CHAPTER VII
Public Relations
William C. Menninger, M.D.
ABSENCE OF PUBLIC RELATIONS PLANNING
Because of its universal applicability to the everyday life of the everyday man, psychiatry has long been a favorite theme for feature articles in newspapers and magazines. The theme of Mesmer, ?mile Cou?, and Dale Carnegie have always had an avid consumption by the public. Perhaps on this basis alone, it should have been foreseen that the thoughts and feelings of a 'civilian army' would be of major public interest to the folks at home. In addition, however, it was known from the history of World War I that the neuropsychiatric problem would be no small one, either in magnitude or importance. Despite these facts, however, at the onset of World War II, no particular consideration had been given to public relations or public education concerning psychiatry and its implications in the Army. In fact, one can truthfully state that no planning in this direction was made, which in some degree paralleled the lack of planning and the adequate understanding of the inherent psychiatric problems of selection, of placement, of personality adjustment, and of psychiatric battle casualties.
The events that transpired rapidly changed this apathy and indifference to one of great concern. Alarm was expressed relative to the high rate of rejection of men at induction centers because of various types of personality disorders. It was discovered that even in basic training camps the major causes for failure in training and consequent discharge were personality disorders. The figures leaped to such heights that G-2 (intelligence) of the War Department apparently sensed inherent and potential dangers in having such facts widely known. In recognition of the demand for information, the Neuropsychiatry Branch, Professional Service, SGO (Surgeon General's Office), under Col. Roy D. Halloran, MC, on 25 September 1943, prepared the following release which was, however, disapproved by the Bureau of Public Relations of the War Department:
Neuropsychiatric Data for Press Release
Between 8 and 10 percent of men examined at induction have been rejected as being unfit for service because of nervous and mental disorder. In spite of this, the incidence of neuropsychiatric disorder, particularly in combat troops, has been high.
In the Southwest Pacific Area, the admission rate has been in the region of 60 per 1,000 strength per year. In the South Pacific Area, the report states that 25 percent of all admissions have been neuropsychiatric. Twenty percent of casualties suffered
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by an Army Corps in the Maknassy-El Guettar battle were neuropsychiatric, and for 3 days, the figure was as high as 33 percent of the total. The vast majority of these cases are anxiety states resulting from extreme exhaustion. In a few days, with prompt sedation and rest, as high as 80 percent of them may return to full combat duty. There is a distinct question as to whether they should even be labeled as 'neuropsychiatric' cases, for they are merely the reactions anybody might have if exposed long enough to combat conditions.1
In the continental United States, the neuropsychiatric admission rate has shown a steady increase until now at 48 per 1,000 strength per year for the month of August 1943, it is over 6 percent of all admissions and higher than ever reached in the last war. In 1938, the admission rate of civilians to civilian mental hospitals was 1.1 per 1,000 population per year. This, of course, does not mean that there is forty times as much nervous and mental disease in the Army as in civilian life, since in civilian life, cases of psychoneurosis, organic neurological disease, epilepsy, and even inconspicuous insanity are not admitted to mental hospitals. The ratio merely points out that certain individuals who can get along perfectly well in civilian life, when they get in the Army, even though no more nervous than before, cannot get along, go on sick call and are admitted to the hospital.
In June 1943, the rate of medical discharges from the Army for neuropsychiatric reasons was 20 per 1,000 strength per year and 46 percent of the total medical discharges. This figure does not include the cases discharged under section VIII [AR 615-360] for mental deficiency and psychopathic personality.
This high rate of neuropsychiatric discharges also cannot be taken as a measure of the number of men who are breaking down under the strain of Army life. Many of the men were discharged not because they developed a nervous breakdown or 'cracked up' but merely because it was found they could not adapt themselves to Army life. Once out of the Army, many of them will be able to go to work and function as perfectly normal human beings. Seventy percent of the medical neuropsychiatric discharges were for psychoneurosis, practically none of which will need hospital care on discharge.
VACILLATING POLICIES AND PUBLICITY BLACKOUT
Historically, one might say that through 1942 and into 1943, there was no particular planning regarding public relations in psychiatry, and, except for routine approval, there were no restrictions to the publication of psychiatric observations by medical officers except that no identifiable figures could be given. Many such publications appeared in scientific journals and consequently did not reach the public. By the end of 1943, because of concern about the loss of manpower through neuropsychiatric rejection at induction centers and subsequent discharges for neuropsychiatric reasons, the War Department inaugurated a policy2 which placed the whole field of psychiatry under a publicity blackout. This blackout (which also applied to malaria) prohibited the release of any information on the subject and, in fact, even the mention of military psychiatry in either scientific articles or the public press. This extended over a period
1It would seem, here, that Col. Roy D. Halloran, MC, is questioning the use of diagnostic neuropsychiatric terms and would have preferred some other terms, such as 'combat exhaustion' or 'battle fatigue.'-A. J. G.
2Probably inaugurated by Joint Security Control, appointed in August 1942 and responsible to the Joint Chiefs of Staff.-A. J. G.
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of several months. The very rigid censorship made it impossible to release, even through scientific channels, information concerning any phase of this specialty.
Action by the Chief of Staff
The concern about the loss of manpower was amplified through expressed congressional interest and reached such a degree that, on 30 December 1943, Gen. George C. Marshall, the Chief of Staff, dictated a proposed release on the subject of psychoneuroses to the Chief of Information, Maj. Gen. Alexander D. Surles. This release was eventually referred to the Surgeon General's Office where it was slightly modified and a new version written. Processing of the release required over 3 months. By that date, the total blackout had been raised, and because several general news releases had been made, the Chief of Staff's proposed release was deemed unnecessary. For its historical value, it is here reproduced:
MEMORANDUM FOR GENERAL SURLES: 30 DECEMBER 1943
We have been having increasing difficulty with members of Congress regarding physical rejections of men at induction stations. Since June 1st, about 40% of the men reporting have been rejected and during the same period more than 200,000 have been discharged from the Army for physical disabilities. The point of this particular note is that between 25 and 35 percent of both rejections and discharges were for psychological and neuropsychiatric reasons. The War Department has taken steps drastically to curtail all discharges for disability pending the promulgation of new instructions which it is believed will materially reduce the wastage of manpower.
In all of this matter, the great problem is the handling of the psychoneurotics, and I am of the opinion that we should get out one way or another some additional information on the subject. The following is a rough draft hurriedly dictated by me on which I should like your opinion and which would have to be checked by G-1 and The Surgeon General.
(Sgd) G. C. MARSHALL
G. C. M.
The following is General Marshall's rough draft:
The War Department has just completed, under the direction of the Inspector General, whose principal assistant, Maj. Gen. Howard McC. Snyder, is a medical officer, a comprehensive survey of induction and discharge processes in continental United States relating to physical rejections of inductees and discharges from the service for similar reasons. One hundred and thirty-seven stations or installations were inspected so as to assure a nationwide cross-section of the situation. As a result of this survey, new instructions have been issued which it is believed will materially reduce the number of rejections.
However, one problem remains extremely difficult of solution. It pertains to the fact that between 25 and 35 percent of all rejections and discharges for physical reasons related to psychoneurotics. While in the opinion of the several high ranking and experienced medical officers participating in this inquiry, the doctors concerned, Army, Navy, and civilian, on duty at induction stations are performing their duties in a manner which precludes any thought of predilection or partiality, this does not mean that the line officers on duty at induction stations always agree with the medical officers or that the doctors do not at times disagree among themselves. Nevertheless, it appears that all are doing their utmost to fill required quotas with the best material available.
