Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Monday, April 27, 2015

Let There Be Light

One of the things I heard about a couple months ago, in the session I described in Gene Kelly at the Waldorf , and have been meaning to write about, is a 1 hour film by John Huston called, Let There Be Light. Huston went into a psychiatric hospital following World War II, and filmed the treatment of a group of veterans with PTSD.

This took place at an interesting time in the history of psychiatry, when analytic precepts were an accepted and assumed part of psychiatric treatment. 

The servicemen were admitted to Mason General Hospital for an 8-10 week stay. They had individual therapy, group therapy, occupational activities, sports, music and other recreational activities, and training for reintegration into civilian life.

I found the 58 minute film very moving. The men they spotlighted all did well, despite having started out extremely debilitated. One man had repetitive head-shaking, another had developed a severe stutter, another had amnesia, another couldn't walk, still another was suicidal. 

They all completed the program and were shown at a graduation ceremony at the end, walking, talking, and smiling. 

The man who couldn't walk was shown rounding the bases at top speed at a baseball game shortly before the graduation. 

I was powerfully struck, and rendered tearful, by how young they all were. And yet, this is after the war, and even though some of them are maybe 19 or 20, none of them looks like a boy, the way they probably did when they entered the service. These were all men who had been through some terrible experiences. 

I was also struck by how articulate and thoughtful they were, despite some obvious differences in socioeconomic, educational, and intellectual backgrounds. 

It's interesting to watch a film made pre-privacy concerns. The men are told to ignore the camera, that they're simply having their progress tracked. At least one full name is used. The men seem to take it as a given that they have no say in what the military chooses to do. 

I wondered about the effect of the camera. In the scenes with individual therapy, the soldiers tend to avert their eyes from where the camera is positioned.

The psychiatrists, all male, of course, are interesting. They speak like something out of a 1940s movie, and at first I thought they were a bit callous, but after watching for a while, I could see the kindness coming through.

There was one doctor, in particular, who seemed to be the hypnosis expert. He was remarkably skilled. He conducted an amytal interview with the young man who couldn't walk, and after determining that the paralysis started after the soldier heard that his mother was ill, he proceeded to get him to talk about his mother, who was a difficult, angry, critical woman. He was then able to stand the man up and have him walk across the room.

He also used an amytal interview to cure another soldier of his stutter, which rendered him practically speechless. It started when he was talking to his buddies on their boat, saying something about the port side, and he got stuck on the "s" sound. During the amytal interview, the soldier is overcome by the realization that his speech has returned to normal. He then goes on to relate that the "s" sound reminded him of the sound of a, "German 88 high explosive shell coming in." His speech returned to normal after the interview.

This doctor treated a different man suffering from amnesia with hypnosis. I got the impression that it was the doctor's assured tone that made the young man believe he could remember. He got the man to speak about how terrified he was when the shells were coming in, and how he just wanted to forget everything. Then the doctor told him he didn't need to forget, because it was all over, and he could let himself remember. This was effective.

The narration is quite fascinating, at least from my analytic perspective. We are told that the paralyzed man's symptom had been treated, but that his neurosis will require time and therapy.

We hear that the amytal interview is, "Like hypnosis, a shortcut to the unconscious mind. It brings to the surface the emotional conflict that's the cause of the symptoms. And it removes through suggestion those symptoms that impede the patient's recovery."

And also, that, "Modern psychiatry makes no sharp division between the mind and the body."

At the beginning of the film, when we first see the individual interviews, the men make comments like:

I was the first scout. My buddy was second scout, but he got ahead of me, and I couldn't get back to him.

I was just hoping I would die.

I was told I was gonna die, so I thought I was dead.

I'm jumpy. I used to have fun, but now I don't like to do nothing no more.

I never was nervous before. I was a solid man.

The diagnosis given is, "Anxiety Reaction, Severe," and in group therapy, the men refer to themselves as "psycho-neurotics".

In an early group therapy session, they're asked, "Do you feel changed? Not the same boy as when you went away?" They're told that the purpose of therapy is to get them out of their feeling of isolation, to show them that they're like other people. That they will use a core of treatment methods, to help them develop knowledge of themselves. That underneath, "I can't," you usually find, "I won't." That a stutter or inability to speak reflects an underlying anger and resentment. That their sense of personal safety, or lack thereof, stems from their childhood sense of safety, and that, in turn, from their parents' senses of safety. They are encouraged to talk about childhood experiences, and they do.

I thought the last two examples smacked of "wild analysis", of jumping very rapidly to conclusions about the patient without a lot of data. But the soldiers seemed to be helped by it.

A later group therapy session is much different. They openly discuss their concerns about reintegrating into civilian life. They worry the public will think they're crazy. That the hospitalization will be perceived as shameful. That there needs to be an education program for the public. The psychiatrist asks, "Would you make it a point to tell your employer that you're a psychoneurotic?"

One man points out that there are plenty of wealthy civilians on Park Avenue who are more nervous than they are, and who rely on pills to help them cope. He's proud of what they've accomplished, and the doctor comments that they have nothing to hide or be ashamed of, that they've learned a great deal.

Another man, the one who couldn't walk, says, "We just wanna show people we can be as good as anyone else. They just have to give us a chance."

I don't know what they long-term outcome of this treatment was, or if there was even follow-up done. I suspect not all the men were able to maintain the progress they had made, once they left the hospital setting. I also don't know how extensive the program was. But it was so moving to see how much genuine care and effort the military put into helping these men, in the best ways they knew how at the time.


  1. Also liked the film:


    One of the psychiatrists who taught at my medical school told me about programs like this one and how they accelerated residency training by a year to get adequate staffing. Well worth the time to watch this film.