Traumatic Pasts: History, Psychiatry, and Trauma in the Modern Age, 1870–1930

This book is a compilation of scholarly writings by a group of historians specializing in a newly emerging field of historiography—the study of trauma and, more specifically, the study of psychological trauma, viewed from the point of the professional historian. None of the 10 authors is a clinician or has worked in the field of behavioral sciences, i.e., none is a physician, psychologist, or social worker.

The book consists of four parts presenting a temporal as well as conceptual sequence to reflect the development of European and American thought about the nature and consequences of mental trauma. The authors focus almost exclusively on the role of medicine in understanding and managing trauma, but they place medical thinking in the context of scientific and sociocultural developments.

The book starts with the psychiatric consequences of railroad accidents in Great Britain and the United States, goes on to industrial (work) accidents and the development of disability legislation, then presents two chapters on classic papers on “traumatic neurosis” as conceived by Charcot and by Oppenheimer, and concludes with the role of psychiatry in World War I and its extension (mainly in the United States) in the postwar years.

The first question confronting a physician-reviewer of this book is, inevitably, What is there in a collection of historical studies for the physician and, by extension, any allied health professional? The answer is, More than we would expect. The fact that the authors are historians is an asset to the serious reader. The historical studies provide a detailed, chronological narrative about topics of clinical, forensic, and research interest: how do we view psychiatric symptoms following civilian and military trauma, what is the role of somatic and constitutional/genetic factors, how have physicians viewed hysterical or somatization symptoms versus simulation, what has the role of the physician been as disability examiner and as dual agent?

Although the book is a multiauthor compendium, the reader gets the history of psychological trauma in a coherent fashion. Depending on the reader’s needs, he or she can use the data to advantage in his or her field of clinical practice or research with the facilitating context of historical background. The authors have largely stuck to their function as historians; therefore, clinically trained readers are free to lend their own clinical interpretations to the data. Comparing my own studies of psychiatry in World War I (1) with the composite picture created by several different authors in this book, I found historical affirmation of my thesis that Allied psychiatrists approached the traumatic syndromes in the military differently than their colleagues of the Central Powers. The democratic political base of the Western Allies encouraged a more sensitive, scientifically more open, and more humane approach than the more primitive, repressive measures practiced by German and Austrian psychiatrists, reflecting their countries’ relatively more autocratic regimes and their own different roles as government agents. The paper by Bruna Bianchi on Italian psychiatry in World War I is particularly interesting in this regard. Italy was the exception among the Western Allies in that its autocratic form of government (where the psychiatrists were direct agents of the government, as they were in Germany) used methods more similar to those of their enemies (the Germans and the Austrians) rather than their Western Allies. The very convoluted paper on French military psychiatry, which contains very controversial views about the complexities and variations of French neuropsychiatry, nevertheless, because of historical documentation, confirms the persistence in France of democratic civil safeguards in spite of the pressures of military necessity.

Some of the chapters are difficult to read and digest, but all offer valuable information, and the book, overall, is a treasury for the interested and psychiatrically erudite reader. I found the best at the very end: the paper by Caroline Cox on American “shell-shocked” veterans and the impact of Dr. Thomas Salmon and the American Legion on our society ever since 1919 is refreshingly readable and should be of exceptional interest to any mental health professional. As Hausman and Rioch and I have previously proposed (2, 3), American military psychiatry learned from French military psychiatry during World War I and laid the foundations for modern community psychiatry. Cox’s chapter continues the history of important postwar developments: the American Legion succeeded in humanizing society’s attitude toward the mentally ill by bringing about Congressional action to provide psychiatric services and financial support for “shell-shocked” veterans.

In the wake of the World Trade Center terrorist attack, the proper understanding of psychic trauma is more important than ever before. This book, written and published before September 2001, puts psychic trauma into historical, “developmental” perspective. The diligent reader will profit from comparisons of past phenomena in their context with what we see today. History shows the constancy of posttraumatic psychiatric disorder across changing cultures and developmental levels in Western European and American populations. As shown by the historical studies gathered in this book, a great deal is known about reactions to trauma, but the astute clinical observations and the resulting theories by our illustrious medical predecessors were not adequately organized in a generally accepted body of knowledge.

The book, as a whole, shows the growing pains of a field of research and practice in psychiatry. The authors, being historians, correctly leave it to educated clinicians to take the valuable discoveries of the past and incorporate them into contemporary thinking. For that purpose, this book is a good source of historical information to be used judiciously and critically by the mental health professions.