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Psychology at war, 1914-1945
Abstract
Book synopsis: Drawing on more than 25 contributions, this new book presents both a historical and personal account of British psychology over the last century. The book is divided into two sections: Part 1 contains a collection of historical essays concentrating on institutional beginnings, practical concerns, individual projects and post–war developments. Part 2 looks at the professional reminiscences of 12 senior psychologists.
... Psychiatrists J.R. Rees and Ronald Hargreaves became consultants to the Army in 1939 and Rees initially unsuccessfully attempted to show the military the benefits of intelligence testing recruits (Shephard, 2002). In 1941, Rees was formally appointed as a Consultant Psychiatrist to the British Army and he assembled a group of psychologists and psychiatrists to deal with such military issues as the screening of recruits, the selection of officers and the rehabilitation of soldiers after battle (Bourke, 2001). War Officer Selection Boards (WOSBs) were set up in 1942 that combined the work of both psychologists conducting testing and psychiatrists conducting interviews to serve these ends. ...
... British psychologists however, did not conduct research to the same extent on the detection of homosexuality. In the First World War, there was some suggestion that 'active inverts,' as opposed to "passive inverts," would be useful soldiers who might turn their aggressive natures toward the enemy and heroically defend their fellows (Bourke, 2001). Such rare gay-affirmative attitudes were in complete contrast to the singularly homophobic views of military psychology and psychiatry in the US (Bérubé, 1990). ...
Despite the easily recognizable nature of the Rorschach ink blot test very little is known about the history of the test in Britain. We attend to the oft-ignored history of the Rorschach test in Britain and compare it to its history in the US. Prior to the Second World War, Rorschach testing in Britain had attracted advocates and critiques. Afterward, the British Rorschach Forum, a network with a high proportion of women, developed around the Tavistock Institute in London and The Rorschach Newsletter. In 1968, the International Rorschach Congress was held in London but soon after the group became less exclusive, and fell into decline. A comparative account of the Rorschach in Britain demonstrates how different national institutions invested in the 'projective hypothesis' according to the influence of psychoanalysis, the adoption of a nationalized health system, and the social positioning of 'others' throughout the twentieth century. In comparing and contrasting the history of the Rorschach in Britain and the US, we decentralize and particularize the history of North American Psychology.
... One example where testing has been highly influential and has responded to social contexts is the Second World War (see Bourke, 2001). The war acted as a catalyst for applied psychology, and the subsequent NHS Act of 1948 had a major impact on the growth of psychology (see chapters 4 and 6 for full discussion). ...
Malingering has always been associated with avoidance of military duties. So much so, that malingering etymology comes from military life. Indeed, major psychiatric diagnostic manual still maintain military contexts to suspect malingering. Moreover, this way of avoiding public duties was (and is) conceived as an attempted defection and, therefore, identified with cowardice and disloyalty. So Military Justice Codes condemn it.
Because most of psychological problems have a lack of biological substrate, this area of health has been immersed in subjectivity, encouraging stigma and the view of suspicion in mental problems, like if all of them were faked. In this context of arbitrariness, mental problems in military populations have suffered a double stigma. On the one hand, the warrior strength was incompatible with such problems, making them a sign of weakness. While on the other, any attempt to avoidance of military service (as could be psychological problems seemingly faked) became an unfair act. Therefore, soldiers with psychological problems -real or exaggerated- were stigmatized, either by weakness or by cowardice or disloyalty.
Thus, the public needs of territorial or national defense -crystallized in a strict chain of command whose objectives were incompatible with mental weakness and nether cowardice- begun in an intuitive vision of psychological problems, lack of empathy and full of connotations entrenched in this double stigma. The problem for the military health experts was to determine the veracity of the psychopathology of soldiers, but without evidence based criteria and under the pressure from the chain of command.
As a consequence of this stereotyped view and the absence of empirical criteria to base on psychological assessments, thousands of soldiers have been stigmatized, and even executed, throughout history. Fortunately for the military chain of command, military health and forensic industry (judges, lawyers, experts), current psychological classifications are now supported by evidenced based. However, the double stigma associated with psychological problems in military contexts remains.
