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

Reviewed by: James Scully, MD

Disclosures

November 20, 2001

Introduction

Ben Shephard
Harvard University Press
Copyright 2001
448 pages
ISBN: 0674005929
$27.95 hardcover

On the dust cover of A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, there is an endorsement from British military historian/journalist John Keegan, which states, "Ben Shephard's study of how war wounds men's minds, and of medicine's efforts to heal the damage done, is based on years of dedicated research."

Mr. Keegan is wrong on at least one count, however. This book by historian and documentary film producer Ben Shephard is not the place to look for an understanding of trauma and theories and science of combat trauma. Indeed, clinical information about combat trauma in psychiatry is significantly lacking. There is almost nothing on posttraumatic stress from researchers such as Bessel van der Kolk, MD, or Robert Rosinheck, MD, and nothing at all from Robert J. Ursano, MD.

Instead, A War of Nerves is a history of psychiatry in the military. In particular, it discusses British psychiatry and its relationship to the British armed forces, especially during World War I and World War II.

Shephard's book contains wonderful descriptions of hospitals the British used to treat psychiatric cases during World War II. Northfield was the largest military psychiatric hospital in Great Britain during the war. He draws an excellent portrait of the training wing run by pioneering physician/psychoanalyst Wilford Bion and the chaos that ensued when Bion decided to test his theories of neurosis.

For example, instead of trying to fix the discord and lack of discipline that ran in the training wing of the British Army Psychiatric hospital he was in charge of, Bion decided to let the turmoil continue to get so bad "that the collective neurosis would be driven... to control it" (pages 258-259). Within a few days, wet beds, drunkenness, and absences without leave went unchecked. Yet, Bion refused to act because he thought that eventually the troops would shape up. He neglected, however, to inform his superior of the experiment, and following an unannounced visit, the whole thing was shut down

The book is replete with wonderful vignettes that bring to life the quirky personalities of those who populated psychiatry in the 20th century. It is also rich with historical detail, particularly of the British treatment of the psychiatric casualties of the first and second World Wars.

Shephard brilliantly describes the intellectual political power struggles and the failings of psychiatric orthodoxy in the 20th century. In particular, he describes in exquisite prose how lessons learned were forgotten or misplaced over and over again due to narcissism, arrogance, and ignorance in both the military and the psychiatric professions. Even 3 years into World War II, for example, the British Medical Chief Sir Ernest Bowell refused to accept that psychiatric casualties were inevitable (page 210).

Shephard does cover important areas of American history, but his Anglocentric world view is illustrated by sentences such as the following regarding World War II: "Whatever the murky obscurities of its beginning the war's apocalyptic ending-the liberation of the concentration camps, Hitler's death pyre in Berlin... " For much of the world, especially Americans, the war did not end in Europe but continued in the Pacific and ended with the surrender of Japan. Much of the book is filled with this kind of observation (or well expressed opinion, if you will).

The last part of the book deals with the Vietnam War until the present and it may be prove the most controversial section because since many readers will have personal experience. For example, at one point, Shephard states: "No purpose is served by taking up the cudgels in this debate and trying to blame either side" (page 395). It is a laudable sentiment that he does not seem to follow, as he later describes US Marine Corps training as "one that produced a degraded masculinity."

On the other hand, his account of the politics of the Vietnam syndrome and how psychiatry was drawn into it in the United States is a powerful and moving, although disturbing, review of American military and Veteran's Affairs psychiatry of the '70s and '80s. Again, however, A War of Nerves sometimes makes omissions.

For instance, Shephard describes psychotherapy of a marine sergeant by psychiatric social worker Sarah Haley and how she dealt with his guilt over supposed atrocities. But the author does not mention that Sarah Haley was an antiwar activist along with psychiatrist Robert Lifton, MD, and others who clearly had a political bias in reporting their clinical work. A useful counterpoint to A War of Nerves might be Stolen Valor by B.G. Burkett and Glenna Whitley, which provides another view of the Vietnam Veteran and the phony combat veterans and hero "wannabes."

However, other chapters in Shephard's book continue to ring true. For instance, chapter 25, "When the Patient Reports Atrocities," is still a timely review of what we do not want to remember, resonating with the recent revelations of former Senator Bob Kerry and the reaction of the culture to these revelations.

All told, A War of Nerves by Ben Shephard is provocative and disturbing and will infuriate many readers. But it is extremely well written and well documented with respect to historical and political conflicts. It is full of interesting characters and few heroes. Anyone with an interest in the history of military psychiatry will find this a must read.

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