THE PSYCHOLOGICAL CASUALTIES OF WAR

Press, Volume LXXX, Issue 24365, 18 September 1944, Page 4

THE PSYCHOLOGICAL CASUALTIES OF WAR

rehabilitation

♦ [By OK. A. T. ** H “ PiM - * sssto^s l sysss& ,, a^ss«■s .s» “ T hg ; reported in this issue. ,

Recent American statistics have shown conclusively that one person in every 20 will, at some, period during his life, enter a mental hospital as a certified patient, whilst another one m 20 will be completely incapacitated by neuro-psychiatric illness for an appreciable time. „ „„„„ In addition to this, some 10 Persons out of 20 will seek medical attention for illnesses whose symptoms are either frankly “nervous” or are physical to all appearances, but possess a ‘ nervous” or emotional origin. Carefully compiled figures also indicate that in America the incidence of mental illness has definitely increased during the last four decades. Shortly before the outbreak of the present war it had been ascertained from general practitioners in England that as many as 70 per cent, of their patients presented illnesses wljose mam cause was nervous or emotional. The experience of medical men in this country leads them to similar conclusions. / .. . The incidence of the grayer types of mental disorder, those which lead to disorders of conduct so grave .as to necessitate enforced detention and treatment, may be appreciated by the fact that throughout the English-speak-ing world beds provided for these patients outnumber those provided for all other forms of illness added together. One type of mental illness alone, schizophrenia, is said to incapacitate for life every year more new patients than does pulmonary tuberculpsis,' and these are mostly adolescents with every promise of a normal and sometimes of a brilliant future. Mental “Casualties’* In view of the wide incidence of mental disorder in the general population, it is not surprising that, excluding those discharged from the Army as the result of wounds, in as many as 70 per cent, of discharges for illness the type of illness is characterised as neuropsychiatric. . . Experience has shown that a high proportion of this type of casualty oc-. curs amongst those men who have never seen combatant service—often have never left Australia. This is an indication that actual frontline service is a relatively unimportant factor in those mental illnesses'that last sufficiently long to lead to discharge, and it is the practically unanimous opinion of psychiatrists in combatant countries that the main causes must be sought elsewhere than in the dangers and stresses of active warfare. It is found that the factors, leading to illness in the soldier are in the main the same as in civilian'life. In the great majority of cases careful inquiry will elicit a history of previous nervous symptoms and/or the presence of mental conflict based on domestic stresses, economic insecurity, sexual or marital problems. When the prisoners of war, return, however, it is expected that it will be found that the long period of life under exfceptionally abnormal conditions will lead to such difficulties of readjustment that by only the greatest care in the rehabilitation of these' men will tragedy be averted. Fundamental Causes Life in the services frequently acts as an indirect or aggravating cause even in the case of personnel who have never left Australia. One has frequently seen a psychosis result when a sensitive, retiring, ultra-con-scious youth suddenly finds himself in the midst of his fellows and is unable to withstand the treatment which that type is likely to receive from men en masse. And in the background of his life there looms only too frequently that potent factor in mental illness in the young male—the dominating or the over-protective mother. This is a factor little recognised except by the psychiatrist, yet so important as to merit a publicity campaign .for parent education. It is important that it be recognised that the main factors in these cases are not directly due to the war. Lack of such recognition is a handicap to treatment, and especially to psycho-ther-apy. The patient must not be permitted the common error of supposing that .“shell-shock" and “bomb-

happy" have any real connexion with the physical effects of shells and bombs. , x . The lack of understanding of the real nature of his illness assists in ; ' building up in his mind what is commonly known as the “pension com-/ plex,” so frequently fatal to treatment in these cases and so frequently leading to the patient maintaining an ineffectual existence on an made- ‘ quate dole. With reference to the pen- ; sions system in another country following the last war, it was said; “With - 30 pieces of silver the country betrayed the soldier.” It was such an easy way out to give him a pension and to provide neither adequate treatment nor effective rehabilitation. Modem Treatment The men suffering from neuro- . psychiatric illness, developed during service, or, as frequently happens, shortly after discharge, may be divided into three categories:— (1) Those milder cases needing mainly assistance to adapt them- ■ selves to their immediate environmental difficulties. These are provided for, to some extent, by varied agencies of which the Red Cross and - the R.S.S.I.L.A. are the best known; (2) More severe cases who do not need hospitalisation but who are in need of assistance in readjustment' and of pschvo-therapeutic treatment. For these It is generally recognised . that the facilities are quite inadequate. ■ (3) The major < tragedies—those patients who for various reasons are ■ certified so that they may obtain / treatment and care in a mental hospital. Fortunately during the present ' century there has been a continuoul advance from the idea of asylum, where the patient was merely de- ■ ■ tained and sheltered, towards the modern • mental hospital 'which,, though as yet far from the ideal, ' now places the accent on treatment . and freedom for the patients. ; “ There are many methods of treat* ment available that were unknown Jn 0 ■ 1918. Electro-shock treatment, intro- - ' duced only some Jhree years ago, hai ■*; provided some dramatic recoveries and in many cases has reduced the time in ' <■- hospital from some 12 months to lesg/ j than that number of weeks. It ha*' . been found that patients may be al« ' : ’ lowed to leave hospital months earlier -. during the process of recovery than ’ was deemed safe 20 years ago, and the r majority react well to the increased freedom that Is now permitted. That/!-' mental illness has not that hopeless.,,'/ prognosis imagined by so many' it’ 1 ' shown by the fact that during 1943-4s‘: vJ in one of our large mental hospitals, • ’ 64 per cent, of those admitted, excluding thpse due to physical changes the brain, recovered sufficiently to re*|< turn to their previous spheres of life., /-'/ Reviving Interest During the last three decades occu-/ ,' pational and recreational therapy hai« gained increased recognition, with de^; v , finite benefit to the patients. For thtfjjrrecoverable patient; it has interest and industry, and an elterna-..;; tive from that depressing enforced;/; idleness that was a definite brake 6a hj; *, recovery. For the less recoverable ’ tients, it has provided a means of sttol® ulating mental activity, and so vented , the development of lethargy that is akin to dementia. - IjS furnishes interest" and pleasure - keeps him in touch with’ reality,; S]#||l that frequently he is able to lead 'an :-||| industrious life, moderately happy, il and, finally, though still a patient ia the hospital, able to seek interJ pleasures outside the institution, One important adjuvant to ment and to after-care is lacking—safe; enlightened and charitable public when patients are able to return froWSf; a mental hospital to their usual; en-*/; vironment, will receive them, not suspicion, criticism, or veiled allusions,/*:;; but with sympathy and ing. In no case will this be more necessary than in the soldier recover-v/?.. ing from mental illness who, at pre-//i sent, has to face not only the ties of readjustment to a life from ,- which he has , long been absent, but:/ - also the undeserved stigma which mi. i illness at present carries. - J