Psychiatric Casualties Research Articles

Psychiatric Casualties during the Korean War: Focusing on American and Common Wealth Soldiers.

A crucial gap in the medical history of the Korean War is the history of psychiatry during the Korean War. War puts those who participate in it through physical and mental extremes, inflicting not only physical injuries but also psychological trauma and damage. However, studies of the medical aspects of the Korean War have been limited to topics related to physical injuries and their treatment, and there are no studies that systematically summarize the traumatic effects on the human mind thrown into the midst of the war, the consequences of these effects, and the medical efforts made to deal with these problems. As the Korean War was fought only five years after the end of the Second World War, the experiences and achievements of the Second World War were used in the Korean War. In terms of personnel, many of the soldiers who fought in the Second World War also fought in the Korean War. This continuity with the Second World War had both positive and negative aspects. On the positive side, treatment and transport systems were quickly put in place to respond to the large numbers of soldiers with psychiatric problems on the front lines early in the war. This is an example of a positive use of the legacy of the Second World War. On the other hand, the negative side of the coin was the much higher frequency of psychiatric symptoms among veterans of the Second World War. This could be explained by the fact that the psychological trauma experienced on the battlefield during the Second World War remained latent and was reactivated in the Korean War as a kind of conditioned reflex. In addition, the brainwashing of prisoners of war and their subsequent psychological problems are also characteristic of the Korean War in the context of the Cold War. These psychiatric features of the Korean War will provide a useful historical example for understanding and helping those who are inevitably involved in war and suffer from mental distress.

From here to I.A.P.T? (improving access to psychological therapies), preview for a new deal for dynamic psychotherapies: The psychoanalyst as street‐level bureaucrat

AbstractThis paper offers a preview of a forthcoming article on the world's first, universal free‐to‐access, evidence‐based talking therapies programme to treat depression: Improving Access to Psychological Therapies. It was pioneered not in the USA, but the UK, in 2007. At one time it could have been led by psychoanalysts, but it wasn't. It was a New Deal, in fact, for CBT. But did this New Deal in 2007 also offer psychoanalysis an opportunity to renew its vitality as a discipline, after decades of being eroded by our long‐term retreat into private practice? Illustrated in the film From Here to Eternity, through characters played by Burt Lancaster, Montgomery Clift and Frank Sinatra, this Preview shows how applied psychoanalysis can once again aspire to become a universal, genuinely popular, relevant professional discipline. How would we engage ethically with psychiatric casualties of war, for example, within an evidence‐based practice framework today? A novel, brief psychoanalytic treatment for depression, Dynamic Interpersonal Therapy, was developed for use in the UK's Improving Access to Psychological Therapies (IAPT) programme. It is recommended by NICE (National Institute for Health and Care Excellence) as cost‐effective for treating depression. By engaging with evidence‐based practice in this way—as Street Level Bureaucrats—we can reclaim our position at the centre of contemporary publicly funded mental health services.

Review of <em>Psychiatric Casualties: How and Why the Military Ignores the Full Cost of War</em> by Mark C. Russell and Charles Figley

Review of <em>Psychiatric Casualties: How and Why the Military Ignores the Full Cost of War</em> by Mark C. Russell and Charles Figley

