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Book Forum: Psychological and Physical Trauma   |    
A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century
ROBERT J. URSANO, M.D.
Am J Psychiatry 2003;160:601-601. doi:10.1176/appi.ajp.160.3.601
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By Ben Shephard. Cambridge, Mass., Harvard University Press, 2001, 487 pp., $27.95.

Mr. Shepherd takes us from 1914 to 1999, marching through the terrors of war of the past century, with a British perspective. As a journalist, his writing is engrossing and moves across time attracting the interesting, the notable, and the informative. Mr. Shepherd has written widely on psychiatry and its history and has produced television documentaries for the British Broadcasting Corporation. To point out the missing information and the areas of controversy would require much time and space. However, the reader who embarks on this historical perspective piece will find much to keep his or her attention and, of course, much to wonder about and disagree with.

The first recorded case of "shell shock" was in February 1915. The term was already in use in the Army. The debate over the cause of these cases was "fierce." Shepherd notes that this debate was in the context of a change in world view in Britain. In the 1894 Spectator, it was noted that the words "nerve" and "nervous" had changed their meanings. At one time, "nerve" meant to have strength or force, and "nervousness" denoted courage and vigor. Now "nerve" had become "nerves" and "nervousness" meant timidity or cowardice. One "lost one’s nerve." It was in this context that shell shock was born.

Mr. Shepherd describes cases and the social history of the times that led me frequently to consult the references cited to find the exact time, place, and origin of the statements. There is a rich streak of history that a historian might find wanting, but if one keeps in mind that this is a perspective piece, an extended editorial, then the history evokes "you have got to be kidding!" feelings in every chapter, particularly in the discussions of World War I (the first 200 pages).

The stories of World War II, Korea, Vietnam, and the Gulf War are in the later 200 or so pages. The Gulf War is barely mentioned, perhaps rightly because the closer in time to the present, the more difficult it is to get historical perspective. To my reading, the editorializing increases in the later half of the book, and, of course, some of one’s own treasures are barely mentioned. There is little on the importance of the studies of prisoners of war after World War II, nothing on the Vietnam-era prisoners of war, and nothing on the other engagements of the century, such as Somalia and Haiti. The Navy, with its particular stresses and horrendous losses at sea in both world wars, is not discussed, nor is the Merchant Marine. The Air Force is occasionally added to the discussion (1).

Great Britain and the United States are contrasted, usually in a balanced manner, identifying errors on both sides. Many would find things to disagree with, such as Shephard’s statement that in the care of soldiers after World War II, "British post-war policy was very low-key and, by modern standards, tough, whereas American policy was more ambitious, even tender….What especially distinguished the American approach from the British, however, was the lavish psychiatric treatment provided" (pp. 328–329).

The recent legal battles in Great Britain of veterans of the Falklands War have raised the issues of how veterans should be cared for, from diagnosis to treatment. We still struggle with this issue today, particularly as we look for new early interventions after traumatic events, including war and the possibilities of terrorist attacks with weapons of horror (2, 3). Ben Shepherd reminds us of the historical context of such societal events. We might not all agree with his perspectives, but his documentation will fascinate and require thoughtful discussion among all who read this volume. It is worth the time.

Wells MK: Courage and Air Warfare: The Allied Aircrew Experience in the Second World War: Case Series: Studies in Air Power. London, Frank Cass, 1995
 
Ursano RJ, Norwood AE, Fullerton CS, Holloway HC, Hall M: Terrorism with weapons of mass disruption: chemical, biological, nuclear, radiological, and explosive agents, in Trauma and Disaster Responses and Management. Edited by Ursano RJ, Norwood AE. Washington, DC, American Psychiatric Publishing (in press)
 
National Institute of Mental Health: Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices: NIH Publication 02-5138. Washington, DC, US Government Printing Office, 2002 ()
 
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References

Wells MK: Courage and Air Warfare: The Allied Aircrew Experience in the Second World War: Case Series: Studies in Air Power. London, Frank Cass, 1995
 
Ursano RJ, Norwood AE, Fullerton CS, Holloway HC, Hall M: Terrorism with weapons of mass disruption: chemical, biological, nuclear, radiological, and explosive agents, in Trauma and Disaster Responses and Management. Edited by Ursano RJ, Norwood AE. Washington, DC, American Psychiatric Publishing (in press)
 
National Institute of Mental Health: Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices: NIH Publication 02-5138. Washington, DC, US Government Printing Office, 2002 ()
 
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