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Books on medical care
Gregory M. Thomas, Treating the Trauma of the Great War. Soldiers, civilians and psychiatry in France 1914-1940, Louisiana State University Press, 2009
ISBN 978-0-8071-3436-8
pp. 259
Together with the attention for psychological problems in soldiers caused by respectively Vietnam, Gulf War, Iraq and Afghanistan, the historical attention for war neurotics came of ground. Especially what can be called the mother of neurological problems – shell shock in World War I, although their were of course also grandmothers and great grandmothers - draws a lot of scientific interest. The majority of this focuses on Britain and America, with however a few exceptions. Gregory Thomas’s Treating the Trauma of the Great War is in more than one way such an exception, and a praise worthy exception by that. In his book, as he states in his introduction, he argues that ‘in their quest to understand the psychological impact of the war, doctors were strongly influenced by the goals of serving a state at war, rescuing a nation from decline, and – most importantly – demonstrating the capabilities of their medical specialties.’ Not the patient was first in the psychiatrists’ mind, but showing that they could contribute in making a strong and victorious nation. The war was not a medical disaster, it was a welcomed means to an end. This exactly was the reason why in depth psychoanalyses was rare. Not being a rapid cure, it did not serve the needs of the military. But it also was not seen as serving the needs of the psychiatric trade. In the eyes of many psychologically driven explanations of mental diseases did not advance psychiatric knowledge for most psychiatrists, as neurologists, saw them as physically caused. That psychoanalysis was seen as a German invention, un-scientific on top, did of course not help.
Thomas not only focuses on the mental problems of French soldiers, but also on those of civilians, and not only on how the war caused these problems, but also on how the war had a negative – not to say: disastrous - effect on the treatment of civilian lunatics. In wartime, treating civilians was of no importance; neither to the state, nor to the psychiatrists themselves. Just a handful of doctors were left to study civilian patients, and they were not among the prominent ones.
Furthermore Thomas throws a light on how neurotics were viewed by psychiatrists and neurologists – as a symptom of national degeneration and a tool for expanding psychiatric knowledge making the war, in the words of one of them ‘a grandiose laboratory experience’ -, making clear that also the French had their share of harsh opinions and treatment. This of course is already known to everybody familiar with the work of for instance Mark Roudebush, but Thomas gives a broad view on this. Nevertheless, he too, and rightly so, has a special place reserved for the well-known, authoritarian psychiatrist Joseph Babinski, who, with his as authoritarian concept of pithiatism - cure by persuasion which needed absolute control of the doctor over the patient - made sure that in general the war neurotics were seen as hysterics and hysterics were weak, feminised malingerers and/or cowards, be it consciously or unconsciously. This degrading diagnosis was already part of the treatment for it was the doctors expectation that soldiers would stop feigning when labelled a hysteric. This was one of the reasons of the later on widely accepted forward psychiatry. Treatment should take place before the comfort of hospital was reached so psychological suggestions could not take deeper route or could pass on to the physically wounded in hospital, and therefore delaying their recovery. The patients had to be convinced that return home was out of the question. On top hysteria showed itself mostly in those who already before the war were showing ‘strange behaviour’ or had peculiar family members. Race and social class too were popular explanations. The war itself was not a cause, a way of thinking surviving the war itself by many years The war even was supposed to be a revitalizing, re-masculinizing experience. Sadly enough, it also brought to light how hard degeneration had struck.
All this by the way is not to say that French neurologists and psychiatrists were one in their opinion. Diagnoses could differ from patient to patient and from doctor to doctor caused for instance by the absence of a classification system, using al kinds of already existing or freshly invented terms like battle hypnosis or the more popular commotional syndrome.
In combination with the much shared opinion that a pension would be unjustified for everyone who not actually had a physical wound, and with the idea that a pension for a neurotic would make it worthwhile not to heal, this too had its effect on compensation after the war. Not that it was totally impossible for French neurotics to receive a war pension - although it was even harder as it already was in Great Britain of Germany -, but even when receiving one, when as well diagnosis and prognosis were favourable, it was almost always not enough to come by. And this goes for their families, often depending on what the former soldier financially brought home, as well. And if he did not get home, for he was diagnosed untreatable and therefore send to an asylum, they had to pay the costs of staying there as well, leaving them with next to nothing. No surprise, this did not diminish civilian psychological problems, although evidence for a widespread explosion of mental civilian illness is absent, as well during as in the years following the war.
