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'War Uncovers , !lumbers" o Maimed Minds Distinction Between Neurotic Condition and Insanity Few War -Neuroses Are Lasting *What Help Can Be Given
Those Emotionally Unstable? tion. Some of the public concern is an outgrowth of a misunderstanding of the requirements of the armed forces; but certainly apart df it is due Me opinions and assertions contain• to reluctance to face the facts. cd herein are the private opinions of A number of men who should have the author and are not to be construed been eliminated, at induction centres as official or reflecting the views of escaped detection largely because of the Navy Department or the Naval the limited number of psychiatrists Service as a whole.) and the rapidity with which they had The problem of mental disease and to function. If they were assigned to emotional instability in the general the Nav_v, some of them were detected population has long since assumed later at naval training stations where, -major proportions, but until the war focussed attention upon the number of 'following a trial of duty and a demonstration of their imbility to adjust T rejections for psychiatric reasons, renaval life, they were eliminated by rea• latively few people were aware of its son of inaptitude. There is no doubt magnitude. In the United States, about the • visdom of these " screening' before the outbreak of the present war, examinations, for they have eliminated more hospital beds were occupied by many men who are potential psychiatpatients with mental diseases than by ric casualties. patients with all other diseases. It is In civilian life, the unstable and in. estimated reliably that in this genera adequate persons who are not adapted tion one child in every twenty-six will to one particular type of work or living spend some time in a mental institu• Lion. These figures include only frank' are able to move to another lorality or seek another job and eventually to mental disease—those psychological demake some kind of adjustment. Even viations from normal thinking and bethe severe neurotics rarely are seen by haviour which are designated familiarpsychiatrists: so they carry on in one. ly by the legal term insanity. No way or another, meanwhile blaming 'di• effort ever has been made to deter• verse situations, conditions or people mine the number of the civilian popufor their unhappy states. In military lation who suffer with the milder emo. life, however, a man cannot change tional disturbances known as neuroses his job at every whim, nor can he or psycho-neuroses. Neuroses are fremove about, hoping to make a satisquently called by other names and exfactory adjustment . For the most press themselves by symptoms such as part his adjustment is on an all-or-nnne colitis, backache and various ill-defined basis. if he fails to perform his job complaints referable to the heart, stomsatisfactorily, he is regarded as inadeach and other organs . It is estimated quate; and if in the process of failing variously that seventy-five per rent, of he develops emotional symptoms, he is all the illness seen by the general prac. regarded as neurotic and eventually he titioner is initiated or complicated by comes to the attention of the military emotional factors. If we add to this psvchiatrist. In contrast to the neu• the vast number of neurotics—diagnnsrotic in civilian life, therefore, hospitaled and undiagnosed— as well as apisation and observation are the rule proximately 200,011(1 alcoholics and for the neurotic in military life. To drug addicts and several hundred thenkeep him in the Service and expose sand feeble-minded and epileptics, we get some idea of the size of the psy, him to further stress is unfair to the man himself and to the shipmates who chiatric problem. work with him and depend upon him Meaning of bMitary Rejections. To eliminate him from the Service re• Recently there has been a growing quires,a medical diagnosis. public interest in this problem because Mtnass for Civilian Life. the armed forres find it necessary to Here is where misundderstandinR reject some of the selectces at indurarias, for the diagnosis is frequently tion examinations and discharge other that of psvehoneurosis and anything emotionally unstable recruits who were to which the prefix "psycho" is atnot detected by the original examinaBy COMMANDER F. J. BRACELAND.
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tached is immediately misinterpreted by many people and is confused with mental disease. Such a misinterpretation obviously is unfair, for miry of us have some psychoneurotic symptoms and all of us can become psychoneurotic provided the proper set of circemstances arises. The unknowing believe there is a stigma attached to this diagnostic term; they fail t o see that the stigma exists only in the minds of the persons who so regard it. Some of the fine work of the world has been done by people who were quite definitely neurotic; and an exaggerated reaction to the term is often itself in* dicative of an underlying instability.
fyingly low. In fact, it is far below the ratio in the civilian population. Once an individual has had a psychosis—an actual mental disease—the Navy does not return him to active dluty. The reasons for this are readily understandable. Apropos of this, there is an interesting and noteworthy fact which should be mentioned here, Pod that is the rapid and high recovery rates of men who have developed mental disease iq this war. Thus far eighty-five per cent. of naval personnel who have been committed to hospitals for the meosally ill have been discharged'to their homes free from symptoms within a period of six months. A follow-up study of a group of these patients after one year indicates that over sixty per cent of them have made a good adjustment in civilian life and have satisfactory work records.
A psychiatric diagnosis is not stigmatising particularly in military per. sonnel. What it Teally indicates is an inadequacy for military life as is deronstrated by incapacitating emotional It is apparent, therefore, that the symptoms. Nothing is implied relargest segment of the problem which garding the man's potentialities for civi. confronts the military psychiatrist has lian adjustments; in fact, tht military to do with the proper handling of the psychiatrists believe that the great emotionally immature and the men majority of the individuals discharged who are unable to adjust to the militfrom the Service because of inadeary service. From a hasty review of quacy will make a satisfactory adjustdischarge statistics which appear at inment when they return to the less tervals in the newspapers, an unqualiconstricting atmosphere of civilian life. fied observer might be tempted to inThis is borne out by an examination of fer that we are becoming a nation of, the records of the men already disimmature and inadequate individuals, charged. but thg denial of this is written in the The whole problem becomes more excellent records and outstanding perunderstandable when it is realised that formances of our fighting men in all not every one is adapted to military parts of the world to-day. life any more than to the hazardous job of a structural steel worker. The Aids to Rehabilitation. National Emergency Act requires, It is true that our specialisation and however, that all men' within certain single-purposeness of education have age groups present themselves for ex• made our national quality of adjustamination to determine their fitness ment a little too brittle. The antefor induction into the military service. cedents of some of the problems we If one is physicaAy qualified, be be• encounter are apparent to all of us— comes a member of the armed forces inadequate educational , •family and ecoand, if he cannot adjust himself to nomic backgrounds, poor,social indocmilitary life ,he must be discharged and trination and loss of the proper sense returned to civilian life. The military of values in all spheres. The psychiatscrviceg cannot temporise with indivirist is forced, albeit reluctantly, to deal •uals, for the future and life of the with the end product of these situagroup are at stake in this global war. tions; yet the causes are outside of his The prime function of the Army and sphere of influence—at least as far as Navy is to fight and to win the war, control is concerned. He has the unand all other considerations must be enviable task of trying to reconcile a secondary. grorwing individualism on one hand and a rising tide of group pressures on Few War Neuroses Lasting. the other. , In the minds of the undisPeculiarly enough, ,voile neuroses made up the bulk of the psychiatric cerning,the marginal adjustments cast out of the group by diverse circumcasualties in the last war, actual menstances are lumped together with the tal disease as a result of combat conmentally ill, probably because the ditions was not a serious problem. psychiatrist has to deal with them. It From the trend of events at present. ig the task of the psvchiatrist to try it seems as though the same situation to help people to adjust emotionally will recur in this war, for though the wherever possible: it is his form of pretendency toward emotional instability ventive medicine. Treatment, if adand constitutional inadequacy is high, ministered earlv in the illness, may the incidence of mental disease in the (Continued on Page 4.) Navy thus far is surprisingly and grati-
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