Treating and Preventing Trauma: British Military Psychiatry during the Second World War Nafsika Thalassis EuropeanStudies Research Institute Centre for ContemporaryHistory and Politics University of Salford, Salford, UK Submitted in Partial Fulfilment for the Degree of Doctor of Philosophy, October 2004 Table of Contents Acknowledgments iv Declaration Vi List of Abbreviations Vii Abstract Viii Introduction I Chapter 1: Trauma, Psychiatry and the Military c. 1860-1939 15 Introduction 15 Five disorders of the I 9th century 17 Psychiatry, Psychology and Social Medicine 1900-1918 34 Shell-shock 1914-1918 38 Intelligence Testing 53 The inter-war years 1918-1939 54 General Psychiatry 1918-1939 57 Conclusion 66 Chapter 2: The Administration of psychiatric services 67 Introduction 67 Preventionand Specialisation in the Army MedicalServices 70 Morale 72 The Army MedicalDepartment 74 The Directoratefor the Selectionof Personnel 82 Psychiatristsand the TavistockClinic 83 Psychiatryand Preventive Medicine 85 Oppositionand Patronage 90 Conclusion 99 Chapter 3: Selection of Personnel 102 Introduction 102 Currenthistoriography 104 Section1: Men in the Ranks 107 The introductionof new selectionprocedures 107 The purposeof personnelselection III The Reportof the British War Office Committeeof Enquiryinto Shell Shock 115 Factorsthat facilitatedthe adoptionof intelligencetests 119 Section2: The Officers 124 Selection 124 Validation 129 Meritocracy? 131 PsychologicalDefeat? 136 Conclusion 138 Chapter 4: Sutton Emergency Hospital 1940-1942 140 Introduction 140 Sutton1940-1942 142 ii Conclusion 152 Chapter 5: Psychiatry in the Theatres of War 153 Introduction 153 The Middle EastForce and the Historyof the MedicalServices 160 HaroldPalmer in Tripoli, 1943 170 AmericanPsychiatrists in Algiers, 1943 177 Italy, 1944 180 Conclusion 187 Chapter 6: Northfield Military Hospital 1942-1945 191 Introduction 191 The Setting 192 The First Northfield experiment 198 The SecondNorthfield Experiment 205 S.H. Foulkes 211 Conclusion 216 Conclusion 219 Appendix 234 Bibliography 248 iii AcknowledlIments I would firstly like to thank my parents, Dr George Thalassis and Dr Alexandra Thalassis, whose encouragement, generosity and intellectual inspiration have supportedme all my life. I would also like to thank my supervisor, Professor John Keiger, for the trust he has shown me and for always keeping me anchoredto the military side of things. I also want to thank the University of Salford, particularly the ESRI and ESPaCH departments for funding me generously and for giving me the opportunity to teach the History of Military Trauma. I also need to extend a special thanks to my examiners,Dr Mark Harrison and Dr Mathew Hughes for their very considerateand thorough comments on this work. Many fellow researchershave read and commentedon this work. I would particularly like to thank Peter Barham and Ben Shephardwho helped me enormously when I needed it most. Others who have read my work and have supported me are Dr Edgar Jones,Professor Lawrence Friedman and Dr Paul Lerner. This project would never have taken place if I had not studied for the MSc in the History of Science, Technology and Medicine at Imperial College, University College London and the Wellcome Unit for the History of Medicine. Therefore, I would like to thank the staff and fellow studentsfor teaching me and for continuing to help me long after I graduated. In particular, I would like to thank Professor David Edgerton, Dr Michael Neve (who first suggestedthis project), Dr Robert Iliffle and Professor Andy Warwick. I would also like to thank ProfessorElizabeth Valentine of Royal Holloway, who introduced me to the history of psychology and who IV has been an inspiration ever since. Many thanks also to the numerous staff of the British Library, the Liddell Hart Centre for Military Archives, the National Archives, the Psychoanalytic Society, and especially the Wellcome Library. Others who have helped make theseyears particularly enjoyable are James Banks, Martin Edwards, Shebnem Emiroglu, Caroline Essex, Christine Glover, Joe Quirke, Helena and Angelica Thalassi-Hill. My biggest debt is to my partner, Terence Banks, who has been my most exacting critic and my greatest friend. V Declaration Somethe material found in chapters I and 3 has been published in: N. Thalassis (2003) 'The use of Intelligence Testing in the Recruitment of "Other Ranks" in the Armed Forces during the Second World War', Histoiy and Philosophy ofPsychology, Vol. 5, No 1, pp. 17-29. vi ABSTRACT This is a study of military psychiatry in the Second World War. Focusing on the British Army, it recounts how the military came to employ psychiatrists to revise recruitment procedures and to treat psychiatric casualties. The research has shown