[00:00:00] Announcer: Over NBC's coast-to-coast network of independent and affiliated stations, the University of Chicago Roundtable. We present Dr. Henry W. Brosin of the Department of Psychiatry. Dr. Brosin.

[00:00:17] Dr. Henry W. Brosin: We propose on this Roundtable to discuss the emotional cost of the war and the wartime lessons for peacetime psychiatry. The money cost of the war was $335 billion. The emotional cost of the war was far greater and is far harder to deal with. Psychiatrists were partially responsible for maintaining the mental health of millions of men living under abnormal conditions and carrying out an abnormal assignment. What was learned? Joining me in a discussion of wartime lessons for peacetime psychiatry are two noted psychiatrists.
Dr. Williams C. Menninger, medical director of the Menninger Sanitarium and former director of Neuropsychiatry for the Office of the Surgeon General with the rank of Brigadier General. Also, Dr. Roy R. Grinker, director of psychiatry at the Michael Reese Hospital in Chicago. As a colonel of the Army Air Forces, Dr. Grinker had extensive experience in treating combat casualties at home and abroad.

For me, one of the great lessons of the war is a disturbing contrast between the pin money we spent for constructive human pursuits and the huge money costs of destruction. The total money spent for all medical research in America in 1944 would pay for only 8 hours and 20 minutes of this last war. The total value of all the property and funds possessed by our institutions of higher education would only pay for 20 days of this war. Dr. Menninger, how would you assess the emotional cost of the war?

[00:02:03] Dr. William C. Menninger: I don't think anyone can assess it. We know that 60 million people were displaced from their homes or many, many of them even from their countries. I think it's impossible to estimate the sorrow and the grief, the maiming, the death, the disruption of families. I think from our army experience, we can have a very rough appreciation of the emotional cost when we recognize that 12 out of every 100 men that came to our induction centers had to be refused because of some kind of personality problem, that 40% of all the men that were discharged for medical reasons, a total of nearly 400,000 were because of personality problems.

Uh, nearly another 150,000 were because they couldn't fit into the Army's scheme of things. I think with all of this terrific emotional cost, however, we have to confront ourselves with the many misconceptions that exist about this emotional problem. This in spite of our recognition of the tremendous magnitude of the psychiatric problem, people have a relu-re-reluctance to seek psychiatric help because of certain misconceptions. Some of them feel that people who go to a psychiatrist are crazy when as a matter of fact, most of the psychiatric ills are related to symptoms that refer to the body, uh, symptoms of jitteriness, the stomach disturbances, difficulties in breathing, heart troubles, high blood pressure, and so on.
Other people have a feeling of shame and inferiority because they feel that if only they have stronger willpower, they needn't consult a psychiatrist when as a matter of fact, we know that no one can will himself emotionally ill, and therefore he can't will himself to become well. The results of treatment in the Army experience have shown that a person's misconce-ception that once he recognizes himself as, uh, emotionally ill, that he cannot be cured shows to the contrary that the satisfactory treatment can resolve.

On that point, Dr. Grinker, I think that supporting this, uh, misconception that is widespread, that the psychiatrist has to do only with the "crazy" people, using crazy in quotes, I think that it is significant that only 7% of approximately a million admissions for psychiatric disorders to army hospitals, only 7% were severely mentally ill. And if we recognize that perhaps for every man admitted to a hospital, there were three who were seen by psychiatrists outside, this means that less than 2% of all the patients that came to all army psychiatrists were psychotic, that is, severely mentally ill.

[00:04:47] Dr. Roy R. Grinker: And the job is to treat them before they're so sick that they have to go into hospital.

[00:04:51] Dr. William C. Menninger: Yes. I think it has to do with the misconception of perhaps of what the psychiatrist does because the psychiatrist in the Army and in civilian line, has a-a much more of a job than treating the severely mentally ill, that it is his job to try to evaluate personality problems of the minor type. In the Army, he had selection. He had concern with morale. He had concern with prevention and many other things that the psychiatrist did that concerned the way- with the way people feel and think, and there's a consequence act.

[00:05:22] Dr. Henry W. Brosin: Uh, it might be of interest to add that it- the Veterans Administration estimates that about 20 million men will be on their roles when demobilization is complete, but that less than 2% of those men will require the kind of ambulatory care which you described.

[00:05:41] Dr. Roy R. Grinker: Well, regardless of this ambulatory care, have we learned anything since the last World War?

