Pat Barker, PTSD, Regeneration

Kennedy Fraser had an illuminating profile of the novelist Pat Barker in a recent New Yorker (not online):

Barker grew up with silent, wounded men. "And with talkative women, spinning stories," she said. "Stories with bits missing." She is a true war baby. "My mother was in the Wrems" - the Women's Royal Navy Service - "and her stories about World War Two were always quite interesting. She used to run home through an air rad, because she knew her mother would be worried. It was a very dangerous thing to do, but I'm afraid that wouldn't occur to my mother. She really adored the war. She was one of those women whose lives were expanded by the experience of it. She was on this huge mixed-service base, and there were lots and lots of young men. One of whom was my father! But her stories stopped short of revealing which one."

The only Barker novel that I've read is Regeneration, which is really wonderful. It's a fictionalized version of a true story and recounts the treatment of shell-shocked poets Siegfried Sassoon, Wilfred Owen and the officer Billy Prior. (Sassoon and Owen are real; Prior is Barker's creation.) The protagonist of the novel is Dr. William Rivers, the great British psychiatrist who helped pioneer some startlingly modern therapies for "shell-shock" during World War I.

At the time, shell-shock was largely dismissed as a failure of nerve, a disease of cowardice. As Elaine Showalter has pointed out, doctors treated this new scourge using the same blunt tools they had been using on "hysterical" women for decades. These "treatments" included everything from drugging the patient with bromides, to confining them in bed and force feeding them milk, to pulling their teeth, which was believed to lower the temperature of the body. Other unfortunate patients got "the fever cure," in which psychosis was treated with an injection of malaria, tuberculosis or typhoid. The Nobel Prize was awarded for this sadistic treatment in 1927. For more on the cruelties of wartime psychiatry, see what happens to Septimus Smith in Mrs. Dalloway.

In Regeneration, Barker demonstrates how River differed from the medical mainstream. He encouraged his patients to express their emotions, to confront their mental traumas. He believed that, unless patients dealt with what they'd been forced to repress - Prior, for instance, is haunted by the image of a loose eyeball - they would never recover from shell-shock. In this sense, Rivers helped pioneer the modern treatment of PTSD, which is similarly focused on helping patients get past their nightmarish memories.

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The later books in the Regeneration Trilogy, though perhaps not up to the level of Regeneration itself, and very much worth reading, too.

You find out a lot more about Rivers in the later two books, and he really seems like a fellow to find out more about.

I completely agree about "Regeneration." I put 90% of my books in storage when I moved cross-country, but I brought that one, planning to read it again. I can't believe I missed that profile of Barker - it must be in my pile of unread New Yorkers!

Err no. That Nobel prize was for curing dementia and paralysis caused by syphilis by inducing fevers. The cure was often partial and temporary but it was better than anything that had come before it.

By Peter Lund (not verified) on 18 Mar 2008 #permalink

I'm entirely sure I'd describe fever treatment as sadistic, although it was certainly grossly unpleasant. You have to remember that it was developed when the major cause of 'madness' was neurosyphilis.

The syphilis bacteria doesn't survive very well outside of the normal range of body temperature, so inducing a long enough malaria fever was an effective cure and was considered an acceptable risk-benefit trade-off, especially as quinine could be used to treat the malaria. Given the choice, I'd probably choose the same myself (it's fairly inevitable that neurosyphilis will lead to madness and death).

In fact, if you look at the earliest papers pulled up by this PubMed search you can see some of the final review papers on the effectiveness of this treatment, just as the transition to the use of antibiotics began.

Of course, the treatment got used more widely than was warranted (e.g. in treating shell-shock) where the results were undoubtedly disasterous.

It seems I missed out the one important word! My last comment should begin "I'm not entirely sure I'd describe fever treatment as sadistic..."

Check out the film adaption (still called "Regeneration') an excellent film & version of a book.

As for PTSD/shell shock, there are some great books on the subject. The strange thing was the difference in treatments on both sides during Word War I. The Germans only gave them a few days break away from the front line & only had a fraction of the number of PTSD casualities that Britain had, who'd often remove many back home. It was as if the more treatment, the more counselling, they gave the casualty & the more physical distance from the event the worse their symptoms became or the longer they took to heal. It's worsened in recent years, a very high percentage of those that suffer from PTSD from the Vietnam War when they got back home apparently never saw front line action!