COVID–19 járvány hatása a pszichiátriai megbetegedések gyakoriságára – PTSD

Összefoglaló. A poszttraumás stressz zavar (PTSD) egy súlyos mentális állapot, amely nehezen gyógyítható, és évtizedeken keresztül fennállhat. Gyakorisága 1–3%-ról világszerte 20% körülire emelkedett a COVID–19 járvány után. Az észlelt gyakoriság nem függött a vizsgált populációk érintettségétől: a gyakoriság közel azonos volt fertőzöttek, karanténba kerültek, pusztán életmódváltozást elszenvedők és egészségügyi szakemberek körében. Ez vetekszik a háborús helyzetekben tapasztaltakkal, azzal a különbséggel, hogy a modern háborúk a világ népességének kis részét, míg a járvány az emberiség tekintélyes részét érintette. A COVID–19 járvány lecsengése után tehát számolnunk kell azokkal a pszichiátriai jellegű károkkal is, amelyeket maga mögött hagy, köztük a PTSD áldozataival. Summary. Almost 20 years ago McNally (2003) wrote a paper on the Vietnam War with the title “Psychiatric Casualties of War”, outlining that people may suffer psychological injuries in war beyond those that harm them physically. Like wars, epidemics also have “psychiatric casualties” e.g., people who avoid the dangers of the epidemic per se but do not survive the situation without harm. One possible form of impairment is psychiatric in nature; this category includes among others post-traumatic stress disorder (PTSD). This study addresses the question of how how much concern the COVID-19 epidemic raises in the long run for an increased incidence of PTSD. PTSD is a severe and difficult-to-treat mental disorder caused by traumatic stress i.e., an event that threatens life and/or physical integrity. It is usually attributed to disasters, war, and interpersonal violence, but it can also be caused by serious illness such as AIDS and cancer. The COVID-19 epidemic conforms to the concept of trauma in the Diagnostic and Statistical Manual of Mental Disorders, as the disease it causes is potentially life threatening. Thus, even a purely logical approach suggests that the epidemic may increase the incidence of PTSD, an assumption that is confirmed by numerous targeted studies. The pre-epidemic PTSD morbidity rate of 1-3% has risen to around 20% globally over the past year due to the COVID-19 epidemic. PTSD affected not only those who fell victim to the disease, but also those who have “merely” witnessed the development and spread of the disease, those who have been placed in preventive quarantine, and healthcare workers who have had the burden of treating the epidemic. Behind the global 20%, an uneven picture emerges. In certain populations and at certain times, the frequency was reported to be much lower (e.g., 8%) or much higher (e.g., 96%), depending on the specifics of the study participants, as well as the place and time of the investigation. Overall, however, the post-epidemic prevalence of PTSD appears to rival that observed in war situations, such as the Vietnam War. The difference is that modern wars mostly affect a small portion of the world’s population, while the COVID-19 epidemic affects almost the entire humanity. Recent events suggest that the epidemic will soon recede. However, the epidemic leaves behind a large number of people who have sustained long-lasting and severe mental injuries - including those who have developed PTSD. Tackling this problem is the task for the future, but it must be prepared in advance. To this end, the study also briefly maps the factors of inborn and acquired resilience in a new network science approach.

Considerations for Acute and Emergent Deployed Mental Health Patient Management and Theater Transports: A Scoping Review.

ABSTRACTBackgroundAlthough combat stress and psychiatric casualties of war have consistently contributed to the need for deployed patient transport to higher echelons of care, little is known regarding specific evidence-based strategies for providing psychological support and optimal transport interventions for warriors.Study ObjectiveThe purpose of this scoping review is to map existing literature related to considerations for deployed mental health patient transport. The review’s primary aims are to identify the existing scientific research evidence, determine research and training gaps, and recommend critical areas for future military research.MethodsWe used Arksey and O’Malley’s six-stage scoping review methodological framework (identify the research question, identify relevant studies, select studies, chart data, report results, and consultation). Using a systematic search strategy, we evaluated peer-reviewed literature from five databases (PubMed, CINAHL, PsycINFO, Web of Science, and Embase) and gray literature from the Defense Technical Information Center. All publications were independently screened for eligibility by two researchers during three review rounds (title, abstract, and full text).ResultsWe identified 1,384 publications, 61 of which met our inclusion criteria. Most publications and technical reports were level IV evidence and below, primarily retrospective cohort studies and epidemiologic surveillance reports. Few rigorously designed studies were identified. Eight research themes and a variety of research and critical training gaps were derived from the reviewed literature. Themes included (1) characterizing mental health patients aeromedically evacuated from theater; (2) in-flight sedation medications; (3) need for aeromedical evacuation (AE) in-theater education, training, and guidelines for staff; (4) epidemiological surveillance of AE from theater; (5) mental health management in deployed settings; (6) suicide-related event management; (7) transport issues for mental health patients; and (8) psychological stressors of AE. Research is needed to establish clinical practice guidelines for mental health condition management in theater and throughout the continuum of en route care.

Psychiatric casualties and the British counter-insurgency in Malaya

ABSTRACT The psychiatric cost of Britain’s post-war counter-insurgency campaigns have gone largely un-investigated. Focusing on the Malayan Emergency, this article will show that counter-insurgency operations were sufficiently intense to produce what were conceptualised as cases of mild psychoneurosis. These conditions were managed using convalescence and simple psychotherapy. Managing these conditions in this way risked leaving more serious conditions untreated and meant recorded cases of psychoneurosis were kept artificially low. That the stresses of the counter-insurgency in Malaya were reproduced elsewhere suggests there was a wider psychiatric cost of Britain’s post-war period of decolonisation.

Patient visits to a psychiatric casualty clinic during the initial phase of the COVID-19pandemic.

