On Wednesday, January 28th,
Bell Canada once again is holding their “Let’s Talk”
event, encouraging a more open dialogue about and hopefully reducing the stigma
of mental illness. This is an incredibly
important effort which involves the entire population generally and the
military community specifically. Not
only is the state of mental health amongst veterans a legitimate concern and a
recurring issue, the military itself has been a force of positive change in the
development of the field of mental health.
Much of that, in fact, has come as a direct result of the experiences
within WWI.
I’ve touched on this subject previously
in an essay examining the occurrence of “shell shock” during the war. It can be found at the University
of Oxford’s WWI Centenary Project.
It is not my intent to restate the nature of that piece here. Rather, I aim to take a wider view on the
state of our current understanding of mental illness, and how a terrible event
in human history helped to get that understanding to where it is now.
Psychiatry and psychology in their
modern iterations are relatively new medical practices in comparison to
There was, perhaps, a lot more to be
understood of psychological conditions, and moral treatment was a good starting
point. A great increase of occurrences
of neurological disorders among a nominally healthy population could only serve
to accelerate this progressive development.
World War One would produce such conditions. Dr. Stepasky illustrates a particular irony
of war- “Out of human destructiveness emerge potent new strategies of
protection, remediation, and self preservation.”[2]
The notion is entirely true of medicine as a whole within the history of
conflict, but reflects particularly to WWI in the case of mental health.
One of the main realisations to come
about from the war was that of distinguishing between psychosis and
neurosis. “Although there is a
minor rise in the psychosis rate during any war, a major increase in the
incidence of neurotic disorders was observed, starting with World War I.”[3]
A post war assessment by the US Army concluded “Rates of hospitalization for
mental disorders in Army personnel…ranged from 11 to 12 per 1,000 men per year….The
incidence of psychotic disorders during this period was from 2 to 3 per 1,000
per annum.”[4] It also became more understood that aspects of
character had little to do with susceptibility. In the official War Office
report commissioned after the war on shell shock, British Army historian, the
Honourable John Fortesque mentions in particular “my brother, Brigadier General
Charles Fortesque, had, in his column in South Africa a Canadian officer who
was a proverb of daring; but even this officer broke down for the time after
every enterprise of any continuance and needed a fortnight’s rest to restore
him.”[5]
Prevailing wisdom held that it was not the person, but the exposure to extreme
situation which caused neuroses “Like clothes increasingly worn threadbare
until they finally ripped…soldiers were steadily worn down to the point where
the slow descent into breakdown was accelerated by a traumatic event.”[6]
From a
military clinical perspective, a man is an asset. In this light, with sentimentality removed,
the practicality is to return a wounded man to useful work as quickly as
possible. If the injury is too severe to
permit employment in his former role, then he should be retrained with those
limitations in mind for the most productive work to which he is suited. When the same logic was applied, in synthesis
with the progressive ideals of moral treatment, psychiatric medicine as a whole
benefitted from the positive results. “Trial and error treatment efforts by
French, Italian, and British psychiatrists and neurologists clearly
demonstrated as early as 1915 and 1916 that
a majority of the so-called war neuroses could be salvaged for duty by
providing care near the front.”[7]
This practical approach without sentiment in its implication doesn’t disallow
for the application of sentiment in treatment.
Crucially, those suffering from a neurological break were generally
treated much better than modern perception of the war usually allows. “In no case,” states historian Gordon Corrigan
“was a soldier whom the medical staff certified as suffering from ‘shell shock’
executed.”[8]
Methods of
treatment, focused on productive employment were part of the emergence of occupational
therapy as a component to a holistic approach to mental health.[9]
This and other civil practices were vastly improved through military
experiences; “after the first world war more modern approaches such as
psychotherapy started to evolve, in response to the effects of thousands of
shell shock cases.”[10]
A rational and scientific approach to the treatment of mental illness is cited
as being a result of WWI in a Senate report on mental health and addictions,
when psychological casualties “demonstrated poignantly” the wide vulnerability
to psychological breaking points.[11]
From the
extreme experience of war, understanding and development in the medical field
has advanced further than it would have without it. Indeed, there are indicators that this remains
contemporary. While a
As occurrences of mental illness is not
markedly different between military personnel and the general population, the
factors behind a reduction of stigma and barriers to care in the civil sector
might be able to continue to take an example from the armed forces. Even the
Hon. Fortesque was forward thinking on this when he asked “Can emotional or
commotional shock, induced by battle, be differentiated from the like shock
induced by other forms of catastrophe?”[14]
Admittedly, there is much yet to be
accomplished; particularly in civil practice and especially when veterans being
discharged still need continuing care which is no longer as available as it was
while they were serving. Above all, the
need to make these changes and to best help those who are suffering is to
reduce the stigma which is the largest deterrent to positive change in mental
health effectiveness. That can only
occur through open, honest discussion.
So, let’s talk. If you are
suffering from an Occupational Stress Injury, please visit the OSI Social
Support website. Are you or your family member a current or
discharged member of the Canadian Forces and need resources to find the help
you may need? The
CAF Member Assistance Program
is a great place to start.
#BellLetsTalk.
[1] Bewley, Thomas, “Madness to Mental Illness. A History of the
Royal College of Psychiatrists” Online archive 1, pg 3
[3] Bernucci, Robert
J. Lt Col, MC, USA (Ret.) & Albert J. Glass Col, MC, USA (Ret.),
Editors for Neuropsychiatry “Neuropsychiatry in World War II Volume I” Office
of Medical History, U.S. Army Medical Department pg 4
[10] Lawton-Smith, Simon & Dr Andrew McCulloch, “Starting Today -
Background Paper 1: History of Specialist Mental Health Services” Mental Health
Foundation pg 2
[11] The Standing Senate Committee on Social Affairs,
Science and Technology Interim Report on Mental Health, Mental Illness and
Addiction Report 1”Mental Health, Mental Illness and Addiction: Overview of
Policies and Programs in Canada” Nov, 2004 pg 135
[13] Zamorski,
Mark A. “Evidence-Based Assessment of Mental Health in the CAF” Surgeon General
Report, Her Majesty the Queen in Right of Canada, as represented by the Minister
of National Defence, 2014 pg 7
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