133

REFERENCES
1. Glad, Donald D.: "An operational conception of psychotherapy." Psychiatry,
November, 1956 9, 371 - 382.
2. Hayne, Melvin L., Glad, Donald D., and Ferguson, Robert E.: An Inverse Factor
Analysis of Behavior in Paranoid Schizophrenic Groups. Paper presented at Rocky
Mountain Psychological Association Convention, Grand Tetons National Park,
June 11 th, 1956.
3. Smith, W. Lynn, and Glad, Donald D.: "Client reactions to therapist operations in
a controlled group situation." Group Psychotherapy, 1956, 9, no. 1.
4. Smith, W. Lynn, and Glad, Donald D.: "Client reactions to therapist operations in
a controlled group situation." Sociometry Monograph, 1956, no. 35 (in press).

OBSERVATIONS ON THE RELATION OF PSYCHOSOCIAL

FACTORS TO PSYCHIATRIC ILLNESS AMONG
COAL-MINERS
LEWIS W. FIELD, PH.D.
Clinical Psychologist and Director of Research, Bluefield Mental Health Center,
Bluefield, West Virginia*
REED T. EWING, M.S.W.
Director of Social Service
St. Albans Clinics and Bluefield Mental Health Center
AND
DAVID M. WAYNE, M D., F.A.C.P.
Director, Bluefield Mental Health Center
I
NE-THIRD of man’s waking life is taken up by his job. Another significant
O
portion of man’s life, intimately connected with his work, is his leisure
time and social activities. The twain not only meet, but melt inseparably in the
individual’s total emotional response to living. This is man’s life and this is
what must be studied if the total man is to be understood. For purposes of our
study, the problem of psychiatric illness in miners and its psychosocial deter-
minants, miners, like other people, are conceived as living a work life and a
social life. The miner’s work life is the focus of the first part of this article.
His social life will be the concern of the second part, and part three will discuss
the importance of parts one and two with respect to the total man.
The miner’s work life is underground; his social life above the ground. Like
the farmer, he lives off the earth and closer to the earth than most people. There
is an earthbound locus to the mining occupation that cannot be ignored in any
psychological evaluation of the miner’s life situation. As one miner described
his work situation: &dquo;In a way you can compare it to the country. There is one
main highway, the main line track. It extends all the way to the pits into the
mine and there are sections that turn off. One road turns right, one to the left
and then maybe two or three turn off from each one of these. They are just like
good country roads. Each one of these sections is like a little town. The place
where they are getting the coal out is like a little farm&dquo;.
We believe the miner is psychologically different when he is underground
on the job than when he is off the job and on the surface, although he is at the
same time one and the same man. He is two separate psychologies, yet he is one
psychology unto himself. To state it in another way, for the purposes of our
study, miners lead three lives: one, subterranean; one, supraterranean; and one,
* The Bluefield Mental Health Center is one of six private out-patient psychiatric
clinics affiliated both with St. Albans, a private psychiatric hospital, Radford, Virginia,
and the United Mine Workers of America Welfare and Retirement Fund.

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panterranean.
The subterranean miner finds himself in a world of tension. Underground
the miner is potentially expendable, close to danger, close to actual physical
threat. He may lose his life. The threat and the tension associated with this
situation are well described by one of our patients who formerly worked in the
mines: &dquo;When a pillar falls it can get exciting. After you have taken out
approximately two acres of coal there is nothing in there but a few timbers, and
tension builds up. Tension is everywhere-in the people as well as everything
around them-on the timbers, especially. I have seen the time when timbers
would be so tight they would sound like a bell when you hit them with a
hammer&dquo;. This same individual goes on to describe what happens when a
cave-in takes place: &dquo;The timbers first begin to get tight, and you can hear
them tingle. Then little splinters begin to break off and you hear this every
two or three minutes. As it goes on, it gets louder, and way off in the distance
you can hear a rumble-like roar-something like thunder, and the closer to it
you get the louder it becomes. Later the timbers begin to break a little bit and
then a little bit more. Finally, as it comes closer, it seems like the noise is all
around you, and you don’t know where it is coming from. Then you better run.
It all seems to come to a point, this roar all at the same time, and it seems
like these big timbers give away all at once and the whole mountain comes in.
Usually it’s a big territory and you are around close. After the fall it seems to
relieve the tension not only in the men but in the timbers too&dquo;.
The miner is not only exposed to such dramatically tense situations, but
he also works under protracted tension, because as long as he is on the job
he constantly faces the potential threat that &dquo;he may be the next man to get it&dquo;.
He is like the soldier under fire thinking: &dquo;Maybe the next bullet has my name
on it&dquo;. As stated in the Medical Survey of the Bituminous Coal Industry, the
ranks of miners are diminished each year by 900 to 1,250 men who lose their
lives in accidents. Each year some 50,000 or more suffer injuries which incapa-
citate for long periods of time. ~6>
Thus, while on the job, both potential and actual threats are all around
the miner, and this has to be dealt with in such a way as to minimize psychic
&dquo;wear and tear&dquo;. Miners, like other groups, deal with such stress by strong
social cohesion on the job. An example of such unity under stress may be seen
in army and civilian groups during war-time. When such groups face danger,
prejudice, selfishness, pettiness, hatred and the other frailties of personality
that complicate human relationships in normal times, melt in a &dquo;common
defence&dquo;. There is a social security among men who team up, not only to keep
working, but to stay alive. One coloured miner expressed this as follows:
&dquo;Down there [in the mines] I’m your brother, but up here [on the surface] I’m
just another black bastard&dquo;. This esprit de corps among miners while on the
job is illustrated in another quotation from our patient referred to above: &dquo;The
men usually work in crews and stay with each other for a long time and maybe
work together for several years. They form friendships with each other, and
each one knows what to do in these crews&dquo;.
Social cohesion within work-teams in the mines has in recent years become
fractionated and therefore less effective as a protection against psychic stress.
Trist and Bamforth blame the work structure itself (the Longwall Method of
Coal-getting) for &dquo;the segmented quality of the social organization&dquo; among
miners on the job. (10) We believe along with Halliday, however, that such