We wished to investigate how the flow of patients to the Psychiatric Casualty Clinic in Oslo was affected during the acute phase of the COVID-19pandemic. All patient records from the Psychiatric Casualty Clinic in Oslo from and including 13 March 2020 up to and including 1 April 2020 were compared with the patient records from the same period in 2019. Patient visits were registered as COVID-19-related when the patient came to the clinic for an issue linked to the pandemic. The Psychiatric Casualty Clinic in Oslo had 105patient visits in the period 13 March 2019-1 April 2019 and 63 in the same period for 2020 (-40%). The number of admissions amounted to 16 in 2019 and 7 in 2020 (-56%). The number of COVID-19-related consultations was 14/63 (22%). There was a reduction in the number of patient visits for crisis reactions, from 28 in 2019 to 8 in 2020. The background for the decline in the flow of patients in the acute phase of the COVID-19pandemic is most likely a complex one. We believe that patients primarily chose not to visit the clinic due to the risk of infection and the wish to avoid burdening the health services. With the reservation that our data are limited, it does not appear that increased access to psychiatric health services requiring physical attendance is indicated in the acute phase of a pandemic.

Revisiting the U.S. Navy Submarine Service Psychological Casualty Rate in World War II

Conclusions concerning how many World War II U.S. Navy submariners should be classified as psychiatric casualties have long been based on a pioneering study by two navy physicians, Commander Ivan Duff, MD, and Captain Charles Shilling, MD, that was first made public in the Journal of the American Psychiatric Association shortly after the war. This article seeks to show that, despite the longevity of the resulting published figures, there were serious problems in their approach and conclusions. The data set of the study was far from comprehensive, which, in turn, led to erroneous calculations generating a minuscule number—approximately two cases per 1,000 submariners—that in turn necessitated explanatory overreach. Reasons for the approach taken in the original work, and subsequent longevity of acceptance and celebration of the results produced, are then examined through the lens of confirmation bias.

Trans-Generational Transmission of Traumatic Memory and Moral Injury

ABSTRACTThe scale of casualties in World War I and the reinterpretation of the conflict in terms of futility and waste suggest that many veterans experienced moral injury. Memory of the war was in part determined by their experience of the peace. Governments sought to contain traumatic memory through commemorative rituals such as Armistice Day and homage to the Unknown Soldier, whereas relatives were not permitted to repatriate the dead from military cemeteries on the battlefields. Despite gains in treating psychiatric casualties, many veterans with shell shock never recovered from their psychological wounds. To what extent their symptoms were a consequence of moral injury is not known, though individual accounts suggest that shame and guilt were features of their enduring illness.

The Darker Side of Military Mental Healthcare Part One: Understanding the Military’s Mental Health Dilemma

The military’s primary mission is to prevent, fight, and win wars. A critical key to its success is the military’s dual mission of force health protection that translates to preventing and treating the physical and psychological wounds of war in order to preserve the fighting force. To accomplish both missions, the military relies extensively on documenting its lessons learned to build upon its successes and prevent avoidable disasters caused by repeating its failures. The military’s commitment to learning battlefield lessons are directly responsible for unparalleled technological and medical, life-saving advances that greatly benefit both military and private sectors. However, the evolution of modern industrialized warfare’s capacity to kill, maim, and terrorize has exceeded the limits of human endurance whereby psychiatric casualties have outnumbered the total of combatants, both wounded- and killed-in-action, since the Second World War. Psychiatric attrition and skyrocketing costs associated with psychiatric treatment and disability compensation threaten the military’s capacity to accomplish its primary mission as well as risk straining the finances of society, thereby presenting a significant mental health dilemma. Central to the military’s mental health dilemma are two competing alternatives: (1) to fulfill its moral, ethical, and legal obligation of preventing and treating war stress injuries by learning from its documented lessons learned, or (2) develop strategies to avoid learning its war trauma lessons in order to avoid psychiatric attrition, treatment, and pensions. The first option conjures deep-seated fears of mass evacuation syndromes should the military treat mental wounds similar to physical injuries. Consequently, the military has embraced the second option that inevitably has been harmful to veterans, their families, and society, in what we refer to as the darker side of military mental healthcare. In this, the first of a three-part review, we examine the contextual factors framing the military’s dilemma and 10 strategies utilized to avoid learning its war trauma lessons, which will be explored in-depth in parts two and three. While disturbing, these signs of failures are readily ignored and dismissed by a war wary republic. To our knowledge, such an analysis has never been undertaken before or publicly disclosed. When considered as parts of the whole, the findings point to a critical need for improvement in treating military psychological injuries in the war theater.

