September 22nd 2001

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Articles from this issue:

STOP PRESS: Who has declared war on the United States?

COVER STORY: Canberra to blame for Ansett's demise

CANBERRA: Asylum seekers bring ill tidings for Beazley and the ALP

COMMENT: Boat people reaction - echoes of the 1970s

NEW ZEALAND: Army caught in political imbroglio

STRAWS IN THE WIND: Send in the counsellors / Good morning, Vietnam

MEDIA: Out of touch with majority sentiment

LETTERS: Tristar: another view

Letter: Poor reception

Letter: Let them stay

REGIONAL AFFAIRS: Why East Timor chose Portuguese

TRADE: Lamb exports: where to now?

BUSINESS: Selling wholesome food to Australia's homes

FAMILY: Well-being of families and nation intertwined

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Send in the counsellors / Good morning, Vietnam

by Max Teichmann

News Weekly, September 22, 2001

Send in the counsellors

Writing in 1787, of the new Humanism, in his Italian Journey, Goethe observed, "I think it is true that Humanism will triumph at last; only I fear that the world will at the same time be a vast hospital, where each will be his fellow man's humane sick nurse."

In A War of Nerves, Ben Shephard, a producer on the television series The World at War and The Nuclear Age, and contributor to collections on imperialism and popular culture, and to histories of psychiatry, has produced a remarkable and very well researched book on the relations between soldiers and psychiatrists, from 1914-1994. But this study is also a history of the disputes between the psychiatrists themselves, over classification and diagnosis of soldiers' mental collapses and psychosomatic symptomatology; over prognosis, and methods of cure. Behind them stood the State and the military establishment, the latter conservative and hostile to psychiatry, with both it and the State basically fixated upon winning the war, if necessary at all costs.

From the beginning, RMOs (Regimental Medical Officers), as well as psychiatrists, were really at odds with the State and Army. Doctors were trained to save lives, not collude in their destruction (I leave aside Nazi doctors, abortionists and euthanasiacs); and restore the patient to health, to rejoin the community and his family and friends. But here - was the saving of lives and restoring men to health an end in itself - or a means to returning them to war, and possible death? Like repairing a tank or a gun?

The State and the military mind had no problem - soldiers, and if necessary civilians, are the means indispensable to the State achieving its political aims - in this case, successfully defending the State from attack, and/or winning the war. If the State gives up this role, and this right, then it must perforce embrace some variety of Pacifism - some would say, cease to be a State - while the job of military leaders and planners could become impossible.

But the dilemma of doctors and psychiatrists is not normally regarded as soluble by appeals to Realpolitik - borrowed from State and army ideologies. This was dramatised when dealing with "shellshock" cases, for these men were signalling their inability, or their tacit refusal - albeit confused - to go on fighting.

Ben Shephard gives a brief history of the concepts which purported to explain what was in such a soldier's mind, and how it related to his body; concepts, the currency of which rose and fell as they were found to be in one way or another, inadequate, or even, irretrievably speculative.

The concepts of hysteria and neurasthenia predated Freud - he used them, then passed on to others which he thought more illuminating, but anyway, both were in season in 1914. But a flood of, if you like, hysterical conversion cases appeared, especially after the Somme in 1916, and became known as "shellshock". Because the experience of being continuously shelled and mortared, and sniped, with gas shells thrown in, seemed as war progressed to be producing an eventual psychic/physical collapse on the part of many soldiers. Quite dramatic symptoms - blindness, loss of the power of speech, uncontrollable shaking, continuous vomiting, paralysis of the limbs, constant terror when awake, and heart-rending nightmares, to name but some - swept through the troops. Such men could no longer fight, and had to be treated. But how?

Shephard takes us through the various curative strategies tried from 1914 on, for psychosomatic disorders, i.e., physical symptoms of a disabling kind which, apparently, had no organic base, or cause. Very often the treatment reflected the philosophy and social attitudes of the doctors. I should add that psychiatrists had very little influence in the World War I armies, and the psychoanalysts even less - and were only empowered then, and at war's end, to look after the long-term cases. World War II was rather better, but physical medicine still occupied the high ground - as it appears to be doing again, e.g., medication of a sophisticated kind, and before that electro-convulsive therapy and an era of leucotomies and lobotomies.

In the beginning soldiers with disabling psychosomatic symptoms were "malingerers" or "cowards" and treatment should really be punishment, and deterrence. That became most difficult to sustain as many soldiers decorated for bravery - and many officers (assumed to be of stronger character) and men who'd fought non-stop for two or three years - were collapsing and becoming weeping, terror-stricken children.

The army tried rest - holiday-camp-style, retraining, more frequent spells out of the line (this depending on how many fighting men a country had); peer group pressure ("What would your mates think?"; "Are you going to leave them out there on their own?"); the ignominy of being regarded as a failure - a break-down - by family, and the world. But also, electric shocks, which the Germans used extensively and ferociously. Their psychiatrists reported great success, even though some patients died during treatment.

