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 45 september 13, 1997 What appears to be bizarre and senseless is in many cases a quite reasonable expression of horror. I n a previous column I made mention of my experiences as an air force psychiatrist—the different ways we were expected to respond to our fellowofficers,asopposedtotheordinarymenandwomenwhohadn’t such high rank to their credit. Again and again some of us doctors, in the military for only two years, were reminded that we had to accommodate ournotionofwhatoughttobetotherequirementsofalargeorganization with its own traditions, customs, needs, and values. Regeneration,anovelIrecentlyreadbyPatBarker,anEnglishwoman, brought back that military experience and reminded me of what was often at stake as I first sat with people having trouble with their personal lives and then sat with my fellow air force doctors as we tried to figure out what to do, and why. In the pages of Regeneration we are told of the terrible carnage of the First World War—millions of young lives lost in senseless trench combat over yards of territory drenched in blood. Three years into that human and moral disaster the British poet and army officer Siegfried Sassoon, a decorated war hero, abruptly refused to have any more part of thefighting.Hisdefiantchallengetomilitaryauthority,called“ASoldier’s 46  Declaration,” is put at the beginning of the novel. At one point he insists: “I have seen and endured the suffering of the troops, and I can no longer be party to prolong these sufferings for ends which I believe to be evil and unjust.” Soon enough this well-known officer was a patient at Craiglockhart War Hospital, classified “mentally unsound.” Such a procedure was supposedlyasignofearlytwentieth -centuryprogress,anefforttounderstand rather than a quick punitive judgment. At the hospital Sassoon became the patient of William Rivers, M.D., a neuropsychiatrist who even now is known to people in my profession as one of the pioneers in what came to be called the study of “war neuroses.” Hewasoneofthefirstdoctorstotakeseriouslythesubjectivityofsoldiers afflicted with all sorts of paralyzing symptoms: terrible nightmares, spells of deep gloom, appetite loss, insomnia, and a host of other idiosyncratic complaints that seemed to defy comprehension. He learned that what appears to be bizarre and senseless is in many cases a quite reasonable expressionofhorroronthepartofmenwhohadwitnessedandexperienced a degree of suffering and vulnerability unimaginable to those who have never been on a battlefield in, say, Ypres or Verdun, where corpses by the thousands covered land meant to grow crops, all in the name of this or that nation’s “freedom” or “destiny.” Thanks to almost a century of psychoanalysis, we readily comprehend now how the mind tries to find symbolic expression for its grave distress, how the unconscious wields its way; but Dr. Rivers came to such knowledge on his own, through careful clinical observation and analysis and without resort to the sometimes ponderous and overwrought theoretical language of today that contrasts so markedly with the marvelously  47 clear-headed and inviting narrative writing to be found in, say, Freud’s The Interpretation of Dreams. In fact, Dr. Rivers belongs to the tradition of British empiricism—a way of seeing things not unlike the approach to people and their behavior that William James, on this side of the Atlantic, called pragmatism. Indeed, had James lived another few years (he died in 1910), one suspects he would have been much interested in pursuing just the kind of inquiry Riversmadeinhismanyencounterswithso-calledshell-shockedsurvivors of those hard-fought battles on French soil during the second decade of this century. This is a chronicle that summons up a historical scene and probes it deeply, to the reader’s considerable benefit. We learn what happens not only to hurt, war-weary soldiers, but to the doctors who must try to heal them—so that, alas, they will return to places of wanton slaughter as participants, as those who aim to kill, while hoping and praying they will themselves be spared. Fiction varies, of course, in its relationship to the actual and factual. The account in this novel has obviously been made possible by the writer’s long-standing and full immersion in historical sources of various kinds, as she readily acknowledges in an author’s note at the end—a novel in the documentary tradition and an attempt to evoke through the strategiesofthestorytelleralong -agomedicalandsocialreality:thepsychiatric hospital as a place of twentieth-century military decision-making. But the book is also informed by a moral seriousness not always explicitly acknowledged by some of us psychiatrists as we do our work, in...

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