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This chapter examines the role of the medical services in the major offensives that began in the summer of 1916 with the Battle of the Somme. It shows how arrangements for casualty disposal were gradually altered in such a way as to maximize efficiency. It also argues that medical planning was sufficiently flexible to cope with the advent of mobile warfare in 1918. It argues that the success of medical arrangements was due to an unparalleled degree of coordination between different branches of the army and the consistent interest taken in the medical services by senior commanders. In addition to operational planning, the chapter considers the ways in which efficiency was improved through growing specialization of treatment. It does so first by examining various aspects of surgery, including the treatment of abdominal wounds, then medical problems, such as the treatment of gas casualties, and, finally, the management of shell-shock in front-line facilities.

This chapter examines Ford’s Parade’s End in comparison to Rebecca’s West’s earlier novella, The Return of the Soldier, exploring the different ways in which their respective protagonists ‘work through’ the psychological and emotional legacy of war. Opening with an initial survey of contemporary responses to the newly-emergent condition ‘shell shock’ – medical definitions, military classifications and the emerging field of psychoanalysis as theorised by Freud and W. H. R. Rivers – the chapter goes on to discuss Ford and West’s engagement with these discourses in their fiction as both attempt to imagine the possibilities for the reintegration of the mind after the return from war. It concludes by exploring the ways in which this paradigm of psychological trauma contributes to the authors’ literary modernism.

Chapter 2 launches our study of the body at war—the injured soldier’s body during and after World War I, and specifically the body that, once injured, appeared to be at war with itself. The chapter focuses on the fierce debates around “wound shock” that took place in the period 1916–1919 and that brought together many of the protagonists of this book who have since receded into historical oblivion. It also locates shock in a group of daunting whole-body conditions: “soldier’s heart,” shell shock, sepsis, shallow breathing, and exhaustion. These conditions provided sites for pursuing, adapting, and applying research, particularly on hormones and the interaction between different systems within the body, and consequently they supplied a framework for understanding how each organism behaves—and collapses—as a unit.

This chapter presents a historical outline of trauma as it was understood during the First World War, the interwar years, and the Second World War, and studies the cultural context of war neuroses in Britain, pinpointing their roots in nineteenth-century models of traumatic neuroses. It discusses the transformation of war neuroses into ‘shell shock’, a term that was coined by Charles Myers in 1915. Myers, along with W.H.R. Rivers, determined that ‘shell shock’ was due to psychological damage, and not physical damage. The chapter notes that the Freudian concept of repression is relevant to Rivers’ and Sassoon’s understanding of trauma. It also shows the link between Sassoon’s socially detached response and the wider social and cultural response to the renewal and threat of modern war.

Contrasting the fractured point of view of combatant writers like Siegfried Sassoon, Wilfred Owen, Isaac Rosenberg, and Ford Madox Ford to the heroic prospects projected by official War Artists like Muirhead Bone and war poets like Rupert Brooke, this chapter argues that most urgent task confronting the military authorities was to bridge the gulf between the commanding strategic perspective and the collapses of vision in the trench labyrinth of the Western Front. It explores how despite its notorious failures the war machine used propaganda, censorship, military discipline, camouflage and other new technologies to recapture the oversight of battle, turning the imperial sovereign gaze on the minds and bodies of the mass army in the trenches. Despite antimodernism on the home front, the military authorities covertly cannibalized modernist culture in their struggle to modernize. But the camouflaged modernism of Rosenberg, Vera Brittain, or Ford's Parade's End demonstrates a more sceptical response to the dominant perspective of war.

This chapter discusses the complex representations of war heroism in Ford Madox Ford’s Parade’s End and in May Sinclair’s four war novels: Tasker Jevons: The Real Story (1916), The Tree of Heaven (1917), The Romantic (1920), and Anne Severn and the Fieldings (1922). It argues that Ford and Sinclair, albeit differently, helped forge a new type of literary war heroism through their specific use of Freudian psychoanalysis. With Ford and Sinclair, heroism is transferred from the expected war records to the many intellectual and psychological battles fought by the soldiers’ minds. The antecedents, thoughts, feelings, impressions, and unconscious mind of the soldiers are the main focus of Ford and Sinclair’s construction of war heroism. This chapter argues that the experience of fragmentation, the struggle for continuity through culture, and the impossibility of a return to civilian life are three of the key dynamics in Ford and Sinclair’s portrayal of their modernist heroes.

