A War of Nerves

I’ve just started reading Ben Shephard’s stunning book A War of Nerves: Soldiers and Psychiatrists that tracks the history of military psychiatry through the 20th century.

Even if you’re not interested in the military per se, the wars of the last 100 years have been incredibly important in shaping our whole understanding of mental breakdown, mind-body concepts and clinical treatment.

For example, the effects of trauma stemming from World War I were so shockingly obvious and happened in such large numbers that the medical establishment could no longer deny the role of the mind in both the theories and practice of treating ‘nervous disorders’.

In effect, it made psychology not only acceptable, but necessary, to a previously sceptical medical establishment that were largely focused on an ‘organs and nerves’ view of human life.

One of the big concerns during World War I was ‘shell shock’, a confusing and eventually abandoned label that was typically used to describe any number of physical problems (such as paralysis, blindness, uncontrollable shaking) that arose from combat stress.

The original name came from early theories that suggested these symptoms arose from the effect of ‘shock waves’ on the nervous system.

However, it became clear that only a small percentage of cases actually resulted from actual brain injury (interestingly, a recent article in the American Journal of Psychiatry notes parallels between ‘shell shock’ and concerns over the effects of Improvised Explosive Devices or IEDs in Iraq).

It turns out, many of the symptoms were triggered or exacerbated by unbearable stress and were shaped by beliefs and expectations.

This was clearly demonstrated when a ‘gas shock’ syndrome emerged during World War I when gas attacks became more frequent.

Like ‘shell shock’, it arose from a combination of extreme stress and was shaped by expectation and fear (the descriptions of death by mustard gas are truly horrifying) even when no gas injury could be detected.

An eye witness recalled that: “When men trained to believe that a light sniff of gas meant death, and with nerves highly strung by being shelled for long periods and with the presence of not a few who really had been gassed, it is no wonder that a gas alarm went beyond all bounds. It was remarked as a joke that if someone yelled ‘gas’, everyone in France would put on a mask. Two or three alarms a night was common. Gas shock was as common as shell shock.”

The military managed (and still manage) these forms of combat stress reactions by rest (stress and fatigue play a great part) but also by managing expectations.

Soldiers are typically treated briefly and near the front line, with the expectation they’ll rejoin their unit. In effect, instilling the belief that the effects are unfortunate but transient. As a result, they usually are.

Shephard’s book is full of fascinating facts, quotes and insights on every page as he’s used some incredibly in-depth historical research to bring not only the scientific and medical issues alive, but also the culture and attitudes of the time.

He’s interwoven military records and scientific research with press commentary and personal letters to make the book really quite moving in places.

I’m sure I’ll be posting more gems as I read more.

Link to book details.
Link to abstract of ‘Shell shock and mild traumatic brain injury: a historical review.’

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