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fractionation may be attributable also to broader psychosocial factors intro-

duced as disrupting influences into the miners’ work situation both from without
and within. <5>
Disrupting Psychosocial Influences from Without. There was an influx into
the industry during the war years of those who had not previously been miners.
A number of these were potentially psychologically ill (draft-avoiders, 4-Fs,
dissatisfied migrant people, etc.). Others, who were also not ill themselves,
served as psychosocial pathogenic agents (malcontents, agitators, etc.). Discon-
tent, whether with one’s job, one’s way of life, or one’s self, is a noxious
psychological bacillus that can penetrate even the strongest psychic armour and
infect the mind. The war years also removed a large number of young miners
from the mining community who, upon their return, acted like an invasion
from without. Back home after having seen other places, other cultures, other
ways of life, they became discontented with the home situation, additional foci
of psychosocial disruption. Another disrupting social influence introduced from
without was the increased communication with the outside world (automobiles,
airplanes, radio and TV), which has shown the miner other ways of life and
in many cases resulted in causing him to become discontented with his own way
’

of living. (5, lIb)

Disrupting Psychosocial Influences from Within. The introduction of
machinery into the mines has produced a marked change in the work system.
First, machinery noise prevents the detection of earth activity (&dquo;bumps, kettle-
bottoms, settling&dquo;). These things formerly served to warn the group of impend-
ing danger. Now, even though safety devices have increased, the din of mining
machinery masks the protective sounds of Nature, reducing sensory acuity on
both an individual and a group level, introducing new psychological hazards
to the job. Secondly, the miner now works to keep pace with machinery rather
than at his own and his fellow-workers’ pace. Work schedules are set up on
the basis of the productive capacity and impersonal rhythm of the machine, not
the personal needs and idiosyncratic rhythms of the worker and his group.
Fractionation of the work group as a social unit has resulted from mechan-
ization of the mines. This has brought about an increase in the psychological
stress associated with the work situation. Before mechanization each member of
the work group was an all-round workman usually able to substitute for his
mate. The efficiency and safety of the miners’ jobs depended on their all-round
skill and confidence in each other’s work. External dangers and internal anxiety
were shared with each other. Each member of the team was looking out for
the other man as well as for himself. Groups of workers were united by bonds
of affection in a common social purpose. The work system, evolved from
experiences of successive generations, was founded on a group with an autonomy
which promoted social cohesiveness. Job satisfaction depended upon values
gained in human relationships through mutual respect, confidence and belonging
to a group. The presence of danger and threat to life made this factor of belong-
ing to a group even more important to these earlier miners. There was a
working together towards a common goal, and pride in the achievement of the
group could be seen as an important morale factor.
Halliday illustrates this morale factor in his report on &dquo;a small mine in
mid-Scotland in which the twenty-two miners employed ... produced an
average amount of coal per man-shift several times in excess of the Scottish
average in general&dquo;. Halliday reported further that: &dquo;This mine has held the

