“N-P”: The Case of Neuropsychiatric Disability (1944)

The program of aggressive normalization remained in force throughout the twentieth century and was improved and expanded on in numerous ways, especially as new understandings of disability and new conditions of war demanded. One particularly significant area of transformation was in the provision of psychological services, especially to those sustaining neuropsychiatric disabilities, which were as old as warfare itself, but largely misunderstood until the twentieth century as evidence of cowardice and malingering. Through preinduction testing, some armed forces tried to weed out men unlikely to have the emotional stability to serve under wartime conditions, but the greater the manpower needs, the more such standards were relaxed, and the more the armed services needed to be able to provide psychological treatment.

Every month thousands of men return home from preinduction examinations or from the U.S. Army [Page v415]with N-P stamped on their medical records. N-P (neuropsychiatric) sometimes means insane but usually means psychoneurotic. What psychoneurotic means, few laymen know. Most psychoneurotics do not know either. Many of them think they are insane or soon will be. So do family and neighbors who look askance, and employers who sometimes refuse jobs. (Last week the Army changed its N-P stamp to read “Unsuited for military service.”) Because few N-Ps discuss their plight, few people realize how many there are.

But last week 2,000 psychiatrists at the 100th meeting of the American Psychiatric Association heard some startling figures from the Army's Colonel William Clare Menninger (brother of famed Psychiatrist Karl Menninger). Since Pearl Harbor the Army has turned down 1,340,000 men for neuropsychiatric causes, has discharged 216,000. These figures would be even higher if the men in Army neuropsychiatric wards were included.

Most practical report on the N-P problem was made to the meeting by New York Hospital's white-haired, 40-year-old Dr. Thomas Alexander Cumming Rennie. Dr. Rennie realized that discharged and deflected N-Ps need psychiatric care, without it might develop real mental illness. He also realized that there was no place where they could get such help. So last August he started a psychiatric clinic at the hospital, manned one night a week by twelve psychiatrists, a psychologist, seven social workers. The clinic gives psychiatric interviews, group treatment, occupational therapy, arranges social gatherings, dates, helps men get jobs.

Dr. Rennie told last week's meeting that the clinic has definitely proved its value to N-Ps. Of its 200 patients (about one-third from the Army, only 14 actual combat veterans) 104 are improved (some became perfectly well after only one one-hour psychiatric interview), many are still under treatment: a very few had to be sent to mental hospitals. (Some of these have since been discharged, now hold jobs.)

New York City already has six such psychiatric clinics; Boston has four, and there are a few others. But Dr. Rennie will not be satisfied until all available psychiatrists are helping in such clinics. Even so most of the cases would go untended—the U.S. has only about 3,000 psychiatrists altogether, of whom 800 are at war.