Overlooked trauma of nuclear bomb survivors

The atom bombs dropped on Hiroshima and Nagasaki in August 1945 announced a new era – creating an enduring sense of threat and uncertainty for the global population. Why so little was done to treat civilian psychological casualties of World War Two, and indeed to understand the nature of their post-traumatic illnesses, remains a fundamental question. 

In Nuclear Minds, Ran Zwigenberg addresses this topic with a focus on post-war Japan, the only nation ever to have experienced the destructive power of an atomic bomb.

In the aftermath of the attacks, the US Strategic Bombing Survey sent teams to Hiroshima to interview survivors. Their goal, however, was not to research ways to assess and treat the psychological casualties but to assess the effectiveness of the air raids in damaging individual and national morale.

Later studies by Japanese psychiatrists, notably Masuho Konuma, focused on a biological rather than a psychological explanation for enduring symptoms and functional impairment reported by survivors. Brain lesions and damage to the central nervous system were proposed as the cause of persisting mental ill health, though by the mid-1960s Konuma proposed an interaction between psychological and organic factors to produce 'interbrain syndromes'. 

Yet his insights were not widely shared by health professionals and failed to prompt the design of an integrated care programme. Although the testimonies of a thousand survivors were surveyed in 1956, the evidence was regarded as unreliable, thought to be fragmented and distorted by the subjective nature of personal experience.

To explain why severe and persisting psychological trauma was overlooked by mental health investigators in post-war Japan, Zwigenberg offers several explanations. Firstly, the physical effects of radiation dominated the research agenda, and secondly, ideas of scientific objectivity freed from socio-political context discouraged researchers from attempting to engage too closely with the minds of individual survivors. Further, the desire to promote the application of atomic energy to drive post-war reconstruction and wellbeing led many to avoid any association with personal suffering.

Zwigenberg argues that the concept of trauma as an interpretive category was almost non-existent in Japan and the West before the late 1960s. This may be overstated as there were other terms that described psychological wounds such as combat fatigue or shell shock and, as the author notes, by 1945 advances in military psychiatry had identified risk and protective factors, whilst also developing a range of treatments.

It is likely that the scale of the problem and the limited resources directed towards mental health contributed to the failure to address the suffering of so many civilians impacted by World War Two. As a result, most received little more than medication for symptom relief, whilst others took part in rebuilding and reconstruction programmes, which may have functioned as informal occupational therapy.

The experiences of those who lived through the Holocaust are compared with the citizens of Hiroshima and Nagasaki. A common belief in Europe that survivors of genocide had been toughened by their experiences also led to physical explanations for enduring symptoms.

A concentration camp syndrome, proposed at an international conference held in Copenhagen in 1954, was attributed to organic neurological changes caused by mechanical and toxic injuries in a context of starvation and disease. Even when psychological factors were identified, intra-psychic conflict in childhood was considered more significant than the trauma of the camps. As a result, calls for organised psychiatric intervention and financial compensation were ignored in Israel and in the West generally until the late 1960s.

This book presents an insightful and persuasive analysis of Japanese psychiatry and the troubled experiences of atom bomb survivors. In 1948, Paul Friedman, an American psychoanalyst who assessed the mental health of Jewish survivors in displaced persons' camps in Europe and Cyprus, recorded an 'enormous dislocation of the spirit' and 'serious emotional problems'. Zwigenberg provides important evidence to understand why so many people, who had endured unimaginable suffering, were neglected in the post-war period.

Reviewed by Edgar Jones, Professor in the History of Medicine and Psychiatry at King's College London.

Read an extract here.