Some Wartime Problems of Mental Health
MENTAL HEALTH The Editorial Board does not hold itself responsible for the opinions of contributors Vol. II. No. 2 APRIL 1941 Price lOd. (1/- Post Free)
- Author:
DORIS M. ODLUM, M.A., M.R.C.S., L.R.C.P., D.P.M.
Hon. Secretary, The National Council for Mental Hygiene It was to be expected that people who have been subjected to air raids and Specially those who have actually been bombed out or injured would show evidence ?f a certain amount of nervous strain. It is a matter of universal surprise that the ^rge majority appear hardly to feel any nervous strain at all in these circumstances, ?r, if they do, it is only of a transient nature and they soon regain their emotional equilibrium.
There are, however, a certain number of persons, both adults and children, who do develop considerable nervous and emotional reactions, and these cases are met with in shelters, rest centres for those who have been bombed out, and at first aid Posts. Such cases present considerable difficulties to those who are in charge and, the uninstructed, appear very frightening. Moreover, unless they are rightly handled the condition becomes worse and is catching. Thus one unstable emotional Person may infect a crowd with hysteria or even panic. The symptoms are dramatic and often alarming, but the condition if properly treated at the outset is seldom as Serious as it appears. First aid treatment is comparatively simple and is usually effective.
Although conditions vary considerably as between shelters, rest centres and first aid posts the types of nervous and emotional instability encountered will be similar.
The Normal and Abnormal Personality
The majority of persons as has already been stated are essentially well balanced and emotionally stable, and even if they have been bombed will quickly regain their emotional balance after the first shock is over. There are, however, people of the 0ver-sensitive type who tend to be more severely upset and are slower at regaining their balance, also the so-called hysterical type prone to excitability and loss of emotional control, and the chronic-anxiety type who are over-anxious and take themselves and life too seriously and may in addition suffer from physical sensations induced by nervous instability, such as headaches, palpitations, attacks of trembling, breathlessness, etc. A comparatively small number of persons are more profoundly unbalanced and are liable to develop ‘’ nervous breakdown ‘’ so called as the result of emotional shock. Persons of sub-normal intelligence may also be encountered, and epileptics and persons who may be suffering from emotional shock caused by sudden and extreme fear or grief. Emotional shock is not the same as ordinary shock although it may have some resemblance to it and in severe cases may develop into it. The condition develops swiftly, it reaches its maximum almost instantane- ously and gradually decreases as the intense emotion fades and reason begins to regain control. It is impossible to remain in a state of intense emotion for more than a few minutes at a time.
The aged are apt to become mentally confused and forgetful if they are subjected to sudden shock. Cases of head injury without evidence of any external damage may occur, and for these it is important to remember that after concussion or any kind of head injury persons may show symptoms which occur in the other types of cases mentioned, especially mental confusion, loss of memory or stupor. Sometimes they appear fairly normal although in fact they are acting automatically without any real consciousness of what they are doing or saying.
In the case of fear, which may be for one’s own safety or that of another, the first sensations are of complete terror and panic with the desire to escape or, less commonly, to fight. The commonest symptoms resulting from fear and emotional shock include: trembling, shaking, chattering teeth, rapid heart beat, weakness of the legs, suffocating feelings, sweating, chilliness, ” stomach turning over ” heart in the mouth “, sickness, dizziness, pressure on the head, the need to pass water or faeces, weeping, and a desire to cling on to someone strong and protective. In this state the adult loses all sense of responsibility, dignity and self-control, and becomes like a frightened child.
These are the sensations of the average person if subjected to a very severe and sudden emotional stress. In the normal person, however, these soon pass off even with little or no help from others and control and emotional balance are quickly regained.
More serious manifestations include, hysteria, loss of consciousness, stupor, mental confusion, loss of memory, temporary loss of voice or sight or of the use of one or more limbs.
First Aid Treatment
The first aid treatment for all these conditions is of a somewhat similar character and fairly simple. The first thing is to avoid the spread of panic by adopting an air of calm assurance. Excitable people should always be spoken to in a calm level tone of voice and with an air of absolute authority. They should never be ridiculed but dealt with firmly and kindly and treated exactly like a frightened child. To lose one’s temper or shout at them or to appear fussy or anxious not only increases the patients’ symptoms but will spread the infection. It is wiser to explain to them that everyone is as frightened as they are and that no one thinks the worse of them for their loss of control, but that they will be helping themselves and everyone else by trying to keep calm.
Adults feel annoyed when bullied or patronized, and both of these attitudes should be avoided. A patient who is excitable is always better lying or sitting down and should not on any account be allowed to walk about. It is often of great comfort to them to be allowed to tell their experiences to a sympathetic listener, and it is well worth while trying to spare a few minutes to listen to their story. Constant repetitions should, however, be discouraged, and patients should be persuaded to keep completely quiet. Physical restraint should be avoided unless absolutely necessary and then it must be adequate. A useful method of restraining an excited patient is to cover him with a blanket and have two people sitting on either side of it to keep it in position.
