read  “a load of ‘mumbo jumbo’” from the King’s regulations and Air Council Instructions.^[366] However with no operational experience or recognised medical condition, Larkins was treated rather differently.

Larkins viewed his final board at Eastchurch in March 1945 as almost a court martial.^[367] He was escorted by a Warrant Officer into a room where one of the three officers behind a table accused him of LMF.^[368] He maintained that, like others he met at Eastchurch towards the end of the war, he was involved in a “pantomime procedure”^[369] to deliberately remove men from aircrew duties in order to save the exchequer money.^[370] There is of course no official evidence to substantiate his claim, and while an absence of evidence is not evidence that this did not occur, written in the 1990s, it is more likely that this belief is his way of justifying what happened to him. After VE day it was common for sergeants to be demoted to AC2 to save on pay and pensions,^[371] but it is perhaps more likely that in common with medical officers such as Stafford-Clark, Larkins was viewed by the officers at his board as a typical NCO lacking in moral fibre; as someone who had become a member of aircrew for the glamour and promotion who thought of themselves as a “cinematograph hero”.^[372]  Indeed this may have been the case. Throughout his memoires Larkins seems far more concerned with his exploits on leave with his numerous girlfriends than with flying,^[373] and it is at these points that his narrative is most detailed.^[374] Despite referring to an obviously carefully kept diary he is inconsistent with dates after he was taken off flying duties, and he admits to have been suffering from a four day headache on the day of his air test.^[375]

At his board Larkins was told that he had been found lacking in moral fibre and was given a choice; he was to be demoted to AC1, but he could either stay in the service or volunteer to become a coal miner.^[376] He chose the coal mine but had to remain at Eastchurch until, nineteen days later, when he returned from a period of leave, the DROs announced he was to report once more to the board. The letter from the Air Ministry was read to him, he was officially demoted to AC1 and, pending his transfer to the mines, he was posted with immediate effect to RAF Silloth in Cumbria.^[377] Rather than being humiliated in front of a parade as his badges were torn from his uniform, a “very sympathetic officer” told him to cut of his flying badge, stripes and crown and to hand them to him in his office.^[378]   At Silloth he was employed as an orderly room runner and his main duties were cleaning, lighting officer’s fires and printing the station’s orders using a temperamental Gestetner machine.^[379]  He was frequently reprimanded by the CO and on one occasion an acquaintance he recognised from training cut him short; the flight commander had told everyone not to speak to him because he was a coward.^[380] Shortly after VE day Larkins was sent to RAF Kirkham near Blackpool to be demobbed and transferred to the coal mining industry.^[381] He was subject to recall to the service in the event of remobilisation, but there was no reference to his having been a pilot. Contrary to rumours that LMF would lead to disgrace and unemployment in civilian life, but in common with the procedure stated in the Waverer’s letter, there was no mention of LMF on his discharge papers or his service record.^[382]

Larkins left the RAF in June 1945 and began a training course at Woodhouse, near Sheffield.^[383]  The men at the training centre on the course with him were a mixture of ex-aircrew accused of LMF, conscientious objectors, and Bevin Boys.^[384]  Still denying that he should have been found to be LMF, Larkins mentions a man from his close group who he believes was truly LMF as he was frequently absent and shirking when he was there.^[385] Even though he became proud of his job working six hour weeks and three hours of overtime a day, Larkins still felt humiliated and angry at his treatment as at a dance in a village hall some locals shouted abuse such as “Conchies” and “Too scarred to fight” to the trainee miners.^[386] Apart from Larkins’ rare manuscript, what happened to ex-aircrew in the mines and in other armed forces after they left the RAF seems to be only recorded in infrequent anecdotal hearsay evidence. Just as the numbers of those found to be LMF cannot be empirically verified, it is equally obscure how many were mentally fit to become an effective member of the infantry or to work at the coal face. Where possible men were retained in the RAF, those who had volunteered from reserved occupations were returned to them,^[387] and as late as September 1942, arrangements were only just being made for aircrew with no basic trade to be transferred into the army.^[388] Officers who resigned or relinquished his commission were eligible for call up to offer services by the Ministry of Labour.^[389] Looking forward to a peacetime RAF Sir John Slessor, AMP, insisted “I do not want to go back to the old system of quietly disposing of these cases by posting waverers to ground duties.”^[390] Arguably in a large proportion of cases this was the unofficial practice.  

Throughout the war LMF aircrew were treated inconsistently. Some men lost their wings at their original stations and were then sent away, while, following the procedure of the Waverer’s letter more closely, others such as Larkins, were removed from their squadron, retaining their wings until after their final board and the letter from the Air Ministry. Informed by consultant neuropsychiatrists it was believed by the Air Ministry and unit commanders that refusals to fly were contagious; those suspected of LMF had to be removed from their squadrons immediately. Group Captain Tom Sawyer, who after commanding a bomber squadron ended the war as a Station Commander, remembers only two cases of LMF. One, a “wretched NCO,” was told to pack his kit and incarcerated in the guard-room cell until he was “whisked away” to Group HQ the following morning.^[391] The example of the bomb aimer, discussed on page 67, who was persuaded by a psychiatrist to return to his unit, appears to be a very unusual example. Before aircrew posted to reselection centres, could be officially designated as lacking in moral fibre and reduced in rank, executive and medical reports had to be collected and assessed, and if necessary further medical test were needed. Lawson believed that it was inevitable that a number were harshly treated,^[392] and Jones argues the treatment of LMF aircrew was a motivated by the need to punish and stigmatise those who refused to fly as a deterrent to others. Rumours of the fate of those who had disappeared from their squadrons and those who had been seen parading without their rank and wings were common in squadron messes,^[393] but while Larkins was at Eastchurch he spent a considerable amount of time on leave or AWL.^[394] At an airman’s medical board any neuropsychiatric illness had to be discounted before a lack of moral fibre could be confirmed. There was some attempt at rehabilitation at the Air Crew Disposal Unit and activities were arranged for small numbers of aircrew, but the dominant impression of Eastchurch is of delay and boredom in overcrowded and miserable conditions. Arguably the treatment of LMF aircrew at Eastchurch was more dependent on the volume of those posted there for reselection and the subsequent bureaucratic delay than deliberate policy.  

Conclusion.

Much of the knowledge concerning LMF is based on myth and hearsay. Not Yet Diagnosed Neuropsychiatric centres and the Air Crew Disposal Unit are infrequently mentioned by historians and the medical treatment of aircrew suspected of or found to be suffering from neuropsychiatric symptoms, or the conditions at places such as Eastchurch are rarely discussed. This dissertation investigated three connected topics that have to date been largely overlooked by the historiography. Utilising previously unused and rare individual testimonies, together with medical journals and official sources, the medical treatment of aircrew members with neuropsychiatric symptoms has been described. The prophylactic treatment of emotional casualties by the station medical officers on operational bases, the medical interventions and remedial treatment of aircrew at Not Yet Diagnosed Neuropsychiatric centres and hospitals, and what happened to those found to be lacking in moral fibre once they were removed from their squadrons have been examined.

In station sick quarters and at NYDN centres, neuropsychiatric casualties were treated in accordance with the most up to date medical knowledge of the period. The theory that three quarters of those who broke down were predisposed to neurosis was dominant and it was believed that although it was not a medical condition, a lack of moral fibre was contagious. Arguably due to their finite human resources, unlike the USAAF, the Air Ministry could not afford to admit that everyone has their breaking point, but these beliefs influenced the treatment of both neuropsychiatric casualties and those found to be lacking in moral fibre.

The role of the squadron medical officer was crucial to Bomber Command during the war. While the treatment of neuropsychiatric casualties varied from station to station and between the treatment of officers and sergeant aircrew, squadron and station medical officers made a serious effort to prevent the development of neurosis. With the aid of specialists at NYDN centres, they tried to diagnose aircrew with neuropsychiatric symptoms and physical illnesses and treat them efficiently. In station sick quarters and in the messes, medical officers were responsible for the prophylactic treatment of aircrew using stimulants, psychiatric counselling, by recommending short periods of leave, or by admitting patients to sick quarters for forty-eight hours rest and recuperation, often assisted by barbiturates. The medical officer’s original diagnosis could influence the treatment of airmen at NYDN centres and, with the concurrence of the commanding officer, could lead to airmen being disposed of as LMF by the executive.  The squadron medical officer was part of the RAF system of authority. Prescribing Benzedrine to be taken during operations and Barbiturates after particularly stressful experiences, combined with subtle psychotherapy, they did all they could to keep men flying. As was shown on page 44 in the case of the rear gunner who was killed on his twenty-second operation, it was common for medical officers to successfully persuade waverers to fly more operations, and approximately 70% of aircrew displaying neuropsychiatric symptoms were successfully treated by their medical officer. At NYDN centres patients were treated with Freudian abreaction, hypnotism, occupational therapy and other more ‘cutting edge’ medical procedures. Like the “guinea-pigs” in the burns unit at East Grinstead under Dr. Archibald McIndoe,^[395] neuropsychiatric patients were experimented on by the medical profession. Insulin Therapy, Narco-analysis and Prolonged Narcosis, were used on RAF casualties as well as on patients from the other armed forces, and at Matlock at least one sergeant underwent Electro Convulsive Therapy.

While a station commander quoted by Hastings maintained that anyone under his command who refused to fly was punished by court-martial and a prison sentence,^[396] Lawson highlighted the difficulties of arranging a court-martial; witnesses were often posted or became casualties, and the procedure required the individual to remain on the station for an unacceptable length of time.^[397] Group Captain Sawyer was of the opinion that the “Trick Cyclists… would try to dig out psychiatric reasons and excuses for them.”^[398] Conforming to more accepted, narratives of the war endorsed by Terraine and Hastings, senior officers like Sawyer tell the bare minimum about neuropsychiatric casualties. In his account he admits that two men went LMF from his unit but he omits to talk about those posted to NYDNs. As one CO wrote on his report concerning a waverer:

So long as this man is permitted to wear his air-gunners badge and hold N.C.O. Rank, he is an incentive to further similar difficulties, besides being an insult to the men who are doing the job.^[399]

The RAF’s treatment of LMF aircrew was believed to be both punitive and disciplinary by senior officers and by aircrew themselves, and was a successful deterrent. As Jones and Wells discuss, men may have been more afraid of not flying operationally and being found to be lacking in moral fibre than of dying. Influenced by the culture of the RAF of which they were a part, aircrew were persuaded that the worst punishment for LMF was the stigma of the loss of their coveted and hard won wings. Together with the prophylactic treatment by medical officers, the RAF’s policy towards waverers and neuropsychiatric casualties was effective in persuading aircrew to attempt to continue their tours. 

