Work for Air Raid Victims
The Editorial Board does not hold itself responsible for the opinions of contributors yol. II. No. 1 JANUARY 1941 Price lOd. (1/- Post Free) Some Preliminary Notes on Mental Health
- Author:
Priscilla Norman
Chairman, Mental Health Emergency Committee
These notes cover the whole period of the Blitzkrieg and therefore deal, in part, Wlth conditions which have by this time either been remedied or are now in process of being remedied. As one new area after another is attacked, increased experience ls acquired as to the best method of dealing not only with those who are rendered homeless but with the much larger number whose daily lives are seriously affected by the temporary suspension of vital services. We are concerned here only with ?ne particular aspect of the whole problem and it may therefore appear that undue Prominence has been given to it, but we fully recognize that during the actual Blitz Period, the first concern of public authorities and voluntary helpers must be in the direction of rescue work for its victims, including the provision of shelter, warmth and food, and that only after these essential widespread needs have been met, can Mention be paid to the special problems of exceptional individuals.
The information which follows is derived largely from the Mental Health emergency Committee’s workers in Rest Centres and Reception Areas, from the 0cial Case Work Department of the Central Association for Mental Welfare which w?rks in close touch with the Committee and to which many emergency cases are referred direct, and from reports of members of the Committee and of its other c?nstituent bodies.
Our experience of bombing and its aftermath has now been extensive enough to fnable us to make some estimate as to its immediate effect on mental health, although ultimate effects must continue to be unknown until a further period of time has ^Psed. It is proposed in this article to give some idea of the problems with which ental Health workers have been called upon to deal in raided areas, of the lines ?n which they have attempted to solve them and of the further measures which it is Proposed should be taken before the need is fully met.
On one point there is striking unanimity, viz. that there are unexpectedly few Cases ?f severe emotional or mental disturbance following immediately on the experience of being ” bombed out One worker in a large East End Rest Centre comments on this as follows:
” In some cases, excitement and mild hysterical outbursts showed themselves amongst the little parties of people coming from a bombed house or street. In others, apparent indifference, slight irritation, bewilderment or boastfulness, were the outward signs of inward disturbance. Children seemed on the whole to be remarkably little disturbed.”
Another, writing from an area in the North-West, testifies to the wonderful way in which the ” bombed out ” seem to recover, and from the West Country comes the statement: ” Generally speaking, strain does not show during the first ten days.” Even in a Midland town where one night’s intensive bombing had subjected the population to a terrifying experience, the worker sent by the Mental Health Emergency Committee found that the chief ” Mental Health problems ” were those of long standing, intensified and thrown into prominence by the ” Blitz ” but not produced by it. It is true that 40 per cent, of the population had been evacuated before her arrival and that this number may have included those who suffered most acutely, and that there was an absence of continuous raids after the severe one, but nevertheless the absence of widespread loss of nerve is a striking testimony to the stability of the people.
The experience of Mental Treatment Clinics, Child Guidance Clinics and individual psychiatrists is in line with that of other workers, and contributions to The Lancet and the British Medical Journal* have commented on the fact that the advent of air attack has not resulted in any appreciable number of psychiatric cases directly attributable to it. Even in the Psychiatric Departments of large London Hospitals serving heavily and continuously bombed areas, only the merest handful of such cases have presented themselves for treatment, and the majority of these have a previous history of mental instability.
This initial immunity from ” shock ” may be due to a variety of factors?a feeling of gratitude for preservation from danger, the excitement of being suddenly thrust into prominence as a ” victim “, and the fact that neighbours are sharing the misfortune. In a Rest Centre, the care and ” mothering ” that is given to those who seek shelter there has the effect of temporarily dulling anxiety, allaying fear, and producing a sense of security which, although illusory, is of real help to those con- cerned. Moreover, the many opportunities which occur for helping others and giving useful service in the Centre, are also no doubt of therapeutic value as is, too, the provision of regular hot meals and other facilities, some of which were, at first, unfortunately absent in many of the Centres.
