Similar to other modern Western nations, Japan experienced a state of total war during the twentieth century, expanding state intervention in the economy, scientific community, and the bodies of the populace. This article illustrates how Japanese psychiatrists engaged in the production of knowledge and the distribution of government funds via war disablement pensions in response to national demands during the Asia-Pacific War (1931–45). After the Second Sino-Japanese War started in July 1937, Kōnodai Military Hospital was converted into a special army hospital for mental and neurological illnesses, admitting about 10,500 patients by the end of the war. Most of the psychiatrists assigned to Kōnodai Military Hospital were elite professionals who went on to be leaders in Japanese psychiatry after the war. It is noteworthy that the main task of these psychiatrists was not only to treat patients but also to make judgments on who would or would not receive war disablement pensions. Their interpretation of what was termed “war neurosis” became closely aligned with the goals of the war disablement pension system and was affected by economic needs during and after the war. This article reveals that wartime economic decision making by the government demanded medical officers to make it clear who deserved a war disablement pension in order to minimize potentially excessive spending on “pension neurosis.”
Kanamori Osamu, in his later work The Crisis of Science, argued that the nature of modern science changed radically from the 1930s onward.1 During that time, the division of intellectual work increased in scientific communities, and the relationship between scientific research and the state became more intertwined (Kanamori 2015: 61–65). As we know, many scientists conducted their research in response to national demands during the First and Second World Wars. Kanamori himself focused especially on the Manhattan Project, because of its destructive influence on the scientific community.2 Politics also strongly affected scientific research after the Second World War. Western and Eastern countries promoted military-related scientific research during the Cold War with the full support of the military-industrial-scientific complex.
In postwar Japan, on the other hand, both scientists and industrialists hardly engaged with military production. The export of weapons was basically prohibited under the Three Principles on Arms Exports policy. Moreover, the Science Council of Japan (SCJ) committed itself to not engaging in scientific research for war purposes in 1950; a policy that it reiterated in 1967. Japan’s governments have gradually loosened the principles, however, subsequently releasing its own Three Principles on Transfer of Defense Equipment and Technology policy in 2014. This new declaration removed the ban on military exports and the international joint development of weapons. In March 2017, the SCJ affirmed the earlier statements from 1950 and 1967 in response to the government’s promotion of scientific research for military purposes.3 It could be said that Japanese scientists today are at a potential turning point in their stance on scientific research for military purposes.
This paper attempts to consider Japanese military medicine as an example of where science and the military encountered each other and focuses especially on military psychiatry during the Asia-Pacific War (1931–45).4 Japanese military psychiatry confronted the issue of psychological trauma in the Second World War, after Western countries had already done so in the First World War.5 After the Second Sino-Japanese War broke out in 1937, the Japanese military started to prepare for the treatment of psychiatric patients. The next year, 1938, it converted Kōnodai Military Hospital (hereafter KMH)—located in Chiba Prefecture, southeast of Tokyo—into a special army hospital for mental and neurological illnesses, which admitted approximately 10,500 patients by the end of the war. This number most likely constitutes only a tiny part of the total number of psychiatric casualties during the war, because most of those casualties were not transported back to mainland Japan. However, the hospital itself is significant since the psychiatrists who were assigned to KMH constituted the elite of the profession at the time and they went on to occupy leading positions in the profession after the war.
Modern warfare requires a reorganization of the nation’s financial system as well as a strengthening of frontline forces.6 In terms of the costs of care for the war-ill and the war-wounded, medical care was financially significant to the wartime economy. This paper also examines the actions of psychiatrists at military hospitals during the Asia-Pacific War who engaged in two related processes: the production of medical knowledge and the distribution of government funds via war disablement pensions. Medical officers at KMH played three roles: clinicians, researchers, and administrative officials who dealt with war disablement pensions. This paper is concerned with the latter two roles. As researchers some medical officers at KMH found the hospital to have an academic and free atmosphere, but others felt that it restricted freedom of scientific research during the war. Also, medical officers were engaged in evaluating soldiers’ eligibility for receiving war disablement pensions. In other words, medical officers had the power to judge who deserved a pension or not. War disablement pensions were paid to those veterans who were injured or fell ill in the line of duty. As Lee Pennington has shown, after the pension system was revamped in 1923, veterans with war wounds were treated with more respect by the state, and they received greater financial awards (Pennington 2015: 44). However, this was not the case with the veterans with mental illnesses.
Medical officers at KMH especially concentrated their efforts on research on war neurosis, which was commonly known as “shell shock” to the participants in the First World War. Some psychiatric cases were reported in the official military medical history of the Russo-Japanese War, but it did not refer specifically to war neurosis (Department of War 1924). It was in the medical history of the Manchurian Incident that war neurosis was referred to for the first time and where psychogenic war neurosis was depicted as symbolic of the demoralization and corruption of soldiers and citizens (Department of War 1937: 639). Medical officers at KMH did not use the phrase sensō shinkeishō 戦争神経症 (war neurosis) and officially used senji shinkeishō 戦時神経症 (neurosis in wartime) instead, since the military authorities were afraid sensō sinkeishō might give people the false impression that the war in progress caused neuroses (Nagino 1938; Saitō 1993). Moreover, this translation suggested their perception that senji shinkeishō would disappear as soon as the war ended.
