The mental health of nuclear submariners in the United States Navy.

W HiLE conceptual and methodological problems of defining mental health and its presumed opposite, mental illness, have been considerable, some areas of agreement are begin-' ning to appear among the many psychiatrists, psychologists, and social workers active in this field.' More and more, the most useful criterion of mental illness appears not only to be related to the incidence and severity of psychopathological symptoms but also, and perhaps more importantly, to the degree to which this symptomatology results in social dysfunctioning or, in extreme cases, social incapacitation. This "social-dysfunctional" criterion of mental health is particularly apropos the problem of adjustment of the 100 to 140 nuclear submarine crewmembers confined in close proximity to each other for extended submerged missions of 60 days or more. The introduction of the deterrence concept with the launching of the first Fleet Ballistic Missile submarine in the early 60s accented not only the importance of careful psychiatric screening of all incoming submarine personnel but also the requirement for a continuing assessment of the mental health status of the entire crew. A series of official instructions issued by the Secretary of the Navy at that time further emphasized the criticality of maintaining the optimal mental health of the submarine crews, in order to minimize the likelihood of an inadvertent launch of a nuclear-armed missile or some other casualty, with ultimate consequences conceivably affecting the viability of the planet Earth. Historically, the incidence of debilitative psychiatric illnesses in the Submarine Service has reportedly been incredibly small. For example, during World War II, the incidence of psychiatric casualties in the Submarine Service was reported to be 56 out of 126,160 manpatrols. A somewhat larger but still relatively low psychiatric incidence rate of 20 per 1,000 in this branch of the Service was reported about 10 years after Nautilus, the first nuclear submarine, was launched in 1954. This study indicated that about 24 per cent of the submariners referred for psychiatric evaluation were diagnosed as personality disorders, another 18 per cent neurotic, about seven per cent as psychotic, and the remainder undiagnosed. The trend toward an increase in the psychiatric incidence rate of active duty personnel across all of the US Armed Forces seems to have peaked in the mid-70s. While the diagnostic classifications of the psychiatric cases reported in the above studies were arrived at largely by interview and other direct observational techniques, the present study involved the use of a well-standardized, psychodiagnostic test, the Minnesota Multiphasic Personality