Although prevalence studies indicate that military context is not, nor has been, more likely than others to develop malingering of mental disorder, this criterion has not been removed. Moreover, manuals for mental health professionals still encouraging. This thesis reflects on this, showing that this criterion is fruit of the stereotype intrinsic to the wartime history past, the dual stigma associated with mental health problems in military culture, the role conflict under which military health experts decided in the past, the lack of evidence based practice in mental health professionals, the absence of psychosocial perspective in understanding how mental problems take place and, finally, fruit of giving to psychosocial problems –or human problems- a physical illness status.
Since the late twentieth century malingering detection is an evidence based practice for psychologists. Although this development is recent, scientific literature is prolific in demonstrating that detection of psychological patterns faked can be measured with instruments built with a precise methodology. Due to demands associated to military profession, this context is no strange to this technological improvement, implementing it in a variety of psychophysical assessments. Thus, in recruitment phases is used to detect both positive and negative impression, while in regular or special psychophysical assessments, the objective is also to reveal hidden patterns.
Although this technology has proven its reliability and validity in civil and military studies in different contexts and countries, in Spain, had only been tested in military samples once, reporting good results. Given the relevance of psychological assessments in the military, it seemed necessary to replicate the results of this single study, to expand the sample size, to use a more complex experimental design and to measure instruments including more distortion scales. Therefore, the methodological study of this thesis emerged.
This thesis consists of a theoretical part (four chapters) and a second methodological part (three chapters), in which empirical studies are conducted. First chapter is an introduction to malingering. Here, different authors throughout history describe the term malingering and its types. It also identifies the not few myths that have been established around the
concept of malingering, some of these still encouraged by reference manuals for health professionals themselves and some others just from purely descriptive studies with the intention to make prototypes to help decision making. But instead of making prototypes to help, sometimes are promoting stereotypes. The prevalence of malingering is then treated with special emphasis on the military contexts, especially in XX and XXI centuries. After describing how first malingering diagnostic manuals were made, malingering criteria by current reference manuals for mental health professionals are presented. Then, this work reflects about the lack of empirical evidence for malingering suspicion proposed by these manuals, about stereotypes that these manuals encourage and about the omissions that committed. Chapter closes a proposal for improvement.
Second chapter focuses on malingering in military contexts, dating back to the first description of madness malingering in the Trojan War, told for the first time between the IX and VII century BC. Then, the course that military malingering has had in scientific community is described, starting first texts in mid-nineteenth century. About prevalence of malingering in the military, there is a certain incongruity between the view the history has done and what scientific literature has written. This fact could be explained by the hypothesis of the intrinsic wartime history view that has been until the periods referred as "long peace" and "new peace". Then, the body of legislation of malingering in the military is detailed. It is also mentioned that mental problems in the military are associated with a double stigma, which means that a soldier with psychological problems could be reject because of weakness but also because of a suspicions of cowardice and disloyalty (that is to say malingering). This double stigma not only affects raising barriers to access to the right help at the right time, but also creates an unfear feeling of being rejected just because it´s hard to get into military life. This double stigma also promotes fake good behaviors, which could have serious consequences for the units, civilians, even for National Security or diplomatic strategies.
Due to the very raison d'être of the military profession, one of the most argued mental disorders in applications for disability is PTSD, so there is a section in this chapter treating PTSD and malingering in the military. Another issue that could not fail to mention is that intelligence of some countries at war times, have used malingering as a strategy to demoralize and inflict casualties to the enemy, placing this tactic in the field of counter-propaganda or black propaganda. The chapter ends explaining how are psychological assessments in the Spanish Armed Forces.
Third chapter explores different models of malingering. First, the models that have been accepted and then new developments and improvements are mentioned. The problem associated with these actual models, is that they only have a medical point of view and are far of psychosocial problems, so includes human problems in the category of physical illness. The chapter ends by proposing a model to understand malingering from a psychosocial and multilevel view.
Fourth chapter deals with an empirical view of detection of malingering in mental disorders, referring to the developments that have been made in scientific community, the methodology and experimental research designs in this area, the instruments used to detect malingering, and finally the main empirical criteria on which to base malingering detection for mental disorders.
