Thursday, January 1, 2009

Review: Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, [Harvard University Press, 2001]

During the 1970s American lobbying by psychiatrists and veterans succeeded in elevating Post Traumatic Stress Disorder to the status of a category in the DSM III. Efforts on the part of advocates for abused women and children have further established PTSD in our minds as a timeless phenomenon. Research over the last twenty years has buttressed this view with reams of biological data. However, in spite of these recent events, at least one important historical question remains. Why has psychological trauma, as a medical problem, been discovered, disappeared from sight, and then been rediscovered, several times?
Some, like Judith Herman in her book Trauma and Recovery, have argued that this periodic disappearance phenomenon of trauma has been due to willful forgetting-- a repression of the phenomenon analogous to the repression some think of as a part of it. It has been hard to adequately challenge simplistic, tendentious and mythic interpretations such as Herman’s because of the scope and complexity of the history of traumatic phenomena over the last century.
Ben Shephard’s A War of Nerves: soldiers and Psychiatrists in the Twentieth Century succeeds admirably, however, in doing just this. Shephard maintains his focus by limiting his story largely to the Anglo-American military from World War I through Vietnam. He has little to say about France or the Soviet Union, but his chapters on German war experience are among the most interesting in the book.
Shephard sets out to counter what he calls the “bipolar” view that emphasizes William Rivers work during World War I and the emergence of PTSD during Viet Nam but ignores the “important historical fact that the problem of war neurosis was comparitively well handled during the Second World War.” Llooking beyond case histories, Shephard tries to consider the multiple ways soldiers and psychiatrists have responded to the stresses of war in the twentieth century. Indeed the subtitle of his book aptly emphasizes the struggle of individuals rather than the visissitudes of an abstract diagnostic category.
As a journalist Shephard has a wonderful eye for detail. The numerous anecdotes about individual soldiers and psychiatrists enliven the narrative considerably. While he is always sensitive to the moral contradictions involved in treating soldiers in order to send them back to war, he balances this with his acknowledgment of the legitimacy of concerns about maintaining manpower on the front lines. He is also well aware of the irony that while treatment has sometimes increased disability, the threat of punishment has at times helped soldiers get over their symptoms.
Because Shephard narrative is so rich his argument is hard to reduce to a simple statement. What he clearly recognizes is that damage claims can be exaggerated and fabricated as well as minimized and denied. For those who want to consider the complex history of psychological trauma in the twentieth century this book is a great place to start.

Edward M. Brown

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