War & military mental health: the US psychiatric response in the 20th century

Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan

IMPORTANCE

In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response.

OBJECTIVE

To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk.

MAIN OUTCOMES AND MEASURES

The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting.

RESULTS

Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

The model of psychological safety of a soldier's personality

BACKGROUND

From 2014 to the present, Ukrainian military personnel have been fighting in Eastern Ukraine against illegal armed formations of separatists. The resulting combat stress negatively affects servicemen's mental health status. This study aimed to examine the factor structure of a scale to assess the psychological safety of a soldier's personality (PSSP), taking into account changes in the conditions of military service to improve the professional and psychological training of military personnel.

PARTICIPANTS AND PROCEDURE

The study involved 118 officers of the National Guard of Ukraine. The semantic differential method, expert judgment, and exploratory factor analysis were used to determine the factor structure of the PSSP.

RESULTS

The PSSP model to maintain combat readiness in daily activities includes four components: "Moral and communicative", "Motivational and volitional", "Value and meaning of life" and "Inner comfort". For activities in extreme conditions (during combat deployment), the personality potential of four structural components is used: "Moral and volitional regulation", "Coping strategies", "Value and meaning of life" and "Post-traumatic growth/regression".

CONCLUSIONS

The PSSP model consists of four components that have different content depending on the conditions for performance of professional tasks by military personnel. It is advisable to use the obtained results of the content of the PSSP model in the development of professional and psychological training programs for the purposeful formation of the resilience of military personnel, taking into account the conditions of their activities.

Getting On in Gotham: The Midtown Manhattan Study and Putting the "Social" in Psychiatry

In the spring of 1962, a series of alarming headlines greeted American newspaper readers. From "New York Living for Nuts Only" and "One in Five Here Mentally Fit" to "Scratch a New Yorker, and What Do You Find?" and "City Gets Mental Test, Results are Real Crazy," the stories highlighted the shocking and, to some, incredible statistics that fewer than one in five (18.5%) Manhattanites had good mental health. Approximately a quarter of them had such bad mental health that they were effectively incapacitated, often unable to work or function socially. The headlines were gleaned from Mental Health in the Metropolis (1962), the first major output of the Midtown Manhattan Study, a large-scale, interdisciplinary project that surveyed the mental health of 1660 white Upper East Side residents between the ages of 20 and 59. One of the most significant social psychiatry projects to emerge following the Second World War, the Midtown Manhattan Study endeavored to "test the general hypothesis that biosocial and sociocultural factors leave imprints on mental health which are discernible when viewed from the panoramic perspective provided by a large population." Despite initial media and academic interest, however, the Midtown Manhattan Study's findings were soon forgotten, as American psychiatry turned its focus to individual-rather than population-psychopathology, and turned to the brain-rather than the environment-for explanations. Relying on archival sources, contemporary medical and social scientific literature, and oral history interviews, this article explains why the Midtown Manhattan Study failed to become more influential, concluding that its emphasis on the role of social isolation and poverty in mental illness should be taken more seriously today.

"Missing in Action" in Psychiatric Nursing History: The Role of Chief Nurse Adele S. Poston and Her Band of Nurses During World War I

This is the first nursing journal article to introduce the pioneering work of American psychiatric nurse leader, Adele S. Poston. Poston supervised a team of nurses as they cared for soldiers serving with the American Expeditionary Forces during World War I in France. Poston and her nurses worked in the first American specialized neuropsychiatric hospital in a war. The soldiers they treated primarily had functional nervous disorders described at that time as "shell shock" or "war neuroses." The traumatized officers and enlisted men were considered capable of being cured and returned to active duty based on research done by American psychiatrists among British troops during the first 3 years of the war. The story of Poston's career prior, during, and after the war and her work with other nurses during a global war are significant in psychiatric nursing history. Bringing this hitherto missing piece of psychiatric and nursing history into the light gives us a unique opportunity to recognize Poston and the nurses who served with her, even as today we recognize the nurses who serve during the global COVID-19 pandemic. [Journal of Psychosocial and Mental Health Services, 59(6), 37-47.].

Rehabilitating the mind: Avatar (2009), Inception (2010) and the science fiction imagining of lucid dreaming in the treatment of post-traumatic stress disorder in the U.S. military

Transcultural psychiatry has increased awareness of alternative approaches to mental health and wellbeing, influencing developments in Western psychotherapeutic treatments. In this article, I look at the recent interest in alternative therapies by the U.S. military, which has explored the possibilities of lucid dreaming in order to help soldiers cope with the adverse mental and emotional effects of combat-commonly referred to as post-traumatic stress disorder (PTSD). In this context of concerns about effective rehabilitation and the cost of veteran care, I examine the popular science fiction films Avatar and Inception, which have been discussed in the media as illustrations of the potential use of lucid dreaming and digitally created virtual worlds to "heal" the minds of soldiers affected by modern warfare. In these media portrayals, psychology and science fiction come together to envision and promote human-machine fantasies of the endlessly salvageable and, therefore ultimately, invincible American soldier.