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The greatest differences of opinion relate to rejections for psychiatric reasons. Most physical defects can be seen and measured and therefore quite accurately diagnosed and appraised. Psychiatric disorders, however, are for the most part invisible, and their detection rests with professional ability and experience of neuropsychiatrists. These specialists at times have appeared either over-enthusiastic or over-cautious. In other instances, it is evident that medical personnel have been too limited in numbers or too inexperienced in training properly to diagnose the large groups of men which must pass rapidly through induction stations. As a consequence, many psychoneurotics have been inducted into the Armed Forces, with the consequent complications of a later discharge.
It is this question of psychoneurotics which is least understood and is most difficult to handle. Functional nervous diseases are recognized as entities by neuropsychiatrists but these disorders cannot as a rule be definitely measured nor confirmed by laboratory tests or objective findings. For this reason, there is a greater divergence of opinion regarding these cases than in any others. To the specialists, the psychoneurotic is a hospital patient. To the average line officer, he is a malingerer. Actually, he is a man who is either unwilling, unable, or slow to adjust himself to some or all phases of military life, and in consequence, he develops an imaginary ailment which in time becomes so fixed in his mind as to bring about mental pain and sickness. In a sense, this might be considered as shirking, yet among the thousands of psychiatric cases in the Army no record exists of any psychoneurotic ever having been convicted for malingering. This is because no doctor is either willing or able to state under oath that the pain complained of by the psychoneurotic is nonexistent. The doctor may believe there is no pain. He may even say so-off the record-but he cannot swear to it. For this reason, the laymen or uninitiated line officers incline to the belief that a medical officer's diagnosis of psychoneurosis is either wrong or else that the doctor is influenced by a hyperconsiderate professional attitude.
This view is emphasized in the light of certain happenings with which line officers in time become familiar. For example, at one general hospital during the course of this recent inquiry, there were approximately 85 psychoneurotic patients. Most of these were walking about, performing light duties, and appearing quite content with their lot, and with the prospect of an early discharge for physical disability. Shortly after representatives of The Inspector General arrived, rumors spread through the hospital that discharges for physical disability, insofar as psychoneurotic disorders were concerned, had been discontinued. Immediately, practically all the psychoneurotics became confined to their beds, too sick, by their own testimony, even to get up and go to meals.
A further example has been handed down from the last World War when on the publication of the Armistice some 8,000 of 10,000 shell-shocked patients were reported to have made an instantaneous recovery.3
3This example is not supported by any known documentation. On the contrary, it is stated in 'The Medical Department of the United States Army in the World War. Neuropsychiatry. Volume X,' page 287, that after the armistice 'the necessity for beds for neuropsychiatric patients increased for a time instead of diminished * * *" and, on page 279, 'After the armistice began, new admissions [NP] to Base Hospital No. 117 declined very rapidly and a large number of men were restored to duty who otherwise would have required a considerable period of treatment. There was not, however, as has been stated, any very marked change in the character of the war neuroses or in their prognosis. It was simply possible to restore to A or B status some men who would have been classified C or D had the war continued. [A, B, C, and D represented grades of disability.] * * * The total admissions from the opening of the hospital [Base Hospital No. 117] were 3,268, 50 percent of whom were returned to combat duty and 41 percent for other military duty in the American Expeditionary Forces.' Considering the 3,268 figure in the World War I history, it is difficult to understand from whence the 8,000 to 10,000 figure of General Marshall is derived. There was a recorded total of 20,309 white enlisted neuropsychiatric admissions in Europe from January 1918 through July 1919, and 7,913 white enlisted neuropsychiatric admissions from December 1918 through July 1919 (see 'The Medical Department of the United States Army in the World War. Statistics. Washington: Government Printing Office, 1925, vol. XV, pt. 2') .-A. J. G.
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The fact remains that thousands of hospital beds are being occupied by soldiers under observation and treatment for psychoneurosis who require the services of cooks, nurses, doctors, ward attendants, and so forth, all a burden on the Army and manpower generally. Whether or not the diagnosis in their cases is correct does not appear to be half so important as does the fact that the men are occupying hospital beds and taking up valuable time of limited medical personnel. Furthermore, in most cases, the primary reason for these men being in hospitals is not because doctors made patients of them but because line officers were unable to make soldiers out of them.
The desire of commanders to be rid of below-average soldiers is understandable, particularly so when those commanders are necessarily held to rigid training schedules and the accomplishment of objectives according to a time schedule. In addition, there is no established method by which psychoneurotics can be adjusted more slowly to military service than are normal soldiers. They all must of necessity, in a huge Army, receive virtually the same treatment and undergo similar training. The standards set for all men are more or less alike, but are based on what is to be expected of the average man. However, the true psychoneurotic is not average; he cannot keep up nor assimilate military life as do the others, whereupon, as a defense measure he discovers some ailment to which he attributes the reason for his inadequacy and immediately begins to go on sick report. This latter action is quite frequently condoned, if not actually encouraged, by the officers and noncommissioned officers who have become weary of waging a losing struggle to keep the men up to the standard of other soldiers. We find in some instances that the line officers have importuned medical officers to help rid them of the burden of these particular cases, meaning of course by the method of disability discharge. As one doctor stated: 'Conducting sick call is a game of wits; the man says he has it and the doctor says he hasn't.' In some cases, it appears that the men are smarter than the doctors, especially the inexperienced medical officers; on the other hand, the doctors do not care to disregard the possibility that the psychoneurotic does have some organic ailment. In any event, the psychoneurotic eventually gets into the hospital. Once there, the man's potential value to the service is either destroyed or seriously impaired. There, he exchanges information regarding his ailment with other patients and from them he learns the symptoms most likely to perplex the doctors. He is recognized and treated as a sick man. He wears the clothes of an invalid. His food is brought to him. He is catered to by 'gray ladies,' and above all, he escapes from those duties which he seeks to evade. He cannot be punished for malingering; therefore, the worst that can happen is to be sent back to his organization where he can and will start the same process all over again. In the meantime, he enjoys a life of leisure with one great goal ahead; to wit, a discharge for physical disability, a comparatively high paid job as a civilian, a discharge bonus, and eventually a pension from the Veterans Administration Bureau.
Perhaps the most important factor contributing to the spread of psychoneurotics in our Army has been the Nation's educational program and environmental background since 1920. While our enemies were teaching their youths to endure hardships, contribute to the national welfare, and to prepare for war, our young people were led to expect luxuries, to depend upon a paternal government for assistance in making a livelihood, and to look upon soldiers and war as unnecessary and hateful. The efforts to change these teachings in a few short years have left millions of our people unconvinced. The burden of changing the minds of such people who are being inducted into the Army has fallen primarily upon the hard working young platoon leaders and company commanders of our great war Army, and the indications at present are that the problem is not yet being satisfactorily met. This is manifested by the ever-increasing number of psychoneurotic patients crowding into our hospitals. A determined effort is being made throughout the Army to better this situation. It is admittedly difficult, and also it is important that there be a general public understanding of the problem.
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Reaction of Neuropsychiatry Consultants Division
The following memorandum was submitted by Col. William C. Menninger, MC, for The Surgeon General:
MEMORANDUM TO: Mr. Harvey H. Bundy 3 APRIL 1944
With regard to the memorandum which you sent to The Surgeon General's Office, after careful re-reading, from the viewpoint of a psychiatrist, I again want to express satisfaction with the general tenor of the memorandum and with most of the comments in it.
