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A War Of Nerves
From shell-shock to Post Traumatic Stress Disorder, the fascinating story of how psychiatrists have tried to keep men fighting.
The first case of shell-shock arrived at the Duchess of Westminster's Hospital - in the casino at Le Touquet - in September 1914. "I wish you could be here," the Oxford Professor of Medicine wrote to a friend, "in this orgy of neuroses and psychoses and gaits and paralyses. I cannot imagine what has got into the central nervous system of the men."
A War of Nerves is a history of military psychiatry in the 20th century. It reaches back to the Western Front when modern war and medicine first met, and traces their uneasy relationship through the eras of shell-shock, combat fatigue, post-traumatic stress disorder and Gulf War syndrome. Rich in character and detail and drawing on a vast range of unpublished diaries, interviews and papers, the book is at once an absorbing historical narrative and an intellectual detective story.
The first case of shell-shock arrived at the Duchess of Westminster's Hospital - in the casino at Le Touquet - in September 1914. "I wish you could be here," the Oxford Professor of Medicine wrote to a friend, "in this orgy of neuroses and psychoses and gaits and paralyses. I cannot imagine what has got into the central nervous system of the men."
A War of Nerves is a history of military psychiatry in the 20th century. It reaches back to the Western Front when modern war and medicine first met, and traces their uneasy relationship through the eras of shell-shock, combat fatigue, post-traumatic stress disorder and Gulf War syndrome. Rich in character and detail and drawing on a vast range of unpublished diaries, interviews and papers, the book is at once an absorbing historical narrative and an intellectual detective story.
500 pages, Hardcover
First published January 1, 2000
11 people are currently reading
318 people want to read
About the author
Ben Shephard
14 books8 followersBen Shephard was an English historian, author and television producer. He was educated at Diocesan College, Cape Town and Westminster School. He graduated in history from Oxford University and he made many historical documentaries for the BBC and Channel 4, including producer of The World at War and The Nuclear Age.
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Displaying 1 - 13 of 13 reviews
January 27, 2015
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.
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.
March 9, 2012
I bought and read this book some time ago as it relates to my excessive interest in the emotional cost of combat on soldiers. I think it is the most complete and readable history of combat stress in the 20th century, providing good insight into how military psychiatry has evolved from "shell shock" (little understood then) in WW 1 to combat exhaustion and PTSD to-day. Its understanding is still evolving in Afghanistan and Iraq, but this book is a good start.
November 10, 2018
A detailed and highly-researched account of 'shell shock', and its various other guises, and especially its treatment, from the First World War through until recent times. Almost half the book focuses on the period 1914 to 1918, but there is also significant coverage of the Second World War.
Four things stood out for me. First, the intense self-belief and unwavering confidence of some of the psychiatrists involved, whose determination allowed them to proceed with treatments that were highly experimental and often verging on the cruel, and used their patients as guinea pigs, with almost no value as individuals. Second, the way in which the lessons from one war tended to be lost, forgotten, or ignored by the time of the next. Third, the level of psychiatric casualties experienced in the Second World War, despite the greater understanding displayed in the British and American Armies. Fourth, the ongoing tension between whether the purpose of treatment was to cure the individual and return him (and it normally was 'him' in these times) to a stable life, or whether it was mainly aimed at returning the man to the front line, to strengthen the armed forces, even if that meant he might well be killed.
The book treads a fine line between describing broad trends and developments on the one hand and focusing on the careers, approaches and idiosyncracies of individuals. Generally, it does so well, though the result is sometimes difficult to follow and the pace of the narrative can be slow. The main weakness is the absence of a concluding chapter, bringing the various threads and trends into some form of synthesis and looking forward to the future. Nonetheless, a fascinating (and sometimes disturbing) read.
Four things stood out for me. First, the intense self-belief and unwavering confidence of some of the psychiatrists involved, whose determination allowed them to proceed with treatments that were highly experimental and often verging on the cruel, and used their patients as guinea pigs, with almost no value as individuals. Second, the way in which the lessons from one war tended to be lost, forgotten, or ignored by the time of the next. Third, the level of psychiatric casualties experienced in the Second World War, despite the greater understanding displayed in the British and American Armies. Fourth, the ongoing tension between whether the purpose of treatment was to cure the individual and return him (and it normally was 'him' in these times) to a stable life, or whether it was mainly aimed at returning the man to the front line, to strengthen the armed forces, even if that meant he might well be killed.
The book treads a fine line between describing broad trends and developments on the one hand and focusing on the careers, approaches and idiosyncracies of individuals. Generally, it does so well, though the result is sometimes difficult to follow and the pace of the narrative can be slow. The main weakness is the absence of a concluding chapter, bringing the various threads and trends into some form of synthesis and looking forward to the future. Nonetheless, a fascinating (and sometimes disturbing) read.
February 18, 2017
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).
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).
November 20, 2017
A great read, of far greater value to someone like me trying to understand war inflicted psychosis than I thought it would be. Shepard manages to cover a lot of ground which includes five wars and references to earlier wars. He provides just enough dialogue to address the history of each conflict and then quickly moves to the relevant medical approaches of that particular conflict. He manages to link the various political, medical and military issues that each war produced and the solutions used by the hierarchy. However ultimately the book ends on a bit of a negative( which I agreed with) that no particular treatment ultimately solved the issues encountered by soldiers having to go to war and the inevitable mental problems that would result.
September 7, 2022
I think I read this in the mid 00ies and thought it was great at the time. Cover still rings a bell.
I read the author's book on the liberation of Belsen a couple of months back and was trying to find out what else he had written.
So am going by a couple of decades old memory and remember this being quite scathing. Especially in the First World War before there was any idea of empathy and discipline was the main treatment despite widespread shellshock.
May need to reread this , think it was good.
I read the author's book on the liberation of Belsen a couple of months back and was trying to find out what else he had written.
So am going by a couple of decades old memory and remember this being quite scathing. Especially in the First World War before there was any idea of empathy and discipline was the main treatment despite widespread shellshock.
May need to reread this , think it was good.
October 29, 2021
super book - It helped fill in some areas of knowledge about the MH profession and war in the 20th century. The author's role of historian rather than helper added to the broad perspective, I think. There were many interesting tidbits of knowledge.
August 8, 2023
Excellent summary of the hubris of mental health and the history of trauma as it relates to modern combat. An enjoyable read. Well researched and dense.
June 30, 2015
Have you heard the terms "battle fatigue" or "shell shock"? How about "PTSD"? If you are interested in the development of treatments for psychological issues caused by war-time experiences, you will find Shephard's book illuminating. It is dense, but it is readable, and will take you through the variety of explanations and treatments for psychological trauma during the twentieth century. A significant amount of the book discusses non-US experiences, theories, and physicians, so if you are interested solely in the US experience, you may find this work tedious.
2025-tbr
December 19, 2016Reading this related to my work. This book is about the treatement of mental health crises in soldiers through the ages of modern warfare.
June 9, 2008
Not always well written but worth a read for anyone interested in the history and development of psychology.
December 31, 2012
Heavy going but got there...
May 24, 2015
THE work to read for anyone interested in the topic!
Displaying 1 - 13 of 13 reviews