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136

highest figure per man-shift among Scottish mines for some time. It was started
only three years ago when work was reopened on three seams which were
abandoned more than a hundred years ago. An official said yesterday: ’Our
lads can do it because they are a contented and informal little crowd who settle
differences among themselves. We carry out trouble-free mining here. The
manager is just &dquo;John&dquo; to his men, who all know each other by their Christian
names. Every morning they travel five miles to work in the same bus. They
eat together, boil their tea-cans over the same fire. Five of the workers are
Bevin boys. The oldest told our reporter: &dquo;We use hand-picks here and have
no cutting machines. It’s hard work but we’re used to it. Besides, we’re a happy
crowd&dquo; ’9, ,’(5a)
The following statement is made by Wilson and Ryland regarding the
psychosocial aspects of any work or life situation: &dquo;The quality of interpersonal
relationships within a single group and the quality of the functioning of the
group as a whole have profound influences upon the individuals who are
associated together to earn a living or to plan leisure-time activities9’.(&dquo;)
Dickson emphasizes group interpersonal relationships and morale as impor-
tant emotional stabilizers among workers, especially miners. (3) In a manner of
speaking, it might be said that &dquo;in the old days&dquo; a mining work-team of six
had twelve ears listening, twelve eyes looking, six skin surfaces sweating, six
noses smelling, and six minds with mining experience interpreting sensory data.
The work-team was a psychosocial gestalt, a solid block of mobilized brain and
brawn psychologically bonded together for both defence (against injury or loss
of life) and attack (the extractipn of coal). This situation fostered a state of
heightened attention in such a way that anxiety, instead of inhibiting, potentiated
thinking processes. Thus, brain functioning took place in a psychosocial situation
conducive to maximal cortical vigilance, a greater sense of security and therefore
better psychological health.
The bituminous casualty reports(6) apparently do not support an argument
which says that the work situation was better for the miner in the &dquo;old days;’
than it is now. Operators and union officials quickly point to the decrease in
injury and death statistics per man-hour worked and per man-ton produced in
recent years. This is a proud safety record for the physical side of this problem
and should be properly recognized and encouraged, but what about the psycho-
logical side? The statistics are going in the opposite direction in this respect.
Psychological casualties are increasing. Halliday has found that the frequency
of psychosomatic affections among miners in England increased in the 20th
century &dquo;at a rate definitely greater than among the male population generally,
so that by the 1930s their incidence in miners was considerably higher than in
workers who were not miners&dquo;. ~5b> Thus, while mechanization and engineering
know-how have made the positive contributions of increasing production, they
have at the same time contributed negatively to the work situation by intensifying
the psychological stress and increasing the psychiatric casualties among miners.
II
The impressive incidence of psychosomatic illness in the mining group
cannot be solely attributed to the stress factor associated with the miner’s work
situation, his life underground. The stresses operating in the economic and social
spheres are equally important in contributing to the miner’s psychiatric problems.
His supraterranean life is also fraught with stress.

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 137

The setting in which the individual lives and is nurtured is recognized as

significant in developing his physical and psychic self. The area served by the
Bluefield Mental Health Center is predominantly mining country. There are
eight counties, five located in southern West Virginia, and three located in
adjoining south-western Virginia. The population totals 447,677 people, with
the ratio of employed miners to employed males by countiest ranging from
85.1 per cent to 21.6 per cent, with a county median of 44.85 per cent. West
Virginia is the leading coal-producing state in the nation, and the grade of coal
is considered to be high.
In an area where there is only one type of industry present accounting for
almost half the employed males, there is a severe limit placed on a person’s
opportunities. He either works in the mines, does not work, or he leaves the
area to find work and breaks family ties of long standing. Should he leave the
area to seek employment, he is faced with further difficulties, because he is
poorly equipped to compete for jobs in other industries. Again, a one-industry
area such as this is very sensitive to economic changes. When coal is in demand,
employment is widespread; when the demand is down, many are &dquo;cut off&dquo;. The
feeling &dquo;I may lose my job&dquo; is now present more than ever among miners. The
actual threat of unemployment (whether from advancing technology or &dquo;business
slump&dquo;) is a real one. Miners may not be aware of actual statistics, but their
memory will not let them forget the lay-offs, strikes, etc., which they have faced
frequently during their lifetime. A year contains 365 days, and out of this
number miners have been known to work as little as 142 days. Only nine times
in the past twenty-five years have they averaged more than 200 workdays a
year. (6b) When unemployed, the miner, like any other person without a job, tends
to lose his usual pattern of social values. He no longer feels he is a useful person
in society. All of these things contribute to placing the miner under greater
emotional tension. For example, if he owns his home, has strong family ties and
suddenly finds working in the mines no longer feasible because of health or
economic reasons, he can seek a job in another part of town. If he does obtain
employment in the local area he works for considerably less money. This creates
additional frustration. Those miners who migrate have to leave home, family
and friends and seek employment in a strange city, which in many cases produces
additional emotional stress. Due to these conditions the miner in many ways is
trapped in the area.
There are other factors besides those which are economic or emotional that
contribute to the psychology of &dquo;being trapped&dquo;. In this coal-producing area the
people live in a form of relative isolation from the remainder of the country.
The terrain is rugged and mountainous-such that a &dquo;piece of bottom land&dquo;
brings a premium price. Travel is difficult and slow. Other methods of com-
munication, e.g. radio and television, are hampered by the ruggedness of the
hills. The automobile, radio and TV have all improved the communication
facilities, but as a group the people still remain poorly informed. The literacy

