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

Ben Shephard's engrossing account of military psychiatry spans the British and American experiences from the Great War to the Gulf War. He brings to this endeavor considerable skills as a journalist and as a documentarian for British television, which explain this book's rousing good narrative about the interesting—and sometimes eccentric—characters who grappled with adverse reactions to twentieth-century combat.

His treatment of the subject is noteworthy on several levels. First, his scope is broad. He traces the evolution of emotional breakdown under intense fire from its first significant appearance in the "shell-shock" cases of World War I through the stages of war neurosis, combat exhaustion, short-timer's syndrome, Post-Traumatic Stress Syndrome, and the Gulf War Syndrome. Although he focuses on British and American efforts to deal with these afflictions, he also includes French and German approaches, especially in the Great War, giving comparative breadth to his study. Nor does he limit himself to the infantry, but includes armor, air, and prisoner of war experiences.

On another level, his narrative brims with evocative details. He incorporates statistical data appropriately, but not numbingly, and enriches the tale with lively sketches of military, medical, and civilian policy-makers and trendsetters; of the officers and men whose symptoms raised such concern; and of key agencies who treated, disciplined, or compensated afflicted men. Further, Shephard effectively clarifies the tangled confusions, turf wars, and political biases within the psychiatric community as it struggled to understand and treat battle-related mental breakdown. He is as much at home with military as with psychiatric issues. On the one hand, he ably describes the combat pressures forcing the military to turn, with painfully mixed feelings, to psychiatric experts for help in conserving manpower. On the other, he traces the difficult evolution of civilian psychiatrists dedicated to finding cures into "military minded" ones dedicated to bolstering discipline.

Especially noteworthy, however, is Shephard's attention to the reciprocal relationship between military and civilian cultures. His narrative sheds needed light on how military values and practices both influence and are influenced by such diverse civilian forces as the media, international law, literature and film, ideology, religion, class, and public opinion and veterans' organizations. And he comments thoughtfully on the effects, for good or ill, of our modern "therapy culture," showing its significant debt to activist Vietnam veterans. Reviewing how these veterans created Post-Traumatic Stress Syndrome, he notes how this poorly documented, but powerful concept drew lessons not only from combat psychiatry, but also from civilian catastrophes as diverse as the Holocaust and the Coconut Grove fire. He then describes its spread to the larger society, such that "traumatology" became embedded in modern culture, spawning multitudes of conferences, studies, and grief counselors.

In short, this is a good read, gracefully but solidly erected on a substantial foundation of primary and secondary documentation. Its clear, engaging style makes it readily accessible to a broad audience. The general public will find it absorbing, while serious students of both psychiatric and military history will find it valuable for its scope, comparative and contextual approach, and useful bibliography and footnotes.