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A large number of medical officers in the armed forces have expressed their desire for further postgraduate education in psychiatry. Existing training facilities are not adequate to meet those immediate postdemobilization demands, and it is necessary that they be created if we ever hope to progress to a solution.
Psychiatric education cannot be content to confine itself to the medical school student or even the psychiatric intern or resident or fellow. Psychiatric education has to include the public at large. For example, the families and the employers of the mentally ill patients need to know simple basic psychiatric principles or fundamentals if they are to be expected to aid the patient's future adjustment. It is futile to consume weeks and months in the treatment of a mentally sick patient only to have such benefits nullified by the ignorant rejection of a prospective employer or the well-intentioned but poorly directed questions of his family. People have to be taught not only that the mentally ill are sick people, but also that a large percentage recover.
We as a nation have to learn that there is much to be gained in using the partial services of the temporarily disabled and even in some instances the permanently disabled. The huge cost of forcing a high percentage of these persons to be economic invalids is not only wastefully extravagant but detrimental to the national morale. The punitive attitude which characterizes most persons' intolerance of the emotionally disturbed is as anachronistic in our day and time as it is to cry at a leper "unclean.” This is a job to be done which requires operations on a large community scale.
We have no desire to prolong this discussion, the issues at stake and the benefits to be achieved appear to be quite obvious. It seems to us to be mandatory that something be done quickly to coordinate and correlate the individual contributions of isolated groups and individuals who are struggling with a task which is beyond their personal resources. The scientific potentialities of coordinate action in education, research, and development have already been favorably demonstrated in other fields; the impetus which is needed in the field of psychiatry is provided by this bill. In order to begin to solve the mental health problem, it will be necessary to make possible
1. An opportunity to do large-scale research. 2. An opportunity to coordinate the products of such research on all levels.
3. An opportunity to assist both public and private agencies in their worth-while endeavors in this field.
4. An opportunity to make this worth-while contribution available so that continued profit from further research can accrue.
5. And finally, to provide training and instruction for the men upon whom the great responsibility for the successful carrying out of this work will devolve, the teachers.
To quote a statement in the 1944 Report of the Rockefeller Foundation:
It is not too much to assert that in its actual and potential contribution to general medicine, to education, to sociology, indeed, to the general business of living, psychiatry, without claiming omniscience in itself, is cast for a role of fundamental importance in helping to shape any world that may come out of the present one.
Mr. PRIEST. Dr. Braceland, do you have any figures on the number of men in the naval service who may now be receiving treatment for mental ills, or who have been discharged because of some form of mental disorder?
Dr. BRACELAND. I can give you some rough estimates, sir. The incidence of actual mental disease, or insanity, runs about one-tenth of one percent of the total strength of the Navy. That is the incidence of actual mental diseases, which require hospitalization. The number of Naval Service men who have been discharged for all psychiatric reasons, from January 1942, to July 1945, is in the neighborhood of 72,000. That figure includes all sorts of illnesses which come under the heading of emotional difficulties. That is rather a small figure, but we have been extremely careful in our screening procedures. We have screened the men, not only at the induction centers, but we have screened them carefully in the training centers. We felt that if it were possible to detect these illnesses before the men got out at sea, we would be saving them and every one concerned. Thus our figures also show some 88,000 discharges from the training stations, although these are simply boys who come to the training station, spend a few days, and are given inaptitude discharges, our discharge rate is not inordinately high. The reason it is not is because we have screened at every possible opportunity.
Mr. PRIEST. The selective service boards also have rejected quite a number, originally?
Captain BRACELAND. Yes, sir. Mr. PRIEST. In their examination before induction. General Hershey is to be before the committee tomorrow. He was unable to come here today. I am sure he will be able to give us some figures on that angle of it tomorrow.
Do you have a question, Mr. Chapman?
Mr. CHAPMAN. I believe you have made a very fine statement, Captain. Now, do you believe that if even a very small proportion of the expenditures now made for the care and custody of these unfortunate people were devoted to a study of the disease the problem would not be nearly as serious as it is?
