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As we look back upon a Veterans Day or Remembrance Day like no other, it's a good time to think about the impact wars have had on understandings of mental health. The obvious association is that of post-traumatic stress disorder (PTSD), which has its roots in shell shock, combat stress, war neurosis, and other battlefield-related mental health ailments. Originally associated with traumatic military experiences, PTSD is now diagnosed in people who experience other kinds of trauma. Perhaps I'll discuss this in a future blog post, but here I am more interested in the impact the Second World War had on how the prevalence of mental illness was understood in the United States.
The specter of First World War shell shock cast a long shadow over the military in many countries. As the USA prepared to enter the Second World War, its military leaders were determined to recruit soldiers who would be more resilient to the stresses and strains of battle. Having to remove soldiers from the front line because of such mental disorders was costly in terms of maintaining a military presence and in terms of morale. Therefore, they decided to screen recruits for psychiatric illnesses.
Amazingly—to them—over 1 million recruits were deemed to have psychiatric problems of one kind or another and were rejected for military service. We can certainly pick apart some of these figures since included in these numbers were homosexuals (then thought to be a mental illness) and people with learning disabilities. But the important thing is that it planted a seed among both the military and psychiatry that mental illness was more commonplace than previously thought.
Despite the measures to weed out those thought to be vulnerable to combat stress, there were approximately 1 million admissions to hospitals of soldiers made on the basis of psychiatric grounds. Again, we can quibble a little at the figures—some soldiers were admitted multiple times—but the important thing is that this reinforced the view that mental illness was very prevalent in American society. A number of military psychiatrists also began speculating that the sort of stresses experienced by soldiers could be paralleled by stresses that affected civilians. The task of tackling civilian mental illness would be just as daunting.
The solution to this problem was thought to be found in psychiatry. Leading up to the war, psychiatry was not viewed as a particularly respectable medical discipline. Most psychiatrists worked in asylums that were either ignored or stigmatized. But as the war wore on, the number of military psychiatrists increased alongside their influence. By the end of the war, psychiatry was seen in a much more positive light, and many politicians and military leaders put their faith in psychiatrists to solve the nation's mental health problems.
The best example of this can be seen in the foundation of the National Institute of Mental Health (NIMH), which was created shortly after the war. It funded a great deal of research into the causes of mental illness. This faith in psychiatry contributed to the closure of asylums (deinstitutionalization) and the emergence of community mental health care.
As I have previously written, this period was called "The Magic Years" by some psychiatrists. But the magic would soon wear off. Community mental health care centers struggled to deal with the large numbers of deinstitutionalized patients, funding in preventive mental health began to dry up as the U.S. economy faltered during the 1970s, and biological approaches to mental illness began to supplant psychoanalysis and social psychiatry. An anti-psychiatry movement emerged in response to some of these trends, demonstrating that psychiatry's reputation had faltered once again.
In this way, the Second World War's positive impact on psychiatry was short-lived. But its effect on how we view the prevalence of mental illness has endured. During the decades following the war, mental disorder ceased to be associated with asylums and became something much more commonplace.
While this has been good in terms of reducing the stigma of mental illness, it has also led to a narrowing of what is considered "normal," not least because of the aggressive marketing of some psychiatric disorders by drug companies. Recently, the neurodiversity movement has challenged our willingness to diagnose too quickly and has argued that, rather than changing individuals who are different, we should make society more accepting of all.
We are living in tumultuous times yet again with COVID-19, and mental illness is once again hitting the headlines. It will be interesting to see how our views of mental health change as a result.
