The Evil Hours (15 page)

Owen and, to a lesser extent, Sassoon continue to occupy a unique place in the imagination of the English-speaking world.
Through the power of their poetry and the pity they arouse in readers, they helped to cement ideas about war trauma in the public sphere and legitimize later generations' attempts to document their own traumas. The most conspicuous beneficiaries of their eloquence were the veterans of the Vietnam War, many of whom drew inspiration not from their fathers' war—World War II—but from the war that preceded it. Robert Jay Lifton, one of the leading theorists behind the campaign to have PTSD recognized, invoked Owen's poem “Mental Cases” in 1973, saying, “No wonder that Vietnam veterans sometimes express strong identification with certain veterans of World War I—more so than, say, with those of World War II. Wilfred Owen . . . put his death guilt to powerful use in the moving ‘survivor formulation' contained in his poems.”

The first hints that the war was impacting soldiers' minds in a new way came in the winter of 1914.
The German offensive, intended to take Paris in six weeks, had ground to a halt less than a hundred miles from the city.
This opening stage of the conflict, which would later be called the last “nineteenth-century war,” was one of high drama and unprecedented casualties on both sides. The war of maneuver ended in November with both sides deadlocked, each unable to turn the other's flank. Having suffered unspeakable casualties, both sides began digging in. The result was a line of trenches running diagonally across the European continent from the Belgian coast to the Swiss border. The trench system created forms of human misery that the world had never seen before. Wet, filthy, and exposed to harassing artillery fire for months on end, soldiers broke down in bizarre ways. The most damaging aspect of it seemed to be the passivity required of soldiers. Standing in muddy trenches and waiting for an artillery strike or stray mortar round to end your life took an indescribable toll, even on those who were visibly spared. Describing the miseries of trench life, Wilfred Owen wrote,

 

Watching, we hear the mad gusts tugging on the wire,

Like twitching agonies of men among its brambles.

Northward, incessantly, the flickering gunnery rumbles,

Far off, like a dull rumour of some other war.

What are we doing here?

 

Soon, strange cases began appearing in field hospitals and aid stations across France. These soldiers didn't appear to be physically wounded but were exhibiting a host of sensory disorders. Some couldn't see. Some couldn't smell or taste normally. Many had odd gaps in their memory or were vomiting uncontrollably. More than a few were suffering from “the shakes.” It was as if some invisible force, unleashed by the new form of war, had taken possession of these men, disturbing their basic biological functions.

One twenty-year-old private had been caught in a German artillery barrage while moving between trenches and gotten tangled up in barbed wire. Charles Myers, a Cambridge psychologist working at the base hospital at Le Touquet, later wrote about the case: “Immediately after one of the shells burst in front of him, his sight, he said, became blurred. Another shell, which then burst behind him, gave him a greater shock, ‘like a punch on the head without any pain after it.' The shell in front cut his haversack clean away and bruised his side.”

This unnamed soldier was the first documented case of shell shock. In February 1915, Myers published a paper in the
Lancet
describing three such cases, titled “A Contribution to the Study of Shell Shock.” The term seemed to be an apt description of the phenomenon—most of Myers's cases had “followed from the shock of an exploding shell,” leading to the soldier's collapse. With Myers and other doctors, it almost seemed to be a case of the Victorian tendency toward scientific analogy expressing itself, a way of making concrete a decidedly abstract idea, that of post-traumatic stress. However, the fact that the term rolled off the tongue with such ease, and as a result stuck in the public imagination, was to become problematic later.

That Myers had taken notice of these odd cases was itself unusual, so strong was the desire to dismiss the soldiers as malingerers. Qualified as a physician, Myers was an example of that very British species of intellectual, the gifted dabbler.
Along with W. H. R. Rivers, another notable member of Cambridge's fledgling psychology department, Myers had taken part in a groundbreaking anthropological expedition to New Guinea, applying modern scientific techniques to the study of the tribal societies there. As an academic and a Jew, he was a double outsider within the Royal Army Medical Corps, a body noted for its attention to the needs of discipline over the needs of medicine. Nevertheless, Myers possessed a surplus of networking ability and was eager to find a role for himself in the war. While visiting Salpêtrière, the famous French neurology institute, he noticed several soldiers who had lost the power of speech or been partially paralyzed after German artillery barrages. It wasn't long before British soldiers with similar symptoms began arriving at Le Touquet, a hospital sponsored by the Duchess of Westminster. With the publication of his
Lancet
piece, Myers ignited a fierce debate within British society about masculinity, honor, and the rights of the individual.