After crisis: health, politics and reflections on the European refugee crisis

The years 2014 and 2015 saw a dramatic rise in the number of migrants entering Europe via the Mediterranean. This rise was mostly accounted for by refugees fleeing the civil war in the Syrian Arab Republic. Since that time Europe has been gripped in a political and humanitarian crisis as the incoming numbers overwhelmed individual state and collective European Union ability to respond effectively. In this article, I explore the European Migrant Crisis in geographical, political and humanitarian perspectives, describing and explaining the key events of the crisis. I then go on to a study of the major health issues arising from the crisis in terms of communicable and non-communicable disease, mental health, gender-related health and access to healthcare. Finally, I discuss the global dimensions of the refugee crisis and enter into a discussion of the roles and effectiveness of the UNHCR and the European Union's response as a whole.

Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis

Intimate partner violence (IPV) is a global health issue that impacts both civilian and military populations. Factors associated with military service may result in increased risk of IPV perpetration among Veterans and Active Duty military personnel. Six bibliographic databases were searched to identify studies that estimated the prevalence of IPV perpetration among military populations by sociodemographic and military characteristics. Where possible, random effect meta-analyses were conducted to determine pooled prevalence estimates. 42 studies were eligible for inclusion in this systematic review. 28 of these studies met the requirements for inclusion in subsequent meta-analyses. Among studies that measured past-year physical IPV perpetration, the pooled prevalence was higher among men compared to women (26% and 20% respectively). Among Veterans, there were consistently higher prevalences compared to Active Duty samples. Similarly, higher prevalences were found among studies in general military settings compared to clinical settings. Further research that considers the impact of the act(s) of IPV perpetration on the victims is needed. This, along with the use of a consistent measurement tools across studies will help to develop a stronger evidence base to inform prevention and management programs for all types of IPV perpetration among military personnel.

Mental Health in the UK Police Force: a Qualitative Investigation into the Stigma with Mental Illness

Police work is a high-risk profession that can cause mental health conditions. With increasing sickness levels and falling police numbers, it is essential prompt mental health treatment be implemented. The study aims to explore institutional negativity and stigma in the police force towards mental ill health. Semi-structured interviews attended by five police officers with thematic analysis captured (i) police culture, (ii) the stigma of mental illness, (iii) disclosure of mental illness and (iv) breaking down barriers. Findings indicate police culture and attitudes to mental health may contribute to the causes of psychological illness, rather than the nature of the job itself. Increased education and awareness surrounding mental health have been shown to be fundamental in how an officer reacts to stress, but change is needed at a managerial level. Future research needs to explore the effects of mental health stigma on ethnicity and gender in the police force.

Analysis of Mutants Suggests Kamin Blocking in C. elegans is Due to Interference with Memory Recall Rather than Storage

Higher-order conditioning phenomena, including context conditioning and blocking, occur when conditioning to one set of stimuli interacts with conditioning to a second set of stimuli to modulate the strength of the resultant memories. Here we analyze higher-order conditioning in the nematode worm Caenorhabditis elegans, demonstrating for the first time the presence of blocking in this animal, and dissociating it from context conditioning. We present an initial genetic dissection of these phenomena in a model benzaldehyde/NH₄Cl aversive learning system, and suggest that blocking may involve an alteration of memory retrieval rather than storage. These findings offer a fundamentally different explanation for blocking than traditional explanations, and position C. elegans as a powerful model organism for the study of higher order conditioning.

Male psychosexual therapy in the UK military

Military personnel can experience psychosexual difficulties for a variety of reasons. Problems can arise because of psychological trauma, physical injury, consequences arising from pharmacological and surgical complications and social or emotional concerns relating to intrapersonal and interpersonal relationship dynamics. Such individuals might seek to minimise or avoid resolving their pertinent difficulties, while others can experience cultural, personal or organisational barriers to accessing professional help. This paper offers an overview of the development of a national specialist psychosexual therapy service (PST), commenting specifically on the service delivery for male military personnel. It will also consider factors which may support progress in treatment and reflect upon the importance of considering psychosexual functioning in relationships as part of the broader service-life context, which is especially relevant to military personnel.