There are certain generalities concerning the issuance of any such material to the public press which I should like to call to your attention. This memorandum was written and describes the psychiatric picture as seen in installations in this country some months ago. It deals almost entirely with Zone of Interior soldiers. There is a tendency to depreciate the type of psychoneurotic patient seen at that time in our hospitals. Since then, we have had a large number of such patients returned from the combat zone, veterans of fighting, the great majority of whom prior to their battle experience were 'normally' adjusted men. There have been literally hundreds of these men awarded citations for bravery. To depreciate the whole group of such men with this diagnosis within the Army is not intended, and for this reason, I believe a closer delineation of the types of cases should be made, and probably a recognition of the combat cases as well as a host of men with psychoneurotic symptoms who carry on with their Army jobs in a highly commendable fashion.
Then I want to suggest that in a few places the reference to the physician's ability and knowledge might be worded slightly differently. Perhaps the statements made are true, but it seems to me the point can be made without possible reflection on the physicians. Thus line 5, page 132, describes some of the examiners as 'over-enthusiastic or over-cautious'; page 132, line 27, intimates that the doctor might be guilty of 'hyper-considerate professional attitude.' On page 133, lines 25-26, it is stated that 'in some cases it appears that the men are smarter than the doctors.'
There are some other points which I want to suggest might be changed and a list of these is attached. If it is desired, the Division of Neuropsychiatry of the Surgeon General's Office would attempt to rewrite the memorandum, including the major portion of it as it now stands with the changes noted in the attached critique.
SUGGESTED CHANGES IN THE PROPOSED PRESS RELEASE ON THE PSYCHONEUROTIC PROBLEM IN THE ARMY
Page 131, line 7. No doubt the release from the Inspector General's Department stimulated this memorandum, but this whole problem is essentially a medical one and one which has received a great deal of attention and effort on the part of The Surgeon General and the Medical Department. So far as the public and the medical profession of the country is concerned, such information will perhaps carry a great deal more weight if such information is forthcoming from The Surgeon General.
Page 132, line 5. 'These specialists at times have appeared either over-enthusiastic or over-cautious.' This might be modified to indicate that initially great caution was urged and reports from oversea theaters continue to indicate a large number of men who should have been caught at the induction station examination.
Page 132, line 12. Functional nervous diseases are recognized as entities by all branches of medicine, not only psychiatrists.
Page 132, lines 15-16. 'To the specialists, the psychoneurotic is a hospital patient.' This is true only in the Army, and an explanation would clarify the public understanding of the reasons: An individual in civilian life, even though he may have neurotic difficulties so long as he can govern his own life and lead it as he wishes can get along, often without medical help. In the Army, this cannot happen. It is not possible to
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prepare special diets in the field and soda mints cannot be included in K-rations. To have an effective army, there must be regimentation, discipline, and a strenuous existence. There is no middle ground; a man is either carrying on a job or he is a casual. Consequently, many men are sent to the hospital who in civilian life could find many other alternatives.
Page 132, line 16. 'To the average line officer he is a malingerer.' General Marshall certainly should know, but this seems to indicate the line officer has no discriminating judgment and no understanding of a great mass of his soldiers. Malingering, in the correct usage of the word, is regarded as rare in the Army by the great majority of our psychiatrists. On the other hand, there is a very great frequency of capitaliza?tion on complaints, no doubt exaggeration of these, a universal human trait, even in the non-neurotic but accentuated in the neurotic.
Page 132, line 18. '* * * in consequence he develops an imaginary ailment.' No true psychoneurotic ailment is imaginary. This implies that the illness and/or symptoms were consciously devised in which case the man is a malingerer. In fact, the symptoms of the psychoneurotic have an unconscious origin and this is a generally established scientific fact. Suggest that 'imaginary' be changed to 'psychological.'
Page 132, line 23. '* * * that the pain complained by the psychoneurotic is nonexistent.' It is the best psychiatric judgment that, in a great many cases of certain types of psychoneurosis, the pain is existent. Furthermore, there are a very large number of psychoneurotic patients (conversion hysteria, anxiety hysteria, obsessional and compulsive states, acute anxiety states) who do not complain of pain.
Page 132, 3d and 4th paras. These facts are probably accurately related but should have sufficient further explanation so that it does not appear that all such individuals are fakers and all doctors in charge of them dupes. It is a universal human trait that when faced with an insoluble problem the individual reacts with his entire personality, and this may be anxiety, physical upsets, unusual behavior. When the problem is solved, these neurotic symptoms clear, but the man still has the same fundamental personality makeup as before. He is 'readjusted' but not 'recovered.' This phenomenon is just as frequent in civilian life as in army life.
Page 133, line 1. The implication in this and the immediately following lines is to the effect that the psychoneurotic individual is not a sick man. In the Army, as stated above, there is no choice about his disposition. Were he in civilian life, he would probably not be in the hospital. If they can be rehabilitated for further service, then hospitalization is justified, and at the present time, more than 50 percent of these men are rehabilitated in the hospital. We hope shortly to have arrangements within the Medical Department to provide care for these individuals in barracks.
Page 133, lines 17-18. '* * * as a defense measure he discovers some ailment.' This might infer that he consciously concocts a symptom and would be more accurate to state 'he develops.'
Page 133, lines 25-26. 'In some cases, it appears that the men are smarter than the doctors.' This is very possibly true but the point can be made that often men in this group are of superior intelligence and capable of overstatement or understatement of their illness in a convincing manner. The implication is present also that in the absence of an organic difficulty the man is not sick, which may certainly not be the case.
Page 133, line 41. In attempting to explain the contributing factors to the picture, it is urged that no reference be made to the 'Nation's educational program' unless we want to offend the educational group. There are two explanations that I should like to suggest:
(a) An extremely important reason for both the high rejection rate at induc?tion centers as well as the discharge rate within the Army is the unresolved problem of the motivation of men for war. Why should a man fight? The answer of the individual man is uncertain; it will depend on his information and his attitude and this is directly related to the attitude he has had toward the question before he comes to the
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Army, formulated in civilian life. It is largely the reflection of his immediate associates-his own family, friends, and community. If he doesn't see any need to fight, and is supported in this by his civilian associates, it is an uphill job for the Army to make a soldier out of him against his own wishes.
(b) A second explanation is concerned with our culture. We are a group of rank individualists, doing what we want when we wish and the way we wish. Consideration for the group is very secondary. Even as a Nation, we were isolationists. To form an army and to fight a war, the group welfare and purpose must come first and the individual's wishes be secondary. There must be regimentation and discipline, two features conspicuously absent in our civilian way of life. The problem is not so much any parental coddling as it is the exaggeration of individual freedom, 'doing what I want, if and when and how I please.' Psychiatrically, it is a modification of the infantile, the immature stage of development, characterized by 'I want what I want when I want it and to hell with the rest of the world.' This great importance of the individual and his freedom is, paradoxically, the chief reason why we fight but it does not and cannot apply within the functioning army. We are rediscovering the fact that there are a large number of people whose lifelong attitudes and patterns of behavior are more important to them to maintain than are the needs and attitudes of the group.
Leaks to the Public Press
The blackout had other interesting results. Later in 1943, soon after it was enforced, there was sufficient leakage of information that the lay press became interested and curious about neuropsychiatric problems. There were many evidences of such leakage. A proposed release submitted by Colonel Halloran to the Director, Office of Technical Information, SGO, on 25 September 1943, was disapproved by the War Department Bureau of Public Relations. Yet, a few days later, an article appeared in the Washington Post which said: 'Mental cases trebled over World War I. O.W.I. [Office of War Information] reports heavy draft rejection, more crackups. Rejections 3 percent last war, 8-10 percent this.' The latter figure appeared prominently in the proposed but disapproved release. In general, some of the figures which were periodically quoted at times were nearly correct and at other times exaggerated.