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138

level in this area is not high. This limits their ability to communicate and
further accentuates their isolation. One of the local practising medical doctors
stated that in his letters to patients he usually tried to state what he wanted in
three different ways so he could be sure that his letter would be understood.
The miner will feel the effect of this isolation for many years, even though his
situation is being ,changed and improved. This is another factor which leaves
the individual ill-prepared to deal with outside urban living conditions, should
he wish or be forced to leave the pits.
As is well described in the Medical Survey, much of the housing in the
area served by the Bluefield Mental Health Center is sub-standard with very
poor sanitary facilities. &dquo;A large majority of the mine employees and dependants
live in company-owned or -controlled communities and the standard of living
is unsatisfactory in view of the level obtained by most families throughout the
United States in a comparable income class. The miners are dependent on
employers to a great extent, not only for their work and income but also for
the character of the houses in which they live, and for the resources and
atmosphere of the communities of which they are a part.&dquo; ~6~> In 713 com-
munities reported in the Medical Survey, &dquo;95 per cent of the company-owned
houses are built of wood, with two-thirds of the roofs being of composition
paper with poor foundations. Maintenance as well as construction is usually
poor. In the worst-controlled communities the state of disrepair at times runs
beyond the power of verbal description or even photographic illustrations.
Neither words nor pictures can portray the atmosphere of abandoned dejection
or reproduce the smells. Old unpainted boards and ... batten houses going or

gone and boards fast falling, roofs broken, porches staggering, steps sagging,
a riot of rubbish and a medley of odors-such are the features of the worst

camps. They are not by any means in the majority but wherever they exist
they are a reproach to industry and a serious matter for such mineworkers and
mineworkers’ families as are dependent upon the companies for living
facilities&dquo;. (6d)>
Another important psychosocial factor related to the setting in which an
individual lives is the amount of social outlet available to him. Social outlets
in mining areas are extremely limited. Not only is the miner’s home unattractive
and uncomfortable, but most of the communities in which he lives have little
to offer in the way of social activities. He may participate in the local poker
game, attend church, or go to the cafe and drink beer. His wife is limited to
church because none of the other places is considered proper for her. Usually
she is too tired to care much either way. The Medical Survey further reveals
that the &dquo;inadequacy of organized recreation in the nation’s coal-mining areas
clearly reflects public inability or unwillingness to appreciate its importance in
good living and accord the problem due respect and consideration.
&dquo;The dividends of a sound recreation program are indirect. Its rewards
are not measurable precisely in dollars and cents, but are undeniable and the

consequences are equally manifest&dquo;. (6e)

Steps have been taken in England to do something regarding the lack of
social outlets in mining and other industrial areas. As reported by the National
Council of Social Service in London: &dquo;From 1927 onwards, small groups of
unemployed men, in the mining areas especially, began to meet together in
disused garages, in vacant shops and warehouses, wherever premises could be
found. In this way, clubs were formed for unemployed men, where they and

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 139

those anxious to help them could evolve ways of putting up some resistance to
idleness and poverty.
&dquo;From these small beginnings, there grew in all parts of the country a
partnership between unemployed people and men and women of good will....
In this way clubs where men first met in revolt against their idleness have
become centres of social and educational activity....
&dquo;Nor has the movement been confined to men alone. Unemployment of
sons and husbands has meant to many thousands of women an additional strain
and anxiety and an increase in need for fellowship and encouragement. These
clubs were concerned to help women harassed by unemployment to find ways
through sewing and thrift classes to resist the impoverishment of their homes.
Other classes and many social activities developed around these first meetings
... the clubs came to represent a permanent interest in the lives of many of the
women in their neighbourhood and a help to them in the running of their
home....
&dquo;Today there are in all about 900 clubs for men and 500 for women, with
a membership of some 120,000 men and 40,000 women&dquo;. (s)
On the other hand, the American recreational situation in the mining area
is described by the Medical Survey as follows: &dquo;Recreational facilities and
programs are: (1) better and more readily available in the larger incorporated
communities with diversified classes of people, such as factory workers, farmers,
white-collar workers, and others in addition to miners; (2) poorer in those
incorporated communities comprising primarily mining families and workers
in professions, trades and businesses dependent upon mining; (3) poorest in
coal camps, the company-owned, unincorporated communities made up almost
solely of mining people. These facts point out that community organization is
needed to provide the basic needs for recreational facilities and comprehensive
leisure-time programs.
&dquo;organization into some form of local government, with citizenship re-
sponsi bilities shared by the residents, is needed to achieve improved re-
creational opportunities as well as better sanitary facilities&dquo;.<6f>
The female role dramatizes the stultified social life forced on these mining
families. The miner’s wife does housework. No careers or jobs are open to her
even on a part-time basis, and club life for women is practically non-existent.
Telephones are scarce. Thus even this social outlet is not available. Generally
the miner’s wife finds herself living in a social vacuum, a life situation which
would appal most women by its absence of stimulation.
Nutrition and sanitation are like the social situation, retarded and inade-
quate. Meals are based on a traditional rather than a scientific diet, and made
up of food purchased in the company store or the corner grocery where the
greater share of the family shopping is done. Concepts about hygiene and
matters of health are unknown. Flies move freely through screenless windows
from slop piles in the backyard to the sugar bowl on the table. Economically,
geographically and psychologically trapped in such a life situation, the hope
&dquo;that bums eternal in the hearts of men&dquo;, and makes life worth living, must
indeed be but a dying ember in the case of the miner and his wife.
III