Chapter Four addresses Arthur Hurst’s experimental treatment of shell-shocked soldiers at Netley Hospital in Hampshire, many suffering from exaggerated or inappropriate flinch-reflexes. Shunning both the physical punishments and talking therapy approaches used by his colleagues, Hurst’s approach relied on developing a theatrical ‘atmosphere of cure’ in the hospital, both recorded in and facilitated through his medical film War Neurosis (1918). Whilst the relationship between actresses and hysterical patients has been well documented, this chapter argues that in Hurst’s theatre both medical staff and patients were suggestible audience members, an idea which resonated with the period’s concerns about contagious emotions in theatrical crowds. The chapter ends with a discussion of the author’s winces whilst viewing Hurst’s film in the Wellcome Library, London. It argues that paying attention to our embodied encounters with ‘intolerable imagery’ of the last century may help us think about questions of participation and looking in the twenty-first.

This chapter discusses the means by which the protagonist of Parade’s End manages to preserve his sanity and peace of mind under wartime conditions. The war offers him relief from the trauma of his marital difficulties; his position as a member of the landed gentry obliges him to provide unofficial therapy to fellow officers and subordinates suffering from trauma and shell shock; and various images of pastoral innocence help him to control his fragmented ‘minds’ and emerge from the hardships of war with ‘a mind entire’. His mind is not shattered by the war but clarified and purified by it. When peace arrives he refuses his heritage and returns to his beloved to live simply, frugally, and with respect for the natural world.

This chapter surveys the limited success of psychiatry in reaching beyond asylums through the development of psychological clinics and the promotion of ‘mental hygiene’ in the interwar years. It draws attention to a quieter but more far-reaching process of integrating a psychological dimension within general practice and general hospitals that reflected, in part, misgivings about an overly materialist medicine. This was encouraged initially by a focus on private consumers of medicine, as well as worthy shell-shock recipients, and by forms of psychotherapy and discourses that focused on the nerves, rest, and personal attention. A shift to patients who were recipients of a state service, despite psychiatric epidemiology that claimed a psychological dimension in a third of all illness, exposed limited state resources and a continuing concern about malingering that held back the development of psychological medicine, even under the National Health Service.

This chapter analyzes the “case study” during and after WWI as a narrative, analytical, administrative, and hermeneutic device crucial to the narrativization of war neuroses, neurological damage, and physiological disorder. Case histories, already a psychiatric, criminological, and medical device, proliferated during the war. We offer a historically-informed theory of the case study and its uses, and we focus on studies reported by W.H.R. Rivers, Charles S. Myers, E.E. Southard, René Leriche, and Adhémar Gelb and Kurt Goldstein, because they adopted the case study method in different ways a tool for researchers to understand the effects of uncategorizable war wounds. Case studies thus aided in bureaucratic administration as much as individualized care. Thus, Myers tried to divide patients into straightforward categories despite the great complexity of their individual scenarios. Southard collected thousands of case studies on shock, drawing material from records in Germany, France, England, and the US to aid in the clustering of symptoms and an aggregative organization of disease. Gelb and Goldstein, for their part, began presenting case studies toward the end of the war, emphasizing the individuality of his patients and his focus on practices of interpreting “performances” and caring for “individuals” rather than wounds or types.

This chapter begins by considering Wilfred Owen’s powerful poem, ‘Mental Cases’. The devastation of shell-shocked men is starting to be understood but what of the women who nursed these traumatized victims? The chapter teases out their experiences and assesses the implications for the professionalisation of mental nursing using the Cardiff City Mental Hospital/Welsh Metropolitan War Hospital as a case study. A variety of sources aid examination of the intersection of four key themes: medicine, gender, class, and war. In addition, nursing registers are used to identify the occupational and social backgrounds of recruits and to track the destinations of staff leaving the Hospital, often after only a short period of service. This raises questions about how far the pressures of war dissolved traditional gender and class relations.

By the end of the First World War the defence that an accused was prompted to committing his crime because of shell shock was heard regularly in British courts. There are no statistics available for the number of occasions on which such a defence was employed, but this chapter explores the range of cases for which it was used and draws comparisons between such use during and in the immediate aftermath of the two world wars. The chapter concludes with a similar assessment of the use of the defence that the accused had suffered trauma as a result of being a prisoner of war.

World War I marked a moment of social transformation in British medical culture and was thus an extraordinary period of change for clinical neurology in Britain. Before the war the British medical world was avowedly generalist; after the war that medical world embraced specialisation. It was the conditions of the First World War that stimulated these changes, and for neurology, as neurologist Edwin Bramwell observed, ‘the Great War constitute[d] a convenient if arbitrary dividing-line between the present and the past.’ How it did is a story of head-injuries, shell shock, pacifism, and the emergence of medical modernity in Britain.

This chapter first argues that Some Do Not . . ., the first volume of Ford Madox Ford’s First World War tetralogy Parade’s End, appropriates the plot and themes of Rebecca West’s The Return of the Soldier. Both works are early engagements with the formulation of shell-shock as a medical condition and are simultaneously theorizings of modernist historical practices. For Ford especially, traumatic amnesia becomes a model for a modernist historical narratology and an impressionist aesthetic: language cannot directly name historical objects, which instead must be “thought round,” to use the words of Ford’s protagonist Christopher Tietjens. Some Do Not . . . also suggests a place in historiography for amnesia and forgetting: the novel’s ellipses, nonlinearity, and radical use of indirect discourse, rather than distancing the text from history, actually pull intimately close to the process by which human memory becomes historical text.