The main goal of this paper is to inquire into the relationship between medical diagnoses and national needs by analyzing war neurosis not only as a medical category but as a socioeconomic one. Over the past few decades, some research has been made on the connection between war neurosis and the awarding of wartime pensions. One of the pioneering works on the issue is an article by Joanna Bourke, which examined how gender and ethnicity affected the treatment of British and Irish men with shell shock. Bourke argued that pension officials were “obsessed” with reducing the cost of pensions and with proving that most mentally ill veterans, especially Irish veterans, were malingerers (Bourke 2000). Also, given that Japanese military psychiatry was especially affected by German psychiatry, work by Paul Lerner that explored medical arguments over what was termed “pension neurosis” in Germany is noteworthy. Lerner argued that German psychiatrists, after the German Chancellor Bismarck adopted a social security system in the 1880s, began to keep a strict watch on patients with what they termed “pension neurosis,” because those patients were suspected of cheating the state out of pension money. German psychiatrists looked suspiciously at war neurotics, too (Lerner 2003). As will be described later, these views would affect medical arguments among Japanese medical officers.
This paper is divided into two parts. The first part focuses on Japanese psychiatric research during the war by discussing the motivation of Japanese psychiatrists in engaging in the war effort, along with their research environments, then showing the medical interpretations the Japanese psychiatrists gave for aligning goals with the war disablement pension system. The second part is an examination of the policies regarding war disablement pensions at KMH, along with surviving historical materials involving pensions awarded to patients with hysteria—one of the main categories of war neurosis. In doing so, this paper employs clinical records, memoirs, and papers written by psychiatrists and administrative documents about war disablement pensions.
Psychiatric Research during the Asia-Pacific War
Saitō Shigeta, who once worked at KMH as a medical officer, looked back on his days in the hospital as follows:
Someone aptly named Kōnodai Military Hospital “Kōnodai Medical College.” Admittedly, there was an atmosphere worthy of the name. . . . I was one of the feeble medical officers in the reserve and was called up in 1944 when the war situation became worse. A few days after starting life in Kōnodai, I felt that the hospital was a completely different environment than the military. (Saitō 1993: 56–57, 60)
Saitō admired the unbiased policy of assigning psychiatrists that was free from cliquish behavior. He also appreciated that, while an official military hierarchy existed among medical officers, they addressed each other as Mr. in their personal relationships. Even Suwa Keizaburō, the hospital director, addressed Saitō as “Mr. Saitō,” rather than using his military rank. Medical officers had equal relationships among their fellow psychiatrists, although they thought keeping a strict hierarchy between doctors and patients was especially important for the treatment of war neurosis (Nakamura 2016: 155).
It is clear from these examples that KMH was an attractive place for medical officers for three reasons. First, the hospital was like the universities they had grown accustomed to before the war. Second, each psychiatrist was a member of a “dream team” of elite psychiatrists, which enabled them to have more equal relationships with each other than were practicable during peacetime, when professional relationships were more generally influenced by memberships in cliques. Third, each psychiatrist had the opportunity to examine many more rare cases than they could have seen in peacetime. Sakurai Tonao, who was a medical officer at KMH, excitedly described the hospital as “an inexhaustible treasure house [of rare cases]” (Sakurai 1982: 220).
The medical officer who was responsible for the positive scientific culture at KMH was Koizumi Chikahiko. Koizumi was the Director of the Medical Bureau of the Department of War, and he had created a plan to establish the army hospital for mental and neurotic illnesses. He had inspected the German military medical system during the First World War, and he felt the necessity of reconstructing the Japanese military medical system to make it adaptable to a state of total war. Suwa Keizaburō recalled that Koizumi encouraged him and said “I leave everything to you because you’re an expert in psychiatry. Do your work without restraint. I’ll support you as much as possible,” when Suwa came back from China to KMH. While Suwa was obliged to report to Koizumi once a week, Koizumi simply told him to maintain military rules in the hospital and did not comment on technical matters (Suwa 1966: 26–27). Koizumi specialized in military medicine and was an authority on chemical weapons. This episode shows that the two men respected each other as scientists with specialized knowledge and that medical officers at KMH managed to maintain their scientific autonomy to some extent.
On the other hand, Suwa mentioned that the psychiatrists’ freedom was also restricted, because they worked as medical officers at the military hospital during the war. Most obviously, the doctors were not free to publish their research results, due to military confidentiality rules.7 Some medical officers at KMH did publish articles in the journal Gun’i-dan Zasshi 軍医団雑誌 (Journal of the Imperial Japanese Army Medical Corps), but only medical officers were permitted to read this journal. Kobayashi Hachirō also had a similar experience during the war while working as a medical officer at the Musashi Military Sanatorium, which was established in 1940 to provide long-term care to veterans with mental illnesses. Kobayashi said that the doctors needed permission from the Army and Ministry of Health and Welfare before delivering conference presentations about their patients. However, Kobayashi did give a presentation with Sekine Shin’ichi, the director of the Musashi Military Sanatorium, at the plenary session of the 42nd Conference of the Japanese Society of Psychiatry and Neurology in 1943. It was likely that audience members from outside the world of military medicine participated in the conference, thereby raising the concerns of military authorities. Kobayashi said, “As you know, the military, or rather bureaucrats, wanted to restrain publication about mental illnesses in the military” (Medical Office of Musashi Sanatorium 1966: 36).
