Historic WWII Era Film on PTSD

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

http://www.filmpreservation.org/preserved-films/screening-room/let-there-be-light-1946 

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 about 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. 

Wartime atrocities

The recent mass murders in Afghanistan and the analysis of the events in the press highlight my contention from an earlier post that the press really does not do a good job in these situations. We can expect a continued exhaustive risk factor analysis and discussions by various pundits. The accused soldier clearly had a lot of exposure to combat stress, there is a history of traumatic brain injury, there is a possible history of substance abuse, and there are multiple psychosocial factors. So far we have seen the statements by people who knew him describing this event as completely unpredictable based on his past behavior. The debate will become more polarized as the lawyers get involved. The real truth of the matter is never stated.

What we know about these incidents is more accurately described by anthropologists than psychiatrists or psychologists. The best book written on this subject is Lawrence Keeley’s War Before Civilization.  In that book Dr. Keeley explores the contention that primitive peoples were inherently peaceful compared to modern man and a warfare that was waged was brief, fairly nonlethal, and stereotypic. In order to explore that theory, Dr. Keeley ends up writing a fairly definitive book on the anthropology of warfare. There are more lessons in that book about war and peace then you will ever hear on CNN or in the risk factor analysis that is produced in the popular media.

So what do we know about the mass murder of civilians during warfare? The first thing we know is that it is commonplace. It happens in every war and no military force despite their level of training is immune to it.  In prehistoric times, the most frequent scenario was a surprise attack on a village with the goal of killing as many inhabitants as possible. In Keeley's review, that number was generally around 10% of the population and that could have devastating consequences for a particular tribe including the complete dissolution.

Keeley also makes the point that: “Only the "rules of war," cultural expectations, and tribal or national loyalties make it possible to distinguish between legitimate warfare and atrocities.”  He gives the examples of Wounded Knee and My Lai as well as larger scale bombings of Hiroshima and Dresden.  My Lai was a highly publicized incident from my youth. It occurred during the Vietnam War when the US Army massacred hundreds of Vietnamese noncombatants – largely women, children, and old men.  In that situation, 26 soldiers were charged and only one was convicted. The convicted soldier served 3 1/2 years under house arrest.

In addition to outright killing, mutilations of bodies and the taking of body parts as trophies continue to occur in modern civilized warfare in much the same way that these practices occurred in primitive warfare.  Haley reported on a series of Vietnam veterans seen in psychotherapy and the special problems that exist in patients who have been exposed to or participated in wartime atrocities. Based on the literature at the time she suggested that the war in Vietnam resulted in a disproportionate number of atrocities.

My current final analysis of the situation is that there are important social and cultural determinants of war and the inevitable wartime atrocities. Risk factor analysis and analysis of individual biology is very unlikely to provide an explanation for what occurred. The moral, legal, and political environment has changed since Vietnam and that is obviously not a deterrent. A comparison of the final legal charges and penalties in this case with what happened in Vietnam will be instructive in terms of just how far those changes come. If there is a conviction, there will be a lot of pressure to portray the convicted soldier as very atypical and probably as a person who underwent a significant transformation of his conscious state.  There will be many theories. The idea that this transformation predictably occurs during warfare will not be discussed. I have already heard some experts talking about the thousands of soldiers who go though similar situations and seem to do just fine.

The best approach to these events is a preventive one that includes minimizing the exposure to war instead of being involved in the longest war in American history.  I don't expect that much will be said about that either.

George Dawson, MD

Lawrence H. Keeley. War Before Civilization. Oxford University Press, 1997.

Haley SA. When the patient reports atrocities. Specific treatment considerations of the Vietnam veteran. Arch Gen Psychiatry. 1974 Feb;30(2):191-6.