Book Reviews: 1. A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century 2. Waging Modern War 3. While God Is Marching On: The Religious World of Civil War Soldiers Reviewed by Captain Kevin J. Huyser 4. Casual Slaughters and Accidental Judgements: Canadian War Crimes Prosecutions, 1944-1948 5. Ghost Soldiers: The Forgotten Epic Story of World War II's Most Dramatic Mission 6. Resource Wars: The New Landscape for Global Conflict

• Author: Major Susan L. Turley
• Pages: 06

2001] BOOK REVIEWS 197

A WAR OF NERVES: SOLDIERS AND PSYCHIATRISTS IN THE TWENTIETH CENTURY1

REVIEWED BY MAJOR SUSAN L. TURLEY2

I was confronted by cases of combat neurosis who told me that they saw nothing in what they were doing that justified the risks they were being asked to take. In effect, they had seen enough of death to know that they preferred life. What was I to do with deviant behavior like that?3

[I]s it better to be crazy, or is it better to be dead?4

In Arizona, Claude Maturana sits on death row, condemned for murdering a teenage boy in 1990. Maturana's guilt is not in doubt, but whether he'll ever be executed is. State prison doctors have diagnosed Maturana as too mentally ill to be executed.5 They have treated his delusions-but not so that he understands his crimes and his sentence, the standard for competence to be executed. In fact, Arizona couldn't find an in-state doctor willing to make Maturana well enough to die. All who declined cited ethical prohibitions against participating in executions, including restoring competency.6

Maturana's case illustrates how doctors and lawyers in the new millennium still wrestle with one of the ethical dilemmas at the heart of A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, Ben Shephard's history of military psychiatry. As the title suggests, the skirmishes involved are not necessarily traditional military battles (although combat and its impact on those who fight are central to the book). Instead, Shep-hard examines moral and medical conflicts like the one underlying the Maturana controversy-the clash between therapy to restore a mentally wounded soldier to something approaching normal functioning and treatment to return that same soldier to his military role as "potential cannon fodder."7

Early on, Shephard describes how the British Army castigated a World War I doctor who classified a number of troops as unfit for battle due to shell-shock and exhaustion. In the eyes of British officers, steeped in the "stiff upper lip" tradition, a doctor might rightly sympathize with his patients-but he far overstepped his bounds if he tried to prevent the commander from sending those same men out to fight.8 Shephard then traces how each succeeding generation of military psychiatrists grappled with this conflict, up through Vietnam and the Gulf War.9

A doctor in Normandy bluntly admitted that military psychiatrists had to forego the traditional therapeutic goal of restoring the patient to a life worth living and instead had to learn "'to extend an invitation to death.'"10

In contrast, a Vietnam doctor questioned:

Is the military psychiatrist justified in rapidly treating combat fatigue? Is the physician ethical in using his patient's guilt about deserting his comrades and his identification with his unit in order to have him quickly returned to combat, where he might soon be killed? . . . Should not the psychiatrist affirm . . . that the

patient's own self-interest lay in expunging all sense of guilt or obligation to others and in seeing, in a clear-eyed way, what is best for him?11

Shephard chronicles this and other battles of the mind for two reasons-to dispel many of the entrenched misconceptions about military psychiatry,12 and to emphasize the failure to understand and grasp the lessons of past wars-especially the warning that meaning well does not always equate to doing well when it comes to treating combat's mental ravages.13 He largely succeeds on both counts.

For the lay person, psychiatry's stereotypes conjure up Sigmund Freud asking questions about one's mother and showing inkblot pictures. Adding the military to the picture evokes Klinger bucking for a Section 8 discharge and sessions with Dr. Sydney Friedman on M*A*S*H or Joseph Heller's infamous Catch-22. For military lawyers and commanders, mental-health experiences are often limited to fitness-for-duty evaluations, discharges, and perhaps the occasional court-martial sanity board. But even for the military psychiatry neophyte, Shephard's meticulously researched and documented book is both fascinating and accessible-mainly because he emphasizes anecdotal rather than clinical evidence and people rather than case files.

Admittedly, as Shephard recognizes, reading about war's horrors cannot compare to enduring them. Still, he has a storyteller's grasp of the immense power of personal experiences in helping the reader understand and accept his contentions. His deft use of compelling vignettes ensures that neither the book's length (473 pages) nor its occasional dry exposition of competing psychological theories becomes an obstacle. Additionally, Shephard comes much closer to vanquishing the misconceptions about military psychiatry by relying on first-hand accounts rather than using only official bureaucratic documentation. Through the eyes of individual soldiers and doctors, he covers the history of war neuroses and their trea

ment, from shell-shock to battle fatigue to post-traumatic stress disorder (PTSD).