The secretiveness of the Imperial Japanese Army controlled the opinions of psychiatrists expressed in public places like newspapers, magazines, and general medical journals. At the beginning of the Second Sino-Japanese War, an article with the headline “There is no shell shock in the Emperor’s Army” ran in the Japanese newspaper Yomiuri Shinbun. The article cited the word of Hayao Torao, a medical officer who went to the front in China and later served at the KMH (Yomiuri Shinbun, 5 April 1939). Moreover, the directors of both the KMH and the Musashi Military Sanatorium stressed the mental superiority of “the Emperor’s Army” (Suwa 1939: 148; Sekine 1942: 7). Their publicly expressed opinions were clearly affected by the military’s negative stance on war neurosis.
In public, the existence of war neurosis was hidden from the people because the military leadership felt that discussing psychiatric weaknesses found among active-duty servicemen would negatively affect public support for the war. Kasamatsu Akira, a medical officer at KMH, mildly criticized the official denial of war neurosis in an article, but his article was published in the special issues of Gun’i-dan Zasshi that were released confidentially for the purpose of counterespionage (Nakamura 2016: 144, 156–57).
War Neurosis and the Desire for a Pension
With the research environment of Japanese psychiatrists during the war established, it is time for an examination of their medical interpretations of war neurosis. Diagnoses of war neurosis during this time period were strongly affected by the financial needs of the pension system. Also, the theoretical understanding of neurosis by Japanese psychiatrists was influenced by the experiences of Western countries during the First World War. In his research on shell shock and British soldiers of the First World War, Peter J. Leese compared military psychiatry in Britain with that in France and Germany. Leese stated that doctors in France and Germany chose centralized, patriotic, and psychological modes of treatment for war neurosis. British doctors, on the other hand, chose diverse, non-ideological, and empirical treatment modes, and they reluctantly accepted psychological explanations for cases of war neurosis (Leese 2002). Although there were some differences in treatment for war neurosis, as Leese has pointed out, all three countries in the First World War had common interests and concerns: treatment for war neurosis had great significance for the economies and the utilization of the “human resources” of the nation. Many French and German doctors argued that war neurosis was caused by a so-called psychopathic constitution, rather than by the war. They also believed patients with war neurosis lacked willpower and regarded patients’ symptoms as “the flight into illness.” Doctors used this phrase to refer to patients’ fear of death and desire for a pension (Lerner 2003; Roudebush 2001). Thus, doctors would blame their patients’ “weakness” as the cause of their psychic injuries. Doing so allowed the doctors to deny pensions to many soldiers, as their patients’ illnesses, using this interpretation, would therefore have predated the war. In Britain, the demand for manpower during the First World War and the economic constraints of wartime expanded government intervention into the male body itself, and medical officers played an important role in the policing and prevention of malingering (Bourke 1996).
Compensation for nervous disorders obtained during wartime strained the national budgets and finances of Western European countries even after the war. Sixty-five thousand men in Britain were receiving pensions for neurasthenic disability in 1921, and 36 percent of veterans who were receiving disability pensions were registered as “psychiatric casualties” in the early 1930s (Bourke 1996: 109). According to a 1922 study in Germany, veterans with nervous disorders accounted for nearly half of all military pension claimants, and they cost the state as much as one billion marks annually (Lerner 2003: 228). In France and Germany, theoretical models of war neurosis during the war affected postwar compensation. The French paid no pensions at all to psychoneurotic cases, because it was suggested that pensions impeded recovery (Shephard 2000: 152). In Germany, many doctors shared the same view, since wartime, that the granting of pensions hindered recovery. Nevertheless, some German psychiatric casualties received pensions until the National Insurance Regulation passed in 1926, which drastically changed the German system of national insurance. The new law stated that the inability to work, or a disability based on “the idea of being ill” or on “more or less conscious wishes [to be ill],” did not provide psychiatric casualties with a claim to compensation (Kloocke, Schmiedebach, and Priebe 2005: 52–53). The change meant that psychiatric casualties from the First World War were unable to make a claim for a pension after the 1926 law. In Britain during and immediately after the war, journalists, politicians, and the families of patients regarded psychiatric casualties as heroes who had made sacrifices for the war and thus deserved improved treatment. Especially when the patients were officers, people showed compassion, and such strong public support enabled patients to receive pensions. However, as time passed after the war, a more moralistic and judgmental attitude gradually emerged. Ben Shepard, perceptively, has pointed out that postwar British veterans with mental disorders who did not recover came to be seen through the lens of the prewar rhetoric of degeneration, which had mostly been forgotten during the war. Those with shell shock were accused of lacking the will and guts to get better (Shephard 2000: 151).
