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.

Gene Kelly At The Waldorf

This is the main lobby at The Waldorf. The clock is taller than it seems in the photo. That's probably why I never noticed the little lady liberty at the top.

I want to write about one of the discussion groups I attended, the Service Members and Veterans Initiative that I mentioned in my previous post, Waldorf 2015. As preparation, I watched "Combat Fatigue Irritability",  a short film directed by and starring Gene Kelly, which was made for the Navy, to make people aware of symptoms of PTSD. The film was only referenced, not shown, during the group discussion, but it was interesting to hear from his daughter, Kerry Kelly Novick, who led the group. I kept wanting to ask her the completely irrelevant question of, "What is it like to see your father on the big screen?"

She did mention that her father was quite steadfast in his insistence on an accurate portrayal of the main character, Seaman Lucas', symptoms and behavior. He even had himself admitted to a psychiatric hospital to prepare for his role.

In the film, Lucas had worked on a ship that was blown up. His job was to monitor the pressure valves. He never went topside as part of his work. He never knew what was going on. He was not a gunner, so he had no active outlet. All he did was monitor the valves, and feel increasingly frightened and helpless. When his ship was destroyed, and he found himself in the water, he felt relieved, but also horrified at watching his buddies die around him.
After he is rescued and recovered, he has a 30 day furlough, and he returns home. At first things go well with his family, but he feels increasingly isolated and not understood, has trouble reuniting with his girlfriend, startles and gets angry when her little brother throws a paper airplane at him, gets into a fight with a bartender, and starts to shake uncontrollably when he goes hunting with his father, after which, he is hospitalized.
The film shows his coming to terms with some of his feelings in group therapy. The psychiatrist is portrayed as kind but somewhat patronizing and paternalistic, and places an emphasis on "fear that wasn't handled properly" as the origin of Lucas' symptoms. He is also shown sedating him, immediately following Lucas' breakthrough in understanding.

There were a number of interesting points made by various people, most of whom work with soldiers or veterans regularly. One idea that I hadn't considered is that the characters portrayed in the film, like most men in the military during World War II, were just regular guys who were drafted. Whereas today, we have an all-volunteer military, so those who have chosen to serve have done so with the intention of making it their career. They want to remain in the service, which makes them that much more reluctant to acknowledge when they are having emotional difficulties.

There was discussion about Lucas acting as "bad" as he felt he was, for his wish to escape from the boiler room, and then watching his comrades die. And of guilt as a defense against helplessness. Someone noted Freud's comment about the soldier's conflict between the wish to live and the wish to be a good soldier.

Isolation was another topic that came up in the discussion group, as illustrated by the sense Lucas has of not being understood by anyone who hadn't had similar experiences. The idea was that it's important for the clinician and for family members to recognize that this is so, but that those suffering from PTSD symptoms can use this isolation to defend against acknowledging feelings of guilt at their reactions to traumatic events, and feelings of loss-that to truly return to their former lives, they need to recognize that they have lost the versions of themselves that existed before the trauma.

One analyst has been working on petitioning the AMA to include military history as part of the social history for the E/M CPT code. Her group wanted the wording to be, "Have you or a loved one been in the military?" So far, they've gotten "you", but no "loved one".

An unfunded (by the military) area that someone brought up was pets. He said that the military has put together some research to show that pets are not that helpful in recovery for veterans, despite having evidence to the contrary. Basically, the military just doesn't want to pay for it. I don't think I came across this document when I wrote, The Comfort of Dogs.

The question of funding is an interesting one, especially in light of the opinion piece published in the NY Times a couple days later, After PTSD, More Trauma, written by a veteran, David Morris, who sought therapy for PTSD, and was placed in Prolonged Exposure Therapy, heavily promoted by the VA for its effectiveness. In this type of treatment, the patient repeatedly reviews his traumatic experience, over the course of a number of sessions. This turned out to be a bad choice of therapy for him, and he got worse, until he dropped out. He later underwent the VA's other PTSD therapy, Cognitive Processing Therapy, which he found helpful.

Morris notes the VA's contention that 85% of PTSD patients are helped by Prolonged Exposure Therapy. He cites a 2013 JAMA Psychiatry paper, Effectiveness of National Implementation of Prolonged Exposure Therapy in Veterans Affairs Care, that demonstrates evidence supporting the use of this treatment. It's open source, so you can read the whole thing, if you like. As usual, I'm skeptical about research that involves nothing but before and after checklists to establish efficacy, and a treatment for which the clinicians received 4 days of training, and then provided 8-15 sessions of therapy including, "(1) imaginal exposure or systematic and repeated exposure to the traumatic memory; (2) in vivo exposure or systematic and repeated engagement with nondangerous activities and situations that have been avoided because of trauma-related distress; (3) psychoeducation about treatment and common reactions to trauma; and (4) breathing retraining," to treat something so complicated.

Morris then goes on to state:

After my experience with prolonged exposure, I did some research and found that some red flags had been raised about it. In 1991, for example, Roger K. Pitman, a professor of psychiatry at Harvard Medical School, conducted a study of exposure therapy on Vietnam veterans and observed some troubling complications: One subject developed suicidal thoughts, and others became severely depressed or suffered panic attacks. A similar study, published in the Journal of Traumatic Stress in 1992, found that Israeli army veterans experienced an increase in the “extent and severity of their psychiatric symptomology.”

My concern is that the military has strong motivation for funding the most cost-effective, and not necessarily the most effective, treatments. No doubt it feels compelled to conserve its financial resources for use in war-related technological advances that will create more soldiers with PTSD.

It's also interesting to think about the contrast between what the military thought was useful treatment for PTSD back in 1945, and what it thinks now.

It was quite moving to hear people speak about their work with soldiers and veterans. Here's a link to the Service Members and Veterans Initiative page, if you want to learn more about the program.