[00:05:46] Dr. William C. Menninger: Well, I think that would, uh, maybe call for a little valuation of where we were then and now. Uh, at the time of World War I, approximately 75% of psychiatrists were concerned with institutional psychiatric treatment. That has diminished. At the moment, there are approximately 60% of all psychiatrists that are concerned with institutional treatment. I think that at the beginning of World War I, psychiatry was in a kind of an isolated state, uh, not very much, uh, integrated with the general field of medicine, but the pressure and the need for psychiatric help in World War I, brought it out of its backwards, uh, status to meet the emergencies that occurred.

But unfortunately, I don't feel that we can, uh, uh, say that psychiatry maintained this position between wars. Uh, through the period of the 25-odd years, it undoubtedly increased tremendous-tremendously in its body of knowledge. We made a little indent in getting psychiatrists in some industrial concerns. There are about 10 of the adult criminal courts that have psychiatrists associated with them. We made a little inroad into educational problems in schools.

But I think we had to admit that we started this war still with a tremendous amount of prejudice and lack of understanding, and most, uh, tragic, perhaps, a lack of preparation for, uh, the handling again of a tremendous problem that soon became aware in the war of psychiatric disorders. It's-it's a question of what, uh- what, uh, has happened during this period that has held psychiatry back. It-it, uh, takes into account first as to what is psychiatry and what does it concern itself with in the sense of a normal individual? What is a normal individual?

[00:07:38] Dr. Henry W. Brosin: Uh, to that point, I might say that psychiatrists in recent years have given up any attempt to define normality on a statistical basis or on the basis of some platonic ideal. We are much more concerned with defining the goals of maturity for the modern man. Uh, what are the attributes which, uh, help him become happier and healthier and more efficient? How can he become less fearful and more secure? How can he control his hostilities and aggression?

[00:08:15] Dr. Roy R. Grinker: You mean, [clears throat] then, uh, to create a person who is stable in relation to the particular environment in which he finds himself? Now, we found that soldiers who broke down in the war, some of them had, uh, been fairly successful in civilian life, but under conditions of war with a tremendous, uh, request for release of, uh, a murderous fighting spirit, many people broke down.

Now, to determine what caused the man to get sick during the war, we have to consider many factors. In the first place, there were the-the individual factors that were accidental to his particular development. There were an addition environmental and social-economic factors in, uh, hi-his early life. There's one thing we can be sure of, that most of the people who broke down early in the war were prepared to be sick before they went into the Army.

Now, there are others who were, what we might call, relatively stable, who could not stand the tremendous amount of stress which was [unintelligible 00:09:21] upon them. Now, the social conditions which make for the poorest mental health most of us are aware of, the broken homes, the alcoholic parents, the sadistic fathers, those homes which gave little in the way of a reservoir of-of security to the child so that when he came into a-a situation of stress he had nothing to, uh, to, uh, call forth within himself. But in the Army, certain things protected him.

[00:09:50] Dr. William C. Menninger: Yeah, I-I was gonna interrupt to, uh, say, I think that for many of us, the-the interaction between the emotional supports that could be provided uh, versus the emotional stresses that confronted an individual were-were so obvious that in many instances, one was much more impressed with those than the-- than-than he might be with the structure of the personality, per se. That, uh, everyone agreed that the stresses were terrific. Uh, and we saw many, many instances of individuals who were extremely neurotic, who were unstable, and yet with sufficient help with these external supports that could be provided, uh, actually made a remarkable record, uh, specifically of those emotional supports. I think in my own mind that without hesitation, the-- uh, the greatest and most important support was leadership.

[00:10:42] Dr. Roy R. Grinker: Well, don't you think that this leadership, if applied, uh, to civilian life is quite dangerous, that as we hear today in this, uh-uh, period of insecurity, the cry for a strong leader, which in itself can be, uh, detrimental to the furtherance of-of our democratic society?

[00:11:00] Dr. William C. Menninger: Well, yes and no. I think that-that the practical aspect that we saw in the Army was where you had a good leader, uh, a man who acted as a kind of a substitute father that was interested in the wellbeing, the welfare, the comfort, and the personal interest in his men. Uh, could carry a fairly unstable, or at least not very strong, personalities through very difficult assignments. And on the contrary, where you've got a poor leader, you could take the best of the-- of personalities and break them down. I think that it does have a very important application to civilian life, whether it's community, whether it's state, as a matter of fact, even where it's family.

Uh, if we were able to appropriate the-the very elementary things we learned as the importance of mental health on the soldier as exerted by good leadership and were able to apply that to our family situations, to our communities, to our state, I have a great-- uh, I have a very strong feeling that it would be a-an important factor in-in maintaining mental health.