From the late nineteenth century onward, Japanese medicine was under the influence of Western medical theory and practice. As Akihito Suzuki has shown, Japanese psychiatry in the 1920s and 1930s closely followed innovative therapeutic developments in Europe, such as insulin convulsive therapy (ICT) and electroconvulsive therapy (ECT) (Suzuki 2010: 120–28). These new therapeutic approaches were utilized not only at KMH but at military hospitals near the front before conditions during the war worsened and the military medical system collapsed.8 However, the events of the Second World War broke up such global medical information-sharing networks, as also happened during the First World War (Reid 2017: 34). After Japan was internationally isolated and the price of drugs in the country rose drastically, the Japanese government encouraged the domestic production of generic drugs. These efforts to produce low-cost insulin enabled more private patients to receive ICT in civilian mental hospitals (Suzuki 2010: 128–32) and also enabled patients at KMH to continue to receive ICT in the middle of the war. ICT was discontinued at the last stage of the war, however—probably because of its high cost. ECT was also discontinued at KMH because its electric shock machine was taken away for use as war materiel.9
In contrast to the aforementioned medical developments, Japanese military psychiatry did not succeed in catching up to contemporary research or in developing an original theory of war neurosis. Katō Masaaki, who worked for the Shimofusa Military Sanatorium and treated veterans with head injuries during the war, later said that Japanese medical officers at the time were unable to obtain foreign research literature, aside from German psychiatric research that had been conducted during the First World War (Katō 1979: 1085). Japanese psychiatry had been heavily influenced by German medical models since the Meiji period, and this German influence grew even stronger as a result of the Tripartite Pact during the Asia-Pacific War. Japanese military psychiatrists tried to learn from the German cases of war neurosis during the First World War. Uchimura Yūshi, a professor at Tokyo Imperial University, and Akimoto Haruo, a professor at Kanazawa Medical University, submitted a review of research on war neurosis to the Imperial Japanese Army in March 1945. The review referred to German cases twice as often as British and American cases and three times as often as French cases (Uchimura and Akimoto 1945). Psychiatrists at KMH also referred to German psychiatrists such as Adolf Strümpell, Robert Gaupp, Max Nonne, Alfred Hoche, and Karl Bonhoeffer. In his paper on war neurosis, for example, Kasamatsu Akira, a medical officer at KMH advocated preventing the shift from zen’sen hisuterī 前線ヒステリー (hysteria at the front) to byōin hisuterī 病院ヒステリー (hysteria in the hospital) due to a “secondary desire” (Kasamatsu 1944: 254–55). Kasamatsu derived this idea from Bonhoeffer’s idea of Lazaretthysterie (war hospital hysteria), which claimed that symptoms of war neurosis arose not from traumatic war conditions but from a fear of the military or the wish for a compensatory pension (Lerner 2003: 238). The German psychiatrists to whom Japanese medical officers referred were psychiatrists who had left their names on a kind of “counterhistory of the trauma idea.” Concerned about the disastrous impact on Germany’s collective health and national strength, these German psychiatrists rejected Herman Oppenheim’s theory of traumatic neurosis, which deserved, according to Paul Lerner, an “eminent place in trauma’s historic lineage” (249). As with German psychiatrists during the First World War, medical officers at KMH interpreted war neurosis not only through medical frameworks but through financial ones as well. In one extreme case, Sakurai Tonao, a medical officer at KMH, focused especially on patients’ desires for pensions and utilized electric shock therapy as “coercive” treatment to demolish the desires of patients for compensation (Nakamura 2016: 156).
Determining War Disablement Pensions at KMH
To extend the analysis here to the war disablement pension policy at KMH, it is time to look at how actual pension judgments worked. According to Japanese military pension rules, veterans who suffered from war injuries or illnesses and required compensation from the Army Ministry needed to submit two kinds of documents: one was a medical certificate and the other was a certificate that the soldier had been injured or had fallen ill as a result of the war. The former was written by medical officers, and the latter was written by direct senior officers (Medical Corps of Japanese Army 1943: 169–70). Significantly, clinical records kept at military hospitals functioned as archives both of these official documents and of the subsequent decisions made from them. Medical officers filled in judgments regarding the awarding of pensions in a column of clinical records. If the patients were eligible for war disablement pensions, medical officers classified them as Grade One; if not, they wrote Grade Two in the column. In the latter case, patients usually received a lump sum payment.