However, not all psychiatrists applauded this policy or underlined the value of absence of pensions for neurotics and their families. They tried to solve in a non-asylum way – the ‘open’ psychiatric service - much of the agony the war had caused, and by doing so paving the way of many of the human and social reforms in psychiatry after World War II; although in the timeframe of the book itself Thomas’ answer to the question on how the war changed psychiatric realities is simple: it didn’t. It did however change the way in which psychiatric patients were pictured. In a nation recovering from war it was not thought fit to still describe them as degenerates. The idea however that war mainly affects those already predisposed to mental weakness did not alter. On the contrary.
In his epilogue Thomas in short goes into the in my view all too easy, a-historical assumption that ‘war-neuroses like shell-shock are what we now call PTSD’. He too disagrees. Maybe some of them would have been diagnosed PTSD today. Many others certainly would not have been. More importantly however he states that it is a major problem ‘in applying a retrospective diagnosis […] that it ascribes a permanence to diagnostic categories. By claiming that an early twentieth-century French soldier truly had PTSD suggests that there was, is, and forever will be some true, natural category called PTSD, even if doctors at the time had yet to discover it. […] The symptoms expressed by individuals ad the diagnoses and treatments applied to them by doctors are too closely tied to specific professional, political, economic, social, and cultural contexts to allow us to apply today’s categories to yesterday’s patients.’
A valuable and well written book.
Leo van Bergen
Before My Helpless Sight by Leo Van Bergen
Before My Helpless Sight: Suffering, Dying, and Military Medicine on the Western Front. 1914-1918 ,by Leo van Bergen, medical historian at the VU-University Medical Center in Amsterdam,has writtenthe definitive book on the subjects in the title. The depths of his insites in all aspects of what it was like is amazingcertainly given that he is neither a doctor or a veteran There is deftness of touch here of source materials and a vast breath of reading and understanding. Much of the narrative is moving, poignant, and horrific and to my sense right. It has a smooth flow and easy reading style accessible to student and scholar. I say this as a veteran of the Vietnam war who spent his early years 1966-68as a Navy HospitalCorpsman on the psychiatric wards of Bethesda Naval hospital and as a platoon corpsman with the 2nd Bn, 1st Marines, 1st Marine Division in Vietnam in 1968-69. This followedby a 35 year career as a physicians assistant in general surgery and forensic medicine. I highly recommend this book to allwho are students of that war and the wars of today because, the real horrors of warare not on the battlefield but in the aide stations and hospitals then as now.
Jack V Sturiano
For more reviews on Before my Helpless Sight see:
http://www.wereldoorlog1418.nl/helpless-sight/index.html or
http://www.westernfrontassociation.com/book-reviews/91-general-interest/966-before-my-helpless-sight.html
For an extended content see:
http://www.wereldoorlog1418.nl/medical-aspects/index.html
JeffreyLaMonica |
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Keyword tags:
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| Started By | Thread Subject | Replies | Last Post | ||
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| LeoVanBergen | War, Trauma and Medicine in Germany and Central Europe (194-1939) | 0 | Oct 3 2011, 7:26 AM EDT by LeoVanBergen | ||
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Thread started: Oct 3 2011, 7:26 AM EDT
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The bundel of articles War, Trauma and Medicine in Germany and Central-Europe (Freiburg [Centaurus] 2011) gives a fascinating and new insight into German medicine and WWI. Mainly focusing on psychological problems, although it has one on orthopaedics as well, it for instance shows that the differentiation between neurasthenia-officers and hysteria-soldiers is anything but as clear cut as sometimes thought. It also shows the succes of quick cures was marginal and it shows that in the Austro-Hungarian army quick cures were broader and longer accepted than in Germany because of the problem of multi-linguality. Just to name a few.
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| LeoVanBergen | Mark Harrison, The Medical War | 0 | Jul 6 2011, 7:48 AM EDT by LeoVanBergen | ||
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Thread started: Jul 6 2011, 7:48 AM EDT
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Mark Harrison, professor of medical history at Oxford, has written an excellent book on British military medicine in the First World War, making clear the numerous influences on medical care during wartime and by doing so explaining why there was such a difference between the medical care at the western front (in the eyes of Harrison: no collapse although by times stretched to the utmost) and Dardanelles and Mesopotamia: shambles.
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| LeoVanBergen | Susanne Michl, Im Dienste des “Volkskörpers”. | 0 | Feb 21 2011, 5:36 AM EST by LeoVanBergen | ||
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Thread started: Feb 21 2011, 5:36 AM EST
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The book of Susanne Michl, Im Dienste des “Volkskörpers” (In service of the peoples's body) researtches the French and German mide=ical discours during World War One and the influence the war had upon it. Michl as well points at the similarities as has a keen eye for the differences, both of which are explained thoroughly and extensively. Although she does this not in an easy to read manner, it is a great piece of work, that deserves a place in the bookshelf of everyone interested in (the history of) medicine, war and especially of course in the relationship between them.
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