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Bulletin of the History of Medicine 76.3 (2002) 634-635



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Book Review

A War of Nerves:
Soldiers and Psychiatrists in the Twentieth Century


Ben Shephard. A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century.Cambridge: Harvard University Press, 2001. xxiii + 487 pp. Ill. $27.95 (0-674-00592-9).

Interest in the history of military psychiatry has intensified during the past two decades. Writers have tended to focus on circumstances affecting a single armed force during a single conflict—notably Britain and Germany in World War I, and the United States following the Vietnam War. The treatment of psychogenic trauma has attracted the most attention. Ben Shephard's book stands out from previous studies in several respects. It spans eighty years and includes the two world wars, the Korean Conflict, the Vietnam War, and the wars in the Falklands and the Persian Gulf, although most of the book concerns British, American, and German psychiatry during the world wars. While First World War psychiatry has been the object of considerable scholarly attention, the treatment of psychiatric casualties in the Second World War is less well explored—until now at least, for nearly half of A War of Nerves is devoted to this war.

Shepard's highly readable account examines the striking differences in how the three nations diagnosed, treated, and managed their psychiatric casualties. The nature of the practices tended to change over time, partly in response to the changing military conditions (which tended to affect the different branches of the armed forces in different ways), manpower needs, and the influence of particular personalities. Shephard does an especially good job in bringing these now-forgotten psychiatrists and neurologists out of the shadows—men like Roy Grinker in the United States and William Sargent in Britain, who profoundly shaped the perception and treatment of trauma during the war. More-familiar figures are also discussed, but Shephard keeps them in perspective. The best known of these physicians is probably Abram Kardiner. As Shephard makes clear, Kardiner's fame and influence are belated and consequent to his rediscovery by the DSM-III committee responsible for posttraumatic stress disorder.

One of the most impressive aspects of the book is Shephard's success in putting these psychiatric casualties into context. There are vivid accounts of the various battlefield environments—allied bomber crews, for example, suffered very high mortality—and the effects of military decisions on the mental conditions of soldiers. Shephard sees the social organization of the fighting units as [End Page 634] especially significant in this regard, and makes his point convincingly in his analysis of the psychiatric impact of the battlefield replacement policies of the Americans and the British.

Separate chapters are devoted to national efforts to develop procedures and technologies for properly selecting soldiers (with an eye to eliminating men most likely to break down or to simulate a breakdown); for motivating soldiers to fight, and to return to the front line following successful treatment for battle fatigue and breakdowns; and for managing chronic cases and compensation claims during the postwar period. The book also includes a superb chapter on British efforts at planning for and subsequently treating the civilian casualties of the air war.

Shephard never loses sight of the tension between the medical and military imperatives that characterized American and British attitudes to psychiatric casualties. Psychiatrists were asked to heal men sufficiently for them to return to the front line, where their traumatizing fears of death and mutilation were likely to be realized. The perverse unfairness of this situation was obvious at the time, but so was the unfairness of abandoning those soldiers who remained at the front. Psychiatrists with first-hand knowledge of the battlefield were more likely to appreciate this point. For the Germans in both wars, the situation was less complex and therapeutic torture and summary execution were common.

A War of Nerves is a splendid book. It is a sympathetic but entirely unsentimental look at military psychiatrists and their patients. Looking back over eight decades of diagnosing and...

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