On one side of the debate were the army's hardliners, who according to one historian possessed “a rough and ready model of human psychology, with its own clear-cut labels. Men were either sick, well, wounded or mad; anyone neither sick, wounded, nor mad but nonetheless unwilling to or incapable of fighting was necessarily a coward.”
And if the force of tradition weren't enough to persuade, the British Army, in the early years of the war, adhered to a draconian policy toward such “moral invalids.” During World War I, more than 2,200 British soldiers were condemned to death for cowardice and desertion.
Though only around two hundred soldiers were actually executed, the threat of the firing squad had a powerful impact.

Regardless of the policy, shell-shocked soldiers kept appearing at casualty clearing stations. Soon their stories filled the medical press. One Oxford professor of medicine serving in the army wrote to a colleague that “I wish you could be here in this orgie of neuroses and psychoses and gaits and paralyses. I cannot imagine what has got into the central nervous system of the men . . . Hysterical dumbness, deafness, blindness, anaethesia galore. I suppose it was the shock and the strain but I wonder if it was ever thus in previous wars?” The trenches were only nine months old, but it was becoming clear that doctors were facing an epidemic. According to one estimate, at least two hundred thousand British soldiers were eventually discharged because of shell shock.
By the middle of 1916, Myers had personally seen over two thousand shell-shocked soldiers.

As a phenomenon, shell shock confounded the prevailing theories of the day. Within the annals of military medicine there was simply no precedent for it. In the first reports on the subject, one detects a sense of bewilderment at the grotesque symptoms being encountered. One British military doctor wondered if the explosions of the shells weren't damaging the entire central nervous system. A distinguished neurologist, F. W. Mott, speculated that carbon monoxide poisoning or tiny particles from the shells might be the source of the trouble.
Industrialized warfare was new, and the understanding of the effect that it might have on the mind was still dominated by the stark images of exploding shells and the mysterious forces they presumably released. As a result, most of the explanations for shell shock centered on physical causes. The psychiatrists were, in a sense, trapped in the same predicament as the generals: just as the military tactics of the time had yet to catch up to the weaponry, so too had medicine yet to catch up with twentieth-century high explosives.

Myers, who was familiar with French thinking on hysteria, treated the first case with hypnosis and sent the man back to England after ten days of treatment. In his
Lancet
article, he argued that “the close relation of these cases to hysteria appears fairly certain.” Hysteria, derived from the Greek word for uterus, was until the late nineteenth century thought of as basically a female disorder. The idea that men could be reduced to weeping, spasming shadows of their former selves was practically unheard of. Freud's ideas on hysteria, which could have been of great service, were not widely accepted at the time, being largely confined to a group of disciples clustered around Vienna.
Twenty years before the war, Freud had argued that hysteria was caused by unpleasant memories and experiences. These repressed memories were “flung” into the unconscious in an attempt to avoid mental conflict. In extreme cases, repressed memories were “converted” into physical symptoms, which bore some resemblance to shell shock. Later, Freud would theorize that war neuroses were caused by an internal conflict between self-preservation and the need to maintain one's sense of honor and duty to comrades.

Some contemporary trauma workers, such as Bill Nash, a retired U.S. Navy psychiatrist, have suggested that these sorts of “conversion disorders” were related to the stigma associated with not doing one's duty and not being “manly,” a powerful motif in British society at the time.
(This was, after all, an era that saw women handing out symbolic white feathers of cowardice to men not in uniform.) The fact that hysterical blindness and mutism, common during World War I, are almost nonexistent today seems to confirm Nash's thesis, as “stigma reduction” with respect to PTSD has become a part of the medical culture within the military. This issue of stigma is, in fact, one of the great points of divergence between the Great War era and our own.

