Neurosis and Religious Affiliation

A paper read at a Meeting of the South-Eastern Division of the Royal Medico-Psychological Association on 28 October, 1945, at Banstead Hospital, Surrey.

Journal of Mental Science, XCIII, 391, April 1947

INTRODUCTION.

    DURING the six years of the war, from the opening of the hospital in September, 1939, until the end of September, 1945 (to choose a convenient end­point), 13,556 soldiers, sailors and airmen of non‑commissioned rank were admitted to the wards of Sutton Emergency Hospital. From this number have been excluded all women, all foreign troops and prisoners of war, Domi­nions troops, foreign nationals in the British Army, and also a half dozen or so men of whose religious affiliation no record was kept. Apart from these few accidental exceptions, all men on admission to the hospital gave to a nurse particulars which included their religious affiliation, and which were subse­quently entered on the Hospital's Admission Register. From this Register the data which will be discussed below have been obtained. It is to be noted that the religious classification is based solely on the men's own statements and these may at times have been lacking in precision, or have implied a dis­tinction which does not exist. It is doubtful, for instance, whether there is any real difference between "Wesleyans" and "Methodists" but as this distinction was made by the men themselves it has been retained.

   Out of these 13,556 men, 9,354 were admitted to the neuro‑psychiatric wards and 4,202 to the general wards of the hospital. A full account of the first 2,000 men admitted to the neuro‑psychiatric wards has already been published (Slater, 1943). About 77 per cent, of them were found to be suffer­ing from neurotic reactions, such as anxiety or hysteria or from psychopathic personality, and the remainder showed states of partially organic causation (8 per cent.), endogenous disorders such as epilepsy, schizophrenia or manic­depressive psychosis (9 per cent.), or minor degrees of mental defect (7 per cent.). The men admitted to the general wards were suffering from wounds, accidents, injuries, infections, such conditions as gastric and duodenal ulcer, defects such as hernia requiring surgical treatment, and the like. The main difference, therefore, between the two groups was the presence or absence of psychiatric disorder. The men in the general wards can be looked on as roughly repre­sentative of the Forces as a whole, from whom the neurotic population had also been drawn. The selective processes which secured admission to the general wards may have meant that the men who came there were physically slightly inferior to the average; but we have no evidence that this would be correlated in any way with religion. There were, however, some other differ­ences between the two groups. At the time of the Dunkirk evacuation in 1940, and again at the time of the invasion of France in 1944, there were considerable numbers of men admitted to the general wards almost directly from the battle­fields. But on the whole, the majority of the men in these wards came from locally situated units, and included a higher proportion of R.A.F. ground staff than the admissions to the psychiatric wards. The psychiatric wards received patients as a part of general routine from a large part of South‑Western England, and took considerable numbers of men invalided home on psychiatric grounds from all theatres of war, including the Far Eastern. These differences have to be mentioned; but it is difficult to see how they could affect the validity of the differences between the two groups in point of religious affiliation.

 RELIGIOUS AFFILIATIONS.

   Taking together all men who gave the same religion on admission to hos­pital, we have the following numbers of men admitted to the psychiatric and general wards respectively:

   Established and Similar Churches: Church of England, 6,541, 3,174; Church of Scotland, 107, 67; Church of Wales, 1, 0; Church of Ireland, 7, 1; Anglo‑Catholics, 2, I. Total, 6,658, 3,243.

   Nonconformist Churches: Presbyterian, 290, 139; Methodist, 377, 132; Wesleyan, 83, 44; Baptist, 154, 70; Congregational, 69, 35; Unitarian, 22, 7; Episcopalian, 1, 0; Evangelical, 1, 0; Denomi­nation unstated, 79, 42. Total, 1,076, 469.

   Roman Catholics: 1,100, 427.

   Jews: 418, 38.

   Other Small Groups: Salvation Army, 41, 7; Plymouth Brethren, 6, 4; Spiritualist, 11, 2; Quaker, 6, 0; Four‑Square Gospellers, 2, 0; Mormons, 2, 0; Christian Scientists, 2, 0 Theosophists, 2, 0; Total, 72, 13.

   Oriental Churches: Greek Orthodox, 4, 2; Armenian Orthodox, 1, 0; Buddhist, 0, 1; Hindu, 0, 1; Moslem, 1, 0.    Total, 6, 4.

   Unbelievers: No religion, 9, 3; Freethinkers, 2, 0; Agnostics, 4, 1; Atheists, 9, 4. Total, 24, 8.

