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Jay Winter's essay, "War Wounds".

Eddie Mair | 17:45 UK time, Friday, 6 November 2009

You can read more about Jay Winter here.

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"In the ranks of the men who served in the Great War, the men who collectively constituted the Lost Generation, there were many who had lost their limbs, their eyes, their minds. Others were less severely wounded, but still woke up every morning for years after the war accompanied by painful reminders of their injuries.

Some war wounds healed by themselves, by the intervention of time and only time; others healed by the tireless intervention of people, of doctors, nurses, health workers, and above all, by the care-giving of family members. The novelist Pat Barker has said that women in countless families were and are the unsung healers of the wounded of war, and thereby came to join their ranks. Remembering the war requires us to honor these, the wounded, and these, the healers.

But doing so requires us, I believe, to ask some difficult questions about who we are, at this distance of nearly a century from the outbreak of the war. What do we see when we face those wounded in war? It is an essential moral act to look at them, to see what war does to the frail human body. If we turn away completely, we are hardly human; but honesty requires us to admit that if we don't feel the impulse to turn away, we are not human at all. How do we look at the suffering of others? That is the question, following the late critic Susan Sontag, I want to put to you today. In the wake of the wars in Iraq and in Afghanistan, this question is as poignant today as it was 91 years ago at the end of the Great War.

Most of us have little training in helping the disabled. Where do we look when we see their limbless clothes? This is a question millions of women and children had to face when their men returned home disabled from war after 1914.

Although no one knew it at the time, the Great War opened a new era in the history of disability, and of our understanding of who the disabled are. In a sense, the Great War was the biggest industrial accident in history, but one which went so far beyond previous disasters that it changed the framework of compensation and treatment for such injuries. The practices of orthopedic medicine and of rehabilitation medicine were transformed by the war; other branches of medical care - neurology, psychiatry, surgery -- were similarly affected. The next time you visit the dentist, have a thought about the fact that novocaine was an innovation of the Great War.

Healers did what they could for the war wounded, even before they were drawn in to the bureaucracy surrounding compensation for war-related injury. Anyone seeking a pension for disability required medical authorization of the claim. This brought bureaucrats and physicians in contact in ways and to a degree that had not happened before, and has never ceased to happen since. Here we can see how the treatment of those damaged by war between 1914 and 1918 constituted a step on the way to the National Health Service.

This brings us to a second unanticipated consequence of the war. The armies of the wounded - and there were over two million men wounded on active service in the Great War - deserved both the respect and the support of the population for whom they had fought. And yet it was not at all clear whether the treatment and compensation men received for war-related disability was a matter of charity, of grace and favour, or a matter of rights. In some countries, disabled men had rights; in others they had access to minimal care and a pittance of a pension, and were able to resume their lives thanks to the efforts of private charities like the Royal British Legion. The notion that wounded men have a right to care was universally accepted in principle; but in practice, the treatment they received varied hugely from country to country. Ironically enough, one of the most striking instances of veterans' medical care as an established right was in the United States, where the Veterans' Administration has practiced socialized medicine for generations, a fact that still eludes a surprisingly large number of Americans in their current preoccupation with the right to health care.

The right to care, over both the short-term and the long-term, was recognized in principle during the Great War. And yet the differences between how combatant countries faced that fact were substantial. Here is where medical history and the history of veterans' movements and institutions come together. Let me give you just one instance. In the period of the Great War in Britain, it was the injured soldier who had to prove that his injury was war-related; in France, it was the state which had to prove that the injury was not war-related. The burden of proof was on the individual in one country and on the state in another. I account for this distinction by referring to the relative power and influence of veterans' associations in different places. In Britain the British Legion and other veterans' groups were initially conservative in character, and imbedded in the Protestant voluntary tradition, in which private associations and not the state provided care and support. In France, veterans' associations were more combative and assertive; they were imbedded in the Jacobin and Republican tradition of an armed citizenry; in France treatment for war-related disability was a right. The wounded man got the benefit of the doubt when there was doubt as to whether his condition was an outcome of his active service in wartime. In Britain, it was much harder for a disabled man to establish his case that his condition was war-related. In the inter-war years, under conditions of austerity, pensions committees denied thousands of veterans' claims.

The same problem faced some war widows. Private Arnold Loosemore, a Sheffield man, won the Victoria Cross for conspicuous bravery during combat in the Ypres salient in August 1917. A year later, he was severely wounded and had to have a leg amputated. He returned to England, married his childhood sweetheart in 1920. The Sheffield Rotary Club provided the couple with a bungalow and a pony. Loosemore died at the age of 27 in 1924, six years after the Armistice. When his widow, who was left with a three-year old son, applied for a pension, she found out that she was ineligible. The reasoning of the Ministry of Pensions was that if she had married Loosemore in 1914, she would have been entitled to a pension. But she married him after he was wounded, and thereby entered into a marital contract with a damaged man, in full knowledge of the status of his health. Furthermore, she married him after his discharge from the army. Here there wasn't even a doubt about the cause of his death; but the state acted in such a way as to reduce the costs of caring for those bearing the wounds of war and for their families. To add insult to injury, when he was given a funeral by the town, the bill was apparently sent to the widow by the Council.