By late 1915, the British Army, realizing that something had to be done, broke with its old policy and officially admitted to the existence of a gray area between cowardice and madness. This new policy, enacted by the Army Council in London, established what amounted to a two-tier system: shell shock caused by enemy action and shell shock resulting from a simple breakdown.
In official reports, this distinction was to be recorded as either “Shell-shock W” or “Shell-shock S.” In the minds of many, including Myers, this system was ripe for abuse. One medical officer complained to him, “We have seen too many dirty sneaks go down the line under the term shell-shock to feel any great sympathy with the condition.” Six months later, Myers proposed that the term shell shock be abandoned and replaced with two new categories, “concussion” and “nervous shock,” but popular opinion both inside and outside the army was fixed. In part because of its power as a metaphor, shell shock was here to stay.

Confusion about how to treat war neuroses was reflected in this confusion about what to call it.
The nineteenth century had seen the development of a number of psychological theories, and when the war came, these theories were put to the test. More than a few doctors saw the war as an opportunity to experiment. Military doctors on both sides unleashed an arsenal of therapies on the shell-shocked soldiers, including hypnosis, drugs, talk therapy, milk diets, bed rest, physical exercise, “military discipline” (which frequently meant shouting insults at shell-shocked soldiers), and a crude form of electroshock therapy.

Unsurprisingly, the use of electricity on soldiers was controversial.
One French soldier, Baptiste Deschamps, punched a physician when he tried to apply electrodes to his body. Because he had struck an officer, Deschamps was court-martialed. Eventually, the French press, which had been growing increasingly skeptical of the war, seized on the story, and Deschamps's case became a
cause célèbre
. He was given a light sentence in the form of a suspended six-month prison sentence. The doctor who had attempted to electrocute him, Clovis Vincent, whose center at Tours was infamous for its electrocution technique, known as
torpillage
(literally, “torpedoing”), voluntarily stepped down and asked to be reassigned to the Western Front. While a few other doctors continued to experiment with it, by 1918
torpillage
had been discontinued and its leading proponents excoriated in the press.

One doctor who championed a more liberal approach was Myers's old mentor at Cambridge, W. H. R. Rivers.
A doctor who seemed ill at ease in uniform, Rivers was a member of the same New Guinea expedition as Myers, a trip that epitomized both his wide-ranging intellectual interests and his deep human sympathies. His medical knowledge, while not as technically polished as many of his peers', ran deep. If later generations would come to idolize him, converting him into a sort of iconic doctor-hero, as novelist Pat Barker did in her award-winning
Regeneration
trilogy, it was not without reason. With his myopic, reserved demeanor and humanistic sensibility, he seemed the embodiment of the modern physician as Renaissance man.

The son of a Kent clergyman, Rivers possessed a sort of puremindedness and omnivorous curiosity about the human psyche that has fallen out of fashion today. This curiosity took him through a variety of investigatory incarnations, including that of international anthropologist, general practitioner, ship's surgeon, and house physician to two famous neurologists in Queen Square, London, all prior to heading to Cambridge as a lecturer in psychology in 1893. One colleague was later to say of him, “Perhaps no man ever approached the investigation of the human mind by so many routes.”

After the war, Rivers would conduct a study of war neurosis published in the War Office's inquiry into shell shock.
His conclusions were fifty years ahead of their time. Examining the incidence of neurosis in the air corps, he found that neurotic symptoms were best correlated not to the intensity of the action seen nor the amount of time spent in combat but to the relative physical immobility of the victim. In the air corps, as in the infantry, neurosis was a function of having control over one's surroundings. Examining medical records, Rivers found that, among other things, the pilots, who enjoyed a degree of control over their fate, suffered far fewer cases of neurosis than artillery observers in the balloon service, where men were tethered to the ground, essentially sitting ducks. Incredibly, he found that in the balloon service, the psychiatric casualties actually outnumbered those who were physically wounded. In short, the more helpless the patient felt, the more likely he was to be traumatized, a finding that remains essentially unchanged to this day.