One particular figure that 30,000 neuropsychiatric cases were being discharged per month was widely circulated. Actually, the highest number discharged in any one month was 26,000, and the average range was between 10,000 and 20,000. Thus, information reached the public, sometimes fairly accurate, sometimes distorted, and frequently misunderstood by both those who wrote it and those who read it.
Policy of the Surgeon General's Office
Reporters did come to the Office of Technical Information and, in turn, were referred to the Neuropsychiatry Consultants Division. One such energetic reporter who had gleaned information from many sources brought the following prepared outline:
1. We have read in various publications contradictory statements about the inci-
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dence of psychiatric cases in the Army. We understand that although you have screened out five times as many men at induction as you did in the last war, nevertheless you apparently are having twice to three times as many cases in this war as you did in the last. Is this true? We read that almost 50 percent of the medical discharges from the Army are for psychiatric reasons, and that this runs as high as 10,000 per month; in other words, that you are losing the equivalent of almost a division per month for psychiatric reasons. Is this true? We read that in continental United States the psychiatric admission rate is 50 per 1,000 strength per year. Assuming a strength of 5,500,000 men in the Army in this country this would indicate that the equivalent of 18 divisions per year are breaking down during training. Is this true?
This looks like a very serious situation. Could we have a comprehensive picture of the true situation?
2. What are the reasons why these rates are so high?
3. What is the Army doing to meet this problem?
In this case and in every other case, the Surgeon General's Office had to meet the questions with the refusal to give information. Such reporters or feature writers would leave frustrated and annoyed, questioning why the Army was trying to hide certain facts. Explanation that it was withheld because of security reasons did not satisfy the press. The reason the Joint Security Control always gave was that knowledge of the number of neuropsychiatric casualties would give aid and comfort to the enemy as well as serving propaganda material. It was never learned whether the danger in this direction was ever weighed against the great handicap and harm that it was causing on the homefront.
Leak of General Marshall's Memorandum
Another incident of special significance occurred in January 1944. An article, distributed by the North American Newspaper Alliance, appeared in the 9 January issue of the Washington, D.C. Sunday Star, which could properly be designated as chiefly based on a presumed 'leak' of General Marshall's memorandum to General Surles on 30 December 1943.4 The language in the syndicated newspaper article closely resembled that in the memorandum. The terminal statement in this article about there being 'probably four malingerers to one true neuropsychiatric patient' was probably obtained from another source. This article was grossly untrue and presumed to have been released by the Army.
The Surgeon General's Office had not been consulted despite the obvious neuropsychiatric subject matter. Because such an important principle of clearance with proper authorities was at stake and because the statement was so grossly wrong, a protest and recommendation was lodged by the Neuropsychiatry Consultants Division through The Surgeon General to the Office of Technical Information. The blackout was in force and nothing was done about it. The article and The Surgeon General's critical memorandum follow.
4It took 3 months for General Marshall's proposed release to reach and be answered by The Surgeon General's staff, but during the interim, obvious leaks to the press had been made.-A. J. G.
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'MALINGERING' IN ARMY BLAMED BY OFFICERS ON FALSE EDUCATION
In an unpublished report surveying recent medical discharges, Army officials have blamed the youth programs and policies of the last quarter century for the high degree of malingering noted among inductees in American Army training centers, it was learned here yesterday.
While youths of the Axis nations have been subjected to training designed to toughen them against the rigors of war, members of the rising generation in the United States have been taught to believe that the world owes them a living, and that they have a right to expect their Government to support them in luxury, Army officials complained.
The report, it was learned, was undertaken by the Army medical officials when Congress began to show an interest in the fact that about 40 percent of the draftees in recent months have been rejected on medical grounds, while large numbers have been given medical discharges after induction and during their combat training.
Steps have been taken, it was reported, to diminish sharply the number of rejections and discharges based directly on physical grounds, but no way has been found to correct the difficulty encountered in the neuropsychiatric cases which constitute, it was estimated, from 25 to 35 percent of all rejections and discharges.
Many Report to Hospital
In this connection, the report of the Army investigators pointed out that doctors could readily measure and appraise the seriousness of physical disorders, ailments and shortcomings, but were helpless to measure with any degree of accuracy or certainty the seriousness of the neuropsychiatric disorders which they encounter so frequently.
Men who are unable, unwilling, or slow to adjust themselves to Army life, they explained, consciously or unconsciously develop symptoms of illness and report for sick call. They go to a hospital where they have their meals brought to them and receive all kinds of care and attention, not only from the medical staff but from the 'gray ladies.'
In the hospital they also have an opportunity to talk with other patients, comparing symptoms and getting ideas as to other complaints they can discover at opportune moments if it appears they are about to be sent back to the stern and arduous routine of Army camp life.
Symptoms Develop Anew
None of these men is ever convicted of malingering, because no doctor is prepared to state under oath that the patient really does not experience the pain or dis?ability of which he complains. If returned to camp routine, the patient simply develops his symptoms all over again and goes through the same process of hospitalization where he takes up space that may be needed for other sicker patients, and where he takes up the time and attention of an already overworked staff of doctors and nurses.
The line officers, unable to make a soldier of him, are glad to get rid of him, and the overworked hospital staff is likewise glad to see him get a discharge.
So out he goes, into civilian life again, with a bonus, perhaps, and a disability pension for the rest of his life.
In some cases, the report declares, his ailment is undoubtedly real, and as there is no way to distinguish with certainty between the true neuropsychiatric and the malingerer, this works a grave injustice on the truly sick man. The report estimated, however, that there were probably four malingerers to one true neuropsychiatric patient.
11 JANUARY 1944
MEMORANDUM FOR: The Commanding General, Army Service Forces:
(Attention: Lt. Col. John D. Witten, Room 3E 634 Pentagon Building, Washington 25, D.C.
Subject: Incidence of Malingering in Military Personnel.
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1. In the 9 January 1944 issue of THE SUNDAY STAR (Washington, D.C.), page A-19, appears an article under the headline 'Malingering in Army Blamed by Officers on False Education.' In the article, Army officials are claimed to have stated that there is a high degree of malingering among inductees and trainees in the American Army; that there are four malingerers to one neuropsychiatric patient; that none of these malingerers is ever convicted because doctors are unable to distinguish between malingering and psychoneurosis.
2. The above statements appearing in this newspaper article are grossly untrue. If these statements actually arose from an official source, this source obviously was not cognizant of all the facts. The incidence of malingering in the Army or at induction centers has been extremely low in this war. Repeated and extensive investigations of this matter have been made by the Surgeon General's Office both in induction centers and in the field. There is conclusive evidence that malingering, in any form, is less than 1 percent of all patients. Furthermore, in contrast to the statement made in the newspaper article, malingering is not difficult to detect but very easily recognized by any trained medical officer.
3. It is believed that the appearance of these erroneous statements attributed to an official Army source is misleading to the public, harmful to psychiatric patients among military personnel, and casts unjustified implications of incompetence on the Medical Department.
4. It is recommended that (a) an official refutation of the statements be issued by the War Department; and (b) official statements pertaining to neuropsychiatric conditions not be released to the public unless they have been approved by The Surgeon General.
