- Treating Trauma of the Great War: Soldiers, Civilians and Psychiatry in France, 1914–1940
The crucial words in the title of this book are ‘in France’. The historiography of psychological trauma and its treatment during World War One is well advanced in terms of Britain and Germany, but this is probably the first scholarly work that explores the French experience in the English language. As such, it is an overdue publication. Gregory M. Thomas charts how neurologists and alienists came together to provide a network of neuropsychiatric hospitals for soldiers suffering from a range of puzzling but debilitating symptoms. Nevertheless, despite a patriotic spirit of co-operation, little agreement was reached on how such cases should be diagnosed and treated. On the one hand, followers of Joseph Babinski believed that many psychiatric casualties were simply malingerers and had to be managed by strong suggestion in a context of authoritarian discipline. By contrast, Joseph Dejerine, professor of neurology at the Salpêtrière, held that war neuroses assumed a bewildering variety of guises and required treatments tailored to the individual soldier’s pathology, though he had a particular preference for isolation followed by focused psychotherapy.
The desperate need to treat psychiatric battle casualties in order to return them to active duty led to a re-evaluation of the role and status of psychiatry. The distinction drawn between those suffering from organic brain disease and injury (treated by neurologists) and those with severe mental illness (the domain of alienists) became blurred as clinicians struggled with soldiers whose symptoms and traumatic exposure were ambiguous. Wartime thinking promoted the notion of psychological medicine, out-patient clinics and the integration of mental illness within mainstream medical research.
The French Army lost 1.3 million servicemen during World War One, the largest proportion of any combatant nation, while much of the fighting was on French soil causing the destruction of settlements and communications. The impact on the civilian population was significant, though, as Thomas concludes, the post-war period saw no outbreak of mass psychological disorder as families grieved for the loss of their sons, brothers and fathers. Whether people possessed an inherent resilience and adjusted to their losses or whether they suffered from long-term disorders but kept them concealed can probably never be answered. [End Page 1363]
In essence, this is a history of ideas, rather than an analysis of hospitals or patients. Thomas skilfully explores how different groups sought to promote their status and influence by exploiting the imperatives of war. However, the reader who is unfamiliar with French psychiatric history might have benefitted from maps of where hospitals were located and structural diagrams showing how they fitted together in an operational chain.
The only area of weakness is the relationship between diagnosis, symptoms and culture. Thomas does not distinguish between disorders characterized by functional somatic symptoms (that is those bodily sensations for which there is no discernable pathology) and those that are essentially psychological, such as such as depression, anxiety states or post-traumatic stress disorder (PTSD). In the former, a person unconsciously converts fear or stress into a physical symptom. Symptom studies using World War One case notes have shown that somatisation was a common response to the pressures of trench warfare. Such investigation has also shown that shell shock and PTSD were not the same phenomenon described by a different label. Because Thomas focuses on explanations and ideas, rather than actual psychopathology, he is unable to add to this debate. Indeed, it is unclear whether detailed case notes survive in any great number. Despite this criticism, Thomas has added a well-researched and important chapter to our understanding of the psychological impact of World War One.
London, United Kingdom