This chapter examines psychiatric discourse and practice during the war and early post-war years to argue that the doctors’ sense of nationalism and contemporary socio-medical theories determined diagnostic practice when dealing with mental breakdown of prisoners and non-prisoners alike. Following the German approach to psychiatry, Ottoman-Turkish neuro-psychiatrists, namely Mazhar Osman, believed that ‘war neurosis’ and ‘shell-shock’ were nothing more than hysteria or neurasthenia and only those who were weak or hereditarily tainted succumbed to them. During the war, prisoners, having escaped the war, were assumed to be free of mental disorders. However, when they were slowly repatriated well after the war, neuro-psychiatrists observed that many suffered from significant mental problems. Many of them were diagnosed with schizophrenia. Whether it took place while fighting or in captivity, mental ailments from which the soldiers and prisoners suffered were interpreted as indicators of an already existing condition. Rather than being seen as victims of industrial war or long years of captivity, these men were deemed to be the victims of their tainted heredity, where war or captivity only served as a pretext to uncover an underlying condition.

This chapter examines two documentaries about war trauma—War Neuroses: Netley, 1917, Seale Hayne Military Hospital 1918 and Let There Be Light—to explore the ways in which nonfiction film, with its assertion of the knowability of the world, may also be a “document of the real” in Lacan’s sense. The first documentary shows the treatment of soldiers who suffered from “shell shock” during World War I while the second presents the treatment of the trauma symptoms of soldiers in the United States during World War II. The chapter also discusses the excesses of signifying in what is shown and what is said in a factual film.

This chapter investigates the issue of landpower from a demographic perspective, exploring the realities of military manpower in a time when fewer than 1 percent of the American people serve in uniform. Since 9/11, the United States has deployed in combat situations this minority of the population in Afghanistan and Iraq, where thousands have been exposed to a new-age weapon of choice, the IED, the Improvised Explosive Device. Many hundreds have been killed or maimed for life. Many thousands more have suffered debilitating, if not life-changing, head and brain injuries. The latest generation of diagnostic tools now available to medical professionals, magnetic resonance imaging, makes clear the catastrophic damage such weapons inflict on the human brain. These findings have enhanced the scientific and popular understanding of the nature of post-traumatic stress disorder, and such precursors as Combat Fatigue, Shell Shock, and Soldier's Heart. The lingering question remains the extent to which the USgovernment and the governed will recognize and act on the revealed science.

This chapter argues that the pastoral mode in Rebecca West’s First World War novel The Return of the Soldier stages many of the levels of the process of recording history. Due to the protagonist’s shell-shock, we are never directly presented with trench warfare; West instead exploits the pastoral trope of presence via absence: Christopher Baldry’s amnesia continually suggests a traumatic and shattering war that is beyond the scope of representation. Baldry’s amnesia is also the novel’s meditation on the role of forgetting in narrative history. Baldry expresses a Nietzschean desire to escape from the oppressive burden of history, while the text simultaneously alerts us to the sobering need for memory and remembrance. However, Baldry’s forgetting, paradoxically, preserves the traumatic nature of the war in a way that any fully informed account could not, as amnesia becomes the depository of historical experience

Chapter four opens with a close reading of Mrs Dalloway outlining the ‘fugal’ form of the novel. It places the novel in a matrix of medical, musical and military discourses about fugue, proposing that the novel’s form is shaped by Bach’s music. It considers the way music informs Woolf’s representation of shell shock and hysterical fugue, and thus her response to the First World War. The chapter then turns to two related questions: the association of music and homosexuality in Mrs Dalloway, Jacob’s Room and The Waves, and the relationship between music and free association in Mrs Dalloway, The Waves and ‘The String Quartet’. The chapter proposes that music informs Woolf’s representation of (homo)sexuality, and that music provides Woolf with a means of both creating and disrupting textual order.

This book addresses images of nineteenth-century slavery in several twentieth-century, modernist novels and photographs. The texts under discussion here are not direct literary testimony to historical violence; rather, they evince the “overlap,” at once temporal and textual, between writing and the writing process, between traumatic symptom and critical recognition of trauma, between historical events of extreme violence and subsequent, quotidian psychic life. Freud read the game as a figuration of the child's mother's absence. More broadly, he identified the fort/da game as “beyond the pleasure principle”: it is not driven by the search for gratification, since the baby is not representing something he wishes to have. Instead, fort/da is a critical activity. Beyond focuses on traumatic illnesses, such as soldiers' “shell-shock,” whose severity and extrapsychic origins pose a fundamental challenge to psychoanalysis.