    Over 70 per cent, of the total belong to the Church of England, which may be taken as a standard for showing whether members of other religious groups have any preferential tendency for or against admission to the neurotic wards. If the quotient obtained by dividing the number of men of one denomination in the psychiatric series by 6,541 is divided by the quotient obtained by divid­ing the number of men of the same denomination in the general series by 3,174, a figure is derived which will measure this tendency. Dealt with in this way, for instance, the affiliations to the Church of Scotland give a ratio of •775. This is less than ' and it might be concluded that members of the Church of Scotland on the whole do not have such a high tendency as members of the Church of England to neurotic breakdown, or at least under war‑time Service conditions to admission to a psychiatric hospital. Tested by χ² however, the result is not significant. All the significant differences in distribution are provided by those groups who have a greater tendency to neurosis than the Church of England. They are, with their appropriate ratios and the proba­bility value of the associated χ²: Roman Catholics 1•250 (P< •001), Metho­dists 1•386 (P< •001), Salvationists 2•843 (P< •002), Jews, 5•338 (P< •001). If Methodists and Wesleyans had been taken together the corresponding values would have been 1•268 (P<•01).

 DISCUSSION.

   The findings suggest, therefore, that Roman Catholics and Methodists have a somewhat greater tendency to neurosis than members of the Church of Eng­land, that members of the Salvation Army have nearly three times and Jews over five times as great a tendency in this direction. Interpretation of these findings cannot, however, be more than speculative. The suggestion arises that in these groups the incidence of neurosis may be raised by men of neurotic disposition finding that particular religion attractive. It is probable that members of the Salvation Army are recruited to a very large extent by conver­sion. The Salvation Army makes a special effort to attract to a better way of life persons of an irregular social record, among whom a high incidence of neurosis could legitimately be expected. The relative incidence in this group of admissions to general and to neurotic wards can be no matter of surprise. The same considerations apply in a more limited way to the Roman Catholic and Methodist faiths. Both Churches are active evangelically and contain a fair proportion of fresh converts; in both, the non‑rational and emotional aspects of religion are given considerable emphasis. This factor would by itself be sufficient to account for the whole of the differences observed. If we assume a io per cent, incidence of fresh converts among Roman Catholics and a chance of approximately one in ten (Slater and Slater, 1944) of a man being admitted to a Neurosis Centre during six years of service in the Army, then it is suffi­cient to treble this chance among the fresh converts to account for the enhanced tendency to neurosis. The fact that this hypothesis is adequate does not, however, mean that it is true.

   Matters are different when we consider the Jews. In the Jewish community, as a whole, the proportion of fresh converts must be negligible. Nearly all Jews have been born into the faith, and this has been so for generations. Jews, however, are well known to show constitutional differences from their com­patriots in every land where they have been studied; and it is an old clinical observation that they are more than normally subject to psychiatric disorder. The figures reported here would seem to go a long way to support that view. There are, however, other points to be considered. In this material the Jews were unique among all religious groups in showing a progressive rise in their frequency in the neurotic series during the course of the war. The relevant figures are given in the table and diagram below.

    It is to be noted that the proportion of Jews in the admissions to the general wards rises to a peak in 1941‑42, and thereafter falls. This would suggest that the proportion of Jews in the Army as a whole was also falling. But the pro­portion of Jews in the admissions to the neurotic wards rises steadily, until in the last year of the war it is actually over thirty‑four times the proportion of Jewish admissions to the general side of the hospital. This change had nothing to do with, for instance, the enlistment of foreign‑born refugees into the Army; for, as has been said, all foreign nationals were excluded from the figures.

   It is clear that we must call into account some factor which varies very largely with time, and that the supposed greater constitutional instability of the Jew is not an adequate explanation. This factor most probably lies in those subtle influences which we designate morale. Few who have worked with neurotic soldiers during the war would deny that the morale of the Jewish neurotic casualty was even loweri than that of his non‑Jewish brother in arms. It would be superficial to look no further, and simply to lay this to the discredit of Jews as a class. It is a matter of historical record that morale was high among the members of all‑Jewish fighting units during the war; and we know from the distinctions awarded to individual Jewish soldiers in war time, as well as from more recent events in Palestine, that Jews are capable of surviv­ing great military stress without neurotic breakdown. Nevertheless, the Jews of this country are commonly regarded as a pacific people, and they are cer­tainly even more than the average Englishman attached to their immediate domestic circle and the society of their co‑religionists. It seems probable that for reasons like these Army life represented for them a relatively greater strain.

SUMMARY AND CONCLUSIONS.

Among the admissions to the neuro‑psychiatric and the general wards of Sutton Emergency Hospital during the war, the relative proportions of British soldiers of various religious affiliations have been analysed. It is shown that there is an excess of Roman Catholics, Methodists, members of the Salvation Army and Jews in the admissions to the psychiatric wards. The proportion of Jews in the admissions to the psychiatric wards rose consistently throughout the war from 1•3 per cent. to 6•7 per cent. These findings are discussed.

REFERENCES.

Slater, E. (1943) J. Neurol., 6, 1.

Idem and Slater, P.  (1944), J. Neurol., Neurosurg. And Psychiat., 7, 49.