Medical officers at KMH held regular meetings and formulated a policy on the awarding of war disablement pensions, as well as medical treatments for psychiatric patients.10 The policy was updated at each meeting, and two major policies gradually emerged. The first regarded whether or not the patient had become ill at the front. Generally, if the patient had been taken ill at the front, he was categorized as Grade One; if not, he was categorized as Grade Two. This policy affected changes in the interpretation of endogenous psychoses, such as seishin bunretsubyō 精神分裂病 (schizophrenia) and sou utsubyō 躁鬱病 (manic-depressive psychosis). Schizophrenia was the most common disorder treated at KMH. Early wartime policies generally categorized schizophrenia as a Grade Two disorder. If, however, the patient did not have a history of schizophrenia prior to enlistment and had experienced “an extremely difficult situation,” an exception was made, and he would be categorized as Grade One. Medical officers at KMH treated manic-depressive psychosis almost the same as they treated schizophrenia. The policy was last modified in 1944 and clearly stipulated that schizophrenia and manic-depressive psychosis developed at the front were to be considered Grade One, regardless of the patients’ situations and length of service; those cases that developed in the homeland were categorized as Grade Two. Furthermore, if the disorders were defined as such, medical officers did not have to consider any family history of mental illnesses in the patients. Clarification of the policy as stated above was shared with the army’s chief of staff, and the director of the Medical Bureau of the Army required the chief of staff of the Twenty-Third Army to regard psychoses, such as schizophrenia and manic-depressive psychosis, that developed as the result of duty at the front as Grade One disorders.11
The second important point concerned diagnosis. Judgments regarding the awarding of war disablement pensions were based on a diagnosis of a patient’s illness. Mental and neurological illnesses resulting from head injuries or epidemic diseases like malaria were regarded as Grade One because their link with official duties during the war was relatively clear. However, alcoholism and drug addiction, progressive paralysis, and seishin byōshitsu 精神病質 (psychopathy) were regarded as Grade Two because these illnesses were attributed to negligence or degeneracy as a cause. Seishin hakujaku 精神薄弱 (mentally deficient) was also regarded as Grade Two, even if symptoms got worse during the war, because patients were deemed to be mentally and intellectually handicapped by nature.12 Military authorities and medical officers at KMH were cautious about treatment of war neurosis. In his answer to the aforementioned document, the Director of the Medical Bureau of the Army warned the chief of staff of the Twenty-Third Army that “we must be careful about treatment of the neurotic patients because it concerns the essence of the military. If you deem them to be Grade One aimlessly, there is a risk that similar patients will emerge one after another.”13
At the same time, the policies in place for determining pensions for patients with war neuroses remained vague or imprecisely defined. As in European countries during the First World War, “war neurosis” itself was not a diagnosis and was subdivided into the categories of hisuterī ヒステリー (hysteria) and shinkei suijaku 神経衰弱 (neurasthenia). In the last policy on pensions, which medical officers at KMH formulated in 1944, hysteria was regarded as Grade Two with the proviso that “it’s not impossible that a special type of psychogenic reaction would be regarded as Grade One.” Meanwhile, the policy for neurasthenia followed the policy on pensions for cases of schizophrenia. It seems reasonable to suggest that neurasthenia was deemed as being more closely related to war experiences, and it was a less stigmatized diagnosis than hysteria. This situation was similar to that in Britain during the First World War (Leese 2002). It is still unclear whether the differences in pension policies for different diagnoses affected actual judgments, but we have only limited data on these points. Next, then, is an examination of how cases of hysteria were judged concerning the award of pensions.
Pension Judgments for Cases of Hysteria
At the end of the war, the Japanese military ordered all public institutions to incinerate official war documents, including the clinical records of military hospitals. Suwa Keizaburō, the director of KMH, instead concealed and protected the clinical records at KMH because they were filled with medically valuable information. Consequently, about 80 percent of the records have fortunately survived. Asai Toshio, who was a medical officer at KMH, printed, analyzed, and archived these records from the 1980s to the 1990s.14 Shimizu Hiroshi and his colleagues have conducted historical research into these records since the 1990s and reprinted the records of 486 patients diagnosed as “mentally deficient” and 832 patients categorized as having “hysteria.”15 Next is a close look at the cases of hysteria found at KMH.
First is an overview of patients. Table 1 and Figure 1 show where the patients developed their illnesses and when they were admitted to KMH. In the first half of the war, most patients developed their illnesses in China. In the last half of the war, most patients developed their illnesses in the homeland.
Table 2 shows the percentage of patients who recovered, the percentage exempted from military service, and the total by year. A war disablement pension was paid to those who were exempted from military service because of their wounds and illnesses. According to Table 2, the rate of exemption from military service, which had constituted the main outcome of hospitalization, dropped rapidly in the last stage of the war. In contrast, there is an increase in the rate of recovery. We may say that the increase in recovery rates was related to higher pressure to deploy soldiers during the last stage of the war.16
Next are the judgments made on pension awards. Table 3 shows the number of patients who were categorized as Grade One and Grade Two by year. Overall, there were 98 patients who were categorized as Grade One and 723 patients categorized as Grade Two throughout the war.
In accordance with the policy on pensions for hysteria, patients categorized as Grade Two consistently account for 80 to 90 percent of the patients recorded here. There were exceptional numbers of patients categorized as Grade One during the war, but the rate dropped rapidly in the last stages of the war. As will be seen later, one of the determinants for categorizing a patient as Grade One was whether the patient developed his illness on the battlefield. In fact, most of the patients at KMH were transported from hospitals in the homeland after 1942, as seen in Figure 1. That is why the percentage of the group classified as Grade One dropped toward the end of the war.
