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Anxiety Disorders
Depression: Depression & Related Conditions
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Dissociative Disorders

by Ben Shephard
Harvard University Press, 2001
Review by Mark Welch on May 27th 2002

A War of Nerves

This is a very fine book about a very important subject. In some respects it can be seen as charting the journey from shell-shock to Post-traumatic Stress Disorder, and with it the way war, and its reality, moves from the front to the home. Shepherd introduces a wide scope of analysis shot through with a humanity that is sensitive to, but not sentimental about, the horrors to which mankind can subject its fellows. He also conveys a sadness, but not incomprehension, at the ways in which they can be justified.

In the course of a little under 400 pages he charts the parallel histories of the Twentieth Century, modern warfare and psychiatry. This interweaving of social and cultural themes, as well as medical and scientific debates, gives the book a rich texture that rewards careful reading every bit as much as the picking of choice exemplars. He describes the continual tension between neurology and the biological explanations of war neurosis, shell shock and Post-traumatic Stress Disorder on the one hand, and psychology and humanistic understandings on the other. There are areas in which he is less clear than others, for example in the underdeveloped explanation of the different courses of European and North American psychiatry, or the influence and role of other professions, notably nursing and clinical psychology, but these do not detract overmuch from the whole.

It may be seen as a shortcoming that there is a tendency towards the ‘Great Man of History’ thesis. Much of the influence and course of the story he tells is seen to be as a result of powerful and influential individuals. While many are undoubtedly important and fascinating in their own right, and here he cites major figures such as W.H.R. Rivers, who has become almost a mythological figure, Gordon Holmes or Roy Grinker, it is only in the latter passages when he begins to draw more on the social construction of psychiatry itself. He says, and this is of great interest, that no great psychiatrist or movement emerged from the Vietnam War in the way that had happened in World War One, and this may in some paradoxical way be a measure of psychiatry’s success in becoming a model for social understanding. All the successful psychiatrists were being successful in the civilian world and had no need of the military to expand or expound their theories.

There is both an advantage and a problem with the way in which so many of the scenes that are described are familiar to the reader, or at least thought to be so. Battle scenes of the Somme, mud-filled trenches, whiz-bangs and screamers all seem to have a place in our collective memory now and as such may be difficult to represent faithfully, without the layers of interpretation with which they have become imbued. Shepherd extensively uses examples from of literature, especially from the 1914-18 war. He cites familiar names such as Graves and Sassoon, Gurney and Aldington, Manning and Chapman. He uses, and how could anyone not, Remarque and Owen who, in their own ways, have defined that particular conflict forever. However, especially when considering more contemporary situations he uses little by way of cinematic representation. How close, for example, are the opening scenes of Spielberg’s Saving Private Ryan to conveying the intolerable noise and unutterable confusion of battle? The swirl of fear and panic, mixed up with the horror and surreal sensations that men experience when landing on the beach in the D-Day invasion may, in some small way, suggest the terror and overwhelming disorientation of being under fire. Perhaps the combination of vision and sound, so all-encompassing it is almost visceral, is one means to allow those who were not there to appreciate what it may have been like. At its heart, the book attempts to make the behavior of all those involved understandable.

Shepherd’s book has much to offer both the specialist and the general reader. It has a great many moving passages, and some very pertinent insights. It shows that in many cases military psychiatry is a crucible of psychiatry as a whole. The conflicting opinions and debates exemplify those in the wider world, not just in the biological/sociological divide, but in the case of reactive and proactive care, or in psychiatry’s predictive ability. The book makes an important contribution and is to be recommended to all those interested in the field.

 

© 2002 Mark Welch

 

Dr Mark Welch is currently a Senior Lecturer and Postgraduate Coordinator in The School of Nursing at the University of Canberra, Australia. His PhD investigated the representation of madness in popular film, and his other research interests include the mental health of refugees and victims of torture, and the history of psychiatric epistemology.