Erratum to: Do the Military’s Frontline Psychiatry/Combat and Operational Stress Control Doctrine Help or Harm Veterans?—Part one: Framing the Issue

This is the first of a three-part systematic review of the potential benefits and harmful effects of the military’s century-old doctrine of frontline psychiatry or combat and operational stress control (COSC). Since the Second World War, psychiatric casualties have outnumbered the combined total of American service members both wounded and killed-in-action. The original, explicit purpose of frontline psychiatry programs established during the First World War was to prevent mass evacuation and attrition of military personnel experiencing acute war stress injuries by emphasizing brief, nonpsychiatric interventions resulting in return to duty (RTD). Although frontline psychiatry continues to evolve, these bedrock principles of RTD and avoiding psychiatric evacuation remain unchanged. Today, the US military explicitly predicts that over 95% of war stress casualties will be RTD with evacuation limited to those deemed either grossly impaired and/or clear safety risks to self or others. The military justifies its mental health policy by claiming that studies have demonstrated its health benefits to individual service members and their families, as well as findings that medical evacuation and subsequent psychiatric treatment are harmful. However, the only systematic review of the effectiveness of frontline psychiatry was published in 2003, warranting critical examination of the military’s claims. Specifically, the actual evidence for or against the military’s primary mental health policy has never been fully examined, so that any conclusions are tentative. The sheer complexity and national security implications underlying the military’s unchallenged 100-year doctrine required a three-part review. In this study, we frame the debate on the military’s frontline psychiatry/COSC by examining its historical origins, ethical-legal controversies, and contemporary program descriptions.

Do the Military’s Frontline Psychiatry/Combat Operational Stress Control Programs Benefit Veterans? Part Two: Systematic Review of the Evidence

The second of a three-part review provides the first-ever systematic investigation into the military’s claim that its century-old policy of preventing evacuation of psychiatric casualties from war zones is beneficial to the health and well-being of individual service members and their families. We conducted an extensive literature search for studies on the military’s frontline psychiatry doctrine, particularly research comparing the differential effects of deployed personnel returned-to-duty (RTD) via frontline psychiatry or combat and operational stress control (COSC) and behavioral health interventions, as opposed to those evacuated out of war zones as psychiatric casualties. In addition, we examined partial and indirect evidence in support of the military’s argument that RTD and preventing psychiatric evacuations enhances posttraumatic growth and reduces adverse impact from mental health stigma, shame, and guilt, as well as lowering the risk of developing PTSD or other war stress injury causing premature military discharge. Results indicate support that frontline psychiatry benefits the war-fighting mission and goal of military medicine to prevent psychiatric attrition, with RTD rates of 60 to 100% and severely limiting psychiatric evacuations. However, there is paucity of research on differential outcomes, with only three, small uncontrolled retrospective Israeli studies from the 1982 Lebanon War reporting modest long-term benefit, from frontline versus undefined rear hospital treatment, such as lower PTSD rates. Overall, the review showed insufficient and often contradictory evidence of individual health benefits from frontline psychiatry, which calls for further research on military’s chief mental health policy.

“Invisible” War Trauma in Japan: Medicine, Society and Military Psychiatric Casualties

“Invisible” War Trauma in Japan: Medicine, Society and Military Psychiatric Casualties

Combat Social Work During the Surge in Iraq

The military has long recognized the short-term psychiatric effects of war upon soldiers, a significant factor for combat operational readiness and strength (NATO, 2008). Currently referred to as combat stress reaction or combat operational stress reaction (COSR), the condition has debilitating, immediate effects as well as long-term consequences for soldiers and military units. For the wars in Iraq and Afghanistan, commanders expected psychiatric casualties rates equaling physical ones, stemming from the intensity and duration of these conflicts, nonlinear nature of the battlefields, unit morale, and soldier experiences and preparedness. For these recent wars, the concept of behavioral health, combat stress, and its military importance has dramatically changed, as have the protocols dictating the delivery of preventive and restorative combat behavioral health care. This article outlines the conceptual foundation of modern combat stress control, protocols, and the efforts of one social worker–led combat stress prevention team, forward deployed to a small base in a volatile area of Baghdad during the height of the surge in 2006–2007.

Samuel Stouffer and the GI Survey: Sociologists and Soldiers during the Second World War Joseph W.Ryan. Knoxville: University of Tennessee Press, 2013.