NORMAN T. KIRK,
Major General, U. S. Army,
The Surgeon General.
(Capt. John W. Appel, MC)5
PUBLICITY BLACKOUT CONTINUES
The Office of Technical Information, SGO, with the assistance of personnel in the Neuropsychiatry Consultants Division, formulated a number of press releases dealing with the neuropsychiatric problem. In February 1944, for instance, an informative fact sheet was prepared entitled 'The Mental Health of the U.S. Soldier' which was especially directed to the woman in the home. Like all other efforts, the total publicity blackout prevented its release and thus negated another effort to bring important information into the American home.
Further Efforts
In contrast to the policy as represented by the blackout, it was the opinion of the Neuropsychiatry Consultants Division, strongly supported by The Surgeon General, that there should be a frank, open presentation of this subject. Far too many individuals were involved to cloak it in secrecy when information could be given that would in no way reveal the detailed statistics of the problem. Because the situation had become so acute, in
5It would appear from this letter that Captain Appel was unaware of General Marshall's memorandum at this time.-A. J. G.
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February 1944, the Neuropsychiatry Consultants Division drew up a policy recommending that releases should be given, characterized by absolute frankness and honesty about the total situation. This policy was strongly approved by Maj. Gen. Norman T. Kirk, The Surgeon General, and the recommendation was sent to the Joint Security Control who had imposed the blackout. They submitted it to the Navy who concurred with this recommendation, but on 18 March, the memorandum was returned with very limited permission to give any facts and no figures. This resulted in essentially the continuation of the blackout.
During the next 2 months, repeated efforts through personal calls on higher echelon were made by the members of the Neuropsychiatry Consultants Division and the Office of Technical Information. It was hoped that the censoring powers would understand the necessity for and desirability of releasing such information. The basis for the recommendation was essentially that many psychiatric casualties from basic training camps were being released from the Army and returning to their homes; there, being misunderstood, mistreated, and looked upon with suspicion. Communities were rapidly becoming aware of their presence but, without any guidance for their management, were unable to make plans for such guidance. War Department Circular No. 111, which was issued on 18 March 1944, set forth the policies governing the release of military information, but this in no way referred to the psychiatric problem. The Office of War Information was keenly aware of the problem and in March prepared an article on 'Morale in the Armed Forces of the United States' without advice from the Surgeon General's Office. Unfortunately, it contained many erroneous facts and was not concurred in by the Neuropsychiatry Consultants Division.
Crises Develop
The blackout continued into April. The situation became more and more acute because of pressure from communities who were asking guidance from The Surgeon General on the subject of neuropsychiatric casualties; because of pressure from news and magazine writers who were becoming more and more suspicious that the War Department was hiding some kind of dirty linen; and, further, because of pressure from the American Psychiatric Association, the national organization of psychiatrists of some 3,500 strong, which was planning a meeting in May in Philadelphia. A considerable portion of that meeting was to be devoted to the presentation of scientific papers from psychiatrists in the Armed Forces. Since their scientific papers could not be released, the meeting would, of necessity, have to be called off. The meeting was to be essentially a 'war' meeting with many important advantages to the military in evaluating the psychiatric problem, concerned with the Army and the war, exchanging ideas as to methods and management, diagnosis, and treatment.
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PUBLICITY BLACKOUT SLACKENED UNDER PRESSURE
In addition to considerable civilian pressure on War and Navy Department authorities, two special test cases were made. One of these was a paper prepared by Lt. Col. Malcolm J. Farrell, MC, and Maj. John W. Appel, MC, both of the Neuropsychiatry Consultants Division, summarizing the Army experience and the situation as to that date. It was with great effort that this was hand-carried through various echelons to obtain approval, which was finally approved with all figures deleted. The director of the division had also prepared a paper for the annual banquet of the American Psychoanalytic Association meeting, to be held at the same time. This paper was finally sent to one of the assistants to the Secretary of War, who in turn called it to the personal attention of the Chief of the Bureau of Information. When initially submitted, it had been radically censored. When returned from the Director of the Bureau of Information, it was essentially restored to its original form and approved.
Because of the pressure from these many sources, the Joint Security Control, in a memorandum of 28 April 1944, revised the policy on publicity regarding neuropsychiatry, as follows:
MEMORANDUM FOR: Director, Bureau of Public Relations, War Department.
Director, Office of Public Relations, Navy Department.
Subject: Policy on Publicity Regarding Neuropsychiatry.
1. Statistical information by percentages, rates or numbers of neuropsychiatric casualties in the armed service, either by units, theaters of operations, combat troops, service troops, or arms of services is classified. The release of statistical information as indicated above constitutes a violation of AR 380-5 and Article 76, Navy Regulations.
2. The following policy will govern all Army and Navy releases for publication of information concerning neuropsychiatric casualties of the Armed Forces.
a. No statistics (percentages, rates or numbers) of neuropsychiatric casualties in the Armed Forces will be released at this time. NOTE: No objection will be interposed to publication of percentages only of recoveries of neuropsychiatric casualties.
b. No names or identifiable photographs of neuropsychiatric cases will be released nor will there be any mention or description of neuropsychiatric casualties in any specific unit which might identify the unit or the individual.
c. All material on this subject cleared in oversea theaters will conform to paragraphs a and b.
d. All material on this subject originating within the continental limits of the United States will be checked for accuracy by the Surgeon General's Office, U.S. Army, before final clearance by the Review Branch, War Department Bureau of Public Relations. In the case of the Navy, all such material will be checked for accuracy by the Bureau of Medicine and Surgery, U.S. Navy, before final clearance by the Review Section, Navy Department Office of Public Relations.
For Joint Security Control:
J. M. CREIGHTON, J. K. COCKRELL,
Captain, U. S. N., Colonel, Cay,
Navy Executive Army Executive
While this policy placed sharp restrictions on all figures, by inference, it did at least permit the discussion of the problem and of the methods in
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dealing with it and also permitted those in the field of psychiatry to discuss the subject publicly in the press and in popular and scientific magazine presentations. It also permitted the American Psychiatric Association to hold its meeting in May. It precipitated a press conference on 9 May by Maj. Gen. Norman T. Kirk, The Surgeon General, and the director of the Neuropsychiatry Consultants Division. This press conference was attended by an unusually large number of reporters and continued for more than twice the length of time usually allotted to such conferences. General Kirk issued a statement which was then distributed by the Office of Technical Information.
The statement and prepared copy for distribution briefly and generally explained the psychiatric situation. The press was called upon to exert their influence and to explain to the American people the miscon?ceptions regarding psychoneuroses and psychoses. The fallacy of attempting to categorize in advance, by screening, the potential response of all inductees to stress and combat was mentioned. General Kirk praised the American soldier as a fighter and commented on those exhausted by the strain of battle who responded to treatment and returned to their combat units. Still, no figures, statistics, or even percentages were given.
The press conference was followed by a radio report by The Surgeon General and by the director of the Neuropsychiatry Consultants Division, on the March of Time Program, 11 May 1944, followed by a joint radio presentation by the Surgeon General of the Navy and the director of the Neuropsychiatry Consultants Division on 18 May 1944. Numerous popular articles began to appear in current magazines.
