Army Psychiatry in the Korean War: The Experience of 1 Commonwealth Division (original) (raw)
Related papers
Psychiatry in the Army: A Brief Historical Perspective and Current Developments
Psychiatric Services, 1991
fight with bows and arrows or with hydrogen bombs, involves such items as leadership, courage, morale, motivation, perseverance, derelic tion, malingering, and the age-old problems ofdnink and breach of dis cipline. Psychiatry in the military setting finds itself inexorably drawn into consideration of these eternal verities ofmilitany life.― World War I brought the â€oe¿ eternal verities― ofmilitary life into sharp focus, which helped psychiatrists to evolve the basic tenets of military psychiatry. These principles were refined, redefined, and sometimes obscured during World War II and the wars in Korea and Vietnam, as well as in more recent military opera tions. This paper briefly reviews the history ofpsychiatry in the United States Army in the 20th century and outlines the evolution of its prin ciples. The structure of psychiatric practice in the United States Army and its current areas of interest, in cluding combat and crisis strategies and community and family psychia try, are examined. Military psychia try's effects on and contributions to general civilian psychiatry are also emphasized. Historical overview The battles in Europe during World War I resulted in a large number of patients presenting to physicians with a syndrome called ‘¿ ‘¿ battle shock. â€oe¿ Symptoms of dizziness, blindness, deafness, muteness, shaki ness, crying, and general inability to perform were considered to have a neurological origin and to be caused by artillery blasts (2). When the United States entered the war, the psychiatric consultant to the Army Surgeon General assigned Major Thomas Salmon to direct the Army's psychiatric program in Northern Europe (1â€"3). Salmon noted that the British evacuated their battle shock casual tics to neuropsychiatric wards in civilian hospitals, often at home in England. These practices resulted in a low percentage of casualties being returned to duty and a high percent age of entrenched, chronic symp toms. The French, on the other hand, instituted treatment of psychiatric casualties near the battle front, rarely evacuating soldiers to the rear or dis charging them from military service. The French military psychiatrists were sensitive to the concept of 5cc ondary gain from â€oe¿ battle shock.― They understood that soldiers could use these symptoms as a means of separation from the front line, from the unit, or from military service at together. The French military psy chiatnists instituted aversive tech niques, including loss of privileges, for nonpsychotic psychiatric casual ties. These interventions seemed to communicate to the servicemen that they were expected to become func tional again and were to remain on active duty. Salmon sought to create a pro gram for United States troops that would incorporate the compassion of the British but would also provide for the successful retention and rein tegration ofpsychiatnic casualties, as he had seen in France. He initiated the concepts of proximity, imme diacy, and expectancy. Psychiatric casuaLties were to be treated as near to the battle front as possible (prox imity), in as short a time as possible (immediacy), and with the belief that many, if not all, would be able to return to the front to support their â€oe¿ buddies― after a briefrest (cxpectan cy). Treatment interventions were
The US Psychiatric Response in the 20 th Century Military
Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future. The US Psy...
War & Military Mental Health: the US Psychiatric Response In the 20th Century
American Journal of Public Health, 2007
Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and ...
The Journal of Clinical Psychiatry, 2016
See article by Bergman et al I n this month's Journal of Clinical Psychiatry, Bergman et al 1 report on the long-term mental health of military veterans matched with nonveterans with a focus on the impact of the length of the veterans' military service. Using data from the Scottish Veterans Health Study, some 57,000 veterans and 173,000 nonveterans were matched. The authors report that military service was correlated with increased mental health problems among veterans in general and among "early service leavers" in particular. 1 Matching of the exact same 2 groups had been used in a previous study on myocardial infarction, 2 which demonstrates that the methodology is sound and flexible and could be applied to a variety of medical issues. Reviewing the references to the article reveals that sources included many British and American studies, which appeared in both British and American journals. This might arguably suggest that the findings would be generalizable to US Armed Forces, who are also North Atlantic Treaty Organization members and use a common military doctrine with similar training and weapons. But the issue of service in wartime, particularly service in areas of active combat, is not addressed in this article. For countries that have been at war and actively engaged in combat operations for the past 14 years, 3,4 the quantitative effects on mental health are a critically important issue. It is made even more important as many of the troops are sent for repeated combat deployments in what are euphemistically referred to as the "sandboxes" of Iraq and Afghanistan. The United States, United Kingdom, and Canada have engaged in combat operations in both of these areas as allies. The psychological trauma of war, now called posttraumatic stress disorder (PTSD), has quite likely been recognized for millennia. In the US Civil War (1861-1865), it was called "soldier's heart. " 5 Then, in World War I and early in World War II, it became "shell shock" or "war neurosis. " 6,7 Later in World War II, the appellation evolved to "battle fatigue" or "combat stress. " 8 But it was essentially the same disorder and led to large numbers of casualties.