In France, things worked differently; such a case would have been treated as the scandal that indeed it was. The reason was that veterans had substantial political clout and used it to stop bureaucrats from making stupid and insensitive decisions.

This story was repeated all over the world. Everywhere, there was a shifting landscape of entitlements, reflecting the determination and political will of veterans and veterans' groups to press their case. To be sure, even when entitlements were recognized in a liberal manner, whatever the level of reparation provided by the state, it never fully compensated for the suffering and hardship the war wounded and their families endured.

This negotiation over what constitutes a war-related condition or injury, and how to compensate the men and women who bore them. continued throughout the twentieth century. It is with us still. In Vietnam, many veterans were exposed to toxic chemicals - defoliants such as Agent Orange. Did vets who developed cancer in later years suffer from the long-term effects of such exposure? The argument about this is still going on, in particular in Australia.

Then there is the question of what constitutes a war-related psychological disability. Here the shadow of the Great War is particularly deep. In 1915, the British psychiatrist Charles Myers introduced the term 'shell shock' to describe a set of disabling injuries suffered by men at the front. He later regretted using this term, since thousands of men with similar symptoms were stationed well out of the range of the guns. But once put into the vernacular, the term took on a life of its own.

The term 'shell shock' became a commonplace, and a brilliant one it is. It escaped from the realm of medical care and has become iconic. The reason is that the term 'shell shock' tells us a lot about the war. Most casualties in the Great War were inflicted by artillery shells; there were tens of millions of shells fired in the war. The scale of the suffering and human costs of the war produced the shock. Hence shell shock was a term which captured something everyone knew about the war. The term suited a conflict which transformed the meaning of battle, of courage, of war itself.

But the evocative character of 'shell shock' -- this two word encapsulation of the war - still left doctors in a predicament. How could they distinguish between men who had psychological injuries arising directly from their service on the Western front from shirkers and malingerers simply trying to save their skins? The answer is that they couldn't easily make this distinction. And even when they did determine that a man was suffering from 'shell shock', they were puzzled about how to heal his wounds, which were rarely physical ones. Some doctors tried electric shock treatment to restore movement to paralysed limbs; to make the mute speak again; to return these physically sound men as quickly as possible to their units and to the war. Others tried rest and occupational rehabilitation, in domestic settings or on farms. Still others tried psychotherapy, the 'talking cure' as one of the most remarkable physicians of the time, W.H.R. Rivers, termed it during the war.

No one knew what worked, and many physicians remained entirely skeptical about whether such men were simply acting. It is important, though, to remember that the condition was not new; what was original was the diagnosis. There had been similar psychological wounds in the American civil war. Some were termed, again evocatively, 'soldiers' heart'. Later on, during and after the Second World War, 'combat fatigue' became the term of art. Then post-Vietnam doctors validated the current usage 'post-traumatic stress disorder' -- PTSD.

What happened was that a term initially limited in 1915 to those under artillery fire was extended to all those in combat 30 years later during the Second World War. After another 30 year interval, the term physicians and administrators used - post-traumatic stress disorder - was not limited to men in uniform, but to many others afflicted by persecution, cruelty, and violence. Holocaust survivors are among them; so are the hibakusha, the survivors of Hiroshima and Nagasaki.

The history of 'shell shock' is therefore the story of the widening of concentric circles of victims of war. Now the term PTSD extends to the domestic sphere. It has become universal. But it is important to recall the original setting of this category of psychological injury, the setting of the Great War. It took most of a century before the shame and stigma attached to mental illness were sufficiently reduced to enable societies to recognize the fact - the unalterably simple fact - that ordinary, healthy men break down in war. Through no fault of their own, and at the call of the state, they go into the shadows, shadows which stretch long into what we call the post-war world.
By the end of the twentieth century, the medical profession recognized post-traumatic stress disorder as a medical syndrome, with causes, and treatment, and legitimacy as a category of war-related injury. Even then, the veterans of Vietnam were not always well treated for these disorders; but because of their struggles, today's soldiers have a better chance at receiving what is their right. The history of shell shock is in part the history for the search and struggle for veterans' rights, for natural justice for the disabled and the disfigured.

Each time a man or woman in uniform returns from Iraq or Afghanistan, spare a moment or two to think about him or her as joining this long line of soldiers and sailors and airmen who have borne the wounds of war. If we do spend this bit of time in reflection, we can see that those who return home from war always deserve the benefit of the doubt, and the benefit of our compassion for the road so many of the injured will follow in years to come."

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