Review – Treating the Trauma of the Great War – Soldiers, Civilians and Psychiatrists in France, 1914-1940
The social, political and cultural significance of shell shock, or war hysteria, in the First World War has been expertly analyzed by historians dealing with Britain and Germany. However, except for Marc Roudebush’s pioneering work, there has not been a major study of the history of psychological trauma in France. Historian Gregory Thomas attempts to solve this with an exhaustively researched work that does more than just fill this gap in scholarship. Thomas’ study successfully provides new insights into the history of mental illness from the perspectives of both doctors and war victims, including men and women, and the legacy of mental trauma long after 1918. His book is a model for how to integrate the history of shell shock’s impact on medical debates over the origins and treatment of this illness with the history of ordinary individual’s responses to these complex and long-term wounds.
Thomas’ central argument is that the project of healing mental trauma played a key role in reforming France’s health care and welfare system for the mentally ill. As doctors sought to understand the psychological impact of the war, they were influenced by three intertwining factors: serving a state at war, healing a nation in crisis, and asserting their medical expertise and professional authority. These aims directly influenced their medical conclusions about the origins, nature and paths for treating psychological trauma, and they were inclined to view traumatized soldiers and civilians as conscious or unconscious shirkers. One of the most interesting aspects of Thomas’ argument is that although French doctors were, similar to their counterparts in Germany and Britain, inclined to denounce war ‘hysterics’ as ‘malingerers,’ psychiatrists also played an instrumental role in spearheading sweeping reforms in pensions and health care. On the surface, Thomas convincingly argues, the war did not alter psychiatric theory, as there was more continuity than change in perceptions of the mentally ill as social outsiders. But the war did alter psychiatric practice, making mental medicine accessible for the masses as the prison-like asylum system gave way to open door health care services that benefited a diverse population of the ‘living dead’ who struggled in postwar society.
Thomas’ book is well-organized, with chapters that move through events chronologically while examining the symbiotic relationships between doctors and their patients. In chapter one, Thomas analyzes the flashpoint of ‘hysteria,’ or what was often described as ‘mental confusion’ or ‘commotion’ illness, in the terrifying experience of the modern industrial warfare. As doctors debated the origins of psychological wounds and paths of treatment, they were strongly influenced by their cultural environment. Though they were eager to prove the superiority of French over German psychiatry, French doctors were quite similar to their German counterparts: they were highly nationalistic and saw the war as an opportunity to weed out the weak and ‘degenerate’ from the psychologically healthy. Closely aligned with the military, psychiatrists’ main goal was to return men to battle, and they opted for shock and suggestion therapy as the best means to this aim. Doctors imposed their own assumptions and alleged that these men, especially those from the working class or ‘other’ ethnic groups, were predisposed to illness and malingering. At the same time, doctors were concerned about the possibility of a ‘hysteria’ diagnosis stigmatizing men as unmanly, and were eager to prevent the perception that there was a wider crisis of masculinity in French culture. Overall, psychiatrists’ main concern was asserting their professional goals and authority. Using case studies Thomas demonstrates that doctors had little patience for investigating the complex nuances of traumatic injuries, or listening to soldiers who insisted that the main culprit for their problems was the war experience.
In chapters two and three, Thomas turns to mental illness on the home front and the foundations for legislative and health care reforms in the immediate postwar period. Thomas places Great War psychiatrists in the larger historical context of French doctors who analyzed connections between national upheaval and mental illness since the 18th century. Doctors long-believed that heightened passions triggered symptoms of psychological illness in predisposed, ‘weak’ civilians, and psychiatrists in 1914-1918 were no exception. However, while psychiatrists reassured themselves and the public that there was no significant spike in insanity on the home front, they admitted that the war stirred strong ‘emotions’ that triggered a wide range of mental illness. With the end of the war, intersecting interests created the perfect environment for reforming pensions and health care for veterans, and ultimately the mentally ill as a whole. Traumatized veterans demanded health care, legislators were eager to prove their patriotic support for returning soldiers, and the public sentiment was behind compensation for war heroes. Psychiatrists, however, fought the liberal legislative proposals, which guaranteed compensation for all mentally ill veterans regardless of pre-existing or war-induced causes. Similar to most politicians, doctors wanted to speed demobilization and clear out the hospitals, but they also wanted to weed out ‘malingerers’ and chronic neurotics. Advocates for the mentally ill eventually won over the majority of parliamentarians with patriotic pleas for reparation. When the law was enacted in 1919, burden of proof regarding the origins of injury shifted to from soldiers to the state. Doctors mobilized to modify the law to shift the burden of proof back to soldiers. By the early 1920s, doctors got their way, as they asserted themselves at the bureaucratic level and saved the state money by weeding out ‘hysterical’ men and women whose symptoms were allegedly not war-related.