To organize in the Centres a regime which, whilst helping to prevent the develop- ment of psychological disturbance does not, at the same time, by providing complex security, encourage those it shelters to sink into an apathetic state of dependence (e.g. into the attitude that now they had lost everything, it was for the Government to see to all their needs) is obviously a task demanding considerable experience, * e.g. ” Psychiatric Casualties in September 1940 by George Pegge, M.A., M.R.C.S., L.R.C.P. October 26th, 1940.
wisdom and ingenuity. This particular problem was not envisaged at the outset and it is hardly surprising that the first emergency staffs without any special training and faced with gross material difficulties, failed to cope with it adequately. Too often they wavered between a too strict enforcement of discipline and too great leniency leading to the toleration of slack and casual behaviour, and often quite unwittingly, as ?ne worker writes, ” they ministered to the general sense of insecurity, while failure to issue clear, direct orders led to anxiety and confusion “. When the need was discovered steps were taken to meet it, and recently the Ministry of Health and Local Authorities have appointed a considerable number of Welfare Officers and Inspectors for Rest Centres. The special knowledge and training of the Mental Health worker has been found to be of great value in this connection, but it is obviously impossible even if it were necessary to have a Mental Health worker for every Centre and Shelter, ft is, however, essential that Medical Officers and workers in charge should know what local facilities exist for dealing with cases needing psychological or mental treatment or for securing provision for mental defectives, epileptics, etc.* The importance of transferring people from the Centres to billets without delay is a matter which has a definite bearing on Mental Health. As time goes on, workers find that signs of strain begin to manifest themselves; irritability increases and the desire to be helpful dies away. The neurotic, after a week or so, often begin to lapse into a state of depression. Personal antagonism and resentments flare up and increase, and some of the men take to drinking. Moreover, in every Centre appears, sooner or later, the type of neurotic who so completely and happily adapts himself t0 an environment in which he receives food, shelter and protection without the need for personal effort, that he manifests no desire ever to leave it, and considerable difficulty is found in persuading him to do so. An appreciable number of these cases have been referred to the C.A.M.W. and the Mental Health Emergency Coin- mittee. An adequate system of registration of people arriving at Centres is essential if this problem of ” drift ” is to be dealt with. At first, very naturally, in London, n? records were kept and people drifted in and out, without any enquiry being niade as to whether or not they were legitimately entitled to the facilities offered, 0r what was the nature of their particular needs. In this way, the hospitality of the Centres was abused by the unscrupulous, and others who desperately needed Personal advice and help followed by special billeting, were lost in the crowd and left ln a quite unnecessary state of anxiety.
Here again the trained helper is of inestimable value. Into a Shelter, after an ^tensive bombing, pours a cross-section of the local population in which there must ‘nevitably be individuals presenting special problems under normal conditions e.g. the neurotic and unstable, the epileptic, the mentally defective, the senile who should he sorted out and referred to the appropriate authorities and organizations. If this ‘s done expeditiously and wisely, many difficulties and delays in connection witn billeting will be avoided, but only workers familiar with the machinery of the various s?cial services are in a position to call in their help where needed. The disposal of ^ The National Council for Mental Hygiene has recently compiled for the Ministry of Health ?M.S. a Directory of Out-Patient Clinics (see page 19). the mentally defective has been in some areas a particularly urgent problem and one requiring the type of handling which can only be given by the trained worker. The following case also illustrates this need:
” B.M. is a single woman of 40. She was referred to the Mental Health Emergency Committee by a worker who discovered her in a Rest Centre which she was using simply because she was drifting about London and had no money to pay for lodgings, although she produced a completely fictitious story of having been bombed out. She had been in and out of numerous Convents but, when first seen, stubbornly refused to enter another one and asserted her suitability for domestic work, criticizing everyone for her repeated failures in life. An appointment was procured for her at a Mental Treatment Clinic where she was diagnosed as a chronic hysteric, probably unemploy- able. She was, with great difficulty, persuaded to accept a vacancy in a Convent which was found for her, and was accompanied there by a worker. After a few days, however, a report was received saying she refused to settle, and was determined to leave. Nothing has been heard of her since.”
