Neuro-Psychiatry and Patient Protest in First World War American Hospitals

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November 11 marks the 100th anniversary of the end of the First World War. As historian and Nursing Clio writer Evan Sullivan tweeted earlier this week, “We’ve always benefitted from the proximity of living within a century’s distance from WWI, but after this Sunday, it will begin to drift further into history. It will be more important than ever that scholars and the public remain engaged with the costs of the war and their relevance to today. War is good for nobody. And more immediately, we must keep the centenary theme moving past November 11. For most – specifically wounded/disabled/sick veterans, refugees, and other civilians, as well as colonial subjects – the war was far from over. Our remembrance must reflect that fact.” Nursing Clio is proud and honored to bring you a special series on the centennial that explores the importance of medicine to the First World War, reflects on the terrible destruction that war inflicts on bodies and minds, and examines how soldiers and civilians navigated their health care during and beyond the conflict. Sullivan kicks off the series with a look into the soldier-patient protests in Plattsburgh, New York. 

 

In August 1919 over two hundred neuro-psychiatric soldier-patients¹ wrote in protest to the Secretary of War about their treatment at U.S. Army General Hospital No. 30 in Plattsburgh, New York. Their joint statement accused the military of holding them against their will longer than necessary and stated that they believed their “further tenure of service is due entirely to the mal-administration of affairs and not to any cause of circumstances.”² The men argued that they had fulfilled their contract and should be honorably discharged.

The patient protest at Plattsburgh highlights a broader pattern of inefficiency in treating psychiatric wounds of the First World War in stateside hospitals. These stories of protest also help to incorporate patient voices into the myriad histories of First World War medicine and disability, narratives that often overshadow individual experiences. Wounded soldiers were not passive recipients of military medicine, but agents within politically infused systems of healing; neuro-psychiatric patients were no exception.³

Official estimates after the Great War put American psychiatric wounds at almost 70,000.⁴ The Surgeon General ruled that the term “shell shock” wasn’t a sufficient enough diagnosis for these men, who were usually classified in varying degrees as “neuro-psychiatric patients” or cases of “neurosis,” “psycho-neurotic,” or simply “insane.”⁵ Soldiers presented with symptoms including, but not limited to, nervous tics, hysterical blindness, anxiety, deafness, depression, vomiting, and confusion.⁶

Most met a medical-policy atmosphere more hospitable than that in Europe because “curative discourse uniquely framed… American medical policy,” meaning American physicians saw neurological injury as capable of being fixed rather than seeing it as a form of cowardice.⁷ Yet despite guidelines outlining neurosis as something that could be fixed, the lasting complexity of psychiatric wounds challenged the usefulness of “curative” treatment.⁸ And personnels’ lack of understanding often led to mistreatment, as soldier-patients with neurosis regularly returned to encounter inhospitable ideas about mental health and prolonged stays in wards. Soldiers responded by protesting in ways available to them.

They initially faced long and uncomfortable journeys to their respective hospitals in the United States. Soldiers arriving in New York City showed signs of neglect, as many were kept “in parts of the ship unsuitable for any class of sick soldiers, enduring close confinement and under armed guard” that in many cases aggravated symptoms.⁹ According to the director of the National Committee for Mental Hygiene, Thomas W. Salmon, poor treatment was due to the Navy’s “lack of appreciation” of “this class of patients.”¹⁰ For a group of officer-patients on the U.S.S. Manchuria, conditions were so horrific they signed a protest upon arrival in New York City.¹¹

For many, arrival at the hospital was not the end of their journey. The major hospitals for soldiers with various forms of neuroses were in New York City and Plattsburgh, as well as Dansville and Buffalo in western New York. The military sought to designate them for specific psychiatric injuries, necessitating transfers of patients from one hospital to another. Dansville desired “neurasthenics, shell shock cases and the milder psychosis” as well as soldiers with “chorea, drug addiction, epilepsy … tics, tremor” and “hysteria.”¹² Fort Porter refused to take “neurotics, epileptics and other types” and instead sought “insane patients.”¹³

Because of these specializations, patients shifted from place to place, including the transfer of close to 300 soldier-patients to Dansville from New York City, Camp Meade, Fort Porter, and Fort McHenry. Transfers were often necessary for proper treatment, though hospital officers also sought to avoid an “asylum atmosphere” by seeking to return or transfer “maniacal, suicidal and homicidal cases” to places like Fort Porter, which seemed to be the clearinghouse for unwanted patients.¹⁴ Classification systems repeatedly superseded the immediate medical needs of wounded patients.

