Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
This was directly due to the fact that for the first time in history
one of the most important problems, with which the military authorities
had to deal, was the question of mental diseases and defects. For
purposes of comparison and the intelligent consideration of this
important subject, the incidence of mental diseases in the army in
the past is of considerable interest. The rate in enlisted men, as
shown by the Surgeon General's reports, varied from 1.08 per thousand
in 1898 to 1.73 in 1911, and was 2.72 in 1900, the only year in which
it went above two. In 1912, 1913, 1914 and 1915, when defective mental
development, constitutional psychopathic states, hypochondriasis and
nostalgia were included in the reports the rates per thousand were
respectively 3.45, 3.44, 4.18 and 3.82. The frequency of psychoses was
higher in the men serving in the Philippines—2.07 in 1898, 2.79 in
1900, 1.45 in 1905 and 2.01 in 1911.
The ratio of mental diseases in the American and English armies has
been higher for many years than in the French, Italian, Russian and
German forces. Universal military service is supposed to have been the
factor producing this difference, the larger establishments naturally
more nearly representing the normal insanity rate of the country.
From May 1, 1861, to June 30, 1866, in other words, during the civil
war period, there were 198,849 discharges for disability from the
United States army.[85] Of this number 819 men were discharged on
account of insanity, 3,872 for epilepsy and 2,838 for various forms
of "paralysis." Based on the mean annual strength of the army, this
represented a rate of .34 per thousand for insanity, 1.6 for epilepsy
and 1.17 for paralysis. Based on the total number of discharges alone,
it represented a rate of 6.0 per thousand for insanity, 20.8 for
paralysis, and 28.3 for epilepsy or a rate for the three combined of
55.1 per thousand. These statistics are for white soldiers only. The
rate for colored troops, based on the total discharges, was seven per
thousand for insanity, 14.3 for paralysis and thirty-six for epilepsy.
No information whatever is available as to what the term paralysis
includes in these reports. The rate per thousand in the United States
army, as has been shown, increased from approximately one in 1898 to
three in 1901, during the Spanish war, Philippine insurrection, etc.,
and dropped back to one again in 1903. Weygandt,[86] who made a study
of war neuroses and psychoses in 1904, gives the insanity rate per
thousand of the German army during the Franco-Prussian war as .54, the
American troops during the Spanish war as 2.7, the British army during
the Boer war as 2.6, the Russian army during the Japanese war as 2.0,
and the Bulgarian troops during the Balkan campaign .33. The German
expeditionary corps engaged in Southwestern Africa reported 4.95 per
thousand and a rate of 8.28 including epilepsy and hysteria.
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