Even under the best conditions, however, the help that can be given in the Rest Centre to individuals needing psychiatric treatment or the specialized services of a Mental Health worker, can only be in the nature of ” First Aid moreover, it is only the most obvious and acute cases which will probably be discovered. It is in the Reception Areas to which these homeless people are drafted, that the real extent of the need is clearly seen and where the greatest opportunities for constructive Mental Health work are to be found, and the Mental Health Emergency Committee has paid special attention to the devising of machinery for linking up workers dealing with cases in the Rest Centres with those in Receiving Areas where special billets are being sought.
An experimental scheme, on a small scale but yielding results so satisfactory that it is proposed to extend it if possible to other areas, was started in the autumn of 1940 and some account of the experience gained during these three months is given here in the hope that it may be interesting and suggestive.
One worker?whom we will designate as Worker A?was sent to a district of Greater London which received 1,700 evacuees from two badly bombed East End districts. To her 115 families (about 7 per cent, of the total number) were referred as being in need of special help by reason of some Mental Health problem produced or intensified by air raid experience. In a large proportion of these cases it was found that the emotional disturbance was not of a serious type and that the tension was quickly relieved by encouragement and reassurance and by the administration of some simple remedy such as glucose (reinforced by suggestion) for helping to induce sleep. In many cases much of the psychological suffering was due to the loneliness of unfamiliar surroundings and to lack of interest and occupation, and to remedy this state of affairs the worker co-operated actively with the Women’s Voluntary Services and other volunteers in the promotion of entertainments and friendly visiting? the provision of library facilities and the organizing of Play Groups for the children, in which latter activity the help of an educational psychologist was enlisted. There remained, however, a small group of individuals needing definite psychiatric treatment and advice, and for thirteen patients attendance at a Mental Treatment Clinic was arranged. In the majority of these cases, one interview with the psychia- trist was sufficient to bring about the necessary assurance, but there was a residuum |n which removal to an area outside the gun barrage was considered to be necessary the development of further trouble was to be prevented.
It was in these cases that the help of a second worker?Worker B?was called in. She was placed in a rural district of Warwickshire, to act as a Special Billeting Officer working in close co-operation with the ordinary billeting authorities. During two Months in the late autumn of 1940, sixteen cases (comprising forty-six individuals) were referred to her, the great majority coming from Worker A, and consisting of families in which one or more members were urgently in need of security and peace. To illustrate the type of problem presented by these cases, the following examples may be quoted:
The M’s. This family consisted of a grandfather of 79, a middle-aged father and mother, and a young daughter of 13?all of whom had been through particularly distressing experiences. The father (a stevedore at the Docks) had been injured in the street by a bomb and three days later the hospital to which he had been taken was hit. The other members of the family were in a shelter where four neighbours were killed, and they themselves received injuries. Moreover, the girl (” G.”) had on her knees a baby who was killed and (according to her story) when she put out her hand to stroke its head in the dark she found, to her horror, that the head had been blown off. When visited in the area to which they were first evacuated, all of them were in a very distressed condition. Mrs. M. ” fears she is going mad?is excessively irritable and worries lest she may hit G. Cannot sleep. Is anxious about wounds not yet healed.” Mr. M. ” cries very easily?very anxious about himself?gets very excited “. G. ” panics when she hears a gun?frightened if separated a minute from her parents “. Arrangements were made for them to be seen by a psychiatrist who urged evacuation to a country areai out of the range of gun fire, and considered that if this could be effected, no further treatment would be necessary. A small cottage was found for the whole family in which they have settled down happily, although on more than one occasion the help of the Mental Health worker has been needed to steer them through crises. The father later obtained unskilled labouring work and the latest report is that they are all making an unexpectedly good adjustment to village life. The K’s. Mrs. K., a young woman with three small children, was referred as being badly upset by bombing experiences. Before the birth of the baby she ” thought she was going mad ” and the eldest child (3 years) was found to be in a miserable condition of nerves and to be quite unmanageable. A psychiatrist to whom the case was referred considered that the family’s evacuation to a safe rural area was essential. A billet in the cottage of a friendly farm labourer’s wife was found, and after some preliminary difficulties the eldest child gradually became happier, and a cordial relationship was established with the household.