As those who were accused of LMF disappeared from their squadrons, arguably many of the beliefs regarding their treatment were sustained more by rumour than any factual evidence both during and after the war. Myths and rumours have survived into post war writing about LMF and perhaps in many sources aircrew who were posted to NYDN centres were confused and amalgamated with tales of those who were LMF. On a squadron there was a quick turn around of aircrew, disappearances were not discussed and it is possible that those returning from a protracted stay at a NYDN would not be recognised by many of the squadron. Discussing LMF, some historians have perpetuated the myth that those found to be lacking in moral fibre were treated harshly by the executive and were deliberately punished and humiliated. Certainly by the end of the war it has been shown that this was not always the case. Not all those found to be lacking in moral fibre were disgraced by being paraded in front of their squadron and having their wings ripped off. During the war it was acknowledged that LMF would affect the individual’s future career as a civilian in peacetime, but this also seems to be a myth that was perpetuated throughout the RAF, in popular culture and in subsequent historiography. Indeed in the individual cases examined in this study, after the war, no such stigma was applied to their careers.  

At relocation centres such as Eastchurch and at the Air Crew Disposal Unit, further attempts were made to find medical reasons behind a man’s unwillingness to fly. Before a man could be found to be LMF both his commanding officer’s report and a neuropsychiatrist report had to be collated and examined. Further tests to discount any physical illness or disability also had to be undertaken. Arguably at Eastchurch aircrew lacking in moral fibre were more forgotten about and delayed by bureaucracy rather than being subjected to premeditated persecution. However it had been shown that the conditions at Eastchurch were not pleasant; it was wet, cold, the food was terrible and there was little or nothing to occupy aircrew posted there. Although the conditions on some newly built dispersed bomber stations conditions may have been similar, on operational bases the men had a purpose and the camaraderie of their crew mates to divert them. After the cycle of fear, adrenaline and the relief of survival, the neuropsychiatric symptoms of many aircrew may have been exacerbated by enforced inactivity and subsequent introspection. They had lost or were about to loose their flying brevet and to them this was possibly the worst punishment they were to endure. Perhaps for many the conditions and self recrimination led to a further deterioration of their mental state.

The treatment of LMF aircrew and those sent to NYDN centres will remain a contentious issue because of the paucity of sources, and because it is a controversial topic, but this study has balanced official accounts against individual’s experiences, and has shown how that the RAF treated their neuropsychiatric casualties to the best of their ability informed by the medical theories of the time. More casualties were treated at NYDN centres than were seen as LMF, but the largest number of neuropsychiatric casualties were effectively treated by counselling and drug treatment by their squadron medical officers, and were often sent on short periods of recuperative leave. Largely overlooked by the historiography, even national heroes such as Guy Gibson were susceptible to neuropsychiatric symptoms and were out-patients at NYDN centres.^[400]  Although once admitted to a NYDN centre as an in-patient less than a quarter returned to full duty, and more medical boards were held for neuropsychiatric problems than any other causes,^[401] the RAF’s system was effective in keeping the number of waverers and neuropsychiatric casualties to a minimum.

The RAF recognised that a number of neuropsychiatric and lack of moral fibre cases were unavoidable but through prophylactic treatment by squadron and station medical officers, and more intensive remedial treatment at NYDN centres, every effort was made to prolong the efficiency of aircrews to keep them flying. In some instances this meant experimental interventions combining traditional therapy with drugs and shock treatment. The numbers treated at SSQs and the numbers lost on an operation due to an aircrew member’s neuropsychiatric symptoms will never be known. As Jones highlights, the stigma associated with the LMF policy was effective in persuading many “waverers” to continue to fly operations, but the examination of new sources suggests that much of what has been accepted about LMF may have been based on anecdotal evidence rather than on actuality. As was shown in the previous chapter, at least towards the end of the war, aircrew posted to places such as Eastchurch experienced tedious monotony caused by bureaucracy rather than deliberately callous punishment. Such bureaucratic delays were largely because the RAF’s medical officers, neurologists and psychiatrists seriously attempted to find legitimate medical reasons for each individual’s reluctance to fly. 

Aircrew who were found to have a valid medical reason excusing them from flying were treated according to the best medical practises of the time, and although LMF was not a medical condition, even the treatment of those who were found to be lacking in moral fibre was informed by similar medical beliefs, the theory of predisposition and congenital weakness of character. Arguably the Air Ministry was most anxious to maintain morale on operational stations and avoid any contagion; they were less concerned with the punishment of LMF aircrew. Rather than treating LMF airmen harshly as has become accepted, once removed from their squadron and isolated from aircrew at places such as Eastchurch they became less of a priority. This study of a few individual cases, together with a re-examination of more traditional sources and medical journals, suggests that many of the beliefs about the treatment of neuropsychiatric casualties and aircrew lacking in moral fibre were based on myths, rumours and conjecture rather than on actuality. Those admitted to NYDN centres were treated with sympathy and understanding but perhaps, the unfortunate minority of those who underwent ECT or other experimental medical interventions such as insulin therapy received a far harsher treatment than anyone who was LMF.

Glossary

• Abreaction: “term coined by Freud in 1895 to describe the discharge of emotion attached to a previously represses experience or idea.”^[402]
• Barbitone: See Veronal.
• Benzedrine: “or Amphetamine Sulphate, is a drug which produces effects that in many ways resemble those produced by the stimulation of the sympathetic nervous system… It quickens mental processes, gives a feeling of well-being and confidence and increases capacity for work. But all of this temporary. The drug is a powerful one, and should in no circumstances be taken except on medical advice.”^[403]
• Eustachian tubes: “are the passages, one each side, leading from the throat to the middle ear.”^[404]
• Evipan or Hexobarbitone: “the proprietary term for N-methyl-cyclohexenyl-methylbarbituric acid… The sodium salt injected into vein makes the patient unconscious.”^[405] 
• Facies: “is a term applied to the expression or appearance of the face, which often gives indications of the presence of a disease in other parts of the body.”^[406]
• Hyoscine or Scopolomine: “is an alkaloid… often used in combination with morphine for an anaesthetic, or as a hypnotic in delirium or to produce ‘twighlight sleep’”^[407]  
• Luminal: See Veronal.
•  Medinal: See Veronal.
• Narcosis: “is a condition of profound insensibility, resembling sleep insofar that the unconscious person can still be roused slightly by great efforts… it is most commonly produced by drugs”.^[408]  
• Nembutal or Pentobarbitol: an orally or intravenously administeredanaesthetic that can be used to help the patient sleep or to reach a hypnotic state.^[409]
• Otic Barotrauma: “The symptoms are first a sensation of fullness in the ears, then increasing deafness, and lastly pain, which increases with the rate of descent and eventually becomes very severe. If no relief is obtained from opening the Eustachian tube the drum may eventually rupture.”^[410] 
• Paraesthesia: “(I am deceived by my senses) is a term applied to unusual feelings… or loss of sensation, experienced by a patient without any external cause; for example hot flushes, numbness, tingling, itching. Various parathesiae form a common symptom in some nervous diseases.”^[411]
• Pentothal: “the proprietary term for a barbiturate which in small doses is sedative, in medium hypnotic, and in large anaesthetic.”^[412]
• Phenobarbitone: See Veronal.
• Sodium Amytal: another derivative of Barbituric acid with similar effects to Pentothal.^[413]
• Sodium Bromide: “depress activity, and dull the sensibility of the brain… useful for nervy or hysterical people, and… as a mild hypnotic… Sleeplessness due to mental labour and worry is greatly helped by bromides often combined with other drugs, the dose being 20 grains or more at bedtime.”^[414] 
• Tetany: “localised muscular spasms. Brought on in persons… of nervous temperament”.^[415]
• Ultraviolet light therapy: “Ultra–Violet Radiations stimulate the natural defensive powers of the body and enable it to combat disease. The effect produced is greater, in proportion to the area of the body exposed to the rays. Several patients can be treated at on time, seated around a large arc- lamp at a distance of about three feet, stripped to the waist.”^[416]
• Veronal:  and the closely allied derivatives Medinal, Phenobarbitone, Barbitone and Luminal, “is a hypnotic drug which acts with more certainty and less after-depression than sulphonal, trional ect. Veronal-Sodium is said to prolong sleep more than Veronal, though the later is more useful for inducing sleep… Uses.- Veronal is given in doses of 5 to 8 grains, and Veronal- Sodium in slightly larger doses, in a hot drink at bedtime, especially to cases in which sleeplessness is combined with nervousness or depression. Caution must be exercised in taking Veronal or any of its derivatives, because of the danger of over-dosage and of habit-formation.”^[417]  

Acronyms.

• AC1: Aircraftman first class
• AC2: Aircraftman second class.
• ACDU: Air Crew Disposal Unit.
• AMP: Air Member for Personnel.
• AWL: Absent Without Leave
• BBMF: The Battle of Britain Memorial Flight.
• CMB: Central Medical Board NO.1 Central Medical Board was at Halton.
• CME: Central Medical Establishment
• CO: Commanding Officer
• DGMS: Director General Medical Services.
• DGPS: Director General Personnel Services.
• DRO: Daily Routine Orders.
• ECT: Electro Convulsive Therapy
• LMF: Lack of Moral Fibre.
• LAC: Leading Aircraftman
• LOC: Lack of Confidence.
• MO: Medical Officer.
• NCO: Non Commissioned Officer.
• NYDN: Not Yet Diagnosed Neurotic/ Neuropsychiatric.
• SMO: Senior Medical Officer.
• SSQ: Station Sick Quarters.
• USAAF: United States Army Air Force.
• WAAF:  Women’s Auxiliary Air Force.

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Ballard, S. I., and Miller, H. G., “Neuropsychiatry at a Royal Air Force Centre: an Analysis of 2,000 Cases” British Medical Journal, Vol. 2, No. 4357, 1944, pp. 40 – 43.

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B.M.J., “Neurosis in War-Time: Course of Lectures at the Tavistock Clinic” British Medical Journal, Vol.1 No. 4072, 1939, pp. 126 – 128.

B.M.J., “Neurosis in War-Time: Course of Lectures at the Tavistock Clinic” British Medical Journal, Vol.1 No. 4074, 1939, pp. 234 – 237.

B.M.J., “Electrically Induced Convulsions” British Medical Journal, Vol.1 No. 4124, 1940, pp. 104 – 106.

B.M.J., “Army Medical Officers and Man-Mastership” British Medical Journal, Vol. 1, No. 4178, 1941, p. 167. 

B.M.J., “War Neurosis” British Medical Journal, Vol.2, No.4200, 1941, pp. 21 – 22.

