Unemployment and Mental Health
- Author:
Brigadier General C. Menninger
Consulting Psychiatrist and Chief of Neuropsychiatry Division, Surgeon General’s Office, U.S. War Department, Washington
, A’he opinion and remarks to follow, represent r?e personal opinion of the speaker, based upon ls professional and Army psychiatric experience, and are in no way to be interpreted as officially or Unofficially representing the viewpoint of the Army 0r the War Department.
When a physician attempts to present some phase his medical work to laymen, it is important that e omit the more scientific terms and that he insure at the onset that his listeners have sufficient background to understand the content of his remarks, /nis is even more essential when one discusses Mental Health, because of the many misconcepl?ns concerning this specialty of medicine. Twenty years ago, psychiatry was largely limited state hospitals and the care of psychotic, i.e. msane” patients. In the following years it Emulated principles which may be applied in the ^veryday life of every man, far beyond its previously ^mited area of influence. There has been rapid development of Social Psychiatry?the application these principles to all types of social situations? lndustry, education, recreation, child guidance, Criniinology. Less than ten per cent, of all the Psychiatric work in the Army has been concerned ^th psychotic patients.
In considering the relationship between psychiatry and unemployment, it is important to recognize that mental health and ill health can exist in varying degrees and differ as radically as a mild head cold and severe pneumonia. These variations, that is, the state of mental health, are caused by an individual’s way of life, the influence and effect of his strivings and ambitions, of his pleasures and disappointments, of his satisfactions and frustrations. All of these combine in the drama of life, particularly as they relate to the people about him, to determine the individual’s state of mental health. One can establish the basic premise that to be mentally healthy, one must have a purpose in life, and society must be so organized as to furnish him the means of accomplishing that purpose. For the average man, as head of his family, this purpose is the building and maintenance of his home and the facility to be supplied by society is the work for which he shall receive the pay with which to achieve his goal.
The problem of unemployment affects not only the status of an individual, but much more important, the status of his family. The American culture is based on the family unit with its personal and group satisfactions, its participation in the community and ultimately in the nation’s affairs. The father, as the head of the family, is the wage earner and so the active leader of this basic social unit. The mother is the custodian of the home and Bit/ prepared for Hearing before the U.S. Senate Committee on Banking and Currency re the Full Employment l> 24th August, 1945.
children. A family can be happy and successful and “normal ” only if the parents are happy and successful in their roles and so are ” normal Consequently, unemployment becomes a problem concerning two generations?the adults and the children. Probably the most tragic result of unemployment from the mental health viewpoint is the effect on the children. Many opinions have been expressed regarding the causes of the high neuropsychiatric casualty rates of this war and some have assumed that American youth was ” degenerating”. There is no evidence of this although there is much evidence of a rather widespread social illness as manifested in a country which has recently had eight million men unemployed. The effect of this unemployment on the youth of these families is beyond calculation. We know that an individual’s personality and character structure is very largely dependent on his early family environment. Not only are his codes of thought and behaviour established at this period but also his habits of personal relationships are developed. A healthy family relationship is essential to the development of “normal” children. When that family is plagued with unemployment, it is impossible to conceive of the children maturing without some degree of warp in their personality structure and consequently, subsequent difficulties in their relations to people and to the community? evidence of mental ill health.
There is fairly unanimous opinion among social scientists that unemployment is a problem of social organization and not one of individual personality. It represents a defect in our social structure. The unemployed as a group are not inferior, defective individuals who do not want to work. Recurrent business depressions with as many as 25 per cent, of the able-bodied workers deprived of the means of livelihood, have shown the fallacy of the assumption that the labourer is at such times responsible for his plight. Despite the fact that these are the facts as judged by our best social scientists, there is a widespread tendency on the part of the communities and individuals to regard the unemployed as ” bums * or inferior specimens of humanity. By this self-deceptive attitude they adroitly fail in the acceptance of their individual and collective responsibility for our social organization.
Mental Health Problems with Unemployment Many sociological and psychiatric studies have been made of unemployed persons. It is variously estimated that 60-80 per cent, of such individuals manifest definite signs of mental ill health. The great majority give conspicuous evidence of their economic insecurity in their thinking and in their relationships with other people. Many of them are definitely anxious in regard to their future ; they maintain a lurking fear that there is no escape, no end to their predicament. In the majority of instances, the father of the household appears to be a ” failure “?a failure in the eyes of his wife, his children, his friends and the community, often even to himself. Without a job, he, to some degree, fails to be able to fulfil his purpose. Also, as a result of his loss of work, he loses some of the stabilizing factors in every working man’s life? the association with fellow workers, the routine? the need to get up in the morning, and to be at a particular place at a particular time, satisfaction in work done, receipt of remuneration for his effort. Mental ill health is reflected on the wife. In many instances, in her effort to alleviate the situation, she shifts her role to being the wage earner of the family, and so its source of authority and leadership. There is inevitable marital friction resulting from this shift which is further aggravated by the presence of the husband in the home all day and the uncertain division of responsibility.
More tragic is the effect on the children?’ physically, educationally, emotionally. Again, one should stress the fact that unemployment becomes a mental health problem which always affects two generations. Studies have indicated the deleterious effect on the physical health of the children. In the majority of cases, their education is cut short. Emotionally they become quite disorientated, not only because of the marital friction but because of the confused role of each parent in the home. They are inclined to regard the father as a ” failure ‘ and so lose respect for him. Under our previously operated relief system, minor children gained little or no independence if they did work, because the amount of a large proportion of their meagre income was automatically subtracted from the money provided the family from relief sources. Certainly* no part of the income of a child under sixteen should be deducted from the family relief funds. Finally, a major symptom of mental ill health of the unemployed displayed in their social insecurityBecause of what they believe their friends think of thom, they tend to avoid them. Because of what their friends know, these friends tend to avoid themThe unemployed regard themselves as outcasts, disapproved of and looked down on by societyThey often lose a fundamental necessity for good mental health?self respect.
