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What mental health impact of second world war tells us about post-Covid life

Posted at Dec 28, 2020

At the beginning of the second world war, fears were high about the public’s mental resilience, with the committee of imperial defence identifying stoicism “as the core defence against the stress of aerial bombardment”.

But in the face of the unrelenting bombardment of the blitz, the government feared the population could develop a so-called “shelter mentality”, which could make workers so anxious it would undermine national production.

In large part, these fears did not materialise. According to Simon Wessely, former president of the Royal College of Psychiatrists and director of the King’s Centre for Military Health Research, there were fewer admissions to psychiatric hospitals in 1940 than in 1939, while official suicide figures did not increase.

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“While that happened in some areas, it was nothing remotely on the scale that they were expecting … there wasn’t an epidemic of mental health problems,” he said.

But, Wessely added, the wartime government had a tool unavailable to the current authorities: the ability for communities to physically come together and to be useful carrying out vital volunteer roles. Today, all people can do is stay at home: “The threat we are facing is similar, but in order to control that threat, we have brought in measures that will significantly reduce our ability to cope,” he said.

The focus on the “blitz spirit” may brush over the mental health repercussions felt by many in the years after the war, wrote Prof Richard Overy in the Guardian in March. While there was evidence of “stoic” behaviours, the trauma that “destroyed buildings, corpses and body parts … produced was largely unrecorded, and certainly untreated,” he argued.

In Hull, where a team of psychiatrists and psychologists studied why the populations panicked after heavy raiding, researchers found case studies that showed “people developed serious psychosomatic conditions, including involuntary soiling and wetting, persistent crying, uncontrollable shaking, headaches and chronic dizziness,” wrote Overy. “The government papered over the evidence of the physical and psychological effects of being bombed and focused instead on the stories of British resolve.”

Edgar Jones, a professor in the history of medicine and psychiatry at King’s College London, added that studies at the time showed significant regional differences in mental health. “The general principle was that the more death, the greater destruction of housing, the more loss of work, the higher the rates of mental illness,” he said, something he suspected could be true in the post-pandemic era. “My feeling is that we will see those areas where we’ve had the greatest mortality and the highest rates of infection – which often correspond to areas of greatest deprivation – is where we will have particularly high rates of mental illness.”

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Other evidence suggests that the war resulted in long-term mental trauma. A 2009 study that assessed 870 adults aged between 62 and 72 found that young evacuees (aged four to six) or those who were poorly looked after were more likely to suffer depression and clinical anxiety.

Meanwhile, prisoners of war from the far east who returned with severe trauma were given help with finding work, but not with their shattered mental health, Jones said. People may not have presented with identified mental health issues, but visited the doctor on the newly formed NHS with headaches or pain, he added.

“There were very few focused interventions for people who were suffering from really quite severe post-traumatic illnesses,” he said. “And it led to the idea that the British people actually managed the war without traumatic illness, that somehow we coped. And most people did, but that ignores the probably 10-15% of the population who were really quite unwell.”