New works greatly enlarge on this earlier insight by examining cases in different combatant countries and the specific hospital facilities that employed diverse therapeutic modalities.7-9 There were great divergences in how cases of shell shock were viewed and treated from country to country, depending on the outcome of the war, the location of the fighting, the social class of soldier-victims, the dominant religious ideology, cultural attitudes toward health and sickness, and prevalent norms of masculinity.11,15 Recent works also highlight how “neuropsychiatric servicemen” were regarded on the home front. The array of social and cultural determinants of the nature of traumatic experience operated simultaneously in affected individuals, their consulting caregivers, their families, the community, and the state.
Not the least surprising discovery is the tremendous range of experiences that provoked neurotic breakdowns during and after World War I—the physical threat of injury and death, fear of live burial, the rigors of training, observation of the death of comrades, the prolonged anticipation of fighting, hand-to-hand combat, the burial of dead soldiers, physical disease, the anxiety of immobility, material deprivation, moral disgust at killing, the anxiety of readjusting to civilian life, and the guilt of survival.7-9 This diversity of past traumatogenic events makes the very notion of trauma relative. The emerging historical record, like contemporary clinical science, eschews the possibility of a clear quantitative characterization of trauma, which is defined by a given intensity of suffering. Rather, historical trauma has emerged as the subjective experiencing and remembering of war-related events in the mind of an individual or in the life of a community.11
The central subjectivity of historical trauma also comes through in a related topic of study. Shell shock did not end in 1918 with the armistice. Over the next decade and a half, France, Germany, Austria, Italy, Britain, and the United States struggled to formulate effective governmental policies and treatment regimens for their psychologically maimed veterans. In European nations with the highest rates of mortality and injury, soldiers’ cemeteries, war monuments, and memorial services, as well as the ubiquitous sight of injured veterans (where tens of thousands of amputees damaged by artillery shrapnel were treated) became part of the visual landscape of postwar Europe. Scores of novels, poems, memoirs, diaries, films, paintings, etchings, sculptures, and photographs of the war and its human toll constantly reminded post-1918 Europeans of the momentous calamity. (The psychological war “invalids” who populate the novels of D. H. Lawrence and Virginia Woolf may be the best-known expressions of this cultural phenomenon to English-language readers.) Likewise, the sight of the emasculated war neurotic, who connoted effeminacy, homosexuality, and sexual impotence, haunted artistic and autobiographical accounts of the war.
The new historical trauma studies suggest that in a real sense the first “culture of trauma” did not form in America following the Vietnam War, as it has been argued.16 Instead, it arose in interwar Europe, especially in Weimar, Germany, which not only lost more soldiers than any other combatant country (more than 2 million dead, mostly young adult males) but also had to accept a humiliating war defeat and a vindictive peace treaty.17-19
The US Civil War
Scholars have been exploring other aspects of the past as well. Recent studies of World War II extend the extensive literatures on shell shock, the Vietnam War, the Balkan Wars, and the Iraq wars to the 1940s.20,21 Much more surprising, however, have been historical studies of trauma and the US Civil War. The key exploration has been Eric T. Dean Jr’s Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War,22 which was followed by a cluster of other texts.23-28 Because the Civil War occurred on the eve of modern technologized warfare, it had seemed outside the purview of the history of trauma. But the findings of Dean and others have established that military and industrial modernity are not absolute preconditions for widespread psychological trauma.