Saturday, May 26, 2012

Historic WWII Era Film on PTSD

An historic film by John Huston on PTSD is available at: 

This is an actual film of veterans being treated. Very interesting film from an historic and psychiatric perspective. Also interesting from a propaganda perspective. One of my first teachers in psychiatry was a WWII psychiatrist who went through an expedited residency in order to treat combat neurosis.  The attached notes about the making of the films is also interesting in terms of the way it is structured, the total footage shot to get this final cut version and why this particular facility was used. 

As an example Huston comments on the treatment process at the hospital he chose for the film: " The hospital admitted two groups of 75 patients each week, and the goal was to restore these men physically, mentally and emotionally within six to eight weeks, to the point where they could be returned to civilian life in as good condition—or almost as good—as when they came into the Army…  "  Just doing the arithmetic, with what we know abut the scale of WWII, that would suggest that most veterans with PTSD never got treated.

He also commented on the goal of the film: "[The purpose] was to show how men who suffered mental damage in the service should not be written off but could be helped by psychiatric treatment….".  That message seems to continuously escape the politicians responsible for war making and repairing the damage afterwards.

The original film was suppressed by the Army and the US Government who suggested that privacy considerations were the reason.  All the men in the film had signed releases for the filming, but at one point those releases disappeared.  During an attempted screening of the film, military police showed up and confiscated a copy.  The author of the Film Notes suggests a few reasons for the suppression of the film as well as discussing the innovative and artistic points.

From a psychiatric standpoint, the use of drug therapy by psychiatrists in film was cutting edge.  According to Gabbard and Gabbard the first film depictions of drug therapy occurred in 1947 (Possessed) and 1949 (The Home of the Brave).  In their book they mention Let There Be Light (1946) as the third depiction of narcosynthesis.  It  also reminded me of The Snake Pit (1948) in that the psychiatrists are portrayed as being generally effective.

From a cultural and political standpoint, the film and Huston’s intentions stand in contrast to the atmosphere today where psychiatrists are portrayed in the media as inept tools of pharmaceutical companies who thrive on prescribing ineffective treatments.  In the film notes section, Huston describes the transformation of some of the patients as “miraculous”.  At some level, there has to be skepticism on the treatment effort and outcomes.  For example, there is an overall lack of aggression and severe depression in the veterans filmed for this project.  In my experience in several different VA facilities those are common problems as a result of combat stress exposure.

As a kid walking 5 blocks to elementary school every day, I encountered veterans with clear problems that were explained to me at the time as being “due to the war.”  In some cases more specific etiologies were suggested like: “he got malaria in the war”.  That was in the late 1950s.

As a civilian, I had no idea what exposure to combat stress could do until I was a psychiatric resident working in a VA hospital.  By that time we had already been through the Vietnam War and any consideration of the impact that war had on veterans was secondary to the over-the-top politics associated with an unnecessary war.

Maybe things would have been a lot different if the Army had allowed a broad release of this film.

George Dawson, MD, DFAPA

Gabbard K, Gabbard GO.  Psychiatry and the Cinema. The University of Chicago Press, Chicago, (1987) p 70-71. 

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