B.M.J., “Pavlovian Physiolgy and War Neurosis” British Medical Journal, Vol. 2, No.4310, 1943, p. 205.

B.M.J., “After-Care of Service Psychiatric Patients” British Medical Journal, Vol. 1, No. 4336, 1944, p. 228.

B.M.J., “Aviation Medical Research: Air Marshal Whittingham’s Address” British Medical Journal, Vol. 1, No. 4390, 1945, pp. 271 – 272.

B.M.J., “Progress in the Psychiatry of War” British Medical Journal, Vol. 1, No. 4408, 1945, pp. 913 – 914.

B.M.J., “Problems of Aviation Medicine” British Medical Journal, Vol. 2, No. 4412, 1945, pp. 123 – 124.

B.M.J., “The R.A.F. Medical Service, 1939 – 1945” British Medical Journal, Vol. 2, No. 4420, 1945, pp. 397 – 398.

Bailey, K. C., “Use of Aphetaminae  Sulphas in Facilitating Electrically Induced Convulsions” British Medical Journal, Vol.1 No. 4286, 1943, pp. 250 – 253.

Brand, W., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4427, 1945, p. 668.

Cleg, J. L., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 624.

Clifford-Richardson, J., “Clinical Experiences with a R.C.A.M.C. Neuropsychiatric Division in England 1940 to 1944” Proceedings of the Royal Society of Medicine, Vol. 37, No. 7, 1944, pp. 373 – 376.

Curran, D., and Mallinson, W. P., “Depressive States in War” British Medical Journal, Vol.1, No. 4182, 1941, pp. 305 – 309.

Davies, F. M. E., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4425, 1945, p. 583.

Dillon, F., “Correspondence: “Predisposition” to War Neurosis” British Medical Journal, Vol. 1, No. 4398, 1945, p. 570.

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Elliot, B. C., “The Therapeutic Efficiency of Ultra-Violet-Light Apparatus: A comparison of Tests,” British Medical Journal, Vol. 2, No. 4433, 1945, pp. 881 – 883.

Fairbairn, W. R. D., “The War Neurosis: Their Nature and Significance” British Medical Journal, Vol. 1, No. 4284, 1943, pp. 183 – 186. 

Fairweather, D. S., “Abstracts: Morale and Flying Experience: Results of a Wartime Study. Stafford-Clark, D. (1949) British Journal of Social Medicine, Vol. 3, 1949, p. 151.

Featherstone, H.W., “Basal Anaesthetics and Allied Substances Their use and Misuse” British Medical Journal, Vol. 1, No. 3816, 1934, pp. 322 – 326.

Garmany, G., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 625.

Gillespie, R. D., “War Neurosis after Psychological Trauma” British Medical Journal,  Vol.1, No. 4401, 1945, pp.653 – 656.

Golla, F., Walter, W. G., & Fleming, G. W. T. H., “Electrically Induced Convulsions” Proceedings of the Royal Society of Medicine, Vol. 35, No. 5, 1940, pp. 261 – 267.

Good, R., “Malingering” British Medical Journal, Vol. 2, No.4277, 1942, pp. 359 – 362.

Gregg, A., “What is Psychiatry?” British Medical Journal, Vol. 1, No. 4346, 1944, pp. 550 – 553.

Hadfield, J. A., “War Neurosis: A Year in a Neuropathic Hospital” British Medical Journal, Vol.1, No.4234, 1942, pp. 281 – 285.

Hadfield, J. A., “War Neurosis: A Year in a Neuropathic Hospital” British Medical Journal, Vol.1, No.4235, 1942, pp. 320 – 323.

Hall-Smith, P., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 625.

Hamilton, M., “Correspondence: War Neurosis, Morale, and Social Psychology” British Medical Journal, Vol. 1, No. 4295, 1943, pp.  549 – 550.

Harris, A., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4425, 1945, pp. 582 – 583.

Henderson, D. K., “Obituary: R. D. Gillespie M.D., F.R.C.P.” British Medical Journal, Vol. 2, No. 4427, 1945, pp. 670 – 671.

Hick, W. E., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4425, 1945, p. 583.

Jamieson, G. A., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 625.

Kemp, P. R., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4428, 1945, p. 706.

Lambert, C., and Linford Rees, W., “Intravenous Barbiturates in the Treatment of Hysteria” British Medical Journal, Vol.2 No. 4385, 1944, pp. 70 – 73.

Laurie, J., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4427, 1945, p. 669.

Maclay. W.S., and Guttmann, E., “The War as an Aetiological Factor in Psychiatric Conditions” British Medical Journal, Vol. 2, No. 4159, 1940, pp. 381 – 383. 

Magurran, G. F., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4425, 1945, p. 583.

Mathews, B. H. C., “The Effects of Altitude on Man” British Medical Journal, Vol. 2, No. 4411, 1945, pp. 75 – 78.

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Mathews, R. M. S., “Eustachian Obstruction and Otitic Barotrauma in Air-Crews of Heavy Bombers” British Medical Journal, Vol. 2, No. 4372, 1944, pp. 523 – 525.

McCluskie, J. A., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 625.

McGregor, J. S., “Insulin Treatment of Schizophrenia in Wartime” British Medical Journal, Vol.2, No. 4157, 1940, pp. 310 – 312.

Milligan, W. L., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No.4425, 1945, p. 582.

Minski, L., “Correspondence: “Predisposition” to War Neurosis” British Medical Journal, Vol. 1, No. 4400, 1945, p. 640.

Mulinder, E. K., “Psychotic Battle Casualties” British Medical Journal, Vol. 1, No. 4403, 1945, p. 733.

Pegge, G., “Psychiatric Casualties in London, September, 1940” British Medical Journal, Vol.2, No.4164, 1940, pp. 553 – 555. 

Perkins, P. H., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4428, 1945, p. 706.

Prewer, R. R., “Psychiatry in Detention”  British Medical Journal, Vol. 2, No. 4367, 1944, pp. 368 – 370.

Prewer, R. R., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4426, 1945, p. 624.

Rees, J. R., “Three years of Military Psychiatry in the United Kingdom” British Medical Journal, Vol. 1, No.4278, 1943, pp. 1 – 6.

Reid, D. D., “Sickness and Stress in Operational Flying” British Journal of Social Medicine Vol. 2 No. 4, 1948, pp. 123 – 131.

Sargant, W., “Physical Treatment of Acute War Neurosis” British Medical Journal, Vol. 2, No.4271, 1942, pp. 574 – 576.

Sargant, W., and Slater, E., “Amnesic Syndromes in War” Proceedings of the Royal Society of Medicine, Vol. 34, No. 12, 1941, pp. 757 – 764.

Shepley, W. H., and McGregor, J. S., “Electrically Induced Convulsions in Treatment of Mental Disorders” British Medical Journal, Vol. 2, No. 4121, 1939, pp. 1269 – 1272.

Shepley, W. H., and McGregor, J. S., “The Clinical Applications of Electrically Induced Convulsions” Proceedings of the Royal Society of Medicine, Vol. 35, No. 5, 1940, pp. 267 – 274.

Stafford-Clark, D., “Aspects of War Medicine in the RAF” British Medical Journal, Vol. 1, No. 4282, 1943, pp. 139 – 140.

Stafford-Clark, D., “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, pp. 10 – 50. 

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Symonds, C. P., “The Neurological Approach to Mental Disorder” Proceedings of the Royal Society of Medicine, Vol. 38, No. 8, 1941, pp. 289 – 302.

Symonds, C. P., “Anxiety Neurosis in Combatants” The Lancet, Vol. 242, No. 6278, 1943, pp.785 – 789.

Symonds, C. P., “The Human Response to Flying Stress: Neurosis in Flying Personnel” British Medical Journal, Vol.2, No. 4326, 1943, pp.703 – 706.

Symonds, C. P., “The Human Response to Flying Stress: The Foundations of Confidence” British Medical Journal, Vol.2, No.4327, 1943, pp. 740 – 744.

Trainer, J.L., “Lack of Moral Fibre” British Medical Journal, Vol. 308, No. 6924,  1994, p. 330.

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Witkower,  E.,  and Spillane, J. P., “Medical Problems in War: Neurosis in War” British Medical Journal, Vol.1, No. 4127, 1940, pp. 223 – 225.

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Websites

Engle, D., “Royal Blue” RAF Feltwell Personnel Memorial pages Website  http://www.feltwell.net/raffeltwell/articles/royal_blue.htm accessed 06.01.10.

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Films      

Comfort, L., The Hatter’s Castle, Paramount British Pictures, 1942.

Powell, M., and Pressburger, E., A Matter of Life and Death, Archers, 1946.

Powell. M., Hurst, B. D., Brunel, A., The Lion has Wings, London Film Productions, 1939.

Secondary Sources

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Bercuson, D. J. and Wise, S. F., (eds.) The Valour and the Horror Revisited, McGill-Queens University Press, Montreal, 1994.

Bishop, P., Bomber Boys: Fighting Back 1940-1945, Harper press, London, 2007.

Bourke, J., Fear: A Cultural History, Virago Press, London, 2006.

Brandon, S., “LMF in Bomber Command 1939-45: Diagnosis or Denouncement?” in Freeman & Berrios (eds) 150 Years of British Psychiatry, Vol. 2: The Aftermath, Athlone, 1996. pp. 119-129.

Buckley, J., Air Power in the Age of Total War, UCL Press, London, 1991. 

Chadderton, H. C. The Morality of Bomber Command in World War Two, The War Amputations of Canada, 1992.

Chickering, R., and Forster, S., (eds.) The Shadows of Total War: Europe, East Asia, and the United States, 1919-1939, Cambridge University Press, Cambridge, 2003.

English, A. D., The Cream of the Crop: Canadian Aircrew, 1939 – 1945, McGill-Queen’s University Press, Montreal & Kingston, 1996.

Ellis, J., The Sharp End of War: The Fighting man in World War Two, Book Club Associates, London, 1980.

Francis, M., The Flyer: British Culture and the Royal Air Force 1939-1945, Oxford University Press, Oxford, 2008.

Freeman & Berrios (eds) 150 Years of British Psychiatry, Vol. 2: The Aftermath, Athlone, 1996.

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Greer, G., Daddy we hardly knew you, Penguin, London, 1989.

Hamilton, T., The Life and Times of Pilot Officer Prune: Being the Official Story of Tee Emm, HMSO, London, 1991.

Harrison, M., Medicine and Victory: British Military Medicine in the Second World War. Oxford University Press, Oxford, 2004.

Hastings, M., Bomber Command, (1979) Pan, London, 1999.

Holden, W., Shell Shock, Channel 4 Books, London, 1988.