Battle for the mind: World War 1 and the birth of military psychiatry
The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the fi rst recognition of what is now called post-traumatic stress disorder and the latter did not off er the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classifi ed military reports, and casualty returns to reassess the conventional narrative about the eff ect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the effi cacy of forward psychiatry were infl ated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance—not as an opportunity for self-congratulation.
Battle for the mind: World War One and the birth of military psychiatry
The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the fi rst recognition of what is now called post-traumatic stress disorder and the latter did not off er the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classifi ed military reports, and casualty returns to reassess the conventional narrative about the eff ect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the effi cacy of forward psychiatry were infl ated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance-not as an opportunity for self-congratulation.
General Hospital Psychiatry, 2011
Objective: This study was designed to describe the epidemiology of psychiatric illnesses experienced by soldiers in a combat environment, which has been previously underreported. Methods: A U.S. Army brigade combat team deployed to Iraq during the Iraq War "Troop Surge" was followed by reviewing unit casualty rosters and electronic medical records for psychiatric diagnoses made by treating providers. The main outcome was the incidence rates of psychiatric disease and nonbattle injury (DNBI). Results: Of the 4122 soldiers deployed, there were 308 psychiatric DNBI casualties (59.8 per 1000 soldier combat-years), which represented 23% of all DNBIs and was second only to musculoskeletal injuries (50% of all DNBI). Most psychiatric DNBI (88%) were treated in theater and returned to duty, 11% were medically evacuated and 1% died. Junior enlisted soldiers, compared with junior officers, and women, compared with men, were at a significantly increased risk for becoming a psychiatric DNBI casualty (77.3 vs. 32.2 per 1000 combat-years, Pb.002 and 110.8 vs. 55.4 per 1000 combat-years Pb.05, respectively). Conclusions: Psychiatric diagnoses are second only to musculoskeletal injuries as a cause for DNBIs sustained in the current combat environment. Most can be treated in theater and permit soldiers to return to duty. Published by Elsevier Inc.
Background: After extensive review of official military records, government investigations, and news media accounts, the authors provide the first-ever examination of repetitive mental health crises after every major American war since the 20 th century. Method: Compelling evidence of generational crises is established using direct testimony from credible first-hand sources, clearly indicating that over the past century American society has continued to replicate preventable mental health crises. Results: This has largely been caused by repetitive failure to learn from and improve upon lessons learned about the psychiatric effects of war. The authors identify ten super ordinate " foundational lessons " essential to meeting wartime needs. Conclusion: Antiquated medical dualism, dysfunctional organizational structure, and leadership ambivalence toward mental health services are believed to promulgate a culture of mental health stigma, discrimination, and disparity. The key to transforming military mental healthcare and ending the cycle is to adopt a contemporary holistic mind-body approach emphasizing full-parity with medical services.
Anxiety, post-traumatic stress disorder and depression in Korean War veterans 50 years after the war
The British Journal of Psychiatry, 2007
Background There has been no comprehensive investigation of psychological health in Australia's Korean War veteran population, and few researchers are investigating the health of coalition Korean War veterans into old age. Aims To investigate the association between war service, anxiety, post-traumatic stress disorder (PTSD) and depression in Australia's 7525 surviving male Korean War veterans and a community comparison group. Method A survey was conducted using a self-report postal questionnaire which included the PTSD Checklist, the Hospital Anxiety and Depression scale and the Combat Exposure Scale. Results Post-traumatic stress disorder (OR 6.63, P <0.001), anxiety (OR 5.74, P <0.001) and depression (OR 5.45, P <0.001) were more prevalent in veterans than in the comparison group. These disorders were strongly associated with heavy combat and low rank. Conclusions Effective intervention is necessary to reduce the considerable psychological morbidity experienced b...