Behaviour in Relation to War Conditions a Preliminary Enquiry
The summer and autumn of 1939, the prophets nad a great time. We learnt then what we were to xPect. Our large cities would be destroyed by air ornbardments. Whole sections of the population would be wiped out by poison gas, and civilization, we knew it, was bound to disappear. Among ne minor prophets were those who were able to oretell the effect of totalitarian war upon the nervous cms of both young and old, and sad and dis- paraging was the tale. Of course many things _i!? . have happened that did not. But as it turned ut, it was not always wise to draw deductions from ntortunate instances of nervous disorders in the rmmai stages of the last war and in the years that followed it. it is difficult enough to assign with : Cu?acy the roles of cause and effect to phenomena the lives of individuals even after close and in?rate scrutiny. To attempt this with groups ol widuals is often more difficult still.
l reasoned attempts should be made, and I have asked to describe a small investigation carried t tinder the auspices of the Mental Health l94irgenCy Committee durin? the latter ?n November 7th, 1940, the Executive Committee of the National Council for Mental Hygiene (the body that convened the Mental Health Emergency Committee and which remains one of its constituent elements), passed a resolution recommending that the Mental Health Emergency Committee (to be hereinafter termed, for short, the M.H.E.C.) should nominate a small sub-committee with a view to collecting and ultimately collating data as to child behaviour in relation to war con- ditions and the subsequent effect of these conditions. The M.H.E.C. accepted the proposal and in March, 1941, appointed a Sub-Committee to report on the matter.
The Sub-Committee recognized that an enquiry of this kind, to be of any value, must not only be extensive but must also be carried out in a manner that would satisfy and meet enlightened criticism. It was, moreover, unlikely that the M.H.E.C. could, unaided, carry out such an enquiry. It had already wide and extending commitments and its staff was fully occupied in attending to these. In order, however, to obtain financial and other assistance, it would be necessary to demonstrate that the results of the enquiry would justify the expenditure of time and money involved.
The Sub-Committee therefore decided: (1) That a preliminary enquiry into the ” Behaviour of Children and Adults under War Con- ditions ” should be attempted. (2) That from a number of selected sources par- ticulars of not more than 400 cases of abnor- mal behaviour should be examined. (3) That the results of this preliminary enquiry should be submitted to the main Committee together with any recommendations that might be agreed upon.
It was then arranged to send a questionnaire with a covering letter to about thirty possible sources of information. The questionnaire was a printed foolscap sheet, one for each case to be recorded. There was plenty of space allowed for the answers and additional notes could be made, if necessary, on the back. The fifteen points about which information was requested, together with the explanatory instructions that were added, were as follows:
1 Initials of Case. 2 Sex. 3 Age. 4 Married or Single. 5 If attending school (mention type of school). If employed. 6 Type of area (evacuation, neutral, reception). 7 Residing in: (own home, billet, hostel, rest centre, shelter). 8 Referred by. 9 Reason for referral. 10 Past history, if available, and sources of informa- tion. (Eldest, youngest, only child. Nervous trouble prior to war. Illnesses and other details.) 11 Diagnosis, by whom made. Supposed cause of present condition. (E.g. leaving home or parents, specific incident, shelter life, physical trauma, etc. Indicate particularly whether cause is related to war.) 12 Present condition. (a) Intelligence (Good, Fair, Poor, M.D.). (b) General condition. (Good, Fair, Poor, Stout, Thin, Losing weight, No change, etc.) (c) Physical symptoms (Fits, Tics, Bed- wetting, Paralysis, Dyspepsia, Asthma, Migraine, etc.) (d) Behaviour. (Give (some idea of patient’s reactions. Interpretation must be left to individual discretion.) (e) Personality (Model child, Delinquent, Aggressive, Passive, Silent, Depressed, Troublesome, Destructive, etc.). 13 Action Taken. (Psychiatric Treatment, re- moval from home or billet, evacuation, con- valescent treatment, referral to other organization, etc.) 14 Would further action have been advisable 1 facilities had existed ? If so, what ? 15 Is a follow-up of the case considered to ^ urgently necessary ? There were, finally, spaces for the names ^ official positions of those responsible for the replieS, It will be seen that the questionnaire was a detail^ one and that specific indications were given of $ kind of information desired. Of the sources of information selected, two wef* excluded when the returns came in, as it was fou^ that in certain ways the cases with which they deal were not exactly comparable to the remainder. 28 sources that were used may be grouped as follo^5 9 from Mental Treatment Clinics. 2 from In-patient Departments of hospitals dealifl- with cases of Nervous Disorder. . (These 11 sources provided mainly adult cases ) 8 from Child Guidance Clinics. 5 from Children’s Hostels. 4 from M.H.E.C. workers in reception areas.
