A close and critical reader of Freud, Rivers believed that the emergence of neurosis in the officers he treated was not the result of a single trauma but was part of an on-going psychological struggle between an officer's desire to forget the horrors of war and his memory's insistence that these events are actually the substance of the what the war represents.
"The Standard for Insanity"
http://www.k-state.edu/english/westmank/regeneration/neurasthenia.blake.html
Susan Blake (Spring 2003)
Since Pat Barker's Regeneration is set in a mental hospital, it seems fitting that questions about mental disease and the definition of sanity should be raised. At the very start of the book, Rivers and Bryce are discussing the case of Siegfried Sassoon, a dissenting officer of the British army. As they discuss his diagnosis of "neurasthenia," Barker is laying the groundwork for one of Regeneration's many themes: no one is completely qualified to judge the sane from the insane, for insanity finds its way into us all. The ambiguity surrounding the definition and treatment of neurasthenia offers just a glimpse into the ever-changing and highly subjective world of mental evaluation.
The history of neurasthenia traces back before World War I to a scientist by the name of George A. Beard. Beard coined the actual term "neurasthenia" which means nerve weakness (Marlowe). Neurasthenia was attributed rather vaguely to the stress of everyday life, or, for soldiers, the stress of the trenches. Many also felt it was a disease primarily of the upper class, which means it would apply more often to officers in the army than regular men. Andrew Scott Myrtle, who wrote on the validity of neurasthenia, believed like many medical professionals of the era that "it is not the machine workers, the factory workers, who suffer but 'the inventors of the machines'" (Gijswijt-Hofstra 145). Not only did neurasthenia come from the many stresses of daily life, but it also had a myriad of symptoms. Every article on neurasthenia offered a different set of acceptable symptoms, the most common being sleeplessness, headaches, and fatigue (Marlowe). Cures for neurasthenia were as varied as its symptoms. When working with one patient, Beard "promptly zapped the young doctor with a 'faradic current' from 'head to toe'" (Martensen 1243). Electric shock was still being used during World War I, as evidenced by doctors like Lewis Yealland, but other cures such as bed rest, sea-salts, and expensive cruises were also circulating (Gijswijt-Hofstra 145).
The sense of ambiguity that surrounded neurasthenia had a large effect on society's views of neurasthenic patients. Although World War I was one of the first instances where people recognized that mental disorder or disease might be responsible for actions that were otherwise characterized as cowardly, there remained a strong sense that diseases like neurasthenia were ultimately the result of a weak will. Robert Martensen describes neurasthenia as giving people a "socially legitimate explanation of their inability to perform their expected roles" (1243). More specifically in the military, "many senior officers argued that with good training and leadership they were avoidable" ("Psychiatric battle casualties"). As a result of the huge increase of diagnoses like neurasthenia, "strong nerves became the new cardinal virtue, representing a new anthropological quality of men" in the military and in everyday life (Hans-Georg).
The use of neurasthenia in Pat Barker's Regeneration occurs early on. Although the word is used synonymously with shell-shock -- which is not technically accurate -- neurasthenia still carries a significant social meaning. Holding up Sassoon's Declaration, Rivers says, "It just occurred to me that a diagnosis of neurasthenia might not be inconvenient confronted with this" (Barker 4). Bryce and Rivers go on to discuss how the officer in charge of the Board believes neurasthenia to be the correct diagnosis for Sassoon, even though that same officer had never before supported the notion of "shell-shock." Sassoon's situation is a fitting example of the ambiguity of the diagnosis of neurasthenia. First, the condition is thought to be caused by some sort of stress, an extremely vague and not very testable theory, and therefore the Board could conveniently apply it to Sassoon. The diagnosis would also be convenient because the symptoms can be altered to fit almost any physical state, including the fatigue from being on the front lines for an extended period of time. Thirdly, Sassoon was an officer, the upper-class of the army. His nerves were supposedly more fragile than the nerves of a working man who was brought up under the stress of manual labor and potential poverty. Perhaps most important, however, is the social implication that Sassoon's diagnosis brings up. Being diagnosed with "nerve weakness" threatened Sassoon's cause in two ways. First, it called into question how much he was in control of his faculties at the time he was writing his Declaration. While the Declaration appears logical, a medical diagnosis such as neurasthenia might be enough to make some members of his audience question Sassoon's claims. Second, part of the appeal of Sassoon's Declaration is that he is not just a dissenter; he is a decorated officer with plenty of war experience. Although mental disorders were becoming more understood during the war, there was still a large percentage of people who scorned neurasthenic and shell-shocked soldiers for not being able to handle the stress. Sassoon might have been a war hero at one point, but a diagnosis of neurasthenia would call into question his will and his masculinity.