We have made some observations about the miner psychologically

underground and psychologically above the ground. What is the substratum

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140

psychology of the miner, that which remains constant under all conditions, the
panterranean man?
Durkheim states: &dquo;No living being can be happy or even exist unless his
needs are sufficiently proportioned to his means.... If his needs require more
than can be granted ... they will be under continual friction and can only
function painfully. Movements incapable of production without pain tend not
to be reproduced. Unsatisfied tendencies atrophy....
&dquo;All man’s pleasure in acting, moving and exerting h,imself implies the
sense that his efforts are not in vain and that by walking he has advanced.
However, one does not advance when one walks toward no goal, or, which is
the same thing-when his goal is infinity&dquo;. (4) The effect of the atmosphere in
which the miner and his family must live may in part be reflected in the apathy
that surrounds much of his activities. In many ways he appears to be &dquo;tired of
living and afraid of dying&dquo;. He fights what he feels is a losing battle both at
work and at home. At work, if he does not get killed or badly injured, he can
only look forward to silicosis and early death. Few minersappear to expect
to collect their pension. They also have little interest or hope of improvement in
their living conditions, partly due to not owning their home and partly due to
a lack of job permanency. Old mines work out, and new ones are started; as a
result of this the miner lacks the economic anchor of the property-owner. The
bad housing and dependency on the employer conspires to force the miner into
a role in life for which he has little appetite. He is placed in a dependent position
from all viewpoints and has little or no opportunity to get out of it.
Historically the miner has always been dependent in one way or another.
The psychodynamic evolution of dependency in the mining group as a sub-
culture may be conceived, as a matter of fact, as being transmitted from one
generation to another psychogenetically in the form of a cultural gene. Depen-
dency in the miner has evolved to the point where the miner’s role has become
one of passive acceptance. The miner’s progenitors were hill-country farmers
who extracted their bare subsistence from the earth. The earth yielded to the
aggressive demands of these pioneers and was made to conform to their needs.
In those days any dependency that existed was satisfied within the conjugal and
kinsman groups. As stated by Wiesel and Amy, &dquo;Kinship ties were the most
important bonds in the mountains&dquo;.<ii> Psychological adjustment was geared
in such a way that hostility was externalized in inter-clan conflict.
At the beginning of the 20th century entrepreneurs started developing the
coalfields. Investment syndicates moved in, built homes, railroads and company-
owned stores, offering the hill people immediate economic improvement. The
price they had to pay for these gains was conformity to the needs of the coal
operators. Thus the social structure of the family clan gave way to a type of
coal camp life which destroyed the previous pattern of living. The family clan
lost its status as a basis of society. &dquo;The coal camp and its laws became the
center of the social structure&dquo;, and the miner lost any sense of community
leadership or responsibility. (11) Conformity previously demanded by membership
in a family or clan was now imposed on the miners by an economic octopus,
which did not allow them to externalize their aggressive drives as they had been
able to do previously in Hatfield-McCoy type clan conflicts. However, when the
union came along as a substitute for the clan, hostilities again resumed through
union resistance movements directed against the exploiting operator. The miner
gradually transferred his allegiance and dependency from the coal operator, who

