This is a very fine book
about a very important subject. In some respects it can be seen as charting the
journey from shell-shock to Post-traumatic Stress Disorder, and with it the way
war, and its reality, moves from the front to the home. Shepherd introduces a
wide scope of analysis shot through with a humanity that is sensitive to, but
not sentimental about, the horrors to which mankind can subject its fellows. He
also conveys a sadness, but not incomprehension, at the ways in which they can
be justified.

In the course of a little
under 400 pages he charts the parallel histories of the Twentieth Century,
modern warfare and psychiatry. This interweaving of social and cultural themes,
as well as medical and scientific debates, gives the book a rich texture that
rewards careful reading every bit as much as the picking of choice exemplars.
He describes the continual tension between neurology and the biological
explanations of war neurosis, shell shock and Post-traumatic Stress Disorder on
the one hand, and psychology and humanistic understandings on the other. There
are areas in which he is less clear than others, for example in the
underdeveloped explanation of the different courses of European and North
American psychiatry, or the influence and role of other professions, notably
nursing and clinical psychology, but these do not detract overmuch from the
whole.

It may be seen as a
shortcoming that there is a tendency towards the ‘Great Man of History’ thesis.
Much of the influence and course of the story he tells is seen to be as a
result of powerful and influential individuals. While many are undoubtedly
important and fascinating in their own right, and here he cites major figures
such as W.H.R. Rivers, who has become almost a mythological figure, Gordon
Holmes or Roy Grinker, it is only in the latter passages when he begins to draw
more on the social construction of psychiatry itself. He says, and this is of
great interest, that no great psychiatrist or movement emerged from the Vietnam
War in the way that had happened in World War One, and this may in some
paradoxical way be a measure of psychiatry’s success in becoming a model for
social understanding. All the successful psychiatrists were being successful in
the civilian world and had no need of the military to expand or expound their
theories.

There is both an advantage
and a problem with the way in which so many of the scenes that are described
are familiar to the reader, or at least thought to be so. Battle scenes of the
Somme, mud-filled trenches, whiz-bangs and screamers all seem to have a place
in our collective memory now and as such may be difficult to represent
faithfully, without the layers of interpretation with which they have become
imbued. Shepherd extensively uses examples from of literature, especially from
the 1914-18 war. He cites familiar names such as Graves and Sassoon, Gurney and
Aldington, Manning and Chapman. He uses, and how could anyone not, Remarque and
Owen who, in their own ways, have defined that particular conflict forever.
However, especially when considering more contemporary situations he uses
little by way of cinematic representation. How close, for example, are the
opening scenes of Spielberg’s Saving
Private Ryan to conveying the intolerable noise and unutterable confusion
of battle? The swirl of fear and panic, mixed up with the horror and surreal
sensations that men experience when landing on the beach in the D-Day invasion
may, in some small way, suggest the terror and overwhelming disorientation of
being under fire. Perhaps the combination of vision and sound, so
all-encompassing it is almost visceral, is one means to allow those who were
not there to appreciate what it may have been like. At its heart, the book
attempts to make the behavior of all those involved understandable.

Shepherd’s book has much to
offer both the specialist and the general reader. It has a great many moving
passages, and some very pertinent insights. It shows that in many cases
military psychiatry is a crucible of psychiatry as a whole. The conflicting
opinions and debates exemplify those in the wider world, not just in the biological/sociological
divide, but in the case of reactive and proactive care, or in psychiatry’s
predictive ability. The book makes an important contribution and is to be
recommended to all those interested in the field.

© 2002 Mark Welch

Dr Mark Welch is
currently a Senior Lecturer and Postgraduate Coordinator in The School of
Nursing at the University of Canberra, Australia. His PhD investigated the
representation of madness in popular film, and his other research interests
include the mental health of refugees and victims of torture, and the history
of psychiatric epistemology.

Categories: MentalHealth