Psychiatrists, more than most people, like to flirt with history, and nowhere is this more true than in the field of psychological trauma, where it has become de rigueur to introduce a chapter or book with an historical overview. More often than not these superficial, oversimplified accounts do little more than attempt to convince the reader that post-traumatic stress disorder (PTSD) as described in ICD-10 has existed since time immemorial. Recent conflict, global terrorism and renewed enthusiasm for the poetry of the First World War as well as the novels of authors such as Pat Barker and Sebastian Faulks have reawakened interest in war-related psychological trauma, leading to a more thoughtful critical analysis of the psychiatric morbidity arising from the major wars of the 20th century. This historical reappraisal suggests an altogether more complex picture, and has prompted a fascinating debate about the nature of PTSD: are the diagnostic symptoms and signs set out in modern classification of disease a constant and enduring function of the effects of trauma on the brain, recognised throughout history, be it in a returning soldier from the Trojan war described in Homer's Iliad (it takes the eye of faith to see PTSD in literature) or in a Vietnam veteran of the 1980s? Alternatively, is PTSD a phenomenon peculiar to the Vietnam era, and are the effects of trauma on the brain patho-plastically shaped by culture, politics and society's attitudes and belief systems? Was ‘shell-shock’ to First World War veterans what Gulf War illness is to contemporary British soldiers?
Against this background, any more rigorous analysis of the sociology of psychological trauma and the effects of combat is to be welcomed. Hysterical Men describes the evolution of attitudes towards trauma and hysteria in 19th century German society and shows how these concepts influenced - and were themselves influenced by - the politics of post-Bismarck Germany and debates about Germany's national health, economic productivity and military strength. Arising from concerns that Germany's revolutionary pensions system would encourage a deluge of claims from the working (and presumed work-shy) classes following industrial accidents and fuelled by the epidemics of shell-shock in the Great War, male hysteria was seen as an affront to the German virtues of Teutonic masculinity. Weakness of personality and a lack of moral courage were seen as crucial ingredients in the genesis of post-traumatic psychopathology, rather than a traumatic event per se (a view that is debated to this day). As a result of these attitudes, German psychiatrists sought to turn these male hysterics into fit workers and loyal political subjects.
American historian Paul Lerner's book is excellent: scholarly, carefully researched and well referenced. Hysterical Men explores the status of psychiatry in early 20th-century Germany as well as psychiatric attitudes to war: a potential ‘cure’ for the degeneration and moral weakness vilified by psychiatry and society alike. The heroic and increasingly desperate treatments used by psychiatrists - treatments often as dramatic as they were ineffective - are described, as well as the influence of the war on psychoanalytical thought.
What this book does so effectively is illustrate the profound impact of politics, culture and social values on medicine, and remind us that none of us works in a social vacuum and how subject to external influence our clinical objectivity actually is. The book will appeal to readers of history and the philosophy of science, as well as giving depth and perspective to the PTSD debate. Most historical accounts of the psychiatry of the Great War are Anglocentric and it makes a refreshing change to read this fascinating account of the terrible toll of war on the vanquished.
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