Empirical part starts in fifth chapter, in which the method is described. Psychodiagnostic tests that have accumulated the main positive evidence in scientific community and have been more acceptance in forensic field are the Personality Assessment Inventory (PAI; Morey, 1991, 2007) and the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1942; Butcher et al., 1989; Ben-Porath & Tellegen, 2008). Another test used for specific screening of malingering is the Structured Inventory of Malingered Symptomatology (SIMS, Smith & Burger, 1997; Widows & Smith, 2005). In the current study, the aim is to examinate the utility of overreporting validity scales of the Spanish version of the PAI (Ortiz-Tallo et al., 2011), the MMPI-2-RF (Santamaría, 2009) and the SIMS (González Ordi & Santamaría, 2009) in detecting feigned psychopathology symptoms in a sample of Spanish soldiers (N = 342) -not experts in psychopathology, nether validity scales-. Analogue simulation design was used comprising a control group (n = 95), an analogue group of general psychopathology (n =70), an analogue depression group (n = 90) and an analogue group of anxiety (n = 87).
Results, described in Chapter 6, show that all of the PAI and MMPI-2-RF scales of the three analogue groups obtained significantly higher scores than the control group, except those measuring good image patterns where the analogue groups were significantly lower than the control group. Furthermore, all faking bad scales of the PAI and the MMPI-2-RF significantly differ between control group and analogue groups. There were also significant differences between the analogue groups with each other in most of the scales. Like in Clegg, Fremouw & Mogge (2009) and Blasco & Pallardó (2013) studies, SIMS scales Af (F(3,336) = 162,02, p<,001) followed by Total scale (F(3,336) = 112,09, p<,001), were those with largest effect sizes (0.59 and 0.50 respectively) measured by Eta square. Cohen´s d effect sizes were very large for Af (ds = 3.79 – 4.42) and also for Total (ds = 2.37 – 6.31). PAI scales, NIM –IMN in Spanish version- (F(3,336) = 134,44, p<,001), MAL –SIM in Spanish version- (F(3,336) = 82,97 p<,001) and RDF –FDR in Spanish version- (F(3,336) = 69,25, p<,001) obtained large effect sizes (0.55, 0.43 and 0.38 respectively; ds = 1.41- 5.65), confirming other authors results (Liljequist, 1997; Liljequist, Kinder y Schinka., 1998; Calhoun et al, 2000 ; Kucharski, Toomey, Fila y Duncan, 2007; Kucharski y Duncan, 2007; Silgo y Robles, 2010). Finally, MMPI-2-RF scales, F-r (F(3,336) = 163,82, p<,001), Fs (F(3,336) = 122,79, p<,001), FBS-r (F(3,336) = 115,14, p<,001) and Fp-r (F(3,336) = 100,60, p<,001) had large effect sizes (0.59, 0.52, 0.51 and 0.47; ds= 2.62 – 4.02) in line with those reported by other authors (Goodwin, Sellbom y Arbisi, 2013; Blasco y Pallardó, 2013).
Discussion in chapter 7, emphasize that analogue depression group was the most exaggerated group according to malingering scales, clinic scales and even faking good scales. This could be because, depression stereotypes could be more intuitive or "common sense" that anxiety ones and so explained the fact that anxiety analogue group had the lower scores in anxiety PAI scales. It could also be that depression stereotypes could conceived it as more serious mental problem than anxiety problems. Another explanation might have to do with the structure of the test, for example, SIMS has an exaggerated scale to assess depressive symptoms, but does not have an own scale to assess anxiety disorders. Then results of this study are compared to results from other authors (Goodwin, Sellbom y Arbisi, 2013; Blasco y Pallardó, 2013). The main conclusion is that SIMS, PAI and MMPI-2-RF were good instruments to differentiate between military control and analog groups.
Chapter 7 concludes with some future prospects, some to complete statistical analysis that are not been done in this study and some related to continue this research with real designs including clinical groups and expert groups. In addition, malingering model proposed in Chapter 3, which implies non-medical factors, such as Bass & Halligan (2014), and introduces psychosocial factors, such as proposed by Snyder (1998), Merckelbach & Merten (2012) and Niesten et al (2015), deserve to be tested and validated. Also, it is proposed to investigate mental disorders stereotypes to have more objective criteria to help detection malingering practices still being based on evidence with different strategies. Finally, it should be recognized that it´s need to study double stigma in Spanish soldiers, just like some other allies countries are doing.
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