Of course, the-- within, uh, the group, the cementing of individuals under that leader is most important. And I think, uh, the Army has always been wise in, uh-uh, furthering the establishment of small so-called combat groups, where the general feeling was that, uh, it was one for all and all for one. And, uh, there was support from each other so that the individual felt himself as strong as the group. Uh, it-it's almost as if you have to season groups, uh, not only in army life but in civilian life, in order to give them a certain quantity of gratification from confidence in a leader and dependence among each other.

[00:12:55] Dr. Henry W. Brosin: Uh, I think it was generally agreed that, uh, the small group, uh, morale was, uh, rather easily maintained by using good leaders. But, uh-uh, the programs, uh, set up by the information and education division to supply overall, uh, concepts for motivation apparently were much less effective when men actually went into combat. Uh, [crosstalk]--

[00:13:25] Dr. William C. Menninger: Well, wait a minute, though. I think that if-if you make it clear that after a man once had got into combat, that he wasn't particularly interested in the heritage of Czechoslovakia or the history of somebody else, but while he was in training, if it were possible to give him a strong conviction as to the importance of the job that had to be done, then I think the motivation was also an equally strong supportive factor.

[00:13:51] Dr. Henry W. Brosin: I'd agree very much that motivation at that level for civilian life has strong implications for advertising and propaganda media in the country today.

[00:14:02] Dr. Roy R. Grinker: The most important factor was the feeling that each one was responsible for the welfare of someone else, and we know that in combat, there was very little, uh, prejudice against minority groups. That same group coming back to this country would find itself with all the old prejudice precipitated out again. It seems that we can only get along with each other when we have a common danger to fight.

[00:14:27] Dr. William C. Menninger: I think, uh, that's pertinent in this discussion and motivation, too, because after all, the Russians had much more of a motivating factor than we did. So did the French. England was threatened, uh, very much more than we were, and I think that, uh, most of us that had the opportunity to see men in combat felt very strongly that the chief motivation of the American was because he had a buddy next to him and he wasn't gonna let him down. And that sense of American sportsmanship that he wasn't gonna be a quitter and when you get, uh, beyond that is the motivation actually in combat.

The-- I always felt it got pretty thin soup as to, uh, granted that a man could act more intelligently if he knew more information. But I think the pertinent application to civilian life about that would be the potential advantage and value, again, whether it was family or community or state. If you had what amounted to an information and education service who was to give you facts and-and information about whether they were candidates for election or whether they were plans or programs in the community, a council session that, uh, had as its chief function informing us so that we could act as more intelligent citizens.

[00:15:36] Dr. Roy R. Grinker: But the emotional aspect of the leadership and group solidarity is lacking in the United States today. And some people ascribe to this fact the-- this apparent increase in mental illness. Now, I-I really don't believe that mental illness is-is increasing, although it's difficult to say. Certainly, the mental disturbances of old age are increasing because, uh, the people are living longer. But there's an increased recognition of the minor difficulties, the recognition that certain physical disturbances really are due to emotional problems. And, uh, one would hesitate to say that actually, there's an overall increase in mental illness.

[00:16:16] Dr. William C. Menninger: I think that-- uh, that plot again, in the Army, I think good many times psychiatrists were accused of making part of the psychiatric problem which always seemed kind of silly to me that after all, the surgeons didn't go out hunting their patients and the psychiatrists didn't go out hunting theirs. They were brought to us, but the fact remains that in contrast to World War I, despite the fact that we rejected a very much higher percentage of men, we had a lot more psychiatric casualties, which of course, led to this point that I think you made that it is an increased awareness of minor difficulties that makes it appear that the problem is very much greater.

[00:16:54] Dr. Roy R. Grinker: You wouldn't think, Brosin, that, uh, the supposed increase, uh, in, um, mental disturbance is due to the war.

[00:17:00] Dr. Henry W. Brosin: No. Uh, my own experience, uh, I think duplicates that of many others, and I find that those men who now come to us with problems, uh, show the clear outlines of difficulties, uh, which accrued through their early development.

[00:17:17] Dr. William C. Menninger: On the other hand, of course, I-I-I presume you men are too, I'm often asked, uh, why were there more psychiatric casualties in this war? I-I don't-- um, perhaps we have answers. I-I have some notions about it. I don't think we have any final answer. I'm sure that we have to recognize that it was a lot tougher war that we were fighting a mobile war, that a man put in his time in a foxhole and not in a communal organization in the French. Uh, that the actual, um, war implements were certainly far more devastating than they were in World War I with airplanes striking and so on.