that psychiatry was a valued specialty and that psychiatrists were given considerable power and independence. For example, psychiatrists reformed personnel selection and placed intelligence testing at the centre of the military selection of personnel. Psychiatrists argued that by eliminating the 'dull and backward' the tests would help improve efficiency, hygiene, discipline and morale, reduce psychiatric casualties and establish that the Army was run in a meritocratic way. However, it is probable that intelligence testing made it less likely that working-class men would receive commissions. Still, the Army had no consistent military doctrine about what the psychiatrists should be aiming for -to return as many psychiatric casualties to combatant duties as was possible or to discharge men who had found it impossible to adapt to military life. In the initial stages of the war, the majority of casualties were treated in civilian hospitals in Britain, where most were discharged.This was partly becausethe majority were regarded as constitutional neurotics. When psychiatrists treated soldiers near the front line most were retained in some capacity. The decision on whether to evacuatepatients was influenced by multiple factors including the patients' military experienceand the doctors' commitment to treatment or selection. Back in Britain, service patients were increasingly more likely to be treated in military hospitals such as Northfield -famous for the 'Northfield experiments'.These provided an alternative model of military psychiatry in which psychiatric intervention refocused away from individuals and their histories and onto social relationships, and where the psychiatrists' values were realigned with the military rather than with civilian general medicine. Vill Introduction This is a study of military psychiatry in the Second World War. Focusing almost exclusively on the British Army, it recounts how the military came to employ psychiatrists (and a few psychologists) to reform its recruitment and promotion proceduresand to treat its psychiatric casualties.In addition, it explores how psychiatrists responded to these challenges with new selection procedures and therapeutic regimes. The military purpose in employing psychiatrists and psychologists was to reduce manpower wastage and this was the principle that underscored psychiatry in the different military contexts in which it was practiced. Nevertheless, this interpreted principle was differently in different military contexts - sometimesemphasis was placed on retaining staff who were still of some use to the forces and other times on discharging unsuitable personnel who were thought of as "consumers of manpower. "' A variety of sourceshas been used for this work. Among them are psychiatric, military and government reports, and the minutes from Army Council meetings found in the National Archives. Further psychiatric reports, anny memoranda as well as unpublished medical articles located in the Royal Army Medical Corps Collection and the General Collections of the Contemporary Medical Archive Centre, Wellcome Trust, have been widely used. Research for this dissertation has benefited greatly from access to the personal papers of the Adjutant-General Ronald Adam, Dr John Rickman, Dr William Sargant and Dr S. H. Foulkes, some of which have included soldiers' medical records from the Second World War, which have never previously been written about. Of great advantage have also been the parliamentary papers, and the official medical histories of the First and Second World Wars. Contemporary articles published predominantly in The Lancet, The Journal of the Royal Army Medical Coips, The Army 1 J.R. Rees, (1945) The Shaping ofPsychiatiy by War, London: Chapman & Hall, p. 43. Quartei-ly, The Journal of Mental Science, Proceedings of the Royal Society ofMedicine, The Bi-itish Medical Jow-nal, as well as other j ournals have been frequently used, as have contemporarypsychiatric monographs and textbooks. In recent years, shell-shock has been rediscovered. This newfound popular interest can be traced to the publication of Pat Barker's Regeneration2 in 1991, the first novel in what came to be known as the Regeneration Triloýy. The trilogy capitalised on the British public's familiarity with the First World War poets to recount the experiencesof Siegfried Sassoonand Wilfred Owen in a military psychiatric hospital -and it succeededin attracting a huge readership as well as literary acclaim. Since then, a number of historical volumes on military psychiatry have been published, though mostly covering the more commercial end of the market, there have also been scholarly works.3 While some of these 2 p. Barker, (1991) Regeneration, London: Penguin Books. Prior to the Regeneration