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 141

had let him down, to the union. (Ila) Since then the union has been functioning
as an outlet for the aggressive drives of the miner. This has placed the miner
in a peculiar position with respect to the handling of his hostility. As arbitration
has increasingly replaced actual strikes with walk-outs, picketing, etc., the
miner’s overt participation in labour conflict (modern hostility outlet replacing
the old hill-country clan battles) has become more and more remote, leaving him
less and less opportunity to act out his hostility. Thus, affect has been forced
inward, further compromising the miner’s psychic economy.
A dependent person is a trapped person. Sometimes the miner almost
appears as though he feels he was born with a curse with which he must live
and under which he struggles, his efforts becoming more feeble as time wears
on. Eventually he appears to develop the apathy of a trapped animal, making
little or no effort to escape his fate. However, one socially acceptable avenue
of escape remains: psychiatric illness of a psychosomatic nature. As a matter
of fact the foregoing may be conceptualized as follows: the internalized feelings
of hostility in the miner seem to be expressed in two vectors-passive aggression
(apathy) and active aggression (somatization).
The subtler psychosocial threats discussed above, combined with the more
obvious threats of the miner’s occupation, present a formidable stress situation
sufficient to overburden the adaptive mechanisms of any group of people. It
was noted earlier that obvious threat is all around the miner in his work situation.
Like a soldier, he must defend himself against physical as well as psychological
hazards. Even with modern safety programmes and engineering knowledge the
most prominent physical hazard facing the miner is still disabling injury or
death. Questions frequently asked by lay people and uninitiated professionals
are: &dquo;Don’t the men who work in the mines develop a fear? Aren’t they afraid
of getting hurt?&dquo; or: &dquo;You would get sick too, if every day you had to burrow
in the ground like a mole and work in low coal and in dampness and darkness
under 500 feet of ’cover’ that’s ready to fall and crush you&dquo;. We have given
such questions considerable attention through interpretation of dreams and
statements made by patient-miners during interviews. We have also asked
patients directly: &dquo;Are you afraid of the mines? When you see slate fall and
kill or injure someone, do you worry that maybe some day it will fall on
you?&dquo; The usual answer to such questions as these put to the miner is: &dquo;Not
any more. When I first went into the mines, I was scared to death, but soon
after that I got used to it. I never gave it a thought&dquo;. Or it may be stated in
another way: &dquo;This is a dangerous occupation, but people get used to it and
don’t pay attention to it; in fact, sometimes they don’t pay enough attention
to it. This is one reason why so many people get killed or hurt&dquo;. Again, too,
when asked about dreams, miners typically say: &dquo;One time, right after I went
to work in the mines, I dreamed about slate falling on me. But that’s the only
time, I never had any more after that&dquo;. These findings revealed, we felt, con-
siderable evidence of repressed fears of the mines similar to that found by Ross
et al. in their investigations.<9> Our findings are also essentially in agreement
with Halliday’s, that miners who have left the pits and are no longer dependent
on the mines speak freely of their distaste for the work, its hazards and incon-
veniences.(5c) Thus, from these findings we have been led to conclude that
repressed fear seems to be a significant factor in the personality adjustment of
miners, both those who are psychiatric patients and those in the &dquo;normal&dquo;
category.

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Repressed fear has another application which we believe is germane to the

miner’s personality adjustment-his apparent apathy. This apathy is probably
the result of a combination of factors, among which passive aggression has
already been mentioned. The Greek derivation of the word &dquo;apathy&dquo; itself may
help to clarify the concept. The word &dquo;apathy&dquo;tcomes from two Greek words
meaning &dquo;without suffering&dquo;. We feel the miner is apparently &dquo;without suffer-
ing&dquo;, that he is apathetic in the original Greek sense, primarily because of two
mental mechanisms, denial and repression. The mechanism of denial is function-
ing in the form of denial of anxiety associated with the physical hazards of the
miner’s job. Regarding the mechanism of repression, our investigations (and
those of Halliday previously cited) indicate that expressions of fear and hostility
regarding their work and life situation are rare among employed miners but
more readily elicited from ex-miners. Latent fear and hostility evidently become
manifest after miners have been away from the mines for long periods. This was
well stated by an ex-miner whose present job requires only occasional visits
underground: &dquo;I recognized dangers before in the mines when I worked under-
ground every day, but then I was used to them, and it didn’t matter. We winked
at them, so to speak. Now, since being away from the mines as a regular
occupation I’m more conscious of the dangers of the work when I go under-
ground. This anxious feeling now is also more conscious-I can run better now.
My wife also worries more now when I go underground. Before, when I was
going underground every day, these feelings apparently were not present&dquo;.
We believe that the miner’s anxieties about the hazards (falling slate, rock dust,
suffocation) associated with his work are repressed soon after he enters the
mines and remain as unconscious sources of tension. His hostility follows the
same psychodynamic pattern. It may be said that at this stage of personality
adjustment the miner does not appear to be suffering. He is apparently without
suffering (apathetic). Actually, though he may not be suffering, he is struggling
with a subclinical or latent tension state.
Our case recordindicate that these mechanisms of repression and denial
may be well tolerated over a period of years. There is, however, a period of
incubation from five to fifteen years during which the miner is rendered &dquo;stress
allergic&dquo;, accident- and illness-prone. We believe it is during this period that
the miner is expending energy repressing the conflicts and anxieties associated
with his work and social situation. This continuous repressive struggle slowly
drains the miner’s life energy (glan vital), producing what seems to be a cultural
syndrome, the appearance of being tired, beat-down, physically and mentally
exhausted. West Virginia miners, in fact, are distinguishable from other patients,
even in distant clinics, by virtue of their debilitated appearance. This may also
be explained in terms of Hans Selye’s General Adaptation Syndrome. Continuous
exposure to stress involving repression of fear and hostility exhausts the adapta-
tion energy, leading to the stage of exhaustion.
As long as the miner’s defence mechanisms are operating economically, he
does not show clinical signs of illness. His illness is subclinical. Unconsciously,
however, the way is being prepared to utilize a face-saving incident (injury,
explosion, shock, lung conditions, etc.) to remove the miner from his threatening
t The low number of responses on the Rorschach and short, unimaginative stories on the T.A.T. we have
elicited from psychiatrically ill miners also suggest a flattened, unemohonal type of personality.

