Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870-1930 (review)

This book is a history of the concept of trauma from its origins in the Victorian era in connection with "railway spine" (resulting from railway accidents in Britain) to the diagnosis of "shell shock" in World War I. It has twelve chapters divided into four sections: "Travel and Trauma in the Victorian Era," "Work Accidents and Trauma in the Early Welfare State," "Theorizing Trauma, Psychiatry and Modernity at the Turn of the Century," and "Shock, Trauma and Psychiatry in the First World War." Micale and Lerner collaborated on the excellent "Conceptual and Historiographical Introduction," and each contributed a chapter.

The book covers the debates about the nature and origins of the symptoms resulting from physical trauma, whether they were due to the neurological or psychological effects of physical injury or were primarily psychogenic—for instance, the result of suggestion in the case of susceptible individuals. Some German insurance advocates offered the possibility that individuals were motivated by the secondary gain of disability pensions.

The descriptions of the injuries and symptoms and the fluctuating concept of causality are placed in the historical context of nineteenth-century society and related to the ongoing debates at the time about the origin of hysteria. The refrain of possible simulation or malingering was a background. That the role of emotional factors in the production of disease was recognized only gradually is also a theme throughout the book, spelled out in various degrees of explicitness and detail. At first, the physical injuries—whether due to accidents or wars—were thought to produce the trauma. Later, some perceived trauma as a result of labeling and suggestion by physicians; others blamed the welfare system with its insurance and pensions. Individual vulnerability was seen in moral terms. That is, the person who suffered symptoms was considered of lesser character or even "degenerate."

Also included is a history of how "an idea," "a mental impression of some kind," was thought to affect the nervous system through the mind (52). The history of trauma is a history of concepts of psychic injury in relation to physical injury.

Despite their considerably greater sophistication, present-day debates concerning the "real" nature of emotional disturbance or mental illness contain some of the older arguments. "Biologically based" mental illness is considered by some the only legitimate mental illness deserving insurance coverage. The concepts of trauma are so much a part of current discussions that it is sobering to realize how recent they are, although the phenomena are age-old. Contemporary conceptualizations extend to emotional trauma without a physical cause.

In Chapter 6, Micale believes that the speculation about psychological trauma played a large part in the development of the "science of the mind" in psychological theory. He also makes the interesting observation that the time lag between the Franco-Prussian War and the appearance of Jean-Martin Charcot's writing about traumatic male hysteria is similar to that between American involvement in the Vietnam War and the diagnostic category of ptsd.

Despite some repetition, these chapters form an unusually coherent whole, conveying a depth and breadth of understanding about a crucial period in the conceptualization of emotional and physical symptoms and the nature of trauma. The book does not go beyond World War I; more contemporary issues concerning the effects of such major traumas as the Holocaust and the terrorist attack on the World Trade Center, or the effects of chronic and sustained physical or emotional trauma are not addressed.