The Role of the Veterans Administration

Even before the end of World War II, the record of the Veterans Administration (VA) clearly indicated that some federal agencies were prepared, even eager, to support vast new programs in the mental health field. The VA, of course, had little choice in the matter; next to the armed forces themselves, it was the agency whose primary job was to care for war casualties. Since huge numbers of those casualties had suffered psychiatric breakdown, the VA found itself in charge of binding more mental than physical wounds and picking up the emotional pieces of military conflict.

The number of psychiatric cases in VA hospitals almost doubled between 1940 and 1948.^[4] Right after the war, in April 1946, around 60

percent of all VA patients were neuropsychiatric cases of one sort or another: forty-four thousand out of a total of seventy-four thousand.^[5] Fifty percent of all disability pensions were being paid to psychiatric casualties and, by June 1947, the monthly cost of such psychiatric pensions was $20 million, with each case running the government something more than $40,000.^[6] The VA's fifty-seven outpatient clinics served over one hundred thousand additional people. By the mid-1950s, half of all the hospital beds in the country were being occupied by persons with mental illness, a fact called the "greatest single problem in the nation's health picture" by the March 1955 Hoover Commission study of federal medical services.^[7] The VA, alone responsible for 10 percent of the inpatient total and providing ongoing treatment to thousands upon thousands of outpatients, was making ambitious plans for new construction of hospitals and clinics.^[8] Waiting lists for clinical services were long and growing rapidly.

Because personnel shortages had been so severe during the war, and psychiatrists, psychologists, and other clinicians were so scarce, professional training soon became "the most pressing medical problem" facing the agency, according to Dr. Daniel Blain, chief of psychiatry in the VA.^[9] Indeed, more open positions existed in the VA at war's end for clinical psychologists than there were clinical psychologists in the entire country. In order to cope with the prospect of drastic, long-term personnel shortages, programs of professional education were swiftly put into place.

An ambitious four-year training program in clinical psychology, for example, was launched in 1946 to train two hundred individuals in twenty-two different universities.^[10] Under the terms of the program, students were given free educations and prorated salaries in exchange for half-time work in a VA facility while they pursued their doctoral degrees. This instantly made the VA the single largest employer of these professionals in the entire country. In 1946, the VA's chief of clinical psychology wrote, "The significant and inevitable consequence of this development is that a large portion of the whole profession of clinical psychology will come under Governmental control. . . . The field is rapidly expanding and the opportunities for service and research are almost limitless."^[11] The VA continued to produce hundreds of new clinicians each year, all of whom could expect interesting work and substantial pay in a job market where their skills were in high demand. Just three years into the clinical psychology program, it had expanded to seven hundred students in forty-one universities.^[12] This pattern of steady

growth, which lasted for decades, ensured that the VA would remain the source of plentiful, exciting professional opportunities and contributed to a massive shift in employment patterns within psychology away from academia and toward clinical work. The year 1962 was, R. C. Tryon noted, "a real turning point" because psychologists employed outside of universities outnumbered their academic colleagues for the first time.^[13] Opportunities were not limited to clinical psychology. By the mid-1950s, the VA was employing 10 percent of all psychiatrists in its 35 psychiatric hospitals, 75 general hospitals with psychiatric services, and 62 mental health clinics; another 10 percent of psychiatrists worked as VA consultants.^[14]

The VA proved a bonanza not only for clinical professionals. It was also the site of increased consumer demand. Veterans and members of veterans' families, most exposed to clinical expertise for the first time during the war, were the first to come looking for assistance with the ordinary—if still extremely difficult—problems of postwar living. It must be recalled that the vast majority of veterans who received discharges for psychiatric reasons were classified as suffering from the lower orders of mental disturbance: psychoneurosis rather than psychosis. These veterans and others tended to bring "normal" problems to the attention of VA clinicians: marital tensions and parenting difficulties were especially common.^[15]

Some veterans undoubtedly remained skeptical that professional helpers could be of any practical use. If the statistics on skyrocketing numbers of VA outpatients are any indication, however, many others had received the message that had been directed at them repeatedly as soldiers: nothing was wrong with seeking psychological help; in fact, to do so was a sign of unusual strength and maturity. Quite a few clinicians who worried about the logistical headaches of servicing millions of returning soldiers reminded themselves that offering clinical assistance to the civilian masses was the logical follow-up to their earlier patriotic contributions in the military. Dispensing psychotherapy to veterans was the link connecting clinicians' past to their future.

Psychotherapy could also advance the process of social readjustment to peacetime democracy. Carl Rogers, for example, was a clinician who would become a well-known advocate of humanistic psychology in the postwar decades. In 1946 he coauthored a counseling manual, Counseling With Returned Servicemen, that he hoped would put simple, do-it-yourself therapeutic techniques into the hands of thousands of new clinicians so that they might ease the adjustment traumas of returning

servicemen whose subjection to strict military authority had temporarily unfitted them for their postwar roles as free-thinking, independent citizens. He spelled out the social relevance of their collective task as follows: "No longer is he just another G. I. Joe. Instead he again becomes Bill Hanks or Harry Williams. In contrast to marching troops who are 'men without faces,' the client begins to resume selfhood as a specific, unique individual."^[16] Not only did Rogers promise that his particular brand of sensitive, nonjudgmental clinical help could facilitate the resumption of selfhood and individuality. It could also help to recapture any democratic impulses that had been lost in the crush of wartime regimentation, and perhaps even generate attractive new styles of democratic conduct and decision making in individuals who had never previously possessed them. "All the characteristics of this type of counseling," Rogers contended, "are also tenets of democracy."^[17] Surely a voluntary therapeutic relationship consciously imbued with tolerance and respect, based on confidence in individual maturity, freedom, and responsibility, might succeed in communicating some of these virtues to veterans.