The A’s. Mrs. A. is a coloured woman with a negro husband (an ex-seaman) and three small ” piccaninnies “. She had had two previous mental breakdowns, was obviously very nervous and unhappy. The problem here was to find a billet where the ” colour bar ” would not create difficulty, and a village was obviously unsuitable. A search was therefore made in a neighbouring town and eventually a billet was secured with a woman whose first husband had been coloured and whose three children were of negroid type. The experiment has worked extraordinarily well and the two families soon became real friends. In view of Mrs. A.’s history of mental instability, however, close touch will be kept with her.
Out of the forty-six individuals dealt with under the scheme, only six returned Precipitately to London. This result has, however, only been obtained by dint of full complete co-operation between the two Mental Health workers concerned.
Thus Worker A, in the first reception area, before notifying a case for billeting to Worker B?in the rural area?collected all the information about it that was procur- able, and where necessary obtained a psychiatrist’s report on any member of the family who appeared to be in need of special treatment. In possession of this information, Worker B was then in a position to assess the type of billet required, and when a suitable offer v/as obtained, she would describe it in detail to Worker A, who would then discuss the proposal with the family concerned and help them to make the necessary arrangements for travelling, billeting allowances, etc. On arrival in the village, the evacuees were met by Worker B, who ensured that they received a welcome and that any initial difficulties with the householder were smoothed over at the outset. Having settled them down, the worker then kept a watchful eye over them, and was at hand to cope with any domestic or psychological crisis that might arise involving perhaps the need for a visit to a neighbouring Mental Treatment Clinic and/or a jaunt to the nearest town with a cup of tea at a restaurant (a procedure found to possess definite therapeutic value !). She was also frequently concerned with the task of helping the father or other employable members of the family to find work or deal with intricacies connected with the payment of allowances, or pensions, to say nothing of coming to the rescue in the various difficulties which arise when town-bred people are called upon to adapt themselves to village life.
In the achievement of this work, the greatest help has been received from local billeting officers, the Manager of the local Labour Exchange, the Women’s Voluntary Services and the Psychiatric Clinic, as well as from the villagers themselves who have shown unfailing kindness to the evacuees and included them in all their social activities. In fact, so far as this particular village is concerned, there has been?the worker writes?” no evacuation problem
The experiment has been admittedly on a small scale, but in assessing its value it should be remembered that the families concerned were selected not because of their special suitability for country life but because one or more members were showing signs of temporary emotional disturbance due to bombing. Haphazard billeting would have been unlikely to meet their special needs, and might have ended in disaster, but because of good team work carried through by trained workers, not only were all the employable evacuees absorbed into employment so that they were no longer a charge on public funds, but?still more important?frayed nerves have been healed, peace of mind has been restored and new hope has been given to those who were in the grip of fear, distress and anxiety. From this practical experiment, the Mental Health Emergency Committee concludes that a scheme worked on these lines is both practical and economical and brings the maximum amount of help to those suffering from the effects of air raids.
The Mental Health Emergency Committee is anxious to be of use to Authorities who are faced with the task of dealing with people rendered homeless through enemy action and hopes that it may be possible to give help wherever needed. The Ministry of Health has recently agreed to recognize, for purposes of grant, the employment by Local Authorities of a Mental Health worker for work amongst evacuated mothers and children (as well as amongst unaccompanied children), where it can be shown that the need exists, and the way is therefore open for an increased use of their services. As a further help, the Committee is seeking to appoint in each Civil Defence area a Regional Representative who will act as a link between the various Authorities and organizations whose work brings them into touch with Mental Health problems, and who will thus be in a position to give advice and ensure that workers throughout the area are fully cognizant of the facilities available. The Committee is also glad to arrange talks to groups of Inspectors, Welfare Officers or other workers employed in Rest Centres or Shelters, based on practical experience and giving information as to the sources from which help can be obtained for special cases.
The present situation offers a new opportunity for Mental Health work of a type that is urgently needed, and, if full advantage is taken of it, much suffering may be Prevented and in the midst of disaster and destruction a lasting and constructive c?ntribution may be made which can be carried over into the post-war world. Applications for the Committee’s help should be sent to the Hon. Secretary at 24 Buckingham Pal applications tor the C ace Road, London, S.W.I
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.