A covering letter sent with the questionnaire ask^ that the cases reported on should be the first that came under notice on or after January 1st, 1941’ In a few instances less than ten cases were returned’ and the total came to 270. Of these, 94 were adul’5 and 176 were children. The one factor common10 all was that they came under notice during the seventeenth month of the war towards the end0’ a period of intensive air bombardment of the larg6 towns and industrial centres.
Taking the sex distribution first, there were amoi^ the adults 59 males and 35 females. Among children there were 117 boys and 59 girls, but as t^e number of boys referred to Child Guidance Clini?s invariably exceeds that of girls, no special signifr cance need be attached to this. It may be noted- however, that the two most prominent symptotf1* for which children were referred were eneuresis afl*1 stealing. There were 39 cases of each. )t It will be realized that the term ” war conditions must obviously cover a number of factors of vetf different character. But for the purposes of tin5 enquiry, it seemed necessary to distinguish only twd varieties, namely those of a terrifying nature afljj those of a disturbing nature. The former, whi^j included direct bombing experiences, were classify as ” war incidents ” and the latter, which included evacuation, billeting, shelter life, separation frof parents, etc., as ” war circumstances .
In this series, then, of 270 cases of abnorffl^ behaviour collected from 28 different sources, it found possible to answer the following questions: 1 What proportion could be attributed to incidents ? 2 What proportion could be attributed to circumstances ? and in these two sub-groups 3 What proportion had a previous history ^ nervous instability ? MENTAL HEALTH 37 Taking adults and children separately, the figures were: Adults, 94. Attributed to: war incidents .. 9 approx. 9 ? 5 per cent. war circumstances 15 ? 16 0 ? 24 25-5 Children, 176. Attributed to: War incidents .. 4 approx. 2 ? 2 per cent, ar circumstances 24 ? 13-6 ? 28 15-8 ? more’thCaSes among the 24 adults, i.e. in rather attribut e11 those whose disability was the 28 hV0 War con(iitions, and in 21 cases among disabii t en’ ‘-e- *n three-quarters of those whose was a d fi V/as attributed to war conditions, there No^ite history of previous nervous instability. pi-Qvid data available in this investigation can there f n? answer to the question as to whether durinpISti?r t^lere is n?t more nervous behaviour i^med t Second year of the war than in the PfODort pre_war period. We do not know what 1Qn of either the adult or child population is being affected in this way. And if we did know, we have no pre-war figures with which to make com- parisons. The three points that appear to be demonstrated are these:
1 That the number of children in the series who have been adversely affected by war incidents is very small.
2 That war circumstances were found to be a con- siderable but not an outstanding factor in the production of behaviour problems of both adults and children in the series.
3 That there was a high proportion?58 per cent. in the adults and 75 per cent, in the children? of cases with a previous history of mental instability in the war conditioned groups of the series.
In presenting their report, the Sub-Committee did not feel that they were able to recommend that any further investigations on similar lines should be sponsored by the M.H.E.C. But it was suggested that the Committee might be willing to place the data already obtained at the disposal of any competent authority that might be interested to analyse them in greater detail.
Finally, the Sub-Committee wished to express its thanks to all those who co-operated by filling in and returning the questionnaires. H.C.S.
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