Mental Health Problems from Threatened Unemployment The threat of unemployment is of particular significance at this time to our veterans. They are the children of the last depression and they have not forgotten it. This concern of veterans in regard to their future is vividly described by Eli Ginzberg in his book ” The Unemployed”. He pictures them as having fought all over the world, willing to make any sacrifice. They have had no doubt as to the outcome of the war, ” but when they think of peace they are uneasy These soldiers recall that the country fumbled badly in coming to grips with that scourge of peace?unemployment. They remember that pregnant women were dispossessed from their homes ; that farmers were thrown oft their land ; that husky men became soft from idlers. They remember all this and more, and they fonder what will happen when they have won the victory on the battlefield. They wonder whether country will also win the peace. They are uneasy but they are not pessimistic. They have Seen much these last years. They have seen their country suffer the consequence of an unpreparedJess, born of ignorance, and they have seen this failure remedied with speed and efficiency. They know there is nothing within reason that the United States cannot do if it will.
The same situation will be equally grave for the jyigratory war worker ; in fact, his problem may “e even more acute. With the tremendous turner from war to peace industry, we must realistic% face the uncertainty which prevails in the mind the worker as to his chances and the chances tor his family.
Cental 111 Health and Employment
All that has been said above about the effect of Unemployment on mental health applies to a greater e*tent to that group of individuals who have made a Marginal adjustment to life?barely maintaining delicate equilibrium between mental health and I** health. One of the lessons from this war has >een to indicate the size of this group in our nation. 11 attempting to select fighting men for a fighting arniy, we found that 39 per cent, of all men rejected at induction were suffering from some type of Personality disorder,?1,825,000 out of a total of >650,000 men. Most of these men were and are ?”le to get along in their civilian jobs, but, in many nstances, one can be sure that if confronted with ?jneniployment the balance of equilibrium would be efinitely thrown toward mental ill health. The rigours of Army life and particularly of ?mbat are tremendous and to the above figure we pust add an additional 300,000 men who have had 0 be discharged from the Army for neuropsychiatric Masons, constituting the amazing total of 43 per r^nt. of all discharges for medical reasons. We *nust further add the 130,000 men who were disharged on an administrative basis because of nadaptability or ineptness?another way of ndicating that personality factors did not permit ,nem to fit into a job in the Army. Many of these atter two groups may find difficulty in staying niployed. Of all the obligations that we owe, ?ne is greater than to our disabled veterans, ncluding the neuropsychiatric casualties. In a Urvey made six months ago in the Office of the prgeon General, of approximately 5,000 soldiers ‘Scharged for psychoneurosis, 85 “9 per cent, were niployed as compared to 93 per cent, of the same Sr?up prior to their induction. This survey was *nade at a time when jobs were plentiful. If jobs ere scarce, it is likely that only a small percentage 1 these men would find employment.
?With demobilization of the Army and War dustries, unemployment will confront us shortly nd not only will we have the inherent problems of unemployment, but these will directly contribute to making many of this group of veterans into confirmed invalids. If there were assurance of sustained employment opportunities for all, this possibility would be of less concern. Our Army experience has revealed the immense scope of the problems to be found in a select age group. We must assume that these figures would be greatly increased if all age groups were included. Recommendations
From a psychiatric point of view, it is an established fact that unemployment produces a manyfaceted mental ill health problem of serious proportions. Therefore, it would seem imperative to establish an employment system which takes into account very specific consideration of:
(1) Methods of insuring the basic mental hygiene factors of security, gratification and selfrespect for every individual.
(2) The fact that every home affected by unemployment involves two generations, with the children probably suffering more than the parents.
(3) The known facts regarding the incidence of personality disorders as we have learned them from experience in the Army with special consideration given to employment opportunities of all types of medically disabled veterans, including neuropsychiatric discharges. (4) The type of relief programme, if any. If such is necessary, a strenuous and extensive educational campaign should be made to correct community attitudes and individuals towards the unemployed.
(5) The integration relief and work referral on the assumption that if a job is available for which a man is qualified, he will take it? If no job is available, the relief system is so managed as to avoid gestapo technique whereby the unemployed are hounded and deprecated to a point of severe mental ill health.
Again quoting Dr Ginzberg’s survey of an unemployed group “it is tragic paradox that these unemployed men found their salvation in America’s entrance into World War II ; that their return to work was made possible only because American industry was called upon to produce an everincreasing volume of death-dealing instruments ; that the unemployed man and his family were rescued from the community of outcasts only because of the holocaust which covered the earth. “Yet there is meaning in this paradox and it has a moral not only for war but also for peace. Once this country accepted the challenge and actively entered the war, we surprised ourselves and confounded our enemies. Goals were set which brought jeers from the Axis and questions from our Allies. These goals were met and in many cases exceeded. Overnight, millions of men were mustered into an Army, equipped with the most modern arms, and trained according to the latest doctrines. Planes rolled off the assembly lines and millions of tons of shipping were floated in the Atlantic and the Pacific. Clearly, there was no challenge too great for this country to meet. The people understood and they did not hesitate. Nothing frightened them.
” Money was needed?untold billions ; it was found. Manufacturing plants had to be converted ; it was done. Traditions had to be disregarded no voice was raised in protest. Faith gave the country strength.
“So it was in war ; so it must be in peace. The men who went forth to fight, and, if need be, to die, did so that the country might live, and their fathers, brothers and sons could labour to build a perfect union and a more perfect world. ‘ It is for us, the living, rather to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced.’ “
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