Summary and Conclusion

It has been a commonly accepted belief that in spite of the strain associated with submarine warfare the incidence of serious psychiatric illness amongst submariners has been very small. Various theories had previously been advanced to explain this. In order to verify the belief, a series of 71 patients examined psychiatrically has been analysed. An attempt has been made to gauge the relative importance of aetiological factors (particularly the strain peculiar to service in submarines), to study qualitatively the development of reactive disorders in submarines, and to describe the incidence and disposal of such cases.

It has been shown (Fig. 1) that “submarine stress” played a very big part in the majority of cases discharged from the submarine service, and, conversely. that those cases in which “submarine stress” played an important part were mostly discharged from the submarine service.

Neuroses of more severe prognostic significance (from the point of view of further service in submarines) occurred most commonly in the phase of “Cearly stress,” whereas cases occurring in the later phases (of “established tension” and “anxiety with exhaustion”) had a correspondingly better prognosis for a return to submarine duties.

In this group of submariners it has been shown that the incidence of psychiatric illness was small (only 4·6 per cent, per annum required to be relieved even for a short period from full duty in submarines). Moreover, most of the patients who did not return to submarines remained suitable for other forms of Naval service, and less than ·3 per cent, were invalided from the Navy on psychiatric grounds.

The indications are that the submariner is a stable type of person. Less stable personalities do not reach the submarine service, or are eliminated in the phase of “early stress.” The fact that “there is no escape route” in a submarine at sea has no bearing on the matter ; it merely postpones break down until there is an escape route (viz., when alongside the depot ship).

The institution of a measure of deliberate preselection appears to be advisable, particularly as regards pre-existing mild anxiety states, post-concussional states, etc., and especially when dealing with an unwilling or constitutionally inferior rating. Drafting routine to submarines should include a visit to the neuropsychiatrist.

Facilitation of honourable discharge on medical grounds of ratings who have completed a predetermined period of good service in submarines and have begun to develop vague neurotic symptoms is seen to be a justifiable, and indeed desirable, procedure.