Irving, D., The Destruction of Dresden, (1963) Macmillan, London, 1985.  

Jones, E., & Wessely, S., Shell Shock to PTSD: Military Psychology from 1900 to the Gulf War, Psychology Press, Hove, 2005.

Kennedy, C. H., and Zillmer, E. A., (eds.) Military Psychology, The Guilford Press, New York, 2006.

Lindqvist, S., Translated by Linda Haverty Rugg, A History of Bombing, Granta Books, London, 2002.

Mayhew, E. H., The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club, Greenhill Books, London, 2004.

Middlebrook, M., and Everitt, C., The Bomber Command War Diaries: An Operational Reference Book 1939 – 1945, Midland Publishing, Leicester, 1996.

Morris, R., Guy Gibson, Viking, London, 1994.

Nichol, J., and Rennell, T., Tail End Charlies: The last Battles of the Bomber War 1944-45, Penguin, London, 2005.

Richards, D., RAF Bomber Command in the Second World War: The Hardest Victory, (1995) Penguin, London, 2001.

Rolfe, M., Hell on Earth: Dramatic First-Hand Experiences of Bomber Command at War, Grub Street, London, 2006.

Shephard, B., A War of Nerves, Jonathon Cape, London, 2000.

Stafford-Clark, D., Psychiatry Today, Penguin, London, 1952.

Stratten, G. M., No.4 RAF Hospital Rauceby 1940-1947, Unpublished Booklet, Lincolnshire Libraries, L. Rauc 362.2, 1994. 

Terraine, J., The Right of the Line, (1985) Wordsworth Editions, Ware, 1997.

Thomas, K., Flak houses then and now, Battle of Britain International, Old Harlow, 2006.

Watson, A., Enduring the Great War: Combat, Morale and Collapse in the German and British Armies, 1914-1918, Cambridge University Press, Cambridge, 2008. 

Wells, M. K., Courage and Air Warfare: The Allied Aircrew Experience in the Second World War, Frank Cass, London, 1995.

Wilson, K., Bomber Boys: The Ruhr, the Dambusters and bloody Berlin, Cassell, London, 2006.

Wilson, K., Men of Air: The Doomed Youth of Bomber Command, Phoenix, London, 2008.

Winter, J., Remembering War, Yale University Press, New Haven & London, 2006.

Weisbord, M & Mohr, M. S. The Valour and the Horror: The Untold Story of Canadians in the Second World War, Harper Collins, London 1991.

Journal Articles

English, A. D., “A Predisposition to Cowardice? Aviation Psychology and the Genesis of ‘Lack of Moral Fibre’” War and Society, Vol.13, No. 1, 1995, pp.15-34.

English, A.D., “Leadership and Operational Stress in the Canadian Forces” Canadian Military Journal, Vol. 1, No.3, 2000, pp.33 -38.

Hobbins, G., “‘Living in Hell But Still Smiling’ Australian Psychiatric Casualties of War During the Malaya-Singapore Campaign 1941-42” Health and History, Vol.9, No.1, 2007, pp.28-55.

Holley, I. B. Jr., “Review: Courage and Air Warfare: The Allied Aircrew Experience in the Second World War by Mark K Wells” The Journal of Military History, Vol.60, No. 4, 1996, pp.793-794.

Jones, E., “‘LMF’: The Use of Psychiatric Stigma in the Royal Air Force during the Second World War” The Journal of Military History, Vol.70, 2006, pp.439-458.  

McCarthy, J., “Aircrew and ‘Lack of Moral Fibre’ in the Second World War” War and Society, Vol.2, 1984, pp. 87-101.

Ondishko, J. J. Jr., “A View of Anxiety, Fear and Panic,” Military Affairs, Vol.36, No.2, 1975, pp.58-60.

Sharp, D., “Shocked, shot, and pardoned” The Lancet, Vol.368, September 16, 2006, p.975-976.  

Shephard, B., “‘Pitiless Psychology’: the role of prevention in British military psychiatry in the Second World War” History of Psychiatry, Vol.40, No. 4, 1999, pp.491-524.

Smith, M., “‘A Matter of Faith’: British Strategic Air Doctrine before 1939” Journal of Contemporary History, Vol.5, No.3, 1980, pp.423-442.

Spiegel, D., & Vermetten, E., “Post-traumatic stress disorder: medicine or politics (not both)” The Lancet, Vol.369, March 24, 2007, p.992.

Stachan, H., “Training, Morale and Modern War” Journal of Contemporary History, Vol.41, No.2, 2006, pp. 211-227.

Wessely, S., “Twentieth-century Theories on Combat Motivation and Breakdown,”  Journal of Contemporary History, Vol.41, No.2, 2006, pp.269-286.

Winter, J., “Shell Shock and the Cultural History of the Great War” Journal of Contemporary History, Vol. 35, No. 1, Special Issue: Shell-Shock, 2000, pp.7 – 11.

Websites

Skeet, M., “An Airman’s Son Part 3” BBC WW2 People’s War Website, 2004, http://www.bbc.co.uk/ww2peopleswar/stories/46/a2238446.shtml accessed on 14.09.09.

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[1] Stafford-Clark, D., “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, p. 12.

[2] M. K., Wells, Courage and Air Warfare: The Allied Aircrew Experience in the Second World War, Frank Cass, London, 1995, p. 115.

[3] R., Stafford Cripps, A.V. Alexander, P.J. Grigg, A. H. M. Sinclair, The Use of Psychologists and Psychiatrists in the Services. 1942. National Archives, CAB66/27/10 Public Record Office. p. 5.

[4] C. P.,  Symonds and D. J. Williams, “Investigation of Psychological Disorders in Flying Personnel by Unit Medical Officers”  in: Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p.83. The report was based on a twenty week study from May 1941.

[5] DGMS to AMP 11 October 1944 AIR 2/6252, 11 October 1944 Minute 28.2.

[6] Wells, Op.cit, p. 115.

[7] Minutes from AMP to DPS, 21 March 1940, AIR 2/8591, minute 1.

[8] Draft Air Council letter, AIR 2/8591.

[9] See: T., Sawyer, Only Owls and Bloody Fools Fly at Night, William Kimber, London, 1982, p.136, and J., Currie, Lancaster Target, (1981) Crecy Publishing, Manchester, 2008, 89.

[10] M., Hastings, Bomber Command, (1979) Pan, London, 1999, p. 213.

[11] Points include contemporary medical beliefs, the importance of leadership, the dangers the aircrew faced and methods employed by those suspected of LMF to avoid operations. 

[12]  J., McCarthy, “Aircrew and ‘Lack of Moral Fibre’ in the Second World War” War and Society, Vol.2, 1984, p. 87.p. 87.

[13] J., Terraine, The Right of the Line, (1985) Wordsworth Editions, Ware, 1997, p.535.    

[14] Ibid, p.535 – 536.  He found that rather than being flown there by pilots who had had enough of the war, most had diverted there of necessity, and all but a small minority were damaged and unserviceable.

[15] Ibid, p. xi.

[16] Ibid,p.535.

[17] Ibid, p.533

[18] Wells, Op.cit, p. 21.

[19] Ibid,  p. 187.

[20] Ibid, p. 119.

[21] A. D., English, “A Predisposition to Cowardice? Aviation Psychology and the Genesis of ‘Lack of Moral Fibre’” War and Society, Vol.13, No. 1, 1995, pp.15.

[22] A. D., English, The Cream of the Crop: Canadian Aircrew, 1939 – 1945, McGill-Queen’s University Press, Montreal & Kingston, 1996. p.68.

[23] Ibid, p. 40.

[24] English, “A Predisposition to Cowardice?” Op.cit, pp. 15-34.

[25] English, The Cream of the Crop, Op.cit, p.128.

[26] English, “A Predisposition to Cowardice?” Op.cit, p. 29.

[27] This debate was especially heated in the years that followed the fiftieth anniversaries of events of the war. The airing of the Canadian television documentary, The Valour and the Horror: Death by Moonlight, in Canada in 1992, was a catalyst for public debate and, in Canada, resulted in a court ruling. See M., Weisbord, and M. S., Mohr, The Valour and the Horror: The Untold Story of Canadians in the Second World War, Harper Collins, London 1991, D. J., Bercuson, and S. F., Wise, The Valour and the Horror Revisited, McGill- Queen’s University Press, Montreal, 1994, and H. C., Chadderton, The Morality of Bomber Command in World War Two, The War Amputations of Canada, 1992.

[28] English, The Cream of the Crop, Op.cit, p. 91 – 93.

[29] S., Wessely, “Twentieth-century Theories on Combat Motivation and Breakdown,” Journal of Contemporary History, Vol.41, No.2, 2006, p. 286.

[30] J., Bourke, Fear: A Cultural History, Virago Press, London, 2006. p.161.

[31] S., Brandon, “LMF in Bomber Command 1939-45: Diagnosis or Denouncement?” in Freeman & Berrios (eds) 150 Years of British Psychaitry, Vol 2: The Aftermath, Athlone, 1996. p.128.

[32] B., Shephard, A War of Nerves, Jonathon Cape, London, 2000, p. 295.

[33] B., Shephard, “‘Pitiless Psychology’:the role of prevention in British military psychiatry in the Second World War” History of Psychiatry, Vol.40, No. 4, 1999, p.517.

[34] Shephard,  A War of Nerves, Op.cit, p. 297.

[35] Shephard, “Pitiless Psychology” Op.cit, p.522.

[36] M., Francis, The Flyer: British Culture and the Royal Air Force 1939-1945, Oxford University Press, Oxford, 2008. p.106 – 131.

[37] E., Jones, “‘LMF’: The Use of Psychiatric Stigma in the Royal Air Force during the Second World War” The Journal of Military History, Vol.70, 2006, p.441. 

[38] Ibid, p.439.

[39] Ibid, p.442.

[40] Wells, Op.cit, p.194. See also Jones, Op.cit, p.440.  

[41] M., Hastings, Bomber Command, (1979) Pan Books, London, 1999, p. 214.

[42] J., McCarthy, “Aircrew and ‘Lack of Moral Fibre’ in the Second World War” War and Society, Vol.2, 1984, p. 97.

[43] Wells, Op.cit, p. 212.

[44] Hastings, Op.cit, p. 214. From his interviews of a hundred aircrew all lost one crew member.

[45] English discusses the difficulties in estimating the incidence of LMF, and he explains his calculations regarding the numbers of aircrew involved and the ratio of Canadian neuropsychiatric casualties within Bomber Command in the appendixes to his work. However his calculations are based on a post war report regarding the RCAF “R” depot covering the period September 1944 to September 1945; Arguably these figures may not be representative of the numbers sent to the depot for reselection during any earlier twelve month period of conflict before VE day. English, The Cream of the Crop, Op.cit, pp. 159 – 162.