EFFORT TOWARD FURTHER LIBERALIZATION OF PUBLICITY RELEASES
Despite the liberalization of the policy as set forth on 28 April 1944, it was still not possible to give any figures-percentages regarding incidence, casualties, and discharges-of neuropsychiatric cases, even though these figures would not have identified any group or theater. It was only possible to give vague generalizations. It was never possible to give the proper perspective to the magnitude of the problem nor any guidance to a specific community as to how big their individual problem might be. The constant barrage and number of inquiries was reported by the director of the Office of Technical Information as being greater in the field of psychiatry than in any other subject concerning the Medical Department. It was felt extremely important that some planned program should be outlined and carried forward, taking the aggressive leadership in the situation rather than waiting for the necessity to defend or explain some particular incident or finding that came to some critic's attention. The division, therefore, drew up such a policy and submitted it to the Office of Technical Information but no action was ever taken on these suggestions.
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Inspector General Criticizes Blackout
An event transpired in September 1944 of major significance in the development of the neuropsychiatric problem in the Army. Apparently, one of the articles in a popular current lay magazine on the subject of psychoneurosis disturbed some officer high in the War Department. He presumably took the initiative to suggest to the Deputy Chief of Staff that the subject might very profitably be investigated. Directions from the Deputy Chief of Staff to G-1 (personnel) asked G-1 to plan and carry on an investigation and to submit recommendations concerning the subject of psychoneurosis within the Army. This led to an extensive investigation on the part of the Inspector General lasting over a period of several months. One of the pertinent facts in the final report from G-1 to the Deputy Chief of Staff from G-1, on 16 February 1945, was indicated in the succinct paragraph, '* * * part of the confusion on the part of the public about the subject of psychoneurosis has been due to the complete blackout of publicity by the Joint Security Control of the Army and Navy until May 1944. Since then, only fragmentary information has been released. It was agreed that publicity insofar as possible should be given in a factual and nontechnical manner.' In the same report under the recommendations was the following: "* * * that full publicity of the psychiatric problem should be given in a factual manner.' This entire report along with the recommendations was approved and returned in March 1945 to G-1 to implement. One of the recommendations was that the Bureau of Public Relations be requested to assign a full-time public relations officer to handle the planning and execution of a program relative to publicity and public education of psychiatry in the Army. This recommendation, unfortunately, was never implemented.
On 21 February 1945, the Joint Security Control did ask the opinion of the Bureau of Medicine and Surgery of the Navy Department, and the Office of The Surgeon General of the War Department, as to the advisability in view of the overworked staff in Washington, whether it was necessary to submit all material on the subject of neuropsychiatry originating within the continental limits of the United States to the Surgeon General's Office to be checked for accuracy before being released for publication.6 The Surgeon General's reply to this was to the effect that stories for local publication should be cleared by a local public relations officer after a review by a member of the medical staff familiar with the subject and that material for national publication should be cleared by the War Department Bureau of Public Relations and the Surgeon General's Office.
In an effort to implement the recommendation of G-1 that there should be a full-time man devoting his energies to the public relations aspect of neuropsychiatry in the Army, a conference was held on 21 March
6This reaction of the Joint Security Control was probably generated by criticism of the Inspector General in his 16 February 1945 report.-A. J. G.
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1945, with representatives of the War Department Bureau of Public Relations, The Surgeon General, and the Air Surgeon. One of the conclusions of this conference was the request that Capt. Steve McDonough, of the Office of Technical Information, SGO, prepare a document on the popular aspects of neuropsychiatry which, apparently, was to be considered as a 'bible' and was to be used as a guide to the policy of releases of information on this subject. This assignment, probably with good intention, was a totally impossible task since it would have taken nothing short of a manual of hundreds of pages to cover the total picture of neuropsychiatry and its ramifications in the Army. So far as is known, there was an abortive attempt to prepare such a document, but it is not known whether it was ever completed or returned to the War Department Bureau of Public Relations. On the other hand, on 30 March, the Headquarters of the Army Air Forces did issue an instructional letter to the Chief of the Office of Information Services on 'Publicity on Psychiatric Approach to Rehabilitation of Returnees.' Its purpose was to serve as a publicity guide for this very limited field.
Public Education Needed
Through the months of April and May 1945, the Neuropsychiatry Consultants Division continued its efforts to bring to the attention of the proper authorities the importance of and the need for a planned program of public education. This was more and more obvious in its necessity because of the increasing misinformation that was appearing in current magazines and over the radio. Many veterans were returning home. In addition to the problems inherent in handling information relative to the psychiatric casualties, a special problem arose through the release of well-intentioned but misguided information relative to the ordinary soldier who was being discharged. Many articles were appearing on how he should be 'handled.' So many articles appeared that counterpropaganda began to appear written by the veterans themselves or by energetic news reporters trying to indicate the veteran's resentment against being regarded as a problem child. This aspect, coupled with the many continued requests, led the Neuropsychiatry Consultants Division to prepare a further brief on the situation, as follows:
DRAFT 29 MAY 1945
1. Attention is again called to the urgent and immediate need for a planned program of public education on the neuropsychiatric problem, precipitated by the war. In spite of requests from G-1 to the Bureau of Public Relations in March, no plan has been developed. This urgent need is indicated because of:
a. The magnitude of the problem as it has occurred in the Army which with its present and future civilian implications should be known in order to intelligently plan the civilian program:
(1) 1,825,000 men have been rejected for military service because of psychiatric disorders-39 percent of men rejected for all causes.
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(2) More than 287,000 men have been discharged from the Army with certificate of disability up to 1 April 1945 for neuropsychiatric reasons, or 43 percent of all CDD's.
(3) 127,000 men with neuropsychiatric difficulties have been discharged on an administrative basis.
(4) There have been 740,000 admissions to Army hospitals because of neuropsychiatric disorders.
(5) There were 34,333 men and women under neuropsychiatric treatment in Army hospitals as of 30 March 1945, or 13.9 percent of all hospital patients.
b.Much confusion still prevails as to the types of neuropsychiatric disorders, and proper emphasis must be brought to bear to educate the public regarding these types.
(1) The great majority are relatively mild disorders known as psychoneuroses, men for the most part compatible to civilian existence.
(2) The man seriously ill, known as psychoses, who requires hospitalization. Eighty percent of these will recover.7
(3) A large group of chronically maladjusted individuals recognized as misfits because of emotional immaturity or mental defectiveness.
c. The public should know the effective treatment program being carried out in the Army for the handling of this problem, specifically:
(1) At the present time, twenty-two general hospitals have specialized services for the treatment of the psychotic group and are returning five out of six of these men recovered, to their civilian community.8
(2) At fourteen convalescent hospitals, effective treatment returns from 20 to 50 percent of the psychoneurotic patients to further duty in the Army and a high percentage of the remaining are sufficiently recovered to return to normal living.
(3) The method of frontline treatment for combat neuropsychiatric casualties is returning 60 percent of this group to further combat duty and 30 percent to further duty in the noncombat zone.
(4) Effective preventive treatment is being carried out by division psychiatrists in divisional combat units and by psychiatrists in Mental Hygiene Consultation Units in every basic training camp.
(5) Psychiatrists are effectively working in each correctional installation in the Army, aiding in the evaluation and rehabilitation of military offenders.
d. Our soldiers returning to civilian life who have psychiatric difficulties are confronted with these major problems:
(1) The misunderstanding of families and communities as to the nature of psychoneuroses.
(2) Difficulties in obtaining jobs because of misconceptions on the part of employers of this problem.