Next is an examination of the characteristics of two specific groups of patients. One is comprised of patients categorized as Grade One, and the other is made up of patients whose rank was modified from Grade One to Grade Two. There are three features characteristic of the Grade One group. First, many more patients classified as Grade One developed their illnesses at the front than those designated as Grade Two: 90.8 percent of Grade One patients compared to 50.8 percent of Grade Two patients. The certificates written by their direct senior officers described fierce duties and experiences at the front, living in a climate that the patients had never previously experienced, and malnutrition. The significant influence of the environment was usually stressed by minimizing inherent factors. The following serves as an example: The clinical record of Patient WN-99 stated that “his illness was related to the war because he was healthy by nature and passed the strict physical examination for conscription” (Shimizu 2007–8, vol. 5: 160).17 There was even an exceptional case, that of Patient WN-63, who had an anamnesis of neurasthenia before enlistment but was still categorized as Grade One at KMH because he had experienced “extremely severe duties” at the front. His clinical records said, “He fell ill because his mental fatigue increased after terrible shock in battle, repeated attacks by the enemy, and performing dangerous duties” (Shimizu 2007–8, vol. 5: 95).
Moreover, Grade One patient designations were clearly biased toward holders of higher military ranks. The percentage of officers categorized as Grade One was 25.5 percent, whereas officers only accounted for 5.1 percent of all patients with hysteria. Officer patients required special consideration because of their higher military rank, as the following example shows. In the case of Patient WN-52, who was an officer, it was very difficult to transport him back to Japan after he developed his illness in China because he had committed vandalism and tried to commit suicide. The document written by medics at the front said, “We’re not willing to imprison such a high-ranking and honorable patient on the ship” (Shimizu 2007–8, vol. 5: 75).
The third characteristic of the Grade One group is that many patients designated as Grade One not only suffered from mental illnesses but also epidemic diseases such as malaria, paratyphoid, or injuries. According to the pension policy for KMH, patients with mental illnesses developed after experiencing epidemic diseases and injuries were to be given favorable treatment, because epidemic diseases and injuries were categorized as Grade One.
However, not all of the patients categorized as Grade One were paid pensions. It seems reasonable to suppose that the ten patients who recovered and returned to their units did not receive pensions. Furthermore, the records of seven patients out of ninety-seven were attached with memoranda stating that it was unnecessary to pay pensions or lump sums to those patients. In the case of Patient WN-300, who was diagnosed with hysteria, medical officers doubted whether he deserved a war disablement pension although he was categorized as Grade One. The letter from the medical officer to the mayor of his town said, “We should tell you as a supplement that he was categorized as Grade One, but we have question about this judgment because of the nature of his illness” (Shimizu 2007–8, vol. 6: 66–67). This letter indicates that patients with hysteria were often treated suspiciously by psychiatrists, who had to judge whether they deserved war disablement pensions. Medical officers often thought that patients showed symptoms because of their desires for pensions or exemptions from military service—unacceptable behavior for Japanese soldiers.
As mentioned above, the fact that the patient became mentally ill at the front was one of the decisive factors in being categorized as Grade One. However, cases in which the patients’ ranks were modified from Grade One to Grade Two shows that this policy was not applied to every case. Out of 723 patients who were categorized as Grade Two, 133 of those were initially assigned Grade One classifications and eventually changed to Grade Two. Only 12 of these patients fell mentally ill in the homeland, while the rest of the patients developed their illnesses at the front. Clearly, there were factors that could result in a patient being demoted from Grade One to Grade Two other than the place where the patient fell ill. What should be noticed is that about half of these modified cases were described as having a “psychogenic reaction” or being “neurotically tinged” in their clinical records or medical certificates. This would indicate that many medical officers at KMH shared the theory of war neurosis established by Sakurai Tonao. According to Sakurai’s theory, neurosis was fundamentally a “psychogenic reaction,” in other words, an intentional reaction. Medical officers needed to neutralize the impulse for patients to feign being ill as a ruse to obtain either pensions or exemptions from active-duty military service.
Moreover, some patients were reclassified as Grade Two even though their direct senior officers wrote certificates that proved the patients had been injured or fallen ill because of the war. The following serves as an example: Patient WN-208 was reclassified as Grade Two, for “it has been only three months since he went to the front and we couldn’t find any description of a severe situation in his records” (Shimizu 2007–8, vol. 5: 315–16). In the case of Patient WN-375, who felt strange and had convulsions over his entire body, the diagnosis was changed to hysteria and the patient was recategorized as Grade Two because his convulsions disappeared as soon as he was transported to the homeland (Shimizu 2007–8, vol. 6: 167–68).
Medical officers sometimes judged how patients contributed to the war effort, and they kept their eyes on changes in the conditions of patients. Kasamatsu Akira, who was one of the medical officers at KMH and conducted research on war neurosis, focused on the shifting conditions of patients. Kasamatsu negated the desires of some patients who were regarded as “temporary self-defense reaction” at the front, but he was suspicious of patients’ desires and predispositions if their symptoms got worse to be sent back from the battlefield to the homeland (Nakamura 2016: 157). As Joanna Bourke has pointed out, one of the main tasks of British medical officers during the First World War was to police the behavior of servicemen (Bourke 1996: 89). Japanese medical officers also behaved as detectives, and they became gatekeepers of national expenditures during the Asia-Pacific War.