[46] Terraine, Op.cit, p.534.

[47] DGMS, 25 April 1945, Minute 33.2. AIR 2/6252.

[48] Wells, Op.cit, p. 212.

[49] C. P., Symonds “German Military Neuropsychiatry and Neurosurgery” 25 January 1946, AIR 20/10727 Appendix 53.

[50] Jones, Op.cit, p.441.

[51] Shephard, A War of Nerves, Op.cit, p. 287.

[52] Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947.

[53] However parts of this file have been redacted and will remain closed to the public until 2035.

[54] Jones, Op.cit, p.455.

[55] Ibid, p. 451. Inquiries have been made to the Air Historical Branch and the RAF Museum but as yet to no avail.

[56] See for example:  A., Balfour-Sclare, Flying Officer, R.A.F.V.R., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4427, 1945, pp. 668 – 669.

[57] Air Ministry Pamphlet 100 “Notes for Medical Officers on the Psychological care of flying personnel” May 1939, p. 17,  in: AIR 2/8591.

[58] DGMS 9 June 1941, minute 113.1 in AIR 2/8591.

[59] Modern psychological theories such as Post traumatic Stress Disorders (PTSD) and Combat Stress Reaction (CSR) will not be applied to this study.

[60] C. P., Symonds quoted in: “Investigations into Psychological Disorders of Flying Personnel: Review of reports submitted to Air Ministry since outbreak of the war.” April 1942, Appendix 8B. AIR 2/6252.

[61] C. P., Symonds, “The Human Response to Flying Stress: Neurosis in Flying Personnel” British Medical Journal, Vol.2, No. 4326, 1943, p.703.

[62] Ibid., p.740 – 744.

[63] K., Wilson, Bomber Boys: The Ruhr, the Dambusters and bloody Berlin, Cassell, London, 2006, p.65 – 66.

[64] Air Ministry Pamphlet 100 “Notes for Medical Officers on the Psychological care of flying personnel” May 1939, p. 15. in: AIR 2/8591.

[65] E., Jones, & S., Wessely, Shell Shock to PTSD: Military Psychology from 1900 to the Gulf War, Psychology Press, Hove, 2005, p. 49.

[66] Ibid., p. 55.

[67] R. D., Gillespie, Psychological Effects of War on Citizen and Soldier, Chapman and Hall Ltd, London, 1942, p. 181. DAH became known as “effort syndrome” during the Second World War.

[68] B.M.J., “Neurosis in War-Time: Course of Lectures at the Tavistock Clinic” British Medical Journal, Vol.1 No. 4072, 1939, p. 127.

[69] E., Witkower, and J. P., Spillane, “Medical Problems in War: Neurosis in War” British Medical Journal, Vol.1, No. 4129, 1940, p. 309.

[70] Gillespie, Op.cit., pp. 166 – 171. Predisposition will be discussed further below.

[71] J., Winter, “Shell Shock and the Cultural History of the Great War” Journal of Contemporary History, Vol. 35, No. 1, Special Issue: Shell-Shock, 2000, p.9.

[72] E., Witkower, and J. P., Spillane, “Medical Problems in War: Neurosis in War” British Medical Journal, Vol.1, No. 4129, 1940, p. 310.

[73] AIR 2/4019 Treatment of airmen of unsound mind. 1939 – 1946, 29 November 1939, Minute 25.

[74] E., Jones, & S., Wessely, Op.cit., p. 49 -50.

[75] B.M.J., Op.cit., p. 126.

[76]  E., Witkower, and J. P., Spillane, Op.cit., p. 225.

[77]  Winter, Op.cit., p.7 – 11.

[78] B., Shephard, “‘Pitiless Psychology’: the role of prevention in British military psychiatry in the Second World War” History of Psychiatry, Vol.40, No. 4, 1999, pp.491-524.

[79] E., Jones, “‘LMF’: The Use of Psychiatric Stigma in the Royal Air Force during the Second World War” The Journal of Military History, Vol.70, 2006, p.440.  

[80] Jones, & Wessely, Op.cit., p. 97.

[81] See: AIR 2/8591. The Waverers Letter is discussed below.

[82] Central Medical Establishment, Form 540, 11 September 1939, AIR 29/757. Symonds and Gillespie reported for duty as consultant Neurologist and Psychiatrist. Both swiftly rose in rank, Symonds to Air Vice-Marshal and Gillespie to Air Commodore.Symonds was knighted in 1946. Gillespie committed suicide in October 1945 aged 47. See: B., Shephard, A War of Nerves, Jonathon Cape, London, 2000, p. 291. See also: Henderson, D. K., “Obituary: R. D. Gillespie M.D., F.R.C.P.” British Medical Journal, Vol. 2, No. 4427, 1945, pp. 670 – 671.

[83] Shephard, A War of Nerves, Op.cit., p. 290 – 291.

[84] H. R., Rollin, Festina Lente: A Psychiatric Odyssey, British Medical Journal, London, 1990, p. 32.

[85] R. D., Gillespie, “War Neurosis after Psychological Trauma” British Medical Journal,  Vol.1, No. 4401, 1945, p.653.

[86] Gillespie, Psychological Effects Op.cit., p. 168.

[87] Gillespie, “War Neurosis after Psychological Trauma” Op.cit., p.654.

[88] The Neurological Approach to Mental Disorder” Proceedings of the Royal Society of Medicine, Vol. 38, No. 8, 1941, p. 299.

[89] C. P., Symonds and D. J. Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p. 51.

[90] Symonds, “The Human Response to Flying Stress” Op.cit., p.703.

[91] Ibid., p.703.

[92] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., pp. 43- 50.

[93] Ibid., p. 45. “One freshman was scrubbed 17 times before he got his first trip. He only lasted three trips after this, and then said he had had it”. see p. 46.  See also: C. P. Symonds, “The Human Response to Flying Stress: The Foundations of Confidence” British Medical Journal, Vol.2, No.4327, 1943, 740-744.

[94] C. P., Symonds, “Anxiety Neurosis in Combatants” The Lancet, Vol. 242, No. 6278, 1943, p. 786.

[95] Ibid., p. 785.

[96] Ibid., p. 787.

[97] W. R. D., Fairbairn, “The War Neurosis: Their Nature and Significance” British Medical Journal, Vol. 1, No. 4284, 1943, p. 183.  See also: C. P. Symonds and D. J. Williams, “ Statistical Survey Of The Occurrence Of Psychological Disorders In Flying Personnel In The Six Months February To August 1942” in: Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p. 123.

[98] R. R., Grinker, & J. P., Spiegel, War Neurosis in North Africa: The Tunisian Campaign, Josiah Macy Jr. Foundation, New York, 1943, p. 8.

[99] C. P., Symonds and D. J. Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p. 86. See also “Investigations into Psychological Disorders of Flying Personnel Review of reports submitted to Air Ministry since outbreak of the war” April 1942, Appendix 8B. AIR 2/6252. In 1942 it was recommended that the nomenclature for psychological disorders in flying personnel should consist of: Anxiety, Depression, Elation, Fatigue syndrome, Hysteria, Obsessional, Schizophrenia, Organic acute and Organic chronic.

[100] “Investigation into Psychological Disorders in Flying Personnel: Instructions to Medical Officers” Appendix 33A p. 17. AIR 2/6252.

[101] 1,197 cards were returned by NYDN centres and 286 from station medical officers. See: Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers,” Op.cit., p. 83 and  Symonds and Williams, “Statistical Survey of The Occurrence Of Psychological Disorders In Flying Personnel In The Six Months February To August 1942.” Op.cit., p. 117. 

[102] Ibid., p. 17  See also  Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 98.

[103] Symonds and Williams, “Statistical Survey Of The Occurrence Of Psychological Disorders In Flying Personnel In The Six Months February To August 1942” Op.cit., p. 127. The authors admitted this grading was “purely arbitrary” and could “never be accurate in any one case.” See p.121. 

[104] Ibid., p. 121.

[105] Ibid., p. 128.

[106] Ibid., pp. 125 – 126.

[107] Ibid., p. 128.

[108] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 32.

[109] Symonds and Williams, “Statistical Survey Of The Occurrence Of Psychological Disorders In Flying Personnel In The Six Months February To August 1942” Op.cit., p. 137.

[110] Summary of Report on Second Six Months of Royal Air Force Hospital, Matlock, Derbyshire, April to September 1940, p. 2. AIR 20/10727.

[111] D., Stafford-Clark, “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, p. 16. 

[112] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 59.

[113] Ibid., p. 38. See also: Summary of Report on Second Six Months of Royal Air Force Hospital, Matlock, Derbyshire, Op.cit., p. 1.

[114] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 51. See also S., Wessely, “Twentieth-century Theories on Combat Motivation and Breakdown,” Journal of Contemporary History, Vol.41, No.2, 2006, p.282.

[115] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 58.

[116] Ibid., p. 31. Only 44 general duty officers  and 37 medical officers from Bomber Command were interviewed. See p.32.

[117] Ibid., p. 54.

[118] Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 90. See also: D., Bateman., quoted in C.P. Symonds & D., Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. p. 11, AIR 2/6252.

[119] Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 92.

[120] Ibid., p. 92.

[121] Ibid., pp. 84 – 95.

[122] F., Dillon, “Correspondence: “Predisposition” to War Neurosis” British Medical Journal, Vol. 1, No. 4398, 1945, p. 570.

[123] S. K., Weinberg, “The Combat Neurosis” The American Journal of Sociology, Vol.51, No.5, 1946, p. 465.See also B., Shephard,  A War of Nerves, Jonathon Cape, London, 2000, p. 291.

[124] Lord Moran, The Anatomy of Courage, (1945) Robinson, London, 2007, p. 69 – 70.

[125] M. K., Wells, Courage and Air Warfare: The Allied Aircrew Experience in the Second World War, Frank Cass, London, 1995, p.17.

[126] Ibid., p.17.

[127] R., Maycock, Doctors in the Air, George Allen and Unwin Ltd, London, 1957, p.10.

[128] D., Stafford-Clark, “Aspects of War Medicine in the RAF” British Medical Journal, Vol. 1, No. 4282, 1943, p. 139.

[129] D., Williams, “Psychological Problems in Flying Personnel” British Medical bulletin, Vol.5, No. 1020 1947, p. 39. Williams also highlighted that within Bomber Command the continued inefficiency of on member of the aeroplane’s crew could have disastrous consequences.

[130] Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 92.

[131] A.M. Pamphlet 100 1^st Edition, May, 1939. in: AIR 2/8591.  