I think we have to recognize that the greater, much longer separation was a factor that the greater stresses of climate in Alaska and in Guan Canal and many other places was much greater. And I always felt that one-- maybe one of the chief causes for the increased, uh, psychiatric casualty was this question of motivation that in World War I, there was certainly much more national emotional, uh, pressing of the war as contrasted to World War II, where it got to be that a poor fellow that went to the draft was just a poor, miserable fella that finally got caught by the draft.
And then, the Army had the impossible job of trying to make him into a soldier that was perfectly willing to get his innards cut out for the sake of the cause, and that was an impossible job.

[00:18:34] Dr. Roy R. Grinker: Well, just, so,-- just, uh, as we recognize that there were a greater number of emotional disturbances, so we attempted to treat these disturbances, uh, through, uh, the logical person that is the general medical man who was on the firing line in the battalion or in the squadron. And he soon learned that uh, the disturbances that he saw that were characterized by physical symptoms were not due to actual diseases, but were due to the, uh-uh, effects of disturbed feeling, of-of anxiety. And, uh, in recognizing these factors, he searched for means of treating. And of course, uh, he could, by recognizing them early, uh, treat them most effectively at the time when, uh, such, uh, early treatment, uh, could be accomplished.

[00:19:25] Dr. William C. Menninger: I'll grant-- wait a minute. I-I-I can grant that there was a very great increase in interest on the part of these general medical men, but I think a lot of us were impressed, and-and-and I'm glad to take a crack at-at our medical education that allows for 3% to 4% or 5% of all the hours in medical school allotted to an aspect of medicine, which if we accept it, and it seems valid, that 50% of all patients that go to all doctors have fundamentally emotional problems and that's why they go. And yet, in medical school, we try to orient a band with 3% of these hours. and what we kept saying all the time were the-the fellows who were perfectly honest and sincere in trying to treat these fellas but didn't know how.

[00:20:07] Dr. Henry W. Brosin: Well, there are many efforts being made to correct that situation. Uh, the Commonwealth Fund, uh, had a [unintelligible 00:20:15] conference on medical education in which numerous recommendations were made for practical streamlining of the medical curriculum and with extensive revisions for, uh, for pre-medical education.

As a practical implementation, they also had a trial course at Minnesota in which about a dozen, uh, good teachers were assembled in a hall so they could live with 25 Minnesota general practitioners, and then teach them as much psychiatry as possible within two weeks. Everyone concerned was highly enthusiastic with the success of this program.

[00:20:54] Dr. Roy R. Grinker: Yeah. So, of course, uh, we're dealing now with postgraduate education, and as Dr. Menninger says, we hope that the medical schools will recognize the need for teaching psychiatry to the-the medical student. But now, uh, these men have to work under direction. Uh, they can't work independently. Uh, the psychiatrist, uh, cannot take the load of, uh, of the me-medic, uh, uh, disturbances that belong in his field.

But, uh, when cases, when patients get to a serious enough state, then he has to, uh, treat them directly himself. And, uh, during the war, we've learned, uh, a number of, uh, techniques which, uh, have attempted to overcome the-the length of time that ordinary psychiatric treatment takes. That's been a great handicap, uh, the time and cost of psychiatric treatment. Some new methods were learned during the war. Don't you agree with me, Dr. Menninger?

[00:21:49] Dr. William C. Menninger: Uh, yes. I think a lot were, and I wish you'd say something about the-the-the extremely important thing of giving a man psychotherapy under sedation is a shortcut to getting quicker to the core of the trouble. You had an awful lot experience of that.

[00:22:02] Dr. Roy R. Grinker: Well, when-when a man is suffering from a-a nervous disorder, he's suffering from the indirect effects of some feeling that he's not conscious of. He can't master it because he hasn't got it under his control. Usually, it's some, uh, forgotten, uh, situation, some memory that, uh, he's, uh, unable to-to, uh, recall because it's so painful. And the task in all of the psychotherapy is to uncover, to ventilate the, uh-uh, m-material that the patient has, uh, pushed away from his consciousness.

Now, drugs, uh, enable us to speed up that process, and particularly the sodium pentothal and the method that's called narcosynthesis, but it's not, uh, a necessary drug. We can do the same procedure with hypnosis. We can do-do the same procedure with what, uh, in civilian life we call breach psychotherapy interviews over a period of time.

[00:23:02] Dr. William C. Menninger: I think you gotta add to that though. I'm-I'm interrupting you. But I wanted to-to add also, of course, some of the other things that I think were equally important of group, uh, therapy. Uh, we-- it's, uh, maybe a semantic question, whether we call it group psychotherapy but working with men in groups with common problems, attempting to formulate attitudes which we had to do because we had so many patients and some few psychiatrists. And then I think that matter of fact, you, uh, Dr. Brosin had a lot of experience in the treatment of the neuroses in the- in the open--

[00:23:33] Dr. Henry W. Brosin: Uh, yes, indeed. I think one of the most spectacular demonstrations of the efficacy of group therapy was in, uh, the convalescent hospital, which was demonstrated that, uh, the, uh, neurotic patient need not be in hospital uniform at all. In fact, the farther he was kept away from the, uh, regular, general or station hospital, the more effective the treatment became.

