Insanity and war: the Gulf War and a psychiatric institution.

The threat of a chemical war has profound impacts on all layers of society. Hospitalized mental patients, as we have observed them, react in more extreme ways than staff members. They may react overanxiously, totally apathetically, or in context-related flights to partial sanity. Denial and projection were heavily used defense mechanisms together with a tendency of the more acute patients to plunge into their bizarre idiosyncratic world, lending strange meanings to what was happening in the world. Many patients were found to have strong narcissistic traits and to invest most of their libidinal energies in their private world. In times of stress this results in even greater social isolation. Different types of patients in different phases of their illness react differently to such overpowering stress, and the way they react illustrates their cognitive, behavioral, and social deficiencies. WWII literature on the reactions of mentally ill patients to "fly-bombing" seem not to take into consideration the different possible reactions of patients. This may be due to a change in emphasis in the care of mentally disturbed individuals in the last two decades. We propose to use even such an extremely stressful situation as a challenge to the mental health profession to further the well-being of their patients.