[History of Serbian and Yugoslav military psychiatry: founding and development of the Clinic of Military Psychiatry from 1932 to 2002].
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This study examines the co-operation between psychiatry and the army in Germany between 1870 and 1914, leading to the establishment of military psychiatry as an independent discipline. Arguing that military psychiatry played a key role in the history of modern clinical psychiatry, the paper points out how the first generation of military psychiatrists developed innovative diagnostic technologies, such as the intelligence test, and established crucial institutional alliances between psychiatric clinics, military authorities, and local and national administrations. The early history of military psychiatry marks the transition of psychiatry from a medical sub-discipline to a more generally applicable "social technology" assessing the borderline between normality and abnormality in multiple social contexts.
The need for psychiatrists in the military was recognized for the first time during World War I, which involved millions of men in unusually protracted warfare. The policy of treating psychiatric casualties close to the from and returning soldiers to their military units as quickly as possible proved of great significance in the U.S. war effort. During World War II, the Korean conflict, and the war in Viet Nam, military psychiatry made great contributions and learned many lessions, both at home and abroad. The lessions learned by military psychiatry have important applications for the rest of medicine, especially in the fields of stress, crisis therapy, and community psychiatry.
Psychiatrically hospitalized military members are at risk for suicide during Medical/Physical Evaluation Board processing. Following initial hospitalization and treatment, usually for major depression, members are entered into medical administrative channels. During this period they are often returned to duty, placed on "casual" status in a holding company, or moved to a "transition unit" within the hospital, often under the care of other than mental health personnel. It is in this situation that they must face the reality of the loss of their military identity and career. This stressor may occasion a reoccurrence of the presenting illness which may be missed by medical personnel because the member is viewed by them as treated, or no longer actually a patient, but rather in the process of leaving. Medical personnel are reminded that ongoing or de novo psychiatric illness, including the risk of suicide, can and does occur on the occasion of separation from the military as stressor-independent from the reason for admission.
The history of military psychiatry in Israel may be divided into 2 main periods. The first extended from the War of Independence in 1948, through the Sinai, Six Day and Yom Kippur Wars. Its outstanding feature was avoidance of the issue of combat stress reaction (CSR). The Yom Kippur War made the recognition of CSR inescapable, assisted in breaking up denial, and served as a stimulus for development of the next phase of the system. This second phase was characterized by impressive progress in all areas of military psychiatry. The rich experience accumulated during the wars, together with the assimilation of a research culture which began blooming, especially in the wake of the Lebanon War, aided the development and crystallization of concepts related to combat and non-combat military psychiatry alike. The build-up of the mental health organization overlapped field deployment of the Medical Corps.
Military psychiatry has recently generated a lot of interest. In contrast there is virtually no literature on military forensic psychiatry. The first section of the paper is a brief review of British military psychiatric services and recent data on the prevalence of mental illness in British armed forces personnel. The second section summarizes the relevant aspects of the British military judicial and penal systems including the practice of summary justice, the court martial system, and sentencing and corrective training. The third section of the paper addresses issues which are particular to forensic psychiatry, including mental defences in relation to the military, the military offences of malingering and impersonation, risk assessment in military contexts and the notion of 'temperamental unsuitability' to military service.
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This review of the contributions of Dr. William C. Menninger to military psychiatry includes: (1) a brief biography with particular reference to Dr. Will's work with the military in World War II; (2) the status of psychiatry in the Army in 1944 at the time Dr. Will was appointed to head psychiatry in the Army; (3) Dr. Will's discussion of the characteristics of an effective military psychiatrist; (4) psychiatric treatment in combat situations as it evolved in World War II; (5) the concept of prevention, which Dr. Will felt was critically important; (6) a summary of Dr. Will's experience in World II; and (7) reflections from Dr. Will's colleagues.
Although previous authors have noted that U.S. military personnel share beliefs, values, and behaviors defining the military as a separate culture, military psychiatry has not previously been presented from a cross-cultural perspective. Viewing the military psychiatrist from this perspective reveals new observations and explanations for the role he or she plays within that culture, for differences in demographic data regarding diagnoses and patient population, and for different treatment issues surrounding military patients and their dependents. It also has implications for the recruitment, training, and retention of military psychiatrists. Learning to navigate within the minority culture of the military and to act as a liaison between that culture and the dominant one serves to broaden the skills of the military psychiatrist.
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