Older Military Veteran Care: Many Still Believe They Are Forgotten

BACKGROUND

Almost 44% of our nation's 23 million men and women veterans are 65 years of age or older. Most are proud of their service, yet many believe their services for our country were forgotten, especially those in combat between 1950 and 1975.

PURPOSE

Further information to ultimately assist their holistic well-being will be important for nursing practice as countless older veterans are beginning to obtain more care within civilian facilities. Using the Korean War (1950-1953) as a backdrop to illustrate the interconnectiveness of older veteran physical, emotional, and spiritual concerns that can occur from a military deployment, the major purposes of this article are to provide a brief historical snapshot of that war and discuss prior-era military environmental situations that now are producing the lingering effects from their combat exposure.

DESIGN

Relevant literature about the Korean War and Veterans was compiled.

FINDINGS

Some of these health risks for both the Korean men and women veterans are cold exposure, neurologic, and posttraumatic stress disorder concerns, as well as the need for hepatitis C and suicide assessments.

CONCLUSIONS

To ultimately improve their bio-psycho-socio-spiritual well-being, prompt identification of the older military veteran, their lingering combat effects, and reminiscing will be important.

Tobacco and alcohol use, sexual behavior and common mental disorders among military students at the Police Academy, São Paulo, Brazil. A cross-sectional study

CONTEXT AND OBJECTIVE

The lifestyle of military personnel has been little studied in Brazil. This study evaluated the frequencies of tobacco and alcohol use, sexual behavior and mental health among military students.

DESIGN AND SETTING

Cross-sectional study at the Police Academy, in São Paulo.

METHODS

Students answered a questionnaire about tobacco use, alcohol consumption, sexual behavior and common mental disorders (CMDs). To analyze associations among the frequencies of smoking and alcohol use, sexually transmitted diseases (STDs) and CMDs during the undergraduate years, we built a multinomial logistic regression model adjusted for age and sex.

RESULTS

All 473 students were invited to participate and 430 (90.9%) agreed (10.5% were women). Most were white (76.6%), aged < 30 years, from the upper middle class (78.1%). The frequency of smoking was 6.5%, alcohol consumption 69.3%, STDs 14% and CMDs 15.6%. The use of condoms was low. Fourth-year students presented a lower odds ratio (OR) for STDs than the first-year students: 0.44 (95% confidence interval: 0.22-0.90). Third-year students presented a lower OR for CMDs than the first-year students.

CONCLUSION

The frequencies of smoking and CMDs were low, while the frequency of alcohol consumption was similar to that of the Brazilian population. The use of condoms was low, in comparison with previous studies with similar samples. The results suggest that there was a certain degree of protection against CMDs and STDs during the undergraduate years.

Factors underlying the psychological and behavioral characteristics of Office of Strategic Services candidates: the assessment of men data revisited

During World War II, the Office of Strategic Services (OSS), the forerunner of the Central Intelligence Agency, sought the assistance of clinical psychologists and psychiatrists to establish an assessment program for evaluating candidates for the OSS. The assessment team developed a novel and rigorous program to evaluate OSS candidates. It is described in Assessment of Men: Selection of Personnel for the Office of Strategic Services (OSS Assessment Staff, 1948). This study examines the sole remaining multivariate data matrix that includes all final ratings for a group of candidates (n = 133) assessed near the end of the assessment program. It applies the modern statistical methods of both exploratory and confirmatory factor analysis to this rich and highly unique data set. An exploratory factor analysis solution suggested 3 factors underlie the OSS assessment staff ratings. Confirmatory factor analysis results of multiple plausible substantive models reveal that a 3-factor model provides the best fit to these data. The 3 factors are emotional/interpersonal factors (social relations, emotional stability, security), intelligence processing (effective IQ, propaganda skills, observing and reporting), and agency/surgency (motivation, energy and initiative, leadership, physical ability). These factors are discussed in terms of their potential utility for personnel selection within the intelligence community.

Psychiatric ethics in war and peace

Practice of psychiatry is a complex activity because the psychiatrist generally practises his art in an emotionally charged environment with patients who may not be in a in a state of mind to exercise autonomy as a result of cognitive impairment and preoccupation with symptoms. No one principle of ethics will be suitable to guide right conduct in widely variable situations. Making ethical judgements in the military context can be difficult and may have potential for abuse as for an uniformed psychiatrist mission takes priority over man. However mission centered and medical text book centred ethics need not be compartamentalised. The present paper seeks to offer a brief overview of ethical principles and specific situations in which one may have to make ethical judgements.

