Psychiatry and War

Question 1

What did WWI do to Sigmund Freud and his work?

Answer 1

The war upset him, and he became pessimistic about human nature. After the war, he introduced the death drive as a human motivation. Nothing like a world war to make you consider the destructive side of human nature.

Question 2

There are some considerations as to why wars cause trauma for those enlisted and homesickness is one of them, why?

Answer 2

Before the American civil war, those who were enlisted had never left their homes before and so it was considered that homesickness caused the trauma.

Question 3

There are some considerations as to why wars cause trauma for those enlisted and life in the army is one of them, why?

Answer 3

Because life in the army was hard for most people, it was regimented and tense.

Question 4

There are some considerations as to why wars cause trauma for those enlisted and killing is one of them, why?

Answer 4

Because most soldiers found it impossible to kill another person, particularly if they could see into their eyes. It was like transgressing a basic moral code.

Question 5

There are some considerations as to why wars cause trauma for those enlisted and threat to life is one of them, why?

Answer 5

Well… it’s kind of obvious. Most people want to live and knowing that there are people out there who want to kill you is traumatising.

Question 6

There are some considerations as to why wars cause trauma for those enlisted and observing death is one of them, why?

Answer 6

Seeing those around you being killed is hard, and it reminds you of your own mortality.

Question 7

There are some considerations as to why wars cause trauma for those enlisted and coming home & the aftermath is one of them, why?

Answer 7

Coming was hard for a lot of soldiers because being abroad was interesting and full of intense life experiences. Coming home, not many people understood what they had been through and they were expected to resume back to normal.

Question 8

There are some considerations as to why wars cause trauma for those enlisted and a lack of moral fibre is one of them, why?

Answer 8

Because some soldiers who became traumatised were considered to have a lack in ‘moral fibre’.

Question 9

Like it did to Freud, wars caused big changes in psychiatric theory. What were the main changes between the 20th and 21st centuries?

Answer 9

Initially, psychiatry believed that trauma or a breakdown in personality during war was caused by personal characteristics (i.e. a lack of moral fibre, a lack of character), afterwards, the environment played a bigger role (i.e. seeing death, killing others).

Question 10

The different wars had different diagnoses for soldiers who struggled. What were the common diagnoses during the civil war?

Answer 10

• nostalgia,
• effort syndrome (when a soldier was considered to be putting into much effort),
• soldier’s heart.

Question 11

Effort syndrome was a common diagnosis during the American civil war. What was it and how did they treat it?

Answer 11

Effort syndrome was believed to be caused by soldiers putting in too much physical effort, so they lessened people’s loads by taking off heavy material – to no effect.

Question 12

The different wars had different diagnoses for soldiers who struggled. What were the common diagnoses during the great war (WWI)?

Answer 12

shell shock.

Question 13

The different wars had different diagnoses for soldiers who struggled. What were the common diagnoses during the WWII?

Answer 13

war neurosis, combat stress, battle fatigue, battle exhaustion, psychoneurosis, NYD-N.

Question 14

During WWII, NYD-N became a common diagnosis, what was it?

Answer 14

NYD-N means “not yet diagnosed – nervous”.

Question 15

The different wars had different diagnoses for soldiers who struggled. What were the common diagnoses during the Vietnam war?

Answer 15

Post-Traumatic Stress Disorder (PTSD).

Question 16

The different wars had different diagnoses for soldiers who struggled. What were the common diagnoses during the Gulf War?

Answer 16

Gulf war syndrome.

Question 17

The psychological impact of war changed greatly in the 20th century, why is that? And what are two wars that make this comparison?

Answer 17

Wars during the 20th century became longer. Compare the battle of Waterloo (Napolean), which lasted one day while the sun shined, to WWI that lasted for years. Also, desertion and disease had a higher toll. Wars also became more lethal, the Great War became one of the first for industrialised war-fare.

Question 18

What central questions in psychiatry did wars bring to the forefront?

Answer 18

Is war and killing pathogenic? What are the impacts of traumatic experiences?

Question 19

Why were people eager to enlist in WWI? And did this attitude change?

Answer 19

People were really eager to enlist and serve their country, but the enthusiasm did not last for a very long time. People died, they had a terrible time.