Samuel Stouffer and the GI Survey: Sociologists and Soldiers during the Second World War Joseph W. Ryan. Knoxville: University of Tennessee Press, 2013.In 1941, Army Chief of Staff George C. Marshall, concerned about the mass of newly drafted soldiers who had trouble adjusting to military life as manifested in the morale crisis of that summer, enlisted the services of social scientists to conduct interviews and surveys of American GIs to find out what they thought about the army. He did so over the objections of many military leaders whose resistance to the idea of polling was deeply entrenched and had to be overcome during the war. Samuel A. Stouffer, then a University of Chicago sociology professor, was selected to lead this effort. In his role as head of the Army Information and Education Division's Research Brand, he directed a team of sociologists, psychologists, and statisticians who sought to understand a range of problems that afflicted the US Army. Stouffer and his associates investigated such important issues as why men fought, what sustained them in battle, what they thought of their allies and enemies, and why a substantial number became psychiatric casualties. The focus was on soldier attitudes and organizational and small-group processes with an emphasis on policy applications at army level, based on the Research Branch's primary role as vehicle of social engineering.Stouffer and his team administered over two hundred different questionnaires, many of which contained over one hundred items, to more than one-half million American soldiers in all parts of the world. Anecdotal data from case studies were used to illustrate and provide a different check of the findings. They also pioneered focus groups as research method and demonstrated that this combination of sociological methods was highly effective in debunking myths about social life in military units. An eminent example is the discovery that enlisted combat groups were more motivated by a desire to finish the task, to end the war, than by any other factor, including buddy or idealist motivations like patriotism. In general, returning veterans were ethnocentrically and individualistically motivated - an understandable self-centered orientation given the often great personal sacrifices they made during the war. But this challenges the oversimplified view of the World War II veterans in the Greatest Generation mythology that prevails in American culture today.Stouffer and his associates published monthly reports entitled What the Soldier Thinks and made the most important research findings public after the war through the two-volume study The American Soldier, published in 1949. The topics included analytical descriptions of morale, social cohesion and performance, social mobility, motivation, job satisfaction, attitudes toward and behavior in combat, including issues concerning fear, hostility and aggression, organizational change, social problems in the field, blackwhite relations, and demographics of troops and veterans. Stouffer's wartime work influenced multiple facets of policy, including demobilization and the GI Bill. Already by 1930, his ideas on empirical survey research had become part of what was rapidly developing into the mainstream of sociology in America. …

Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession

In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war.

STRESS IN THE MILITARY - A PERSPECTIVE

The concepts of stress and stress management have drawn increasing attention as the issues they adress seem set to become a major part of man's response to the future shock of rapid, threatening change. As with other established institutions, the military is immune neither from the vast currents of change characteristic of the twentieth-century nor consequent pressures for adaptation.Since World War II, the rate of technological advancement in the military sphere has been accelerated to the point where it almost staggers the imagination. The galloping obsolescence of new weapons systems has profound implications, as the ever-increasing technological sophistication of warfare. It has thus been pointed out that the battlefield of the future, with its stark . possibility of continuous day-night combat with nuclear, biological and chemical weapons, could well provoke psychiatric casualties that after 30 days may begin to exceed battle casl.lalties.

Mental Health Screening and Coordination of Care for Soldiers Deployed to Iraq and Afghanistan

Mental Health Screening and Coordination of Care for Soldiers Deployed to Iraq and Afghanistan

Long-Term Military Work Outcomes in Soldiers Who Become Mental Health Casualties When Deployed on Operations

Background: Little is known about longer term military work outcomes in UK military personnel who develop mental health problems when operationally deployed. Deployed Field Mental Health Teams (FMHTs) who support them follow the principles of “Forward Psychiatry,” aiming to treat psychiatric casualties close to the front line to maximize operational effectiveness and occupational retention. Aim: To examine the short- and long-term military work outcomes in soldiers deployed to Iraq between 2003 and 2007 who were referred to the FMHT. Method: FMHT clinical records were linked to occupational records with 825 resulting matches. Results: 71.6% of the referred soldiers with a documented short-term military work outcome returned to their operational unit, and 73.5% of those who had a documented long-term military work outcome served on for a period in excess of two years. Adjusting for potential confounders, a shorter service length and removal from the operational theatre were both strongly associated with premature discharge; however, it was not possible to determine the severity of the presenting mental health problem and assess whether this impacted outcome. Conclusions: The results of this study support the use of the Forward Psychiatry principles in achieving good short-term military work outcomes. Utilizing these principles, three-quarters of those referred to the FMHT were returned to their deployed unit and approximately three-quarters of those assessed by the FMHT remained in service two years after referral. We suggest that these are positive work outcomes; however, being evacuated out of the operational environment and having a short service length were both associated with premature discharge, though we were unable to examine the role of illness severity.

The Empire of Trauma: An Inquiry into the Condition of Victimhood

The Empire of Trauma: An Inquiry into the Condition of Victimhood