on 9 November 2000
From shell shock in World War 1 to Post Traumatic Stress Disorder in recent years, this is a brillant and profound examination of changing views on the nature, cause, and treatment of those who broke down mentally as a result of warfare, and of steps to reduce the incidence of such breakdowns. Based, I should guess, on many years of extremely thorough research, it is an utterly fascinating and beautifully written account of this subject and must become the standard work on the history of military psychiatry. I have seldom been so impressed and delighted by anything written recently in the history of medicine and cannot recommend it too highly. Irvine Loudon Medical Historian
on 22 September 2008
Having become very interested in the tragedy that was the first world world, I actually brought this book to take on holiday with me. Despite not being the usual sun sea and sand fare, I was gripped from start to finish by Ben Shephard's beautifully articulated, compelling and authoritative narrative. Very highly recommended and an absolute must for anyone interested in learning more about the impact of war on individuals and the various floundering responses of the armed forces in managing this on a mass scale.
on 2 May 2011
A superb book-buy it now. I first read this years ago, and I have dipped into it again on many later occasions. It is a history of how battle fatigue was treated, from World War 1 to Vietnam, or so. It is thus an underlying story of the development of social attitudes and psychiatric treatments. It is fascinating on many levels, if you are interested in Psychiatry, Wafare, the Military, Social attitudes etc. He manages to be really interesting n every page-there's hardly a dull sentence in the book.
Joseph Heller seems to have truly hit the nail on the head as regards military psychiatry in his famous Catch-22 - 'anyone who wants to get out of combat duty isn't really crazy', and yet what could be more sane than wanting to escape a battlefield? Faced with the impossible logic of such a scenario, it is no wonder that so many soldiers throughout the years have developed a veritable cornucopia of psychological, psychosomatic and hysterical symptoms under the hell of warfare. When the unconscious mind cannot sustain what the conscious mind insists it must, it is scarcely any wonder men break down under the strain.
This book is a fascinating exploration of military psychiatry from its earliest years during World War One, through the Second World War and the Vietnam War, up to the modern day with the Falklands and First Gulf War. From the WW1 concept of 'shell-shock', at first considered an emotional breakdown linked to an actual physical impact or wounding; through WW2's battle fatigue and combat exhaustion; the drug use, dis-associative states and psychotic breakdowns of Vietnam; through to Gulf War Syndrome and the modern day: the military has always struggled with the best way to deal with psychiatric casualties, both in aiding their recovery and limiting the manpower 'wastage' and assisting the individual in reintegrating into society.
Psychiatrists and the military have always had an awkward relationship, and one of the themes of this book is how military psychiatrists struggled to balance the needs of their individual patient with the requirements of the military and the war effort. Surely it goes against the very concept of medical support and healing to aid a patient to recovery in order to send him back to a likely death in a war zone? This was also an era when psychiatry was in its infancy, and in many ways the various war zones served as experiments for psychiatrists to try out their own pet theories and trumpet their successes. The treadments received depended on the individual doctrine of the treating psychiatrist - some felt a 'man up' tough-love approach best, others believed in forcing the patient to relive their trauma, yet others believed a more relaxed, sympathetic approach best.
It would be comforting to think that we have moved on from the days of WW1, lobotomies and electric shock therapy, but given that there seem to be so many therapeutic options available these days, and yet still so much warfare and destruction and so many broken lives as a result, I'm not sure we've really learned anything yet. If the maxim is true that generals always fight the new war with the tools of the last one, the same must ring true for military psychiatry, and the pages of this book are a sad litany of individual soldiers being failed time and time by lack of understanding and the overriding needs of the military.
on 15 August 2014
Considering that the infantry along with the air and the naval forces have been and continue to be despatched with unending regularity across the globe, an evolving century-wide enquiry into what kind of psychological wounds the soldiers at the frontline have endured over the years should make for an interesting enough read. And not surprisingly, it does.