The military mind's suspicion of shellshock, and terms replacing this, was not entirely baseless: men started producing the symptoms who'd never heard shellfire, or reached the lines; then began reporting chronically ill when they first arrived in France. The symptoms of shellshock had become well known (indeed the term was dropped) - and the verdict was either extreme suggestibility, or malingering. Then there was the fact that most soldiers didn't crack. Dropping imputations of malingering, etc., the predispositional factor was seen as character, sometimes flowing from heredity. Maybe, but the question of what to do remained. If treatment failed with these defectives, then hospitalise them and discharge them. So they were given a pension.

As Shephard says, the effects of pensions and allowances on war neurotics were already noticed during the war. "The whole therapy was so vitiated by the pension system," the British pychotherapist T. A. Ross wrote of his work between 1917 and 1921, "that it was impossible to gauge the value of any form of treatment." He found that, as men got better, the thought of losing their allowance (and with it a guaranteed livelihood) would cause their hysterical symptoms to return or new symptoms to appear.

Agreeing, the French would give no pensions to psychoneurotics; the Germans did, until 1926 Weimer finances couldn't carry them. Then, according to the doctors, the Kriegszitter abruptly lost their symptoms and functioned normally.

British and American public opinion ruled that out. So large numbers of men remained in hospitals not recovering, often not seriously treated. Therapeutic strategies seemed semi-pointless. Large numbers of other non-hospitalised men remained on invalid pensions, for psychoneurotic disabilities, for the rest of their lives.

Britain determined this would not happen again, as did the US when she entered World War II. Since different men reacted quite differently to the same traumatic event or process, that most didn't break down, that those who did break might be predisposed to do so, and were having the psychic collapse that they would have had anyway - testing recruits to keep such people out was adopted. But the loss of personnel continued very much as before - whereas the Germans and Russians didn't have similar problems. For whatever reason.

Good morning, Vietnam

Vietnam produced what Shephard calls the "Culture of Trauma". It was then that the notion of stress became the ubiquitous feature, not only of military life, but of every nook and cranny of our existence. Introduced by Hans Selye, who used it (with indifferent success) to explain diseases such as arthritis, it became a permanent darling for the media, which, along with ambitious psychiatrists and drug companies, have promoted it endlessly.

After stress, there appeared general and then delayed stress syndrome, which came from the experience of trauma, so finally we arrived at Post Traumatic Stress Disorder (PTSD) - which is where we are now.

Except that Holocaust Stress - delayed - not codified before the early '70s, was conjoined in the umbrella analysis; to be followed by "recovered memories" of early childhood sexual abuse - an initially popular new field of research with punitive legal strikes against suspect fathers and much legislation cum compensation, but recently fallen into disrepute because of quite dubious evidence and evidence collection.

Then there are RSI and Chronic Fatigue Syndrome - and Agent Orange. Finally, we have the Gulf War Post Traumatic Trauma.

This need not be the end - the Stolen Children compensation reparation project rests heavily on the theory of PTSD - while I'm looking forward to the coming Illegal Immigrants Detention Centre Post Traumatic Stress Syndrome. Starving lawyers, and publicity-hunting judges and clerics, please note. Don't leave all the work to our cash-for-comment journos.

To return to the Vietnam War, where this whole ambitious operation took off, psychiatrists and liberal journalists became the legislators of mankind, and compensation the biggest game in town. After all, you can't get compo for Weltschmertz or ennui, fin de siècle or alienation, or grief at the death of God, so out with this soft-core stuff.

To dispel some illusions about Vietnam:

  • 70 per cent of Americans supported the war until the end;
  • 70 per cent supported the bombing of Indochina until the end;
  • a 1990 Harris poll found that 71 per cent of Vietnam veterans said they were glad they went;
  • 74 per cent enjoyed their tour; and 60 per cent said they'd serve again.

While drugs were coming into the US in the '60s, by late 1970, one-fifth of the army was addicted to drugs, and in 1971 more troops were being evacuated for drug use than for wounds. But only two per cent of veterans used heroin in civilian life. They got off it. It was the Peace Movement and the Black Power Movement that stayed on it and propagated the drug ethos - while ruining their movements.

But PTSD had certainly burgeoned, for in 1988 a Congress commissioned study reported that in the 15 years after the last American combatant had left Vietnam, 479,000 of the 3.14 millions who'd served there still had PTSD, and almost one million in all had developed full-blown PTSD. Yet of those only 300,000 had been in combat.

Very briefly, television was quick to see the potential of "trauma" as were lawyers, who have set up the legal trauma industry. This overlapped the great new counselling industry, the training for which has in places become as opaque as have the hard-core results, not to mention the very large number of people now adjudged as needing counselling. Whether they want it or not.

And, we now have the Depression we had to have. Replete with Institute. With no clear agreement as to its definition, aetiology, diagnosis, prognosis or cure: nevertheless, drug companies and academic psychiatrists are already licking their pencils in anticipation.

Such psychic huckstering will finish with Goethe's worst fears, and suspicions, being borne out.

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