When the Mind Sounds Retreat

Ben Shephard's A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century traces the evolution of wartime neuroses from the puzzling appearance of "shell shock" in the winter of 1914-15 through the "post-traumatic stress disorder" of the Vietnam War's aftermath, and, more recently, to "Gulf War syndrome." Midway through his engrossing narrative, one especially evocative statement appears: "Every man has his breaking point and these, in the fulfillment of their duties as soldiers, were forced beyond the limits of human endurance."

The words aren't Shephard's. The quote comes from a 1944 propaganda documentary made to reassure Americans on the home front that their mentally wounded sons (and daughters) were being well cared for—and it offers just one explanation for an enigma that continues to plague military psychiatry: Why do some foot soldiers, aviators, and sailors crack under fire? In Shephard's view, the documentary marked a dramatic shift from the traditional "get tough" military attitude toward what was widely regarded as cowardice or malingering to a more compassionate view of the human response to fear.

Both a historian of psychiatry and a producer of documentary films—including The World at War—Shephard, who is British, brings finely honed skills from both fields to his book. He matches his meticulously documented historical research with a journalist/producer's trained eye for the single detail, the precise anecdote, the appropriate quote that tells a story. The combination produces a fascinating and compelling exploration of a complex and still-controversial topic that could easily be ponderous and dull.

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Working from historical accounts, medical records, letters, diaries, even contemporary literature, Shephard lays out the many issues that have confronted both the military and the medical professions as they have attempted to deal with mental casualties. The book's most moving moments come as Shephard recounts the many and varied experiences of individuals who do break down and of those who try to treat them, always against the backdrop of questions. Why were so many World War II bomber pilots, for example, able to continuing flying when they knew the long odds against their surviving? Why did some infantrymen mentally buckle without ever having been near a front line, much less in a battle? How many apparent breakdowns were deliberate efforts to avoid being shredded by bombs or shells? What qualities or conditions kept soldiers and aviators going? Such are Shephard's storytelling skills that his account of the never-ending search for answers never reads like a bloodless recitation of case studies.

Throughout the wars of the past century, the relationship between the military and psychiatry was never easy. Psychiatrists were brought in, Shephard reports, "because they seemed to have ways of alleviating the suffering of war; because the military could no longer cope; or because, in an age of total war, they offered a way of reassuring civilian society that everything possible was being done for the soldier."

Even so, the record shows that military leaders had little empathy for those who cracked under pressure or for the doctors who treated them. And the demands of the military often created professional conflicts for psychiatrists and other doctors. They could not simply meet their medical obligations and tend to the needs of individual patients, for they were military doctors and their duty was to send soldiers back into battle. To carry out this responsibility, they tried rest and reassurance, hypnosis, shock, drugs as they came along, short-term therapy near the front, and longer treatment in specialized facilities. Shephard traces their efforts, which paralleled the evolution of psychiatric therapy through the century, and also describes psychiatrists' role in trying to help the military figure out how to select good soldiers—something the Germans seemed to have mastered—and find ways to prevent mental collapse. But at one point, the author seems to question how much good the doctors did.

It is unusual for a historian, or any writer for that matter, to decide that his material dictates shifting narrative approaches, but Shephard does just that—and explains why: "The story of the war neuroses in 1914-18 is a drama almost Aristotelian in its simplicity of character and setting. Events between 1939 and 1945 were equally dramatic but more diffuse; more like a film made up of different sequences set in different locations, collectively telling a story." So, through World War I, Shephard provides a comprehensive history of military psychiatry. Then, when he gets to Dunkirk, he shifts to developing his narrative around themes common to World War II and the subsequent wars.

Perhaps it is only fitting that A War of Nerves does not end with a neat summary of answers. Instead, Shephard adds new questions: Does the contemporary idea that counseling is the answer to stress "undermine support for strength of will to overcome anxiety and fears and retain respect of colleagues?" And how will the shift in social values that has made stress a "quality of life issue" and provoked public grieving—Shephard uses the death of Princess Diana as an example but one might add the Oklahoma City bombing or the Columbine shootings—affect those who have to go to war in the future?

Interestingly, Shephard closes with an anecdote that has nothing to do with military psychiatry. It does, though, illustrate his belief that "military psychiatry is often done best, not by psychiatrists, but by doctors, officers, or soldiers who understand the principles of group psychology and use the defenses in the culture to help people through traumatic situations." A War of Nerves may not answer why those put in harm's way break down, but it does offer insights into how best to help them.