[132] Air Ministry Pamphlet 100A “Notes for the guidance of medical officers on the differentiation between personnel unfit for flying for medical and temperamental reasons.” in: AIR 2/8591.

[133] DGMS in Appendix 33, AIR 20/10727. There were also exchanges of doctors between operational bases and NYDN centres. See: RAF Hospital Rauceby, Form 540, April 1942, AIR 29/764.

[134] Air Ministry Pamphlet 100A Op.cit., p. 3.

[135] A.M. Pamphlet 100 Op.cit., p. 9. 

[136] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 35.

[137] Air Ministry Pamphlet 100A Op.cit., p. 3.

[138] D., Stafford-Clark, “Personal Observations on Flying Stress.” Appendix 23, AIR 20/10727.

[139] Ibid., See Also: D., Stafford-Clark, “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, pp. 10 – 50.

[140] Stafford-Clark, “Personal Observations On Flying Stress” Op.cit.

[141] D. D., Reid, “Some Measures Of The Effect Of Operational Stress on Bomber Crews” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, pp. 245 -258.

[142] Stafford-Clark, “Morale and Flying Experience: Results of a Wartime Study” Op.cit., pp. 19 – 21. 

[143] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 38.

[144] K. G., Bergin, “Correspondence: Psychiatry in the Army” British Medical Journal, Vol. 2, No.4423, 1945, p. 508.

[145] W. L., Milligan, “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No.4425, 1945, p. 582.

[146] Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 90.

[147] J., Currie, Lancaster Target, (1981) Crecy Publishing, Manchester, 2008, pp. 138 – 139.

[148] See: R., Winfield, The Sky Belongs to Them, William Kimber, London, 1976, p.134. Posted to a Bomber command squadron Winfield flew with crews the CO was “doubtful about.” Squadron Leader McGeown flew as a gunner with Pathfinders see:  Sawyer, T., Only Owls and Bloody Fools Fly at Night, William Kimber, London, 1982, p. 174. By the end of the war there were 120 medical officers qualified as pilots. See:  B.M.J., “Aviation Medical Research: Air Marshal Whittingham’s Address” British Medical Journal, Vol. 1, No. 4390, 1945, p. 271.      

[149] D., Charlwood, No Moon Tonight, (1956) Crecy Publishing, Manchester, 2007, p. 136.

[150] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 38.

[151] Stafford-Clark, “Aspects of War Medicine in the RAF” Op.cit., p.140. (My italics)

[152] F., Musgrove, Dresden and the Heavy Bombers: An RAF Navigator’s Perspective, Pen and Sword, Barnsley, 2005, p. 64.

[153] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 61.

[154] Winfield, Op.cit., p.57.

[155] Symonds and Williams, “Personal Investigation Of Psychological Disorders In Flying Personnel Of Bomber Command.” Op.cit., p. 57.

[156] Ibid., p. 53.

[157] Ibid., pp. 53 – 54.

[158] H., Yates, Luck and a Lancaster: Chance and Survival in World War Two, Airlife Publishing, Marlborough, 2005, p. 148.

[159] Ibid., p. 184.

[160] Musgrove, Op.cit., p. 50.See also: J., Wainwright, Tail-End Charlie: One Man’s Journey Through a War, Macmillan, London, 1978, p. 169.

[161] Wells, Op.cit., pp. 128 – 130.

[162] AIR 14/1886 Investigations into causes of abortive sorties Air Ministry: Bomber Command: Registered Files 1943 – 1945 See: report on Early Returns, 1(C). In over a quarter of these the mechanical defect failed to be replicated in tests on the ground.

[163] Ibid.

[164] B., Sullivan. Fibre, Faber and Faber, London, 1946, p.119.

[165] This letter, S.61141 first published in 22 April 1940 was revised several times throughout 1941. See: AIR 2/8591. The memorandum was further revised in 1943 and 1945 see: AIR 2/4935, Appendix 57C.    

[166] Letter S.61141/S.7.c (1) “Memorandum on the Disposal of Members of Air Crews Who Forfeit the Confidence of Their Commanding Officers.” 19 September, 1941, paragraph 2., in: AIR 2/8591. As well as operational squadrons the memorandum was to apply to “personnel under training in air crew duties after they have completed their first ten hours in the air.

[167] Ibid., paragraph 14. Officers and airmen in category (ii) were to be treated in a similar fashion.  

[168] Ibid., paragraph 3.

[169] Ibid., paragraph 7.

[170] Minute 234. 11 September 1942, AIR 2/8591.

[171] AMP in Minute 235 15 September 1942,.AIR 2/8591.

[172] A. M.  Pamphlet 100A Op.cit., p.1.

[173] DGMS, 25 April 1945, Minute 33.7 AIR 2/6252.

[174] Gillespie, Psychological Effects of War on Citizen and Soldier, Op.cit., p. 185.

[175] D., Stafford-Clark, “Aspects of War Medicine in the RAF” British Medical Journal, Vol. 1, No. 4282, 1943, p. 140.

[176] S., Wessely, “Twentieth-century Theories on Combat Motivation and Breakdown,”  Journal of Contemporary History, Vol.41, No.2, 2006, p.273. See also: Gillespie quoted in C.P. Symonds & D., Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. p. 10, AIR 2/6252

[177] B.M.J., “The R.A.F. Medical Service, 1939 – 1945” British Medical Journal, Vol. 2, No. 4420, 1945, p. 397.

[178] J., Hill, quoted in Symonds and Williams, Op.cit., p. 12.

[179] B., Sullivan. Fibre, Faber and Faber, London, 1946, p. 156.

[180] J., Wainwright, Tail-End Charlie: One Man’s Journey Through a War, Macmillan, London, 1978, p.146.

[181] R. M. S., Mathews, “Eustachian Obstruction and Otitic Barotrauma in Air-Crews of Heavy Bombers” British Medical Journal, Vol. 2, No. 4372, 1944, pp. 523 – 525.during a 30 week study at a heavy bomber station Mathews encountered 56 cases of Eustachian obstruction and 10 of Otic barotrauma.

[182] D., Stafford-Clark, “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, p. 28. The flight sergeant had crashed twice in training and had broken his ankle. On his last operation his aircraft ditched in the North Sea and the pilot and rear gunner were killed. With the rest of his crew he spent 14 hours in a dinghy before rescue.

[183] R. D., Gillespie, Psychological Effects of War on Citizen and Soldier, Chapman and Hall Ltd, London, 1942, p. 195.

[184] R. N., Ironside, and I. R. C., Batchelor, Aviation Neuro-Psychology, Morrison and Gibb, London, 1945, p. 73.

[185] M., Tripp, The Eighth Passenger, (new edition) Wordsworth Editions, Ware, 2002, p. 39.

[186] Sullivan, Op.cit., p.128.

[187] R., Maycock, Doctors in the Air, George Allen and Unwin Ltd, London, 1957, p. 96.

[188] Ibid., p. 97.

[189] J., Currie, Lancaster Target, (1981) Crecy Publishing, Manchester, 2008, p. 111. Perhaps what he recalled was caffeine was actually Benzedrine. By the 1980s as an amphetamine Benzedrine carried a social stigma as an illegal drug.

[190] Tripp, Op.cit., p. 173. Tripp even used to keep a small store of Benzedrine to use when he was off duty and enjoying himself. Benzedrine was also occasionally used by Ron Smith, See: Smith, R., Rear Gunner Pathfinders, Crecy Publishing, Manchester, 1997.  p. 40 and 61.

[191] H., Yates, H., Luck and a Lancaster: Chance and Survival in World War Two, Airlife Publishing, Marlborough, 2005, p. 84.

[192] B. C., Elliot, “The Therapeutic Efficiency of Ultra-Violet-Light Apparatus: A comparison of Tests,” British Medical Journal, Vol. 2, No. 4433, 1945, p. 881.

[193] Maycock, Op.cit., p. 88.

[194] C. P., Symonds and D. J., Williams,  “Investigations Of Psychological Disorders in Flying Personnel by Unit Medical Officers” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p.  92.

[195] Ibid., p.  93.

[196] Ibid., p.  93.

[197] Stafford-Clark, “Aspects of War Medicine in the RAF” Op.cit., p. 139.

[198] Symonds and Williams, “Investigations Of Psychological Disorders in Flying Personnel by Unit Medical Officers” Op.cit., p.  93.

[199] V., Tempest. Near the Sun: The impressions of a Medical Officer of Bomber Command, Crabtree Press, Brighton, 1946, p. 68.

[200] Symonds and Williams, “Investigations Of Psychological Disorders in Flying Personnel by Unit Medical Officers” Op.cit., p.  93.

[201] Stafford-Clark, “Aspects of War Medicine in the RAF” Op.cit., p. 139.

[202] Symonds and Williams, “Investigations Of Psychological Disorders in Flying Personnel by Unit Medical Officers” Op.cit., p.  93.

[203] T., Sawyer, Only Owls and Bloody Fools Fly at Night, William Kimber, London, 1982, p. 136, See also: C., Muirhead, The Diary of a Bomb Aimer, Spellmount Ltd, Tunbridge Wells, 1987, p.124.

[204] A typical neuropsychiatric examination by the MO could take an hour and is described in: R. N., Ironside, and I. R. C., Batchelor, Aviation Neuro-Psychology, Morrison and Gibb, London, 1945, pp. 21 – 31.

[205] Air Ministry Pamphlet 100 “Notes for Medical Officers on the Psychological care of flying personnel” May 1939, p. 15. AIR 2/8591.

[206] Ibid., p. 15.

[207] Addendum to Air Ministry Pamphlet 100 “Notes for Medical Officers on the Psychological care of flying personnel” (unknown date.) in: AIR 2/8591.

[208] Air Ministry Pamphlet 100 Op.cit., p. 15.

[209] D., Charlwood, No Moon Tonight, (1956) Crecy Publishing, Manchester, 2007, p. 138 -141.

[210] Ibid., p. 141.

[211] Tripp, Op.cit., p. 199.

[212] Yates, Op.cit., p.220. See also: D., Stafford-Clark., Soldier Without a Rifle, Collins, London, 1979, p. 44.

[213] The difference in diagnosis between two psychiatrists was the object of a study by D. J. Williams, See: D. D., Reid, “Prognosis For A Return To Full Flying Duties After Psychological Disorder,”  Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p. 240.

[214] Tripp, Op.cit., pp. 193 – 194.

[215] Perkins, P. H., “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4428, 1945, p. 706.

[216] Tripp, Op.cit., p. 194.

[217] P. R., Kemp, “Correspondence: Psychiatry in the Services” British Medical Journal, Vol. 2, No. 4428, 1945, p. 706.

[218] Charlwood, Op.cit., pp. 64 – 66.