The Adjustment of New Recruits to Military Life in the Chinese Army

In this article, the authors present the findings of two studies analyzing new recruits' adjustment to army life in the Chinese military. In the first exploratory study, we developed a scale to measure new recruits' adjustment to military life, and found that new soldiers' adaptation could be divided into two distinct types: interpersonal adjustment and training adjustment. Interpersonal adjustment was a soldier’s ability to build harmonious relationships with peer soldiers, supervisors, and military officers. Training adjustment was a soldier’s ability to achieve standards of professional competence and military training. Based on the findings of this first study, the authors conducted a second study to investigate the predictive power of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) on new recruits' adjustment. The results of this longitudinal study indicated that MMPI-2 could predict the initial stages of both interpersonal and training adjustment, as well as the subsequent change rate of these two types of adjustment. Our analyses have several important implications for recruiting, selecting, and training Chinese military leaders and human resource professionals.

Medical science and the military: the Allies' use of amphetamine during World War II

Although amphetamine was thoroughly tested by leading scientists for its effects in boosting or maintaining physical and mental performance in fatigued subjects, the results never provided solid grounds for approving the drug's use, and, in any case, came too late to be decisive. The grounds on which amphetamine was actually adopted by both British and American militaries had less to do with the science of fatigue than with the drug's mood-altering effects, as judged by military men. It increased confidence and aggression, and elevated "morale."

VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses

Little is known about mental health services utilization among Iraq and Afghanistan veterans receiving care at Department of Veterans Affairs (VA) facilities. Of 49,425 veterans with newly diagnosed posttraumatic stress disorder (PTSD), only 9.5% attended 9 or more VA mental health sessions in 15 weeks or less in the first year of diagnosis. In addition, engagement in 9 or more VA treatment sessions for PTSD within 15 weeks varied by predisposing variables (age and gender), enabling variables (clinic of first mental health diagnosis and distance from VA facility), and need (type and complexity of mental health diagnoses). Thus, only a minority of Iraq and Afghanistan veterans with new PTSD diagnoses received a recommended number and intensity of VA mental health treatment sessions within the first year of diagnosis.

Forever changed: posttraumatic stress disorder in female military veterans, a case report

PURPOSE. This paper examines the experience of posttraumatic stress disorder (PTSD) in a female veteran of Operation Iraqi Freedom, including the barriers to treatment she encountered in an outpatient psychiatry clinic. DESIGN AND METHODS. Case report data were obtained through review of records and interviews with a veteran combat nurse diagnosed with chronic PTSD. CONCLUSIONS. Sex differences in PTSD are controversial, but PTSD in female military veterans is a significant problem. Gender may complicate diagnosis and treatment. This case report discusses these issues and invites further research. PRACTICE IMPLICATIONS. Advanced practice psychiatric nurses increasingly will see female veterans with PTSD in their practices.

Caring for Active Duty Military Personnel in the Civilian Sector

Due to the wars in Iraq and Afghanistan, the unmet medical and psychological needs of military personnel are creating major challenges. Increasingly, active duty military personnel are seeking physical and mental health services from civilian professionals. The Civilian Medical Resources Network attempts to address these unmet needs. Participants in the Network include primary care and mental health practitioners in all regions of the country. Network professionals provide independent assessments, clinical interventions in acute situations, and documentation that assists GIs in obtaining reassignment or discharge. Most clients who use Network services come from low-income backgrounds and manifest psychological rather than physical disorders. Qualitative themes in professional-client encounters have focused on ethical conflicts, the impact of violence without meaning (especially violence against civilians), and perceived problems in military health and mental health policies. Unmet needs of active duty military personnel deserve more concerted attention from medical professionals and policy makers.

Cultural and social history of psychiatry

PURPOSE OF REVIEW

The purpose of this review is to highlight recent English language literature in the cultural and social history of psychiatry. It considers publications from 2007 and early 2008, as well as a few important older works that have not yet been reviewed in this journal.

RECENT FINDINGS

Cultural and social historians of psychiatry are incorporating a growing number of historical objects into their narratives and developing new methodological techniques that can accommodate the full diversity of psychiatry's hybrid past. Increasingly, these histories are coming to be written in terms of multilateral and multivalent interactions with various other disciplines and organizations. In crafting these new narratives, historians face a confusing panoply of historical agents and events, reminding them that like the discipline of psychiatry itself, theirs too is a heterologic undertaking, grappling to understand and explain the otherness of psychiatry's past.

SUMMARY

This review surveys the scholarly literature in several specific areas that have attracted the attention of historians of psychiatry in recent years. In particular, it considers work in the history of psychiatric institutions, borderline disorders, 20th-century somatic therapies, military psychiatry, and colonial psychiatry.