The cultural attitudes toward neurasthenia help develop the theme that no one is completely qualified to judge the sane from the insane, for insanity finds its way into us all. Sassoon was diagnosed with neurasthenia, but his view of the war struck many people as much more sane than the strategies of military leaders. When Rivers informs Sassoon that "taking unnecessary risks" is an indication of mental illness, Sassoon asks, "What's an 'unnecessary risk' anyway? The maddest thing I ever did was under orders" (Barker 12). From Sassoon's perspective, the unnecessary continuation of the war is madness, whereas his logical and sincere objection is completely sane. While Rivers' opinion of the sanity of war is not clearly decided until the end of the book, his opinion of Sassoon's sanity is clear from the beginning. When Sassoon questions him about his opinion of Sassoon's "shell-shock," Rivers replies, "I'm quite sure you're not. As a matter of fact, I don't even think you've got a war neurosis" (Barker 15). This positive view of Sassoon's mental health, so different from the conclusion of the Board, serves to emphasize again that the line between sanity and insanity is extremely subjective.
The blurring of the line between sanity and insanity continues as Rivers begins to experience symptoms that are strikingly reminiscent of his neurasthenia patients. Remembering that such symptoms are not at all remarkable due to their generality, it still makes readers wonder at the supposed difference between stable doctor and instable patient. Rivers even diagnoses himself with war neurosis (Barker 140). By the end of the novel, however, it is apparent that his patients' madness is not at the root of his problem. It is the insanity of war, the insanity of mobilizing men only to confine them to trenches, and the insanity of political manoeuvring being valued over human life that disturbs Rivers' whole view of who he is and what he believes. The men from the front have encountered sights so gruesome that no human should ever have to see, giving them at least some excuse for mental aberration. The madness of the commanding generals, however, is inexcusable, since they see the victims of war come straggling back and yet do not do everything in their power to end it quickly.
Although neurasthenia is not a term many readers are familiar with, its history and societal implications are important when understanding Barker's theme about the fuzzy line separating the sane and the insane. Rivers and Sassoon would have been overly familiar with the baggage that the word carried with it, and understanding what their view of it might have been increases our understanding of two already intriguing characters. More importantly, its ambiguity serves as a great canvas for Barker to explore the definition of sanity and challenge the accepted view of it during World War I. It is an issue, however, that is not confined to a single novel or single war. If sanity cannot be put nicely into a box, then surely other issues defy strict categorization as well. Barker asks us to look clearly at ourselves before passing judgment on others, for we might just find an even larger dose of someone else's problem.
Works Cited
Barker, Pat. Regeneration. New York: Plume, 1993.
Hans-Georg, Hofer. "Nerve weakness and nerve strength. Dealing with nervousness (1880-1920)." June 2000. Austrian Research Centers. 7 Apr. 2003. <http://www.arcs.ac.at/dissdb/rn033257>
Marlowe, David H. "Chapter Four: Conceptual and Theoretical Medical Developments in the 19th and Early 20th Centuries." Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War. 2000. RAND. 7 Apr. 2003. <http://www.rand.org/publications/MR/MR1018.11/MR1018.11.ch4.html>
Martensen, Robert L. "Was neurasthenia a legitimate morbid entity?" The Journal of the American Medical Association 271 (1994): 1243.
Neve, Michael. "Public Views of Neurasthenia: Britain, 1880-1930." Cultures of Neurasthenia from Beard to the First World War. Eds. Marijke Gijswijt-Hofstra and Roy Porter. New York: Rodopi, 2001. 141-159.