Question 20

What happened to the soldiers who were victims of gas attacks?

Answer 20

Their eyes were burnt, they became temporarily blinded and had to form long lines to try and find a medical tent.

Question 21

The great war caused a lot of wounded soldiers, what was the outcome for physicians and the medical field?

Answer 21

A lot of new practices were created with physicians learning more about how to amputate limbs.

Question 22

What are the symptoms of shellshock?

Answer 22

Conversion hysteria (anxiety), paralysis (limping, muscle contractions), blindness, deafness, nightmares (insomnia), heart palpitations, depression, dizziness, disorientation, diarrhea, stomach cramps, speech disorders, facial tics, trembling, uncoordinated movements, muscle spasms.

Question 23

In the world wars, what was the diagnostic bias between officers and soldiers?

Answer 23

Officers were more likely to be diagnosed with neurasthenia (perhaps because they were more protected and felt guilty), while enlisted men were diagnosed more frequently with hysteria.

Question 24

Who coined the term ‘shellshock’? And when?

Answer 24

Charles S. Myers coined the term shellshock in 1917.

Question 25

How many soldiers in WWI were diagnosed with shellshock by the end of the war? How many people were discharged from the British army due to disability?

Answer 25

There were 80,000 cases of shellshock by the end of the war (or 2% of the British army), and 1/7 of people were discharged from the army due to disability.

Question 26

What was the ‘blighty’?

Answer 26

People who would cause an injury on themselves that was serious enough for them to be discharged, but not serious enough for them to be handicapped forever. Also known as ‘voluntary injury’.

Question 27

In the world wars, what was the treatment for cowardice?

Answer 27

Court-martials/trials (300 people were shot), solitary confinement, disciplinary treatment, electric shock treatment, shaming, psychoanalysis.

Question 28

Who was W.H.R Rivers?

Answer 28

He was a physician associated with Cambridge University, he attempted to treat shellshock using psychotherapy. He would get officers and soldiers to talk about their experiences.

Question 29

Getting them to talk about their experiences was a big way to treat officers, how did it work?

Answer 29

W.H.R Rivers got them to talk about their experiences and transform it into a memory, into something terrible that occurred in the past. It was time intensive and only applied to officers, not soldiers.

Question 30

Who was Thomas W. Salmon?

Answer 30

He was an American psychiatrist in the area of mental hygiene. He introduced a treatment called PIES.

Question 31

What was PIES, and what does it stand for?

Answer 31

PIES was a treatment created by Thomas W. Salmon, for treatment of soldiers quickly and near the battle lines but away from danger. The soldiers were given a sedative to sleep for a week and good food. Not surprisingly, most soldiers recovered. PIES stands for Proximity, Immediacy, Expectancy, Simplicity.

Question 32

Did the PIES treatment work?

Answer 32

Yes, the effects that doctors observed were dramatic.

Question 33

Why did psychiatry lose credibility after WWI?

Answer 33

Because it was entirely unprepared and could not actually do much. There was nowhere to treat, and it was unknown the best methods for treatment.

Question 34

After WWI there was an expansion in psychiatry, what happened?

Answer 34

There were more sites developed for treatment, the notion of a mental disorder was expanded, mental factors were finally acknowledged

Question 35

What were the four changes in Freud’s conception of psychoanalysis?

Answer 35

1. ‘Beyond the Pleasure Principle’.
2. Present past: soldiers caught in the past (idea that the past is still present with you).
3. Repetition compulsion (a desire to experience the trauma again and again).
4. Death drive (death is something that drives us forward).

Question 36

What is the great war considered an epidemic of (in terms of mental health)?

Answer 36

It is considered an epidemic of shell shock.

Question 37

In conclusion, the great war highlighted how ___ psychiatry was during that time.

Answer 37

The great war highlighted how unprepared psychiatry was during that time.

Question 38

The great war made what type of therapy popular?

Answer 38

Psychotherapy, although it was significantly revised.

Question 39

The great war created an expansion of what in society?

Answer 39

An expansion of psychiatry and the social factors that contribute to mental problems.

Question 40

During the great war, there was a change in focus on type of mental illness. What were those changes?

Answer 40

The focus changed from severe and persistent forms of mental illness to neurosis.