The case of Japanese military psychiatry and the distribution of war disablement pensions during the Asia-Pacific War, as discussed in this paper, raises some important issues regarding the relationship between science, technology, and society in modern Japan. Similar to modern Western nations at the time, Japan experienced a state of total war, expanding interventions of the state to the bodies of the populace as well as to the economy and the scientific community. Restrictions on research conducted on psychiatric patients at KMH included the prohibition of the publication of results outside the military medicine community. Nevertheless, to some extent, some military officers at KMH maintained their autonomy as members of the scientific community. Medical officers also propagated the ideology of the mental superiority of “the Emperor’s Army” in accordance with national policy. This is an example of the destructive influence of scientific research for military purposes during two world wars on communalism and universalism, which are part of the ethos of modern science known as Mertonian Norms (Kanamori 2015: 54–61).
The theory on war neurosis developed by medical officers at KMH is a notable example of how scientific knowledge relates to politics. Their interpretation of war neurosis was closely connected with the military pension system and affected by economic needs during and after the war. This experience mirrored those of Western countries during the First World War. The wartime economy demanded that medical officers make it clear which people were eligible to receive war disablement pensions in order to minimize wasteful spending on “pension neurosis.” As we have seen, the medical officers at KMH fundamentally thought that patients with hysteria did not deserve pensions, because their illnesses were the result of their own desire to be ill and their lack of will to recover, rather than from their war experiences.18 On the other hand, preserving wartime morale demanded that medical officers compensate those who had devoted their lives to the nation. Thus, there are records of exceptional cases, where patients with hysteria were categorized as Grade One. Medical officers at KMH thought those who were eligible for pensions were those who had experienced “extremely severe duties” and had developed their illnesses on the battlefield. Those patients who held higher military ranks or had developed their illnesses after other Grade One injuries or illnesses were also likely to be categorized as Grade One.
Those patients who were admitted to KMH constituted a tiny part of the whole, and most psychiatric casualties at the time were left at the front without receiving psychiatric treatment due to a shortage of psychiatrists. In other words, it took a long time for psychiatric casualties to enter the military psychiatry system, since Japan had a much more extensive battlefield during the Asia-Pacific War, ranging from northern China to the South Pacific, as compared with that of the First World War.19 However, the stance on war neurosis of psychiatrists at KMH, which was reflected in the theory and actual judgments on pensions, has occupied an important place in the intellectual history of trauma in modern Japan, given that those psychiatrists were elite professionals both during and after the war.
The situation for veterans with mental disorders became harsher after Japan’s defeat in 1945. First, a great proportion of the medical records of psychiatric casualties were lost in the chaos before and after Japan’s defeat, which meant many veterans with mental disorders had trouble obtaining the medical certificates needed to apply for pensions. Second, the pension system had been suspended except for those veterans who were seriously disabled, as a result of the Allied Forces’ policy of demilitarization. Third, medical interpretation of the causal relationship between war and mental illnesses became more strict and severe. During the war, those who had experienced “extremely severe duties” could be eligible for recompense even if they had genetic factors or a previous history of mental illness. However, this possibility was almost completely eliminated after 1945. In his 1948 paper, Suwa Keizaburō denied the existence of causal links between mental illnesses and the war, and he emphasized that soldiers’ illnesses were caused by previous medical histories or degeneracy (Suwa 1948: 18). Furthermore, when some members of the Diet discussed pensioning veterans with mental disabilities after the pension system was reinstated, genetic factors once again became important, although not as decisive as they had been during the war (Nakamura 2018). It seems reasonable to suppose that most veterans with mental disorders were excluded from the postwar pension system. This change in the medical interpretation of the causal relationship between war and mental illnesses serves as an illustration of Kanamori Osamu’s argument that an idea or philosophy sometimes affects political decisions over the degree, speed, and funding of intellectual production. As a result, a long-term perspective on the relationship between state and society is needed to make science policy more mature (Kanamori 2015: 74–78).
Of course, wartime psychiatry and the pension system had unique characteristics, but there is room for argument over how the compensation system for servicemen and that for civilians were related. As research on war neurosis in Europe has shown, “pension neurosis” and the notion of malingering were regarded as a problem before and after the war. After social legislation came into effect in the nineteenth century, the ideas of “pension neurosis” and malingering attracted the attention of doctors, employers, and the state (Cooter 1999; Lerner 2003). Techniques for detecting, punishing, and discouraging military malingerers were also applied to civilian workers after the war. According to Joanna Bourke, doctors had a duty to protect the state and employers “from the unjust and improper demands” of malingerers, and they were required to maximize the number of servicemen and workers (Bourke 1996: 26, 92). The same observation may apply to Japan. Some psychiatrists and neurologists who were concerned with war neurosis treatment during the Asia-Pacific War dealt with occupational injuries and workplace manpower management in the civilian sphere, too.20 Two transwar processes call for further explanation: first, prewar pension allotment practices that informed wartime developments in military psychiatry; and second, postwar transformations in civilian society that were influenced by wartime military psychiatry and pension calculation procedures. Military medicine is not an isolated sphere. It sheds light on the relationship between technologies for governing human bodies and minds in civilian societies.
I am deeply grateful to Ryan Moran and two anonymous reviewers and the editors for their insightful comments that greatly improved the manuscript. This work was supported by Japan Society for the Promotion of Science KAKENHI grant number JP16K21658.
In this paper, Japanese names are written in accordance with Japanese convention in putting family names first followed by the given name.