[219] C. P., Symonds and D. J., Williams,  “Personal Investigation Of Psychological Disorders in Flying Personnel of Bomber Command” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p.  47.

[220] Symonds and Williams, “Investigations Of Psychological Disorders in Flying Personnel by Unit Medical Officers” Air Ministry, Op.cit., p.  94.

[221] Symonds and Williams, “Personal Investigation Of Psychological Disorders in Flying Personnel of Bomber Command” Op.cit., p.  60.

[222] Yates, Op.cit., p. 131.

[223] Maycock, Op.cit., p. 95.

[224] M. K., Wells, Courage and Air Warfare: The Allied Aircrew Experience in the Second World War, Frank Cass, London, 1995, p. 77.

[225] 20 December 1943, minute 103A and 104, AIR 2/8592.

[226] D., Stafford-Clark, “Bomber Command and Lack of Moral Fibre” Typescript quoted in: Jones, E., “‘LMF’: The Use of Psychiatric Stigma in the Royal Air Force during the Second World War” The Journal of Military History, Vol.70, 2006, p. 441.  See also: Tripp, Op.cit., pp. 189 – 190.

[227] Symonds and Williams, “Investigation Of Psychological Disorders In Flying Personnel By Unit Medical Officers.” Op.cit., p. 88.

[228] K., Wilson, Men of Air: The Doomed Youth of Bomber Command, Phoenix, London, 2008, p.70.

[229] War Cabinet report, 11 February 1943 AIR 2/5998

[230] “Organisation of Neurology and Psychiatry in the Royal Air Force” Appendix 9A, p. 2. AIR 2/5998.

[231] War Cabinet report, Op.cit.

[232] Table 24 “Attendances of Neuro-psychiatric cases at NYDN Centres (1)” AIR 2/5998. These figures do not include RAF Torquay, or the centres in Northern Ireland or North Scotland. 

[233] S. I., Ballard, and H. G., Miller, “Neuropsychiatry at a Royal Air Force Centre: an Analysis of 2,000 Cases” British Medical Journal, Vol. 2, No. 4357, 1944, p. 40. The study was of both inpatients and outpatients.

[234] “Organisation of Neurology and Psychiatry in the Royal Air Force” Op.cit., p. 5.

[235] AIR 49/324

[236] Table 26 “Recommendations for Disposal of Neuro-psychiatric cases among pilots” AIR 2/5998.

[237] Table 27 “Recommendations for Disposal of Neuro-psychiatric cases among aircrew other than pilots” AIR 2/5998.

[238] Table 26 Op.cit., and Table 27 Op.cit.

[239] “Organisation of Neurology and Psychiatry in the Royal Air Force” Op.cit., p. 6.

[240] RAF Hospital Torquay, Form 540, 8 December 1939, AIR 29/764

[241] Ibid., 25 October 1942.In addition there was one patient who was “NYD Heart” one suffering from “flying Fatigue”, and one with “Hysteria.”

[242] Ballard, and Miller, Op.cit., p. 43.

[243] RAF Hospital Rauceby, Form 540 April 1943, AIR 29/764

[244] Summary of Work done in RAF Hospital Matlock 1942. 23 March 1943, AIR 29/764

[245] RAF Hospital Rauceby, Op.cit. 29 July 1941.

[246] Ballard, and Miller, Op.cit., p. 42.

[247] “Notes from an Interview with W/Cdr. Phillip & S/Ldr. Smith P.5. on Recuperative Employment in Industry” 6 March 1945, p. 2. AIR 49/324

[248] Ibid., p. 1.

[249] Ibid., p. 2. AIR 49/324 From over a thousand patients, the majority of which were aircrew, only about twenty failed to respond to treatment.

[250] Ballard, and Miller, Op.cit., p. 43.

[251] “Royal Air Force Officers’ Hospital Torquay – Programme of Work” AIR 20/9919

[252] Ballard, and Miller, Op.cit., p. 42.

[253] Symonds and Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. Op.cit., p. 11, See also E.C.O., Jewesbury, “Work and Problems of an RAF Neuropsychiatric Centre” p.10, in AIR 49/357.

[254] Gillespie, Op.cit., p. 202.

[255] R. D., Gillespie, “War Neurosis after Psychological Trauma” British Medical Journal,  Vol.1, No. 4401, 1945, pp.653-656.

[256] Gillespie quoted in Symonds and Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. Op.cit., p. 11.

[257] J. F., Wilde, “Narco-Analysis in the Treatment of War Neurosis” British Medical Journal, Vol. 2, No.4252, 1942, p. 4. Narco Analysis was also used in hospitals without trained psychiatrists.

[258] Gillespie, Psychological Effects of War on Citizen and Soldier, Op.cit., p. 201.

[259] Wilde, Op.cit., p. 5 – 6. Drugs used included Sodium Pentothal, Nembutal and Evipan.

[260] B.M.J., “Progress in the Psychiatry of War” British Medical Journal, Vol. 1, No. 4408, 1945, p. 914.

[261] Ibid.,, p. 914.

[262] W., Sargant, “Physical Treatment of Acute War Neurosis” British Medical Journal, Vol. 2, No.4271, 1942, p. 575.

[263] Jones, E., & Wessely, S., Shell Shock to PTSD: Military Psychology from 1900 to the Gulf War, Psychology Press, Hove, 2005, p. 73.

[264] R. F. T., Grace, quoted in C.P. Symonds & D., Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. Op.cit., p. 11.

[265] Gillespie, Psychological Effects of War on Citizen and Soldier, Op.cit., p. 205. See also:  McGregor, J. S., “Insulin Treatment of Schizophrenia in Wartime” British Medical Journal, Vol.2, No. 4157, 1940, pp. 310 – 312.

[266] Sargant, Op.cit., p. 575.

[267] Gillespie, Psychological Effects of War on Citizen and Soldier,Op.cit., p. 206.

[268] RAF Hospital Matlock, Form 540, AIR 29/764.

[269] Gillespie quoted in C.P. Symonds & D., Williams, Investigation Of Psychological Disorders In Flying Personnel: Review of reports Submitted to The Air Ministry Since The Outbreak of War April 1942. Op.cit., p. 2.

[270] M., Hastings, Bomber Command, (1979) Pan, London, 1999, p.216.

[271] M., Francis, The Flyer: British Culture and the Royal Air Force 1939-1945, Oxford University Press, Oxford, 2008, p.152.

[272] D., Wiltshire, Per Ardua Pro Patria: Autobiographical Observations of a World War Two Airman, Woodfield Publishing, Bognor Regis, 2000, pp. 54 – 58. He also witnessed another Lancaster going down in flames.

[273] RAF Hospital Matlock, Op.cit.

[274] Wiltshire, Op.cit., p. 62.

[275] Comfort, L., The Hatter’s Castle, Paramount British Pictures, 1942.

[276] Wiltshire, Op.cit., p. 60.

[277] Ibid., pp. 60 – 62.

[278] Ibid., pp. 60 – 61.

[279] Shepley, and McGregor, Op.cit., p. 1272.

[280] W. H., Shepley, and J. S., McGregor, “Electrically Induced Convulsions in Treatment of Mental Disorders” British Medical Journal, Vol. 2, No. 4121, 1939, p. 1270.

[281] Ibid., p. 1270.

[282] Sargant, Op.cit., p. 575. See also: F., Golla, W. G., Walter,  & G. W. T. H., Fleming, “Electrically Induced Convulsions” Proceedings of the Royal Society of Medicine, Vol. 35, No. 5, 1940, p.266.

[283] E. B., Strauss, “Treatment of Out-Patients by Electrical Convulsant Therapy with a Portable Apparatus” British Medical Journal, Vol.2, No.4170, 1940, pp.779.

[284] B.M.J., “Electrically Induced Convulsions” British Medical Journal, Vol.1 No. 4124, 1940, p. 105.

[285] Wiltshire, Op.cit., p. 64.

[286] Summary of Report on Second Six Months of Royal Air Force Hospital, Matlock, Derbyshire, April to September 1940, p. 3. AIR 20/10727. 

[287] Ibid., p. 4.

[288] D. D., Reid, “Prognosis For A Return To Full Flying Duties After Psychological Disorder,”  Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, pp. 241 – 243.

[289] Ballard, and Miller, Op.cit., p. 42.

[290] Summary of Report on Second Six Months of Royal Air Force Hospital, Matlock, Op.cit.,  p. 5. 

[291] Jewesbury, Op.cit., p.11.

[292] Gregg, A., “What is Psychiatry?” British Medical Journal, Vol. 1, No. 4346, 1944, p. 551.

[293] Letter S.61141/S.7.c (1) Op.cit., p. 3, paragraph 9.

[294] D., Charlwood, No Moon Tonight, (1956) Crecy Publishing, Manchester, 2007, p. 102.

[295] J., Currie, Lancaster Target, (1981) Crecy Publishing, Manchester, 2008, p.113 – 114. See Also M., Tripp, The Eighth Passenger: a flight of recollection and discovery, William Heinemann Ltd, London, 1969, p. 39, and C.,  Muirhead, The Diary of a Bomb Aimer, Spellmount Ltd, Tunbridge Wells, 1987, p. 31.

[296] Letter S.61141/S.7.c (1) “Memorandum on the Disposal of Members of Air Crews Who Forfeit the Confidence of Their Commanding Officers.” 19^th September, 1941, p. 3 – 4 in: AIR 2/8591.

[297] J., Wainwright, Tail-End Charlie: One Man’s Journey Through a War, Macmillan, London, 1978, p. 182.

[298] 4 May 1942 Message to all groups from Air Ministry. AIR 2/8591

[299] “Organisation of Neurology and Psychiatry in the Royal Air Force” AIR 2/5998, Appendix 9A, p. 3.

[300] RAF Eastchurch, Form 540, 1 May, 1943, AIR 28/243. See also RAF Brighton, Form 540, 29 May 1943, AIR 29/1099.

[301] J. A., Green, “Wartime Memories: Face to face with a Guerrilla” Pontefract Memories and Recollections Website, http://www.pontefractus.co.uk/memories/wartime_jgreen01.htm accessed on 06.01.10.

[302] RAF Eastchurch, Op.cit.

[303] Ibid. Throughout 1943 and 1944 both Symonds and Gillespie made frequent visits to Eastchurch.

[304] R. J., Larkins, “The Pilot Who missed the War An Everyday Story of Flying Folk 1623560 Flight Sergeant Larkins, R.J.” “Wartime Memoirs” MC 2153/3, 926X7, Norfolk Record Office, p. 445.

[305] Larkins, Op.cit., pp. 461 – 462.

[306] Ibid., p. 464.

[307] Ibid., p. 469.

[308] Ibid., pp. 471 – 472.