§ Bluefield Mental Health Center has been operating four years, with an intake of 4,000 patients up to now.

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 143

environment (internal and external). In many cases &dquo;operational or mine

fatigue&dquo; develops and manifests itself in anxiety and psycho-physiological
reactions. The situation may be compared to &dquo;combat fatigue&dquo; among soldiers
during war-time. It has been our experience that &dquo;mine fatigue&dquo; results very
often in a psycho-physiological disturbance. As stated previously, miners as a
group show a higher incidence of psychosomatic affections.
The stress factors discussed so far with respect to the miner apply to his
wife as well. However, the application is different because the miner’s wife
defines her life situation differently. She has her own brand of fear too, only
she expresses it more openly than her husband. The most frequent comment
is: &dquo;I worry about my husband, especially when he is on the night shift and
I am alone&dquo;. While the miner burrows in the mountain and lives with danger,
his wife remains outside the mountain and lives with danger of a different sort.
As we see it, her psychological position in relation to danger is different. She
too is potentially expendable, not physically like her husband, but psycho-
logically. Her husband may lose his life, whereas she may lose her husband, her
chief source of security, emotional as well as economic. This conscious threat
is expressed in the following typical statement of a miner’s wife: &dquo;I’m afraid at
night and remain afraid until he returns home in the morning&dquo;. However, the
unconscious (and psychologically more debilitating) threat in her case is: &dquo;I’m
afraid because my husband may not come back tonight and I may be alone the
rest of my life&dquo;. This is a more insidious threat and must be dealt with
differently. The following is a report from a psychiatrist after interviewing a
fearful wife: &dquo;This patient has never been happy with the fact that he [husband]]
is a miner and in constant dang’ When they were first married she was so
nervous that she frequently let her husband oversleep, deliberately trying to
prevent him from going to work. The patient is very much disturbed and her
nervousness is apparently precipitated by her husband’s arrival home two and
a half hours after his scheduled time. She was certain that he had been killed&dquo;.
Here too, it may be pointed out, is what in experimental stress literature
is called an approach-avoidance conflict. The wife wants her husband’s pay-
cheque as a guarantee against economic hazards, yet this implies another hazard,
subjecting him to possible death or injury and her to being deprived of her
chief source of security. This continuous stress may precipitate an anxiety
reaction. The contrasting psychological roles of the two sexes in the mining
group may thus be sharply drawn as follows: The male on the one hand faces
physical as well as psychological dangers in the mines. The female on the other
hand faces a subtler kind of danger at greater psychological distance. While
there is no direct physical threat on her life, there is the ever-present threat of
losing her main source of her security (financial and emotional), her husband.
Fear and insecurity may thus be seen as different for males and females in the
mining group by reason of the clear-cut difference in their roles. Anxiety
reactions in males and females in the mining group may be seen to be similar
in symptomatology, but psychodynamically different.
SUMMARY
The goal of mental health can be stated simply: A good life well lived.
The life of a miner falls short of this goal. Coal-mining is one of the most
hazardous of occupations. The miner’s subterranean existence fills his lungs
with bad air and his mind with fears and frustrations. Inadequate housing,
limited community resources and social isolation make up his supraterranean