Some stories Shephard recounts are so harrowing as to be almost unimaginable: An Eighth Air Force B-17 pilot sees the plane in front of him explode on his tenth mission, and,

what he took for a piece of debris flew back towards him. It turned out to be the body of one of the gunners, which hit directly in the Number Two propeller. The body was splattered over the windscreen and froze there. In order to see, it was necessary for the pilot to borrow a knife from the engineer and to scrape the windscreen. He had a momentary twinge of nausea, but the incident meant little to him. As he did not know the man, the horrifying spectacle was at a psychological distance.14

Other accounts are less gruesome but no less memorable, such as that of Irish doctor Billy Tyrell, who took command of his unit three times after shelling wiped out his superiors. In July 1915, he and other officers were discussing strategy in a dugout when a German shell killed three of them and wounded three more. Tyrell, whose sole injury was singed hair, was able to carry on without falling apart only because the situation and his command responsibilities demanded that he do so.15 Then,

I mustered what remained of my Battalion behind the line, two Officer boys and less than 300 men and proceeded to march them out. Just before dawn we met our quartermaster, who had heard something of what had happened and came out to meet us. He brought up all the Officers' horses and there were no Officers to ride them. When I saw the horses and realised [sic] what had happened, it finished me. I broke down and I do not mind telling you I cried for a week.16

Shephard rightly asserts that, just as war impacts each man differently, the military psychiatrist's role differs in every war, because society and the military are different in every war.17 However, A War of Nerves

also proves the truth of the old cliché that the more things change, the more they remain the same. Just as Claude Maturana's case demonstrates that some battles are constant in both peacetime and war, Shephard shows us that advancing weapons technology, increasingly far-flung battlefields and shifting alliances often change only the way psychiatric conflicts manifest themselves-not the conflicts themselves.

Military psychiatry's first and most enduring campaign has been the effort to understand how and why war wounds men's minds. Shephard begins with shell-shock in World War I, where the sheer numbers of psychological casualties (by one estimate, 24,000 British troops fell victim to shell-shock in the first four months of 1916)18 forced military doctors to explore as never before why some men broke down and others did not. What circumstances induced so many possible triggers-leadership, group morale, training, societal class, upbringing, intelligence, heredity, character, physiology, sheer exhaustion, new weaponry-to combine to produce the necessary mental catalysts?

The symptoms of shell-shock were incredibly wide-ranging, including losing the senses of sight, smell, taste, and hearing; amnesia; hysteria and intense crying-or catatonic stupor; uncontrollable shaking or partial paralysis; amnesia; vomiting; bizarre movements, such as walking like a trapeze artist on a tight rope; and inability to speak, defecate or urinate.19

Confronted with such diverse and previously unseen symptoms, the military-its doctors, lawyers, commanders, bureaucrats, and even its troops-were understandably confused:

Depending on the circumstances, a shell-shocked soldier might earn a wound stripe and a pension (provided his condition was caused by enemy action), be shot for cowardice, or simply be told to pull himself together by his medical officer and sent back to duty. . . . [A]t the front, . . . doctors continued to label patients "Mental" or "Insane" or even "GOK" (God Only Knows) . . . .20

This confusion begat other predicaments. Lawyers battled over combat trauma's role in the courtroom. From 1914-18, more than 300 Englishmen were court-martialled and subsequently executed for desertion,

cowardice or related offenses.21 Public outcry over the execution of mentally ill men led the British Army to institute rudimentary sanity boards in 1918.22 If a condemned prisoner's mental competency was in doubt or he was identified as a possible shell-shock victim, he could only be executed if a medical board found him responsible for his actions.23 By World War II, Britain had abandoned desertion as a capital crime.24

While the public approved of these attempts to balance the scales of justice, the sentiment among the line troops wasn't always so favorable: "If a man lets his comrades down[,] he ought to be shot. If he's a loony, so much the better."25 Shephard puts that seemingly heartless remark in its context-an expression of the exasperation of commanders trying to stop "wastage," or psychiatric casualties.26 To many commanders, psychiatrists' only usefulness was minimizing...