Transfers between Fort Porter and Dansville in particular provoked conversations among medical officers concerned about poor treatment conditions. Eugene Bondurant, the commanding officer of Dansville, wrote of his colleagues’ general unwillingness to put psychiatric patients on the same footing with other soldiers. To remedy this culture, he suggested, psychiatric patients should be treated in wards within general hospitals just as any other sick man, making “the stigma of mental disease less in evidence.”

Bondurant also argued that hospitals shouldn’t use restraints like bars on windows, seclusion, or bodily constraints, and he believed that hospitals should have fewer restrictions, allowing physicians and the public to “think less about ‘insanity’ as a disease apart, and treat our patient as an individual with feelings, rights and a future like the other men sick in hospital.”¹⁵

Even the best equipped military hospitals continued to lack the necessary experience to adequately treat war neuroses. After obtaining a positive impression of Dansville, Bondurant acknowledged that the hospital did, in fact, have issues. He referenced a lack of trained psychiatrists and a number of officers he would prefer transferred elsewhere due to inexperience with psychiatric patients. The older Chief Nurse was also “entirely destitute of experience in psychopathic hospitals… and entirely out of sympathy with my non restraint methods.” She had little interest in “this class of patients” and “was ordered here under misapprehension of the nature of this hospital.”¹⁶

Not every hospital, however, was as progressive as Dansville, and many medical officers struggled to contend with how best to allow freedom of movement among patients. Fort Des Moines for example used “mechanical restraints” in some cases, and sought to install heavy locked doors and barred windows while building a permanent enclosure surrounded by a nine-foot fence to prevent escape.¹⁷

Yet some patients took power of movement into their own hands. Men at Dansville wrote frequently to family to visit and aid in their discharge. Family members allegedly knew from correspondence that the ultimate decision hinged upon an officer named Captain Patterson, so they specifically focused their efforts on him.¹⁸

In another instance, physicians granted three neurosis patients furlough at Plattsburgh, and they didn’t return until two in the morning. Upon return, the soldiers refused to obey orders and when the military police took them to confinement, one “epileptic” soldier had a seizure.¹⁹

Punishment of neurosis cases continued, as evidenced by the head of psychiatry at Plattsburgh who advised the hospital’s commanding officer three months later that hard labor sentences and confinement were often “detrimental to the health of the patients” and that a neuro-psychiatrist should be consulted first.²⁰

From the initial transport to the United States to their first and second hospitals, neuro-psychiatric soldier-patients encountered a policy system that saw their war injuries as legitimate and capable of being “fixed.” Despite officers’ support for proper treatment, subordinate inefficiency and inconsistency and medical ignorance around psychiatry continued to shape soldier-patients’ daily experiences. Patients were not passive, and they often made evident their concerns in moving ways.

At the terribly understaffed Plattsburgh — a hospital with over 1,000 cases — men referred to being treated like “useless junk,” underfed and overcrowded in their rooms.²¹ Over two hundred of these patients penned their protest to military authorities about their treatment and their wish to be sent home.

Perhaps the most poignant example of this comes from two soldiers transferred from Fort Porter to Dansville. Unhappy with being classified as mentally ill and “locked” in a “Nut Ward,” they penned a poem that explores how it felt to encounter the trauma of both combat and insufficient medical care:

These stories highlight the negotiation of power and autonomy within the medical framework of the war. Though their wishes were often overshadowed, soldier-patients had voices.