[309] Ibid., p. 467.

[310] Anon, quoted in M., Tripp, The Eighth Passenger, (new edition) Wordsworth Editions, Ware, 2002, p. 193.

[311] RAF Eastchurch, Op.cit.

[312] SMO, RAF Eastchurch, Form 540, 31 January, 1945, AIR 28/243.

[313] Ibid., 12 July 1943 and December 1944, AIR 28/243.

[314] Larkins, Op.cit., p. 468.

[315] SMO RAF Eastchurch, Op.cit. 20 January, 1944.

[316] F., Lund, Memories of Frank Lund, (part 9) BBC WW2 People’s War Website, 2005, http://www.bbc.co.uk/ww2peopleswar/stories/88/a5403188.shtml accessed on 06.01.10.

[317] ‘Bob, N’, quoted in M., Tripp, The Eighth Passenger, (new edition) Op.cit., p. 192.

[318] DGMS 11 September 1942 minute 234 AIR 2/8591

[319] RAF Eastchurch, Op.cit., 8 March 1943.

[320] The Consultants in Neuro-psychiatry, “Comments on the Memorandum on the Disposal of Aircrews who Forfeit the Confidence of their Commanding Officers S6.1141/S.7.c (1) of 1st June 1943, p. 6, AIR 2/4935. 

[321] Larkins, Op.cit., p. 470.

[322] Lund, Op.cit.

[323] Larkins, Op.cit., p. 469.

[324] Ibid., p. 473.

[325] ACDU Chessington, Usworth & Keresley Grange, Form 540 AIR 29/603. Under the auspices of the sinisterly named R.I.P. Barker, the ACDU based at Chessington in 1943 moved to Usworth in June 1944 and to Keresley Grange near Coventry in September 1944.

[326] RAF ACDU Keresley Grange Form Op.cit., 4 October to 17 December 1944.

[327] Larkins, Op.cit., p. 470.

[328] Wainwright, Op.cit., p. 183.

[329] J., McCarthy, “Aircrew and ‘Lack of Moral Fibre’ in the Second World War” War and Society, Vol.2, 1984, p. 96. Between October 1943 to April 1944 48 officers and 337 other aircrew were posted to Chessington.

[330] ACDU Chessington Op.cit., 12 April & May 1944.

[331] Ibid., 20 April 1944.

[332] E., Jones, “‘LMF’: The Use of Psychiatric Stigma in the Royal Air Force during the Second World War” The Journal of Military History, Vol.70, 2006, p.451.

[333] Wainwright, Op.cit., p. 183.

[334] RAF ACDU Chessington, Op.cit., May 1944.

[335] RAF ACDU Usworth, Op.cit., 9 August 1944.

[336] RAF ACDU Keresley Grange, Op.cit., December 1944.

[337] RAF ACDU Chessington, Op.cit., April 1944.

[338] Ibid., 29 May 1944. See also: RAF ACDU Keresley Grange Op.cit., 7 December 1944.

[339] RAF ACDU Usworth, Op.cit., 28 June 1944.

[340] R., Winfield, The Sky Belongs to Them, William Kimber, London, 1976, p. 65.

[341] V., Tempest., Near the Sun: The impressions of a Medical Officer of Bomber Command, Crabtree Press, Brighton, 1946, p.73.

[342] Ibid., p.74.

[343] R., Maycock, Doctors in the Air, George Allen and Unwin Ltd, London, 1957, p.37. See also: B. H. C., Mathews, “The Effects of Altitude on Man” British Medical Journal, Vol. 2, No. 4411, 1945, p. 77.

[344] D. J., Williams, “Episodes of Unconsciousness Confusion, and Amnesia While Flying” Air Ministry, Psychological Disorders in Flying Personnel of the Royal Air Force Investigated During The War 1939-1945, His Majesty’s Stationary Office, London, 1947, p. 277.

[345] Ibid., p. 260.

[346] R. N., Ironside, and I. R. C., Batchelor, Aviation Neuro-Psychology, Morrison and Gibb, London, 1945, p. 31.

[347] Williams, Op.cit., p. 270.

[348] Ibid., pp. 264 – 265.

[349] Ibid., p. 273.

[350] Ibid., p, 260.

[351] Ibid., pp, 277 – 280.

[352] Ibid., p, 260.

[353] Letter S.61141/S.7.c (1) Op.cit., p. 3 paragraph 11.

[354] Ibid., p. 4 paragraph 11.

[355] Minutes of a Meeting held on the 20^th October 1944 to discuss the ‘W’ Procedure” p. 1, AIR 19/632

[356] Wainwright, Op.cit., p. 181.

[357] Ibid., p. 181.

[358] Ibid., p. 183.

[359] S., Brandon, “LMF in Bomber Command 1939-45: Diagnosis or Denouncement?” in Freeman & Berrios (eds) 150 Years of British Psychiatry, Vol 2: The Aftermath, Athlone, 1996. p.126, W., Holden, Shell Shock, Channel 4 Books, London, 1988, pp.110 – 111, and B., Shephard, A War of Nerves, Jonathon Cape, London, 2000, p.286.

[360] Letter to G. C., Touche, M.P. 19 April 1943, in AIR 19/632. See also:  Minutes of a Meeting held on the 20^th October 1944 to discuss the ‘W’ Procedure” p. 6., AIR 19/632. The Airman involved was also entitled to read his CO’s report and was to initial all documents forwarded to the Air Officer Commanding.

[361]Wainwright, Op.cit., p. 182.

[362] The Consultants in Neuro-psychiatry, Op.cit., p. 5.

[363] Wainwright, Op.cit.,  pp. 183 – 184.

[364] The Consultants in Neuro-psychiatry, Op.cit., p. 9.

[365] D., Stafford-Clark interview quoted in: Shephard, Op.cit., p. 446.  

[366] D., Wiltshire, Per Ardua Pro Patria: Autobiographical Observations of a World War Two Airman, Woodfield Publishing, Bognor Regis, 2000, p. 63 – 64.

[367] Larkins, Op.cit., p. 480.

[368] Ibid., p. 476.

[369] Ibid., p. 459.

[370] Ibid., p. 464 – 466.

[371] Tripp, The Eighth Passenger: a flight of recollection and discovery, Op.cit., p.169.

[372] D., Stafford-Clark, “Morale and Flying Experience: Results of a Wartime Study” Journal of Mental Science, Vol. 95, No. 398, 1949, pp. 16 – 17.

[373] Larkins, Op.cit., p. 377.

[374] Ibid., p. 488.

[375] Ibid., p. 447.

[376] Ibid., p. 480.

[377] Ibid., p. 485.

[378] Ibid., p. 481.

[379] Ibid., pp. 486 – 487.

[380] Ibid., p. 487.

[381] Ibid., p. 496. For a while before this he had been told he was to be commissioned as second lieutenant in the army to fly as a glider pilot in the Far East against the Japanese. Rather than have the embarrassing situation of a potential officer carrying out menial duties, he was sent on leave awaiting his recall. See p.492 – 493.

[382] Ibid., p. 496. On all versions of the waverers letter it was made clear that no reference was to appear on any documents issued to the airman, however the practice of putting a red “W” on their form 1580 (which was retained by the RAF) was also discontinued in 1945. See: Letter S.61141/S.7.c (1) “Memorandum on the Disposal of Members of Air Crews Who Forfeit the Confidence of Their Commanding Officers.” 1^st March, 1945 in: AIR 19/632.

[383] Larkins, Op.cit., p. 498.

[384] Ibid., p. 499 – 500.

[385] Ibid., p. 499.

[386] Ibid., p. 501.

[387] Undated excerpt of a letter to the Secretary of State in AIR 19/632.

[388] J., Lawson, 7 September 1942 minute 28, AIR 2/8592.

[389] Excerpt of a letter to the Secretary of State, 25 May 1944, in AIR 19/632.

[390] Minute 2, 16 June 1945, AIR 19/632.

[391] T., Sawyer, Only Owls and Bloody Fools Fly at Night, William Kimber, London, 1982, p. 136.

[392] J., Lawson quoted in J., Terraine, The Right of the Line, (1985) Wordsworth Editions, Ware, 1997, p. 532.

[393] See: B., Sullivan. Fibre, Faber and Faber, London, 1946, p. 14, M., Tripp, The Eighth Passenger: a flight of recollection and discovery, Op.cit.,  p. 39 and D., Charlwood, No Moon Tonight, Op.cit., p. 56.

[394] Larkins, Op.cit., pp. 463 – 486. Larkins was at Eastchurch for 46 days; during which he was either on leave or AWL for 28 days.

[395] E. H., Mayhew, The Reconstruction of Warriors: Archibald McIndoe, the Royal Air Force and the Guinea Pig Club, Greenhill Books, London, 2004.

[396] M., Hastings, M., Bomber Command, (1979) Pan, London, 1999, p. 214.

[397] J., Lawson quoted in J., Terraine, The Right of the Line, (1985) Wordsworth Editions, Ware, 1997, p. 532.

[398] T., Sawyer, Only Owls and Bloody Fools Fly at Night, William Kimber, London, 1982, p. 136.

[399] E. C. O., Jewesbury, “Work and Problems of an RAF Neuropsychiatric Centre” p.18, in AIR 49/357.

[400] R., Morris, Guy Gibson, Viking, London, 1994, p. 131 – 132. 

[401] Jewesbury, Op.cit., p. 6.

[402] E., Jones, & S., Wessely, Shell Shock to PTSD: Military Psychology from 1900 to the Gulf War, Psychology Press, Hove, 2005, p. 223..

[403] J. D., Comrie, Black’s Medical Dictionary, Adam & Charles Black, London, 17^th edition, 1943, p. 112.

[404] Ibid, p. 340.

[405] Ibid, p. 340.

[406] Ibid, p. 362.

[407] Ibid, p. 800.

[408] Ibid, p. 626.

[409] H.W., Featherstone, “Basal Anaesthetics and Allied Substances Their use and Misuse” British Medical Journal, Vol. 1, No. 3816, 1934, pp. 322 – 326.

[410] R. M. S., Mathews, “Eustachian Obstruction and Otitic Barotrauma in Air-Crews of Heavy Bombers” British Medical Journal, Vol. 2, No. 4372, 1944, p. 524.

[411] J. D., Comrie,  Op.cit.,  p. 678.

[412]d Ibid, p. 695.

[413] L. G., Zerfas, “Sodium Amytal and other Derivatives of Barbituric Acid” British Medical Journal, Vol.2, No. 3647, 1930, pp.897 – 902.

[414] Ibid, p. 144.

[415] Ibid, p. 889.

[416] Ibid, p. 457 – 548.

[417] Ibid, p. 951.