In extreme cases of fear a state of true ” shock ” may arise. The patient becomes cold, pale, the pulse is weak, the breathing shallow, and there is a danger of collapse and heart failure. Warmth, quiet, and reassurance are essential and, if the patient is conscious, sal volatile, or a hot drink with sugar should be given, and a hot bag applied to the heart, feet, and stomach. The patient should be lying down well Wrapped up, the head fairly low and the feet raised a little above the level of the head. Gentle massage to the feet and hands helps to restore the circulation. If the patient is not fully conscious he should not be given anything to drink as he will choke, and if hot water bags are used they must not touch the flesh or they may make a bad burn.
A cup of hot tea with plenty of sugar, or, failing that, sal volatile and hot water followed by a lump of sugar to suck have an extraordinarily beneficial effect. In every shelter and rest centre there should be available a supply of sugar or boiled sweets, sal volatile, smelling salts, rugs or blankets, drinking water and, if possible, hot coffee with milk well sweetened. Spirits are not necessary and are better avoided. They should never be given to anyone who is in a state of hysteria as this will only increase the excitement.
Some of the milder cases will respond very well if they are given some small job to do. It should, however, not be anything that involves responsibility or that Matters if they fail to accomplish it, but the mere fact of being occupied has a stabiliz- 1Jig effect on many people.
Those subject to epileptic fits present a problem because they need much super- vision and are very distressing to others. The fit is not, however, dangerous provided the patient does not hurt himself in falling and is not allowed to bite his tongue. This can be prevented by putting between the teeth a large rubber ring or a spoon Wrapped up in a handkerchief, or any object which will keep the teeth from clenching. There is no cause for alarm as patients very soon recover. They are better left to steep the fit off if they seem drowsy afterwards. They should not be given anything to eat or drink unless they ask for it.
Even for those showing less marked symptoms proper treatment by a doctor specially qualified to deal with these types of cases is an urgent necessity and should be Mailable as soon as possible. Facilities for treatment are available at many centres in London and the larger provincial towns, and it would be of great value if a service could be provided at each Rest Centre and First Aid Post for patients to be accompanied to a clinic, since many will be too apathetic to go unless someone actually takes them.
At a Rest Centre occupation and various amusements, games and other interests should be provided as a means of taking people’s thoughts off their own troubles. There should be a supply of toys, books, a gramophone if possible, and games, dances, competitions, etc., should be organized. Helpers should also be available to assist harassed mothers by playing with the children or setting them simple lessons. If people who have been through great strain are left to themselves they tend to become apathetic and dispirited, a prey to self-pity, and to spread an atmosphere of discourage- ment, criticism, and grievance around them.
First Aid Posts
Practically all that has been stated above applies to cases brought in to first aid posts, so far as first aid treatment is concerned, and it must be emphasized that no patientwho has shown symptoms of nervous or emotional instability should be allowed to go home alone. If no one in authority is available, a more stable minor casualty should be asked to accompany the nervous patient home and advise the relatives that the patient’s own doctor should be consulted. The name of the nearest clinic for functional nervous disorders and the address and time of sessions should also be given in writing to the patient.
Air Raid Shelters
The conditions in a shelter during a severe raid in some ways resemble those on a passenger liner during a dangerous storm at sea. The people who go into the shelter are of all sorts and all sizes, of both sexes, and of all ages. They are extremely anxious about the safety of their house and household, and distressed by their inability to protect them. In certain parts there may be a large number of foreigners in the shelter and it is well recognized that they are much more emotional than our own race and much more prone to panic.
One of the most trying factors in an air raid is undoubtedly the noise. All so-called ” highly-strung ” people are hyper-sensitive to noise and feel an unreasoning fear of it, quite apart from the fact that it may have no hostile significance and indeed may represent the protection provided by our own anti-aircraft guns.
In order to avoid panic and loss of control it is desirable that there should be a male air raid warden in charge of each shelter with experience of handling people in difficult circumstances, and also that he should have a trained woman as his second in command. Many women are much better dealt with by a woman than by a man, and there may be personal intimate services needed that only a woman can perform. It is, moreover, more difficult for a man to assess the nature and importance of symptoms in a woman than it would be for another woman to do so. The presence of a calm, trained woman will also help to steady the men in the shelter. The provision now made for medical inspection in air raid shelters enables the visiting doctors to give helpful advice in many cases to the nervous and over-anxious and to put more serious cases in touch with hospital clinics or arrange for their special care and disposal.
All those in positions of responsibility will have a most valuable opportunity of helping these unfortunate people, and if they avail themselves of the facilities at their disposal many of them will not only be helped temporarily but enabled to develop permanently a more stable and better balanced personality. This is obviously a matter of the first importance not only to the individual but to the community. Detailed notes for the guidance of those in charge of First Aid Posts, Air Raid Shelters and Rest Centres have been published by the National Council for Mental Hygiene from whom copies may be obtained on application to the Secretary, 76-77 Chandos House, Palmer Street, 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.