Captain BRACELAND. I am sure it would not be, Mr. Chapman. It is only in the last 15 years that any concerted effort has been made to treat these patients. The last 15 years have seen the advent of the shock treatment for mental diseases, insulin, metrozole, electric shock and numerous other treatments which have contributed to a more dynamic approach by psychiatry, and not merely custodial as it was before that.
Mr. CHAPMAN. With regard to the institutions, they have not had the necessary people to give special treatment along this line, have they?
Captain BRACELAND. I have no figures, but I think that is so. (The matter referred to is as follows:)
Washington 25, D. C., September 21, 1945. Hon. J. PERCY PRIEST,
House of Representatives, Washington, D. C. DEAR CONGRESSMAN PRIEST: Captain Braceland, who represented me at the meeting of your committee and who testified at the hearing on H. R. 2550, tells me that you requested some statistics regarding neuropsychiatric casualties.
I believe the following statistics are the ones in which you are interested: For the years 1942, 1943, 1944, and the first 6 months of 1945, there were 72,044 separations from the naval service for neuropsychiatric disabilities. This represents an average rate of 7.97 per thousand total naval and Marine Corps strength for this period of time. Over the same period there were 10,982 psychotic patients (insane) admitted to psychotic hospitals. This is an incidence of 0.11 percent per thousand total strength for this time.
One other factor which must be considered, however, is that over that same period of time 88,241 enlisted and inducted recruits were given inaptitude discharges which disqualified them for naval service. This latter figure includes educational and mental deficiencies and neurological disorders. Actually, this last group never really got under way in the Navy and were eliminated at the training stations. I hope this information is what you desire and that it will clarify the record, Sincerely yours,
Ross T MCINTIRE,
Surgeon General, United States Navy.
It will be necessary for us to adjourn this hearing rather shortly because we have on the floor of the House a rather important biil under the 5-minute rule for amendments coming up immediately when the House meets today.
Without following the regular order of witnesses, if there is someone here who would like to appear before the committee, and who is here for that purpose, and could make about a 10-minute statement, we would be glad to spend that much time before we adjourn. If not, the committee will now stand adjourned until 10 o'clock tomorrow morning
(Whereupon the committee, at 11:45 a. m., adjourned until 10 a. m., Wednesday, September 19, 1945.)
NATIONAL NEUROPSYCHIATRIC INSTITUTE
WEDNESDAY, SEPTEMBER 19, 1945
HOUSE OF REPRESENTATIVES,
Washington, D. C. The subcommittee met at 10 a. m., the Honorable J. Percy Priest (chairman of the subcommittee) presiding.
Mr. PRIEST. The committee will be in order for the resumption of hearings on H. R. 2550. We are very happy to have General Hershey with us this morning. You may proceed with your statement, General.
STATEMENT OF MAJ. GEN. LEWIS B. HERSHEY, DIRECTOR,
SELECTIVE SERVICE SYSTEM
General HERSHEY. Mr. Chairman and members of the committee, it is not my purpose to attempt to analyze, or support, or not support this bill. It would be a presumption on my part as a layman to attempt to go into this field. I feel if I can make a contribution to the committee it will be by making available to you our experience during the last 5 years in examining or presenting for examination men to the land and naval forces, and make available the statistics that we have built up over the years on the rejections for causes that are somewhere associated with the group that this bill means to study, or analyze, or cure.
I have two studies which have been made by our statistical department on the question of mental diseases, and on the question of educational deficiency, which may or may not be quite as closely allied.
I will be glad to submit those for the record. I think they are too long, and they are things you will want to study, rather than have me discuss.
Mr. PRIEST. I am sure they will be very helpful in the record, and without objection they will be included.
(The studies referred to will be found at the end of General Hershey's statement. See p. 38 and p. 115.)
General HERSHEY. I would like to call the attention of the committee also to an article which appeared in the August 11th issue of the American Medical Association Journal, by the former chief of my Medical Division, Col. Leonard G. Rountree, assisted by Mr. Kenneth H. McGill, the statistician, and Mr. Hellman, which has to do with “Mental and Personality Disorders in Selective Service Registrants.” It is on pages 1084 to 1087, and it contains very