In the midst of these battles between psychiatrists and patients, broader health care reforms unfolded that ultimately benefited France’s ‘living dead.’ In chapters four and five, Thomas examines the stories of war victims to highlight the development of an ‘open door’ system of care that had a more positive impact on the mentally ill than the bureaucratically tangled 1919 reform law. Despite parliamentarians’ patriotic rhetoric, few were willing to allocate resources to the often stigmatized, destitute ‘human wrecks’ who languished in asylums were cut off from families. However, by the late 1920s and 1930s, doctors spearheaded the creation of open health services for any mentally ill French citizens, which enabled traumatized soldiers to seek affordable care in public clinics without being subjected to dehumanizing bureaucracy, stigmatization, or neglect in asylums. Originally intended to solve the administrative burden of coping with an overwhelming number of shattered civilians and soldiers, as well as the economic costs of hospitalization and asylums, the open services system revolutionized psychiatry, marking the end of the custodial asylum and replacing it with a modern psychiatric model that especially helped mildly troubled individuals who could not afford private assistance. According to Thomas, the psychiatric profession continued to stigmatize, all the way to the brink of the next war, psychologically ill men and women as predisposed, chronic neurotics. However, new health care practices made it easier for citizens to take control of their own health and seek assistance in a setting that where the treatment itself had become less traumatic.
Thomas’ study utilizes an impressive range archival research, including medical journals, hospital records, and letters by war victims. Effectively balancing the stories of both doctors and their patients, Thomas constructs a compelling, convincingly argued narrative driven by case studies that give us a fascinating glimpse into the experiences of ordinary French soldiers and civilians. At the same time, there is one area of Thomas’ analysis that could be developed. Promising to provide a cultural, as well as medical and political, history of traumatic neurosis, Thomas generally neglects the issue of gender as a factor that shaped perceptions of soldiers who broke down in combat. Especially since Thomas mentions briefly that the hysteria diagnosis challenged patients’ masculinity, this topic could have been further explored in light of extensive scholarship that points to the central importance of shell shock in medical and societal debates over manliness and the legacy of the war. How did physically disabled veterans perceive ‘war hysterics’? Did this ‘unmanly’ stigma, in addition to other social and economic factors explored by Thomas, affect the experiences of traumatized men in work, family life and politics? Despite these lingering questions, Thomas successfully makes a vital contribution to the field, providing scholars with a long-awaited, substantial study of the French experience with shell shock. With his insightful analysis of the politics of health care and social welfare for the mentally ill, his work should appeal to specialists in the history of psychiatry, experts in the social and cultural history of medicine, and a broader audience of those interested in the changing culture of psychiatry and the experiences of populations devastated by the experience of total war.
See, for example, Paul Lerner, Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany (Ithaca: Cornell University Press, 2003); Peter Leese, Shell Shock: Traumatic Neurosis and British Soldiers of the First World War (New York: Palgrave, 2002).
Marc Roudebush, “A Battle of Nerves: Hysteria and its Treatments in France during World War I,” in Mark Micale and Paul Lerner, eds, Traumatic Pasts: History, Psychiatry and Trauma in the Modern Age, 1870-1930 (Cambridge: Cambridge University Press, 2001).
Jason Crouthamel, History, Grand Valley State University
Gregory Thomas, Treating the trauma of the Great War : soldiers, civilians, and psychiatry in France, 1914-1940 (Baton Rouge: Louisiana State University Press, 2009). ISBN: 9780807134368, 39.95$