(3) The lack of available facilities in communities for the guidance and utilization of this group, including educational, vocational, recreational, and medical.
e. These difficulties of readjustment could be alleviated and the transition of
7This optimistic prediction of 'recovery' rate might be more correct if considered as 'remission' rate. Eli Ginsberg and associates (The Ineffective Soldier: Patterns of Performance. New York: Columbia University Press, 1959) state that 55,000 were discharged from the Army in World War II for psychosis (p. 20); that 1 out of 4 separated with a diagnosis of psychosis made an early adjustment (p. 199); and that, in 1953, 11,700 World War II veterans were admitted to Veterans' Administration hospitals with psychosis (p. 172). This latter figure was certainly not all new cases but must include a good percentage of relapses. See also Ripley, H. S., and Wolf, S.: Course of Wartime Schizophrenia Compared With Control Group. J. Nerv. & Ment. Dis. 120: 184-195, September-October 1954.-A. J. G.
8This statement cannot be supported. Menninger in 'Psychiatry in a Troubled World' (p. 346) states: 'After intensive effort (treatment) was instituted, 7 of 10 psychotic patients were well enough to send to their homes.' These included acute temporary psychotic episodes and alcoholic psychoses. In this same volume (p. 598), the percentage of patients returned home alone or to the custody of relatives from 8 general hospitals that had the majority of psychotic patients was 59.1 percent.-A. J. G.
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a man from Army to civilian life made easier and smoother by a planned program of public education. It would seem imperative that the influence and example of the War Department be utilized in the development of such a program.
2. The security problem since V-E Day should materially be relaxed in this field in view of the increasing magnitude of the problem. The present policy on publicity regarding the neuropsychiatric problem, which permits the use of figures only on the percentage of men recovered, is not conductive to an enlightened public attitude on one of the largest and most acute social problems of today.
It is strongly recommended that a general education program be initiated in an attempt to counteract the many present misconceptions in this field, the injustices now being perpetrated on the veteran so afflicted and the floundering state of affairs in communities in their attempts to be of help to him.
Unfortunately, it is believed that this appeal never went further than an intraoffice memorandum. The director of the division, who had composed this draft, left for a period of temporary foreign service, and it is believed that it was never followed through. The policy enunciated in April 1944 continued to be the guide, prohibiting the release of any factual information except a general verbal description of the problem.
On 29 June 1945, Joint Security Control issued a memorandum, again listing 'Topics To Be Withheld From Publication.' In this memorandum, there was the specific note under miscellaneous subjects which read as follows: 'Statistics (percentages, rates, numbers, names or identifiable photographs) of Neuropsychiatric Casualties.' Again, it was believed that the public demand was being ignored, the need of the community being overlooked, and the national health being jeopardized by this limitation in the publication of information regarding psychiatry in the Army. As a result, the Neuropsychiatry Consultants Division again prepared a comment on this restriction as follows:
Ref. to JSC/B25, Serial 6116 from The Joint Chiefs of Staff, dated 29 June 1945, SUBJECT: List of Topics to be Withheld from Publication.
1. The above mentioned memorandum includes under P. VI, B, 2. 'Statistics (percentages, rates, numbers, names or identifiable photographs) of neuropsychiatric casualties.'
2. Attention is called to a memorandum from G-1 to the Deputy Chief of Staff (WD GAP 710 Mar 1945) in which it was stated that 'part of the confusion on the part of the public about the subject of psychoneurosis has been due to the complete blackout of publicity by Joint Security Board of the Army and Navy until May, 1944. Since then only fragmentary information has been released.' In the recommendations, subsequently approved by the Chief of Staff, was included 'that full publicity of the psychiatric problem should be given in a factual manner.'
3. In view of (a) the magnitude of this problem as it affects national life and the urgent need for frank and extended public education in this field, and
(b) the support and aid which the War Department can give to those veterans discharged for neuropsychiatric causes, and
(c) because of the great need to educate military officers as to the extent of the problem, and therefore their responsibility for preventive efforts, it is strongly recommended that reconsideration be given to the above stated limitation.
4. It is believed that since the combat period in Europe is completed, that security reasons for suppression of such information gained in those theaters have diminished.
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5. The NP Consultants Division, SGO, strongly recommends that the limitations be revised so that
a. Statistics on incidence (percentages and rates) of neuropsychiatric casualties in the Pacific Theaters be withheld, but not those from other (inactive) theaters; providing strength and location of organizations are not revealed by the statistics.
b. Statistics on incidence and discharge of neuropsychiatric cases in ZI be made available.
c. The previous policy of giving percentages of men salvaged or returned to duty in all theaters and in the ZI be continued.
6. Consideration be given to the fact that tremendous educational value may accrue to the benefit of the Army, the public, and ultimately the individual psychiatric patient, through the utilization of carefully developed motion pictures and photographs of neuropsychiatric activities. These would in some instances, of necessity, include 'identifiable' patients. Therefore, it is recommended that the restriction given above be modified to permit such photos, taken under Army supervision.
This protest was included in a memorandum from Brig. Gen. Stanhope Bayne-Jones, Chairman of the Board of Declassification of Medical and
Scientific Reports of the Surgeon General's Office. His memorandum of 3 August 1945, addressed to the Joint Security Control, was as follows:
Subject: Neuropsychiatry Publicity Policy
TO: Joint Security Control
Attention: Colonel J. K. Cockrell, Army Executive
Room 2B656, Pentagon Building
1. The Joint Security Control document, subject: 'List of Topics to be Withheld from Publication in Unclassified Documents,' dated 29 June 1945, Paragraph VI, B, 2, states that among the subjects to be withheld from publication are 'Statistics (percentages, rates, numbers, names or identifiable photographs) of neuropsychiatric casualties.' Although the representative of the Office of The Surgeon General concurred in this statement at the meeting with the Subcommittee on Publication Policy, OSRD, when this was recommended, he was not aware at that time of consideration which was being given to this subject by G-1 and of certain new developments in the field of public relations with regard to neuropsychiatry. Request is now made, therefore, for review of the above quoted statement and recommendation is made for the adoption of the following policy.
a. Information regarding neuropsychiatry will be divided into the following classes:
(1) Classified
(a) Statistics on incidence (percentages and rates) of neuropsychiatric casualties in the Pacific Theater.
(b) Strength and location of military organizations in active theaters.
(2) Unclassified
(a) Statistics on incidence (percentages and rates) of neuropsychiatric casualties in all inactive theaters.
(b) Statistics on incidence and discharge of neuropsychiatric cases in the Zone of Interior.
(c) Statements of percentages of men salvaged or returned to duty in the Zone of Interior. (This would be a continuation of a previous policy.)
(d) Carefully prepared motion pictures and photographs of neuropsychiatric activities, including in some instances 'identifiable patients,' such films and photographs to be prepared under Army supervision.
2. The bases for the above recommendations are as follows: The public relations and publicity policy with regard to neuropsychiatry involve a problem of great magni?
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tude. It affects the national life. There is an urgent need for frank and extended publication in this field. By a liberal policy of public education, the War Department can give its support and aid to those veterans discharged for neuropsychiatric causes. Furthermore, there is a need to educate military officers as to the extent of the problem and their responsibility for preventive efforts. With regard to the release of figures from inactive theaters, it is believed that since the combat period in Europe is completed, security reasons for supervision of information gained in European and Mediterranean theaters have diminished. With regard to the recommendation about photographs and motion pictures, it is strongly believed that great educational value may accrue to the Army, the public, and ultimately the individual psychiatric patient through development of motion pictures, photographs of neuropsychiatric activities.