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144

existence. The miner finds himself living in a social environment which is more
frustrating than rewarding. His social outlets are extremely limited. Living and
work conditions such as these are factors contributing to physical (silicosis)
and emotional (anxiety-based smothering) suffocation. Our observations are
based on experiences gained in the operation of a mental health clinic in the
coal-mining regions of West Virginia, U.S.A. Several effects of threat to the
adaptive mechanism are discussed. Mechanization is seen as a two-edged sword.
It has disrupted the social cohesion of the work-team, with an increase in
psychological stress. While mechanization may have increased production, it
has intensified psychological stress and increased psychiatric casualties. Other
stress factors discussed are disrupting social influences introduced from without
as the result of changes in transportation and communications, and an unstable,
fluid employment situation.
The effect of the atmosphere in which the miner and his family live is
discussed as being reflected in the apathy which surrounds much of his adjust-
ment. He fights a losing battle at work and at home, and gives the appearance
of &dquo;being tired of living and afraid of dying&dquo;. Such a trapped, hopeless life
situation is seen as requiring the use of certain mental mechanisms on the part
of the miner: passive acceptance of his role, repression, and denial of fear and
hostility. This defensive psychological structure is posited as helping to explain
the miner’s apparent apathy and his proneness to develop psycho-physiological
symptoms. The miner’s wife also develops psycho-physiological reactions, but
her symptoms are seen as psychodynamically different. While psychogenic agents
arrive at the same pathologic depot in these of the two sex groups, they
take different routes to get there. From a tment standpoint, therefore, the
psychotherapist is cautioned to check his therapeutic itinerary well in cases
involving the two sexes, or he may end up on the wrong track.
Mental health research and planning in the mining culture must analyse
the social structure which provides a hazard to emotional well-being. People
must not only be given an opportunity to make a living, but also to make a life.
A working together towards a common goal and pride in the achievement of
the group must be fostered. Social outlets must be increased, and steps in this
direction such as those taken in England should be considered. The importance
of psychosocial factors in understanding psychiatric disabilities and in planning
for community mental health needs more emphasis. What is needed to deal
with the problems discussed is a corps of group workers who can function as
social catalysts. Such trained workers could activate recreational programmes,
plant seeds for group cohesiveness and group identification, which, as Burgess
says, is so &dquo;significant for the mental health of the person&dquo;. ~2> It is our hope
that effective work by trained people might eventually develop immunological
agents against psychosocial trauma.
In the future, trained workers in the mental health field must function
prophylactically to protect communities from noxious psychological agents
much the same as public health workers are now saving communities from
bacteriological invasion. Opler states: &dquo;There are simply no individuals apart
from specific socio-cultural backgrounds&dquo;.(’) He also emphasizes that: &dquo;While
psychiatry has noted a certain patterning, or typology, in certain disease pro-
cesses, it remains to investigate specific cultural scenes and the pathology within
them, to locate the effectively charged points in the cultural stress systems&dquo;. (7a)

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 145

REFERENCES
1. Bureau of Census, U.S. Department of Commerce: 1950 Census Reports on
Population.
2. Burgess, Ernest W.: "Mental health in modern society." Rose, Arnold M., Editor:
Mental Health and Mental Disorder. New York : W. W. Norton and Co., 1955, p. 6.
3. Dickson, D. E.: "The morbid miner." Edin. med. J., 1936, p. 696.
4. Durkheim, Emile: "The social shaping of human needs." Borgatta, Edgar F., and
Meyer, Henry J., Editors: Sociological Theory. New York : Alfred A. Knopf, 1956,
pp. 97-98.
5. Halliday, James L.: Psychosocial Medicine. New York : W. W. Norton and Co.,
1948, pp. 190-195.
5a. ibid., p. 269.
5b.ibid., p. 187.
5c. ibid., pp. 261-262.
6. Medical Survey of the Bituminous Coal Industry, A Report of the Coal Mines
Administration. Washington, D.C.: U.S. Government Printing Office, 1947, Preface
p. xvii.
6a. ibid., p. 7.
6b. ibid., Supplement, p. 2.
6c. ibid., pp. 58-64.
6d. ibid., p. 59.
6e. ibid., p. 218.
6f. ibid., pp. 218-219.
7. Opler, Marvin K.: Culture, Psychiatry and Human Values. Springfield, Illinois:
Charles C. Thomas, 1956, p. 14.
7a. ibid., p. 20.
8. Out of Adversity. London : National Council of Social Service, 1939, pp. 3-5.
9. Ross, W. D., Miller, L. H., Leet, H. H., and Princi, F.: "Emotional aspects of
respiratory disorders among coal miners." J. Amer. med. Assoc., 1954, 156, 486.
(156 is the volume number.)
10. Trist, E. L., and Bamforth, K. W.: "Some social and psychological consequences of
the Longwall Method of coal-getting." Human Relations, 1951, IV, p. 18.
11. Wiesel, Carl, and Arny, Malcolm: "Psychiatric study of coal miners in eastern
Kentucky area." Amer. J. Psychiat., 1952, 108, 618. (108 is the volume number.)
11 a. ibid., p. 620.
11b. ibid., p. 621.
12. Wilson, Gertrude, and Ryland, Gladys: Social Group Work Practice. New York :
Houghton Mifflin Co., 1949, Introduction p. vii.

THE PROBLEM OF "DISTANCE" IN SEX BEHAVIOUR

PAUL ROM
ASPECTS OF "DISTANCE"

the results of research work which

IT has been said that &dquo;termini technici
one generation hands on
are
therefore, useful
to the next&dquo;. (4) Technical terms are,
as a kind of shorthand but often are discouraging for people outside the parti-
cular field of study. In order to clarify the meaning of &dquo;distance&dquo; as Adler
uses this word as a technical term in his Comparative Individual Psychology, let
us first remember what distance means in general life.
Distance, we may say, is either the space between two objects or points; or
an interval of time; i.e. it can be spatial and temporal. There can only be general

agreement amongst Londoners that Paris is at a greater distance than Dover.

and no argument is possible amongst sane people as to which is now more
distant, Easter or Christmas.
When we speak about the distance which marching soldiers must keep so
as not to step on each other’s heels, we refer to something concrete and exactly
measurable; however, the distance between the soldiers and any of their officers

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