Scholars examining American psychiatry in World War II have tended to find a quick development of modalities to treat combat exhaustion and a tremendous growth in post-war mental health disciplines and popularity.
But the path taken was actually long and tortuous. Indeed, for most of the war, despite military, medical, and public outcry, American psychiatry concentrated almost exclusively on psychiatric examinations. Convinced that some were more “predisposed” than others to breakdown, psychiatrists gave routine examinations to everyone before and after induction, rejecting and discharging on neuropsychiatric grounds 2 and a half million compared to 16 million altogether in service.
Without a uniform classification system, psychiatric diagnoses were inconsistent and contradictory. With each examination no more than a few minutes, psychiatrists engaged in gut reactions, reflecting contemporary regional, racial, or sexual bias. Under scrutiny, adamant in their predictive expertise, they engaged in public relations and added to their repertoire equally flawed written personality tests. Prediction not working, psychiatric discharges mounted despite rising rejections.
General George Patton ‘s slapping two neuropsychiatric patients in military hospitals in Sicily and ordering them to the front was in no way aberrant. While Eisenhower, Marshall, and Roosevelt deplored his methods, they equally apprehended psychiatry’s drain on manpower. As more and more were killed and wounded, concerns rose further, culminating in the Army Inspector General’s three 1945 investigations of psychoneuroses.
Even worse was the incomprehensibility to many of psychiatrist Harry Stack Sullivan’s and others’ expansion of “mental illness” to cover “maladjustment.” How could psychiatrists evacuate those perfectly capable of combat, when the profession itself differed on who was ill, Marshall pondered. Americans back home were equally intolerant of apparently normal psychiatric 4Fs while Fathers served.
Ironically, modalities of treatment and prevention did finally emerge and post-war psychiatry’s stature bloomed. Why and how are subjects for another day.