Since the 1980s, several studies have been conducted on Japanese scientific research for military purposes from both the perspectives of the victims of US military science and also the perspective of the perpetrators. On the special unit of the Imperial Japanese Army, which was known as Unit 731 and established to conduct research on biological and chemical warfare, see Tsuneishi 1994, Harris 1994, and Matsumura and Yano 2007. On Japanese atomic bomb research during the Asia-Pacific War and the state-sponsored creation of an attractive image of atomic power and atomic weapons prior to the war, see Nakao 2009. See also Zwigenberg 2018, which examines the reaction of the psychiatrists in North America, Japan, and the United Nations to the nuclear age from the early postwar period to the mid-1960s.
The SCJ stated, “there exist concerns that government intervention in the activities of researchers might become stronger in regards to the direction of the research and the preservation of confidentiality during project periods and thereafter,” stressing the importance of researcher autonomy and the unrestricted publication of research results. Science Council of Japan. 2017. “Statement on Research for Military Security.” 24 March. www.scj.go.jp/ja/info/kohyo/pdf/kohyo-23-s243-en.pdf.
In the 1980s, Japanese historians proposed calling the war Japan fought against the Allied Forces from December 1941 to August 1945 “the Asia-Pacific War” instead of “the Pacific War” to make it clear that the war included China and Southeast Asia. Recently, “the Asia-Pacific War” is sometimes used in a broad sense and is a substitute for Jyūgonen Sensō 十五年戦争 (The Fifteen Years War), a general term for the process of Japanese invasion which began from the Manchurian Incident in 1931 and ended in Japan’s defeat on August 14, 1945.
Over the past few decades, there have been a considerable number of studies on trauma and its connection with modernity. As Mark S. Micale and Paul Lerner (2001) have shown, three features of modern Western European societies promoted disputes over psychological trauma after the late nineteenth century: first, the rapid growth of technology in various aspects of modern life posed new risks and vulnerabilities to the human body and mind; second, a new set of academic disciplines such as psychology, psychiatry, and neurology emerged and tried to explain psychological reactions to traumatic events; third, the compensation system for victims of traumatic events such as train accidents, industrial accidents, and warfare developed. After its rapid modernization, Japan also faced similar conditions. The Imperial Japanese Army’s treatment of the issue of trauma is in line with similar developments elsewhere but had its own unique features.
Hiroshige Tetsu focused on the establishment of the Japan Society for the Promotion of Science in 1932 with the aim of providing research grants, and he emphasized modernization in 1930s Japan (Hiroshige 1965: 147–68).
In the broader context of psychiatry and the Japanese Empire, Janice Matsumura has analyzed the flow of ideas from the colonies and examined how these studies were received in Japan. She argued that psychiatrists in Manchukuo were able to conduct their research in a more liberal “intellectual time-zone” than Japan, because their research findings was strictly confined to professional circles and their influence was restricted (see Matsumura 2010).
According to a psychological report of Japanese prisoners of war made by US Army Military Intelligence, psychiatric patients in the Pacific theater were ordered to have a rest or received medical treatments such as electric shock therapy, injections, and sedatives. See G-2 Japanese Morale Report from Captured Personnel and Material Branch A-166, 27 September 1944, p. 1, box 1317, entry 31, RG 112, National Archives and Records Administration (NARA); G-2 Report A-182, 23 January 1945, p. 1–2, box 1308, entry 31, RG 112, NARA.
See Reports of the US Naval Technical Mission to Japan, 1945–1946, RG 38, NARA.
For further details about the policy on war disablement pension at KMH mentioned below, see Kosaka 1966.
JACAR (Japan Center for Asian Historical Records) reference C13120665100.
On soldiers with “mental deficiency,” see Shimizu 2006. In Japan, “mental deficiency” was categorized as a mental disorder.
JACAR reference C13120665100.
Military authorities expanded military strength by extending the period of military duty and revising downward the criteria for passing a physical examination for conscription (Ozawa 1997; Yoshida 2005). As a result, the numbers of those who were inappropriate for military duty increased: for example, the rate of patients with intellectual disabilities admitted to KMH increased year by year (Shimizu 2006).
The recollection of Meguro Katsumi supports the harsh judgment on pensions for hysteria. Meguro was born in 1932 and met a patient who suffered from war neurosis when Meguro worked at the National Kōnodai Hospital after the war. This prompted Meguro’s follow-up survey of war neurosis in the 1960s. In an interview with Meguro (19 July 2013, at his home), he pointed out that Suwa Keizaburō, the director of KMH, repeatedly noted after the war that they did not pay pensions to the patients of hysteria but granted lump sums.
According to a report of the US Naval Technical Mission to Japan, “painfully few psychiatrists were available” in the Japanese armed forces. See Reports of the US Naval Technical Mission to Japan, 1945–1946, RG 38, NARA.
For example, Sakurai Tonao, who worked at KMH as a medical officer, had worked on compensation for neurotic patients after railway accidents before the war and worked for the Mitsui Institute of Industrial Medicine as its chief of neurology during the war. In addition, Onuma Masuho, who was the director of the Shimousa Military Sanatorium and treated veterans with head injuries during the war, began research on industrial mental health after the war.