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Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870-1930

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7343.983 (Published 20 April 2002) Cite this as: BMJ 2002;324:983
  1. Simon Wessely (s.wessely{at}iop.kcl.ac.uk), professor
  1. Academic Department of Psychological Medicine, Guy's, King's College, and St Thomas's Hospitals School of Medicine and Institute of Psychiatry, London

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    Eds Mark S Micale, Paul Lerner

    Cambridge University Press, £40, pp 315

    ISBN 0 521 58365 9

    Rating: GraphicGraphicGraphicGraphic

    Our fascination with the psychological costs of the first world war shows no sign of diminishing. The successes of Pat Barker's Regeneration trilogy and Sebastian Faulks's Birdsong have been a publisher's dream. Battlefield tours have never been more popular. Apparently sane men from Humberside recently consented to spend three weeks in a recreated Flanders trench on behalf of the cameras, although the fact that all survived the experience unscathed suggests that the recreation was not entirely authentic. However, afterwards all the participants made a pilgrimage to one of those vast, spellbinding cemeteries—to be confronted with Sassoon's “nameless names”—and paid their tearful respects.

    There is a barely suppressed subtext to much of our modern fascination with the psychiatry of the Great War. It is that we do things better now. Then “shell shock” cases were likely to be shot; now they will get counselling. Then the victims were ignored; now they are seen as the true heroes. Modern texts on traumatic stress pay lip service to history, usually in the shape of the psychiatric parlour game of trying to find the earlier account of post-traumatic stress disorder (PTSD). What underlies most of these amateur psychiatric histories is the belief that people have always reacted to overwhelming trauma in a particular way—labelled by one current psychiatric guru as “the universal trauma reaction.” All that has changed is our recognition.

    Mark Micale and Paul Lerner, both historians of psychiatry, have assembled a welcome collection of essays. They offer an antidote to our over-romantic and ahistorical view of what is the key period in the history of trauma—the birth of the modern—from the end of the 19th century to the aftermath of the Great War.

    Micale and Lerner are appropriately disdainful of any single, “objective” definition of trauma. Trauma, they say, is “not an event per se, but the experiencing or remembering of an event in the mind of an individual or the life of a community.” There is no single circumscribed way of reacting to trauma, either for the individual or for the community.

    The belligerent nations of the first world war reacted differently to the increasing numbers of war damaged servicemen returning without physical injury. The United States valorised and rewarded veterans with compensation and their own healthcare system. Whereas there is little evidence that this therapeutic response achieved much, the semisacred role of the war veteran in American culture persists to this day. But contrast this with the German response. Following the neurologist Hermann Oppenheim's spectacular fall from grace in the so called war congress of German neurologists and psychiatrists in 1916 (a sequence dissected with brilliance by Paul Lerner himself), shell shocked veterans were seen as morally weak and selfish. If they had not contributed to the German defeat (and many argued that they had done just that), then they certainly were not deserving of compensation. In the wake of the Depression and the increasing radicalisation of postwar German politics, the meagre efforts of the Weimar democracy to compensate psychiatric injury were soon withdrawn. In Italy, where the Lombroso tradition of degeneration dominated psychiatric thought, psychoneurotic servicemen likewise received short shrift. The French “ancien combattants” wielded considerable political power, but their British equivalents were depoliticised by the rise of veterans' organisations such as the Royal British Legion, whose focus on welfare and charitable concerns impeded the rise of more radical political movements, as happened in France and Germany.

    Each of the essays in this collection is a gem. I particularly enjoyed Greg Eghihian's stimulating discussion of the rise of workmen's compensation schemes, and their effect on notions of traumatic injury and also the doctor patient relationship, with doctors now taking on the role of defending the moral order from the armies of shirkers, loafers, and malingerers ready to take advantage of the new systems. There is a direct continuity between the controversy over the new social legislation, labelled the “compensation wars” in Wilhelmine Germany, and the doctors so cruelly dissected by Pat Barker. Before the war the insurance doctors considered their duty of detecting malingerers and shirkers to be a moral obligation as well as a means of protecting the exchequer—exercising those same functions at the front was now a patriotic obligation, with the outcome of the war itself at stake.

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