"Psychiatric battle casualties largely determined by intensity of combat." The Royal College of Psychiatrists' Website. 2002. Royal College of Psychiatrists. 7 Apr. 2003. <http://www.rcpsych.ac.uk/press/presleases/pr/pr_184.htm>
"Shell Shock: The Internal Struggles of War"
http://www.k-state.edu/english/westmank/regeneration/shellshock.heck.html
Laura Heck (Spring 2003)
Pat Barker's Regeneration contains references to people, places, and cultural elements of particular significance to her themes as well as to the study of the First World War. One cultural reference, that of shell shock, is made early in the novel. On page four, Dr. William Rivers learns that Siegfried Sassoon is being sent to Craiglockhart War Hospital with a case of shell shock. To prevent shell shock from crippling the patients, Craiglockhart emphasizes the value of therapy, a theme in the novel, as a way to fight back against the mental battles.
The term shell shock was first coined in 1915 by C.S. Myers in The Lancet to describe the disorder found on the battlefield in soldiers who had been exposed to an exploding shell (Spiller). During the beginning of World War One, the disorder was common only among soldiers. Victims were often mocked and labelled cowards by their peers, causing many to desert the army. Around three hundred of these men were shot, and hundreds more were imprisoned for their apparent cowardliness (Storr). Soon officers began falling ill as well, and by 1917, the ratio of shell-shocked officers to shell-shocked enlisted men was an astounding 1: 6 (Bourke). With this shift, shell shock became recognized as a legitimate medical disorder.
The symptoms of shell shock were numerous and varied from soldier to soldier. Physical effects ranged from trembling, sweating, insomnia, diarrhoea, and minor twitches to paralysis, blindness, and muteness. Victims also experienced anguish, anxiety, and the inability to control their emotions. As a result, most were unable to separate their past from reality. During the war, psychologist Karl Bimbaum observed "great weariness and profuse weeping, even in otherwise strong men" (Spiller). Many of the soldiers exhibited what Sigmund Freud termed conversion disorders, which were subconsciously-formed problems such as the inability to walk, talk, see, or hear (Stuttaford). These symptoms were beyond the patients' control.
Shell shock had devastating effects on the British Army. Over 80,000 cases of shell shock were treated during World War One (Bourke). Even after the war, symptoms continued to surface in a majority of the victims. Years later, many veterans still complained of frequent nightmares and hallucinations. In 1927, over 65,000 men remained in mental hospitals suffering from shell shock acquired during the war (Spiller). In every military conflict since World War One, shell shock has been a problem among combat forces. Throughout the years, the disorder has been reclassified various times, with names including combat fatigue, war neurosis, neurasthenia, and most recently, post traumatic stress disorder (Spiller). Although the terminology has changed, the disorder remains a threat to the mental and physical well-being of troops.
In Barker's first reference to shell shock, Siegfried Sassoon is classified as a victim, although the diagnosis is a convenient excuse to silence him. The scene on page four opens with Dr. William Rivers and Dr. Bryce discussing Sassoon's case, specifically in regard to his recent Declaration. Sassoon is a decorated officer, having already won the Military Cross upon his entry into the hospital. He sends his anti-war statement not only to his commanding officers, but also to the House of Commons, where it is read aloud and publicly debated. Sassoon is highly respected among his peers and fellow soldiers. By defying the government and accusing the military of prolonged warfare, he is a threat to the union of the troops. Others are concerned that his influence could produce a whole generation of pacifists and conscientious objectors. The Board ignores the opportunity to try Sassoon for treason and instead sends him to Craiglockhart War Hospital. The officials excuse his behaviour as temporary insanity caused by the atrocities of war and prolonged shell shock. He could easily have been sent to prison and perhaps even have achieved the martyr status. Rather, Sassoon is quietly removed from society until he can be redeemed from his unconventional perspective. Although Sassoon experiences some symptoms of neurasthenia, Rivers realizes that Siegfried is no ordinary shell shock case. This man is not mad. He has just been suppressed, in the form of a medical disorder, for freely expressing his innermost opinions of the military and the war.