Notes

1. Jessica Adler uses this term denoting that the wounded were still in the military despite their often-debilitating wounds in Burdens of War: Creating the United States Veterans Health System (Baltimore: Johns Hopkins University Press, 2017). Return to text.
2. Men of U.S. General Hospital No. 30 to the Secretary of War, RG 112, Series UD 8, Box 1107, Folder: 201.23: Complaints, US National Archives. Return to text.
3. Fiona Reid, “War Psychiatry”, October 8, 2014, 1914-1918 International Encyclopedia of the First World War; For more on soldier-patients and biopower, see Ana Carden-Coyne, The Politics of Wounds: Military Patients and Medical Power in the First World War (New York: Oxford University Press, 2014) Return to text.
4. Annessa C. Stagner, “Defining the Soldier’s Wounds: U.S. Shell Shock in International Perspective” (PhD diss., University of California, Irvine, 2014), 3. Return to text.
5. Stagner, “Defining the Soldier’s Wounds,” 2-3. Return to text.
6. Fiona Reid, “War Psychiatry”, October 8, 2014, 1914-1918 International Encyclopedia of the First World War. Return to text.
7. Annessa C. Stagner, “Defining the Soldier’s Wounds: U.S. Shell Shock in International Perspective” (PhD diss., University of California, Irvine, 2014), 1-3; 91. Return to text.
8. Stagner, “Defining the Soldier’s Wounds”, 10. Return to text.
9. Memorandum: Care of Insane Soldiers During Their Ocean Transportation from the A.E.F.” June 1919, RG 112, Series NM 29, Box 429, Folder: 730: Neuro-Psychiatry, US National Archives; Major Frank Leslie, “Proposed Classification of Neuro Psychiatric Cases for Embarkation” January/February 1919, RG 112, Series NM 29, Box 429, Folder: 730: Neuro-Psychiatry, US National Archives. Return to text.
10. Thomas W. Salmon to the Surgeon General, July 15, 1919, RG 112, Series NM 29, Box 429, Folder: 730: Neuro-Psychiatry, US National Archives; Stagner, “Defining the Soldier’s Wounds”, 13. Return to text.
11. “Memorandum: Care of Insane Soldiers During Their Ocean Transportation from the A.E.F.” June 1919, RG 112, Series NM 29, Box 429, Folder: 730: Neuro-Psychiatry, US National Archives. Return to text.
12. The C.O. of General Hospital No. 2 to the Surgeon General, “Transfer of Patients suffering from Psychoneuroses” April 18, 1918, RG 112, Series 31-J (K), Box 232, Folder: 702.-3 General Hospital #13 (K), US National Archives; Eugene D. Bondurant, “Memorandum for Major Williams” September 25, 1918, RG 112, Series NM 29, Box 231, Folder: 323.7-5 Gen. Hospital #13 (K), US National Archives. Return to text.
13. The Surgeon General to the C.O. of General Hospitals, “Disposal of the Insane” November 20, 1918, RG 112, Series UD 8, Box 876, Folder: Disposition of Insane, US National Archives. Return to text.
14. The C.O. of U.S. General Hospital No. 13 to the Surgeon General, “Treatment of disturbed cases at General Hospital #13” February 18, 1919, RG 112, Series UD 8, Box 969, Folder: 705.1: Admission of Patients, US National Archives. Return to text.
15. Eugene D. Bondurant, “Memo for Colonel Bailey and Major Williams, regarding Neuro-Psychiatric work in the Army” March 1, 1919, RG 112, Series 31-J (K), Box 232, Folder: 702.-3 General Hospital #13 (K), US National Archives. Return to text.
16. Eugene Bondurant to Pearce Bailey, January 15, 1919, RG 112, Series 31-J (K), Box 231, Folder: 323.7-5 Gen. Hospital #13 (K), US National Archives. Return to text.
17. E. Stanley Abbot to the C.O. of U.S. General Hospital No. 26, “Means to prevent escape of insane patients” July 12, 1918 and July 16, 1918, RG 112, Series UD 8, Box 16, Folder: 710: Neurologist & Psychiatrist (INSANE), US National Archives Return to text.
18. Donald L. Ross, Chief of Neuropsychiatric Service to the C.O. of U.S. General Hospital No. 13, “In regard to the difficulties of visitors to patients consulting officers other than those directly responsible for the care of the patient visited” February 17, 1919, RG 112, Series UD 8, Box 969, Folder: 705.1: Admission of Patients, US National Archives. Return to text.
19. D.S. Spellman to the C.O. of U.S. General Hospital No. 30, “Discipline of Patients” November 16, 1918, RG 112, Series UD 8, Box 1109, Folder: 250: Morals & Conduct, US National Archives. Return to text.
20. Chief of Neuro-Psychiatric Service at U.S. General Hospital No. 30 to the C.O., February 24, 1919, RG 112, Series UD 8, Box 1109, Folder: 250: Morals & Conduct, US National Archives. Return to text.
21. General Hospital 30 to the Surgeon General, July 2, 1919, RG 112, Series 31-J (K), Box 276, Folder 210.711-1: General Hospital #30, US National Archives; “Transfers of Our Wounded Soldiers” RG 112, Series UD 8, Box 1107, Folder: 201.23: Complaints, US National Archives. Return to text.
22. “Fort Porter” December 19, 1918, RG 112, Series 31 (K), Box 231, Folder: 333 – U.S.A. Gen. Hosp. #13, Dansville, N.Y. (K), US National Archives. Return to text.

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Featured image caption: Dansville hospital. (Courtesy Academia.edu)