[00:24:00] Dr. William C. Menninger: That's what we're trying to do in civilian life, isn't it? Keep the patient out of the hospital, keep him ambulatory, and treating him in a clinic.

[00:24:06] Dr. Henry W. Brosin: Uh, the techniques which were developed during the last 18 months, uh, for ambulatory convalescent care, I think, uh, shows clearly, uh, the path for progress in civilian life, uh, in all kinds of medical and surgical conditions, as well as in the more narrowly, uh, psychiatric [crosstalk]--

[00:24:27] Dr. William C. Menninger: And I think in describing that too, uh, one of our progress progressive steps, it wasn't new but was the utilization of a team concept using a psychiatrist, a psychiatric social worker, a psychologist along with the adjunctive OT, recreation, nursing, and so on which I think the fact that it was a uniform procedure in the Army, uh, can have a wide, uh, repercussion in civilian life as a better way and a more effective way of doing a psychiatric treatment.

[00:24:57] Dr. Roy R. Grinker: Well, you know, the-the veteran's organizations have really, really developed a tremendous, uh, interest and, uh, have, uh, gone ahead in a remarkable way in treating these large number of people who have come back to civilian life. Uh, under the leadership of General Bradley and, uh, Dr. Hawley, the veterans, uh, hospitals have established tremendous training programs, uh, which will bear their, uh, fr-fruit some three or four years from now.

But in the meantime, uh, bringing their patients into a relationship with faculties of large universities and existing, uh, civilian agencies, uh, it's, uh, the-the veterans organizations are really doing a remarkable job. I think that Dr. Brosin, I'd want to stand up and cheer on that. It's the light and the horizon, the remarkable progress. If we compare the Veterans Administration a year ago and a year now, I think there's one aspect though, that we as psychiatrists shouldn't be blind to, and that's the lamentable present method of handling pensions for psychiatric veterans.
Because I think that unintentionally the nature of the psychiatric problem, uh, we have a system which gives, uh, a man an added reason to maintain his symptoms. And we in psychiatry know it, and we work with odds against people who seem somehow to think we wanna rob the veteran of the pension. And-and a great group of them that try to feel that every veteran should have a pension. God knows I want every-every psychiatric casualty to have the compensation that he's due, but I don't like a system that he has to maintain his symptoms to get his pension.

[00:26:30] Dr. William C. Menninger: Well, isn't it too bad that our state hospitals can't be as efficiently run as, uh, our veterans' hospitals have in the last year?

[00:26:37] Dr. Roy R. Grinker: Well, it could be, but I think that takes a lot of public enlightenment, uh, an opportunity for people to know more of what we're talking about.

[00:26:46] Dr. Henry W. Brosin: Uh, I would agree, uh, thoroughly with, uh, the theses which have just been enunciated. We have attempted here to present a few of the important wartime lessons which are valuable for Peacetime Psychiatry. The magnitude and complexity of the problems require a sturdy faith and willingness to work on the frontiers of human organization. Psychiatrists are only physicians with very human limitations.

Most of us are quite humble in the face of the odds. Since obviously, enormous resources must be mobilized to do an effective job. No single group of specialists can alter the social scene nor provide adequate individual care without the wholehearted support of the general public. As the comprehension of an intelligent, well-informed citizenry increases, the more helpful support we can expect mental health, can be purchased. Two major programs need urgent backing now.

The first is an enlarged intensified training program for physicians, social workers, psychologists, nurses, attendants, and the other members of the therapeutic team. The second great need is research. We need to make possible such an intellectual climate where men can grow, develop new ideas, and implement them for practical application. With such free growth of new ideas, the probability of success will be greatly enhanced

[00:28:25] Announcer: For $1, you can subscribe for four months to the University of Chicago Roundtable pamphlet and receive a copy of today's analysis of wartime lessons for Peacetime Psychiatry. Participating in today's discussion were Brigadier General William C. Menninger, former director Neuropsychiatry Consultants Division, Army Service Forces, and now Medical Director of the Menninger Sanitarium, Dr. Roy Grinker of the Department of Neuropsychiatry at Michael Reese Hospital in Chicago, and Dr. Henry W Brosin of the Department of Psychiatry at the University of Chicago.

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