Memorandum On War Pensions

Mental Health

Undated – possibly 1943

by a Joint Committee of The Haldane Society And The Socialist Medical Association.

The provisions of the Royal Warrant on Pensions, and other relevant official pronouncements, seem to have been drawn up with a number of points in mind, which need consideration.

In the first place, throughout the Articles there appears a tendency to place the interests of economy before those of justice. With the actual sums proposed as pensions this Committee is not here concerned, but we are agreed that the cond­itions under which pensions can be granted are harsh, and, if strictly interpreted, will discriminate against many claimants whose claims are medically fully justified. We entirely approve of the principle of strict economy in expenditure on the war, but as it is possible to guarantee the railways an income of at least £40,000,000 per annum, it is also possible to ensure that no man or woman injured or ill as a result of service in the Armed Forces is denied an adequate pension.

Wartime Neurosis

Secondly, those responsible for the framing of the Warrant and for the memorandum “Neuroses in War-time” (drawn up by a Conference convened by the Minister of Pensions), appear to be so much obsessed by the fear that malingerers will receive pen­sions that they have made the regulations so strict that many genuine cases will not be able to claim.  In particular, the Conference which produced “Neuroses in War-time” seems still to hold the out-dated view that neuroses and malingering are almost indistinguishable, when they say (page 2), “Such was the appeal of the word ‘shell-shock’ that this class of case excited more general interest, attention and sympathy than almost any other, so much so that it is to be feared that it became a most desir­able complaint from which to suffer”.  The Minister of Pensions has accepted the view of the Conference to the extent that he has stated that during war no person should ordinarily be given a pension on account of neurosis.  One is entitled’ to press for some clarification of the form of treatment or disposal the Government intend to apply to these patients during the war, if their pensions are only to start at the end of it.  Disease may be defined as the partial breakdown of an organism in its efforts to adapt itself to the stresses and strains of its environment. This definition covers both physical and psychological disease, and the Committee wishes to emphasise that experience showed that many of the most severe psychological cases in the last war occurred in men who had shown considerable gallantry and who had for a long time managed to adjust themselves to extremely difficult and dangerous conditions.

This Committee is of the opinion that it is more equitable for a few undetected malingerers to receive pensions, than for many genuine cases of physical and mental disability to be debarred from pensions, in a misguided effort on the part of the Minister of Pensions to eliminate malingerers.

The Warrant states that dependents are only eligible for pensions by the generosity of the Minister of Pensions.  “Pen­sions in respect of deceased soldiers provided under this Our Warrant shall not be claimed as a right, but may be given as a reward of their service”, (Article 51). This Committee, on the contrary, considers that the dependents of men and women in the Armed Forces are fully entitled to compensation from the Govern­ment, especially since the introduction of conscription.  It also considers that any injury or disease, caused or aggravated during war service, should be pensionable. Due regard should be paid to the difference in conditions of civil and military life, and the added stresses and strains, physical and mental, imposed by the latter.

Article 2, section 4.

No mention is made of any special qualifications to be poss­essed by a medical officer or member of a medical board.  It is clear that specialist medical officers or boards should be appoin­ted to consider cases which come within the range of their spe­cialised knowledge.  For instance, a board consisting of medical officers none of whom has specialised knowledge of ear condi­tions, is not in a position to make an adequate decision in cases of deafness.  Similar considerations apply with, especial force to psychological cases.

Article 4; section (d).

The decision that the period during which claims can be made shall be arbitrarily limited to seven years, will give rise to hardship. For example, the Americal authors, Hume and Nattrasss found that, in men who had suffered from “trench fever” during the Great War, 45% showed no clinical evidence of kidney damage nine years after Armistice, but pathological evidence showed that they were almost certainly developing chronic disease of the kidneys.  Similarly, with psychological cases, a great number of claims were made several years after the end of the war.  In such cases, the psychological trouble had not made itself appar­ent until after demobilisation, and in many instances not for several years.  In the opinion of psychiatrists, such cases of neurosis are directly attributable to war service.  In the absence of contemporary record, and there would be none in such cases, it is unlikely that any claim would be allowed, (see Article 5, section 2, below).

Article 5, section 1, (a) and (b).

The wording is not at all clear.  It is presumably intended to differentiate between cases directly attributable to military service and other cases of wounds, injury or disease which arose and were aggravated by war service.  As the Article stands, a wound, injury or disease, which arose during war service, must also be aggravated by war service to a material extent. For example, a soldier driving an army lorry in England, who as the result of an accident suffers the amputation of a foot, would have to prove that his condition, which arose during war service, was also aggravated by war service, before he could claim.

As already stated, this Committee is of the opinion that all cases of injury or disease, arising from or aggravated by the war, should be pensionable. With this principle in mind, section I of Article 5 should be amended to read as follows:-

(a)  directly attributable to military service during the war, or

(b)  due to a wound, injury or disease which-

(i) arose during war service, or

 (ii) existed before such service and was aggravated by war service to a material extent and remains so aggravated.

Article 5, section 2,

This Article provides that collateral evidence of a wound, injury or disease may not be considered unless contemporary official records are not available. Even in the best of our hospitals in peace-time it is unfortunately true that records are not always by any means complete.  This is even more likely to obtain in war-time circumstances, when also a condition which may later give rise to serious disability is not mentioned, or is minimised in view of another more important.  The use of collateral evidence, as well as the official contemporary official records, should be permitted in all cases.

Furthermore, this section states that “no doubt” must be left in the minds of the certifying medical authorities as to the genuineness of the claims being due to war service. Much hardship will be caused by this provision, as few doctors are willing to commit themselves to this extent.  The words “no reasonable doubt” would be more equitable.

The Committee wishes to make’ the following additional rec­ommendations:

I. As the whole matter of the justice or otherwise with which claims to pensions are granted largely turns on administration, the Labour Party should keep close watch on the administrative aspect, and should ventilate all grievances at once.

II. The Minister of Pensions should be asked, either in the House or in the Advisory Committee, for assurances on the following points:-

(a)     that specialist medical boards shall be set up, including boards qualified to deal with psychological cases.

(b)     that the medical boards shall from time to time be reviewed.

(c)     that a right of appeal to a specialist board shall be allowed as a matter of course if the claimant is dissatisfied.

III. Medical examination on enrolment in the Armed Forces should be thorough and complete, and should be regarded as definite evidence of the degree of the physical and mental fitness at that time. The result of this medical examination should be accepted as a valid record in any later assessment
of the date of onset of disability, and its aggravation if it arose before the beginning of war service.

IV. The regulation that pensions for psychological cases will not be given during the war should be reconsidered. While the patient is still in hospital, the question does not arise, but the Committee is of the opinion that if he is discharged from the service, he should receive a pension, beginning from the date of discharge. However, there is good reason to believe that retention in the service with  seconding to duties of a non-military character at the base
represents an effective way of handling the problem of those who are fit for discharge from hospital.