Ben Shephard's painstakingly researched synthesis is so compelling that it should be made an essential companion book to all the tomes detailing the political decisions of those in power and social histories of those left behind. I read it fresh after Sebastian Faulks' indulgent Human Traces which in its own schoolboy-curious manner distilled the history of psychiatry from the post-Enlightenment mid-18th century to the First World War and before that Roy Porter's authoritative Flesh in the Age of Reason had helped me traverse the vagaries of thought and thinking-about-thought through the Enlightenment. In short, I came to Shephard's book fully primed and was amazed by how seriously interested he was to get to the bottom of the things.
Shephard's curious inquest of sorts, which sees psychiatrists beginning to be recognised and finding themselves at the core of most of army procedures, details the intra-specialty and inter-professional politics involved at every stage of a soldier's journey: right from recruitment and selection to identification and treatment of war neuroses. Going much beyond the handling of these soldiers in the war, it explores the post-war ramifications to expose the attitudes within the institutions and the larger society that determined compensation, pensions and assimilation of these men as they went back to their societies.
There are scores of conflicts and egos here, coming from all directions, each impacting the eventual processes of men at the front, and in Shephard's clear unspooling here, you get to seep into the particulate of these multifaceted conflicts. Psychiatry, as an emerging profession, is going through its own rediscovery with psychoanalysis, psychosurgery and then psychopharmacology falling in and out of vogue in civilian and professional mind spaces and in this tumbling forwards how it finds itself interfacing with the armed forces is thoroughly interesting. How different institutions, especially one with stakes as high and boundaries as solid as the armed forces, respond to one with uncertain grounds and liquid borders as psychiatry;, how commanders and officers in different shades of cluelessness, come to meet, make sense of, and incorporate the processes advised by the in-vogue psychology and psychiatry masters makes is a tragicomical treatise unfolding within the gruesome theatre of war after war.
Shephard is as comfortable setting the context and real-world set-pieces of each of these wars and wars within wars, as he is in sketching personalities from quotes and testimonies. His enquiry is searching enough to take into account everything: how selection determines and boxes their past-lives and eventual fates, what impact different lengths of frontline duty, different weaponry, different nation-runners, different psychological training, different availability of psychiatric tending when afflicted and different societies meeting them as they go back from the front: what impact all of these have on their psychological health is anything but not instructive. If you squint from some distance at it, the book offers a brilliant comparative study of the American, British (and to some extent, European) responses, within masses, politics and psychiatry, to the two World Wars and the Vietnam War. It's an important read as it not just drives most of the century's political and diplomatic discourse, but as a reference point for a whole corpus of popular media and literature that has sprouted up from it: books, films, biographies, reconstructions, revisionist accounts and what not. In a way, Shephard's recounting of the institutional attempts at taking care of battered men at war takes you behind the curtains and offers a more credible account of the push-and-pull and the damage inflicted than other sources.
Another enduring legacy of this book is exposing the farce of packaging war neuroses into clinical entities: the metamorphoses of the same set of symptoms with labels of shell-shock in 1920s to that of post-traumatic stress disorder post-Vietnam as a result of certain entrepreneurial researchers having furthered their favoured "terms" while other "labels" of certain "connotations" deemed more dangerous dropped from popular discourse. This linguistic tug-of-war fought in increasingly soundbyte-obsessed and medicalising times is analogue for much of the petty politics that plague academia in all spheres today.
If I have to level a criticism, it would be against some level of repetition in chronicling the life and times in two World Wars. Tighter editing, of the kind Shephard resorts to when he switches to Vietnam, Falklands and Gulf, each of these given sequentially less number of pages would have resulted in a crisper read. But Shephard is a self-confessed WW1/2 aficionado and his indulgence is but natural. Another criticism, one Shephard again is well aware of, is the book's contracted viewpoint: that of fiercely Anglo-Saxon nature, limited to British and American responses to war. Given its objectivity, it is a welcome companion piece to other such dialectical approaches from other countries and peoples who had their mental health and selves pulped at a time when we were learning to define what mental health is (and a fabulous prequel to the barrage of humanistic atrocities unleashed everyday at frontlines world over in morally bankrupt wars as more unthinking men are drafted equipped-to-gills with metal-&-fibre carapaces and lethal firearms ejaculated by the arms industry fighting those brainwashed with and earnestly defending bastardised versions of religion but equipped similarly by the same industry).