3. With regard to certain previous considerations of the question, the following information is supplied: In October 1944, the Assistant Chief of Staff, G-1, began extended consideration of this subject. The Inspector General made an investigation and reported on 18 December 1944. A memorandum for the Deputy Chief of Staff from G-1, dated 16 February 1945, reviews the situation and points out that part of the confusion on the part of the public about psychoneurosis had been due to the complete blackout of publicity which existed until May 1945. The memorandum continues with the statement, 'Since then only fragmentary information has been released.' It is agreed that publicity insofar as possible should be given in a factual and nontechnical manner. This memorandum concluded with several recommendations, one of which was as follows:
'f. That full publicity of the psychiatric problem should be given in a factual manner.'
A number of the recommendations advanced in this memorandum of 16 February 1945 for the Deputy Chief of Staff have been put into effect. However, information indicates that the recommendation cited above with regard to full publicity given in a factual manner has not been put into effect. The representative of The Surgeon General is informed by G-1 that this memorandum received the approval of the Chief of Staff on 27 February 1945.
FOR THE SURGEON GENERAL:
ROBERT J. CARPENTER,
Colonel, Medical Corps,
Executive Officer.
S. BAYNE-JONES,
Brig. Gen., USA, Chairman,
Board of Declassification of Medical and Scientific Reports.
RESTRICTIONS LIFTED AS WAR ENDS
The director of the Neuropsychiatry Consultants Division appeared personally with General Bayne-Jones before the Advisory Committee of the National Research Council on the subject of public information. This committee approved their recommendation to the Joint Security Control after the end of the war. On 23 August 1945, the Joint Security Control published a new memorandum on the publicity policy regarding neuropsychiatry. Essentially, this memorandum was the culmination of the efforts of 2 years, permitting the release as unclassified of all material, statistics, and figures about neuropsychiatry with the exception of statistics on incidence (percentage and rates) of neuropsychiatric casualties in an
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'active theater and the strength and location of military organizations in an active theater.' At the time of its release, the European theater had become inactive and there were signs that the Pacific theater would shortly be closing. This did occur on 2 September 1945, thus making all information regarding neuropsychiatry as unclassified and therefore unrestricted in its presentation to the press or other agencies.
This long battle to permit The Surgeon General to function effectively in this field was of special interest in many ways. While the battle was eventually successful, it was too late to have accomplished much of the good that could have been accomplished had a planned program been undertaken 18 months previously. Attempts to obtain aggressive action in public education were not limited to the War Department. Contacts were established with the Office of War Information which did do some effective work. Contact was made with the War Advertising Council who, in preparing their various campaigns on veterans' readjustment, very carefully avoided the psychiatric problem. The Committee on Neuropsychiatry of the National Research Council was informed on the problem. The director of the Neuropsychiatry Consultants Division appeared before the Council of the American Psychiatric Association on 18 December 1944 with the following statement of the problem:
Public education relative to psychiatry. The veteran discharged for neuropsychiatric reasons (and there have been a considerable number) returns to civilian life amidst a welter of misunderstanding. He has an unclear understanding of himself. His family misunderstands him. His friends misunderstand him, Perhaps most important, his employer may misunderstand him. At least an effort to correct this situation would be the development of a long-range program of public education using every available medium, the screen, radio, magazines, and newspapers. In addition, there could very well be organized programs outlined for State and County Medical Societies, special programs outlined for women's clubs, for service clubs such as Rotary and Kiwanis, for industrial groups, for labor organizations. The organization of a speaking bureau seems very much in order.
Not only would such a plan help the returning veteran, but is one of the opportunities referred to above in our present situation created by the war, a golden opportunity to straighten out some of the misconceptions relative to psychiatry.
I am not unaware of the fact that there has been considerable argument as to whether the American Psychiatric Association should attempt to organize this program. It has been suggested that it is not the organization that should carry out such a campaign, with which I must bluntly disagree. It seems to me that it is the responsibility and the fundamental responsibility of organized psychiatry to assume the leadership for this job, whether they themselves do it or whether arrangements are made with the National Committee on Mental Hygiene or some other organization. To me it seems to be quibbling because if the leadership isn't supplied by organized psychiatry, to whom could one turn for leadership in such a program? As I have indicated, this is a very rare opportunity and challenge for the profession of psychiatry, and that's my business. Not only my livelihood but my main interest in life is in this field, and consequently when there are misconceptions that reflect on my patients, that concern their welfare, that concern my methods, that are inseparably bound up with my whole life interest, it doesn't make sense to me to say that I have no responsibility for it or that my professional standards prevent me from giving leadership or participating in such
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a program. I feel that the responsibility is in our laps and it is our choice as to whether we miss the boat or whether we are able to capitalize on it and meet the need. From my vantage point, it is number one problem and number one need.
CONCLUSION
It would be impossible to estimate the time invested by the Neuropsychiatry Consultants Division in the field of public relations. Again and again, reporters would appear, usually unannounced, and, regardless of the pressure of other acute demands, would require literally hours to interview. The subject was delicate; the relations with the press had previously been strained; there was no one informed in or provided by the Bureau of Public Relations to do the job. Despite, major efforts, the success achieved in this field can be considered only in the dimmest light. No planned program was ever successfully sold to those higher in authority nor any implementation to bring such about. The inevitable conclusion from this experience indicates the strong desirability of having someone on the Bureau of Public Relations of the War Department whose chief function is to plan and guide a public education program, covering the ramifications of psychiatry as it is applied in the Army-selection, classification and assignment, adjustment problems, hospitalization, treatment methods, mental hygiene clinics, correctional institution psychiatry, disposition methods of war casualties, and veterans' problems in this field. If we are to learn any lesson, it would certainly be the importance of establishing a full-time public relations officer in this field in the case of any emergency. Such an individual should be appointed early, working in close liaison with the Surgeon General's Office but with the authority of the War Department to release such information as seemed indicated from the social and medical point of view. Only by such a method can impending problems be attacked aggressively and the public educated, thereby avoiding the experience of this war when the War Department and the Surgeon General's Office were so often placed in a defensive role, and the common welfare of communities ignored.
Credit should be given to the many general hospitals and special hospitals which through their own public relations officers did produce some extremely helpful and informative psychiatric information. Particularly commendable were the efforts at Mason General Hospital, N. Y., Darnall General Hospital, Ky., Kennedy General Hospital, Tenn., and Northington General Hospital, Ala. Particular individuals in the War Department Bureau of Public Relations and various echelons were extremely helpful, notably Lt. Col. Robert Brown, Lt. Col. Harry Lutgens, Maj. Munro Leaf, and Capt. Steve McDonough. There were a few outstanding civilian newswriters who took a special interest in the field of neuropsychiatry, notably Will O'Neil of the Chicago Sun, Marjorie Vandewater of Science Service, Albert Deutsch of the newspaper PM, Mr. David
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Dietz of Scripps-Howard syndicate from Cleveland, and Col. Joseph Green of the Infantry Journal.
Nearly every psychiatrist in the Army experienced, to some degree, the necessity for selling himself and his wares. This was true especially in his dealings with Medical Department officers-above all, with those in command positions. The situation was, in part, a carryover from civilian life, where the layman is occasionally better informed psychiatrically than the medical person and is more willing to consider psychiatric advice. That such a problem existed, however, was due largely to the glaring deficiencies in the psychiatric education of doctors, especially in medical schools, which came to light in bold relief during the war. Of course, some of the difficulties resulted from the actions of some poorly informed and injudicious members of the psychiatric specialty. Often one heard the expression, particularly from medical officers: 'You don't look or act like a psychiatrist. You look normal.' Early in the war, these same difficulties were experienced from the lowest echelon up to the Washington level.
