World War II bomber pilot Roman Tritz died earlier this year at the age of 97. He was the last known survivor of a U.S. government program that lobotomized combat veterans who suffered from treatment-resistant forms of mental illness, including profound depression, anxiety and psychosis.
As we honor our veterans this week, this dark piece of history is a reminder that war trauma puts combat veterans at risk for serious and enduring mental illness. It also lays bare the exacerbation of suffering and the extraordinary human rights violations that occur as a result of ignorance about mental illness.
What happened? According to a 1955 Research Council study, 680,000 active-duty WWII US servicemen were admitted to hospitals for battle injuries. By comparison, twice as many – 1.2 million – were admitted for psychiatric and neurological problems. The servicemen who exhibited severe and enduring symptoms of anxiety, depression and psychosis that did not respond to routine treatment presented a conundrum for mental health providers. The proposed solution: lobotomy. It was not until decades later, and thanks to the investigative journalism of Michael Phillips that the public came to learn this dark secret. Between April 1947 and September 1950, at fifty Veterans Affairs hospitals across the United States, physicians lobotomized at least 1,930 former servicemen.
What is a lobotomy? Also called a leucotomy, a lobotomy is a surgical strategy to curtail psychiatric problems. The surgery involves severing neurological connections in the brain’s prefrontal cortex. Most typically, the connections to and from the prefrontal cortex, and the anterior part of the frontal lobes of the brain, are severed. Portuguese neurologist António Egas Moniz was awarded a Nobel Prize in 1949 for the “discovery of the therapeutic value of leucotomy in certain psychoses,” and for about two decades, it over-promised. The use of the procedure increased dramatically from the early 1940s and into the 1950s until it fell completely out of favor as a treatment for psychiatric illness.
From Shell Shock to PTSD. It was called shell shock in WWI. The same traumatic responses among WWII and Korean War veterans were called battle fatigue, combat exhaustion, and war neurosis. In 1952, the DSM-I called it Stress Response Syndrome, so that is the condition with which Vietnam War soldiers were diagnosed. It was not until 1980 that PTSD, or Post Traumatic Stress Disorder, made its debut in the DSM-III and not until 1992 that it was included in the ICD-10. Regardless of what we call it, the core features are the same: re-experiencing of the traumatic event, avoidance associated with the traumatic event, arousal and reactivity symptoms, and cognitive and mood symptoms. This experience of traumatic impairment following the combat of war is common. WWII veteran Roman Tritz was one among many. He went to war in good health, experienced intense combat, and returned home with imaginary voices in his head, nightmares, and related symptoms that we would likely call PTSD today.
Treatment for PTSD. When Roman Tritz presented at his VA for care, the prevailing view was that the mental distress following active military service would be transient. Unfortunately for him, and for many WWII veterans who sought psychiatric care, this was not the case. It is estimated that as many as 54% of WWII servicemen who presented for psychiatric care had PTSD, even if we weren’t calling it that at the time. In Tritz’s case, he spent eight years as a patient in the Tomah Wisconsin VA hospital where he underwent 28 rounds of electroshock therapy, insulin-induced comas, and finally, a lobotomy. Today’s treatment is altogether different, and it is widely recognized that medication and trauma-informed psychotherapy are effective for most individuals who suffer from PTSD.
Collective Trauma, Collective Healing. Individual therapy can have dramatic benefit for people suffering from PTSD, but as Dr. Jack Saul argues, in the wake of widespread community disasters, populations need to heal collectively as well. When the trauma is shared, healing is enhanced when it, too, is shared. Dr. Saul wrote Collective Trauma, Collective Healing in the wake of September 11 and draws on that historical moment and multiple others to describe what it takes to recognize, develop, and sustain a community approach to healing. His wisdom would have made for a completely different approach to treating Roman Tritz and the 1930+ other WWII veterans who underwent a surgical lobotomy. Let us hope that we have learned enough to heed Dr. Saul’s wisdom today in the wake of the current global pandemic.
This week as we pause to celebrate Veteran’s Day in the United States, it is eminently apparent that the mental health cost of war is profound. It is also eminently apparent that the cost of ignorance about mental health and mental illness is incalculable, casting a dark shadow for decades. As war and other collective traumas test our values, may we reach for enlightenment over ignorance in the search for healing.