April 7, 2002

IN his legendary column, “Low life”, the late Jeffrey Bernard once asked why the health service didn’t simply prescribe money. I filed this away as an amusing apercu until reading, in this book, that there was a rather vexed debate after the first world war about how to treat traumatized veterans. Simply paying soldiers pensions seemed to keep their symptoms at bay. If the “treatment” worked, then the Ministry of Pensions would find itself in the unusual position of maintaining payments to healthy people. But, over the years, evidence emerged that giving out money turned out not to work so well after all. People stayed ill, consciously or not, as long as they were being paid. As Shephard observes, compensatory pensions — “a nightmare of complexity and calculation” — happened to be Franz Kafka’s line of work.

This is a book about the history of medicine’s attempt to get to grips with the phenomenon of what was at first known as “shell shock”. The term, doctors soon came to realize, was inadequate: soldiers got “shell shock” whether or not they had been close to an exploding shell. And the range of symptoms was bewildering: paralysis, tortured gaits, wild tics, and the inability to defecate or urinate, resulting in the body blowing up like a balloon. About the only symptom sufferers had in common was complete sexual dysfunction.

The condition of preferring not to fight in a war has persisted as long as war itself, but it was the unprecedented scale of the first world war that made the nerve doctors sit up and take note. Of course, as Joseph Heller noticed, anyone who didn’t want to risk his life was by definition not crazy, but there were other conflicts at work, the most significant being that the army wasn’t interested in making people better; it was interested in making them well enough to fight again. As Freud noted: “The insoluble conflict between the claims of humanity, which normally carries decisive weight for a physician, and the demands of a national war was bound to confuse this activity.”

This book is exhaustive and scholarly, yet compulsively readable. Shephard is a first-rate writer with a preference for understatement. Seeing as he is dealing with the far edge of human experience, this is wise. The book is full of detail about matters things we thought we knew — the pity of war, the blundering efforts of doctors. A brief and laconic description of the mile-long traffic jams of ambulances on their way from the front I found almost unbearably affecting. And it emerges, quietly, that the best way of treating shell shock is to make sure no one ever fights in a war again. —Dawn/Guardian news service

 

A war of nerves: soldiers and psychiatrists 1914-1994

By Ben Shephard

Pimlico

ISBN 0712667830

498pp. £12.50

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