Gilles Tréhel, Paris Diderot University – USPC and Emmanuel Monfort, Grenoble Alpes University

Psychological traumas are now widely recognized and supported. Yet this recognition has not always been obvious. As the celebration of the centennial of the end of the First World War is in full swing, it should be remembered that the knowledge and legitimization of the trauma owes much to the tremendous progress that occurred with the Great War. The massive nature of the horror of world conflict was indeed a turning point in its understanding, but also in the care provided.

Victims of a new kind



In 1914, the armies were unprepared for the occurrence of these internal wounds. As the doctor Jean Lépine said in 1917,

"There was a new breed of victims, often with severe symptoms, with no apparent injury. It was not a good time for detailed observations, the specialty centers did not yet exist, everyone interpreted what he saw according to his medical knowledge and his personal temperament, and it was only slowly that a little bit of Order began in this chaos. "

The questions that emerged were then first dictated by military demands and especially by the goal of giving men back their effectiveness, to send them back to the front. It was a question of a rapid evolution of the practices, to clarify and systematize the diagnosis of the psychic disorders, on the one hand in order to identify possible simulators and, on the other hand to treat those whose pathology had been recognized.

Recognize the devastating effects of war

Fears were as frequent as they were intense: the fear of being torn apart, even reduced to nothing, by bombs of a constantly renewed power, the expectation of death before the assaults … All this, combined with moral exhaustion and major physics.

To consider war as a form of madness in relation to peace, some doctors wondered what it was producing. The doctor and psychologist Georges Dumas recognized for example that the war could give a particular character to certain delusions, but also that it could be at the origin of the mental disorders themselves.

In the medical community, the debate first concerned the origin of these disorders. Were they induced by the war itself, or did they result from the expression of a certain preexisting vulnerability? Was psychic pathology emotional or concessive, that is to say, rather of psychic or neurological origin?

Evolution of symptom recognition and diagnosis

As reported by the French neurologists Gustave Roussy and Jean Lhermitte, authors in 1917 of the book Les psychonévroses de guerre (Paris, Masson et al.), The war "hatched a series of psycho-neuropathic manifestations, with which doctors were little familiarized ".

This novelty of psycho-traumatic symptoms resulted in great uncertainty as to the physical or psychological nature of the symptoms observed in soldiers without obvious injury.

              Image taken near Ypres in 1917. The injured Australian soldier at the bottom left of the photo looks astonished, his gaze lost in the wave, frequent symptoms of "hypnosis of battles".
              British government / Wikimedia
            At the beginning of the war, the terms "shell shock" in British doctors, or "battle hypnosis", which were used to describe the soldiers who suffered from it, were the reflection. These remained in the end always quite close to that of "wind of the ball", which was used during the Napoleonic wars and which supposed a physiological origin to these disorders. The psychic origin nevertheless prevailed during the years of war.

In 1915, the British physician David Forsyth published in The Lancet a description of the traumatic war neurosis, in which he clearly described the fact that it is associated with seemingly neurological disorders (loss of memory, vision, smell and taste). In 1917, French physician Gaston Milian described stupid states, generalized tremors, convulsions and episodes of unconsciousness in soldiers, whose origin was attributed to the fear and anxiety felt by explosions. and the death of the other soldiers and by 1915, the French psychiatrist Emmanuel Régis recorded 88 cases of war neurosis, of which 80% were not associated with any physical injury. In all these situations, it was the vision of the death of the comrades that imposed itself as being the cause of troubles.

To account for these situations, the term "war neurosis" was quickly imposed on both sides of the front line. There was, however, no real count of these psychological wounds among the soldiers of the French army, which was made impossible after the fact, because of the very numerous displacements of the soldiers supported by the services of the health, the the situation was very variable, with some soldiers being sent back to battle, others at home, while others, whose troubles were the most serious, were transferred to hospitals in the back. Nevertheless, if we follow the analysis of the American historian Marc Roudebush, they represented about 10% of French soldiers.

Birth of a war psychiatry

With the evolution of the diagnosis, a war psychiatry was developed which proposed its first treatments: hypnosis, sedatives and narco-analysis, psychotherapy by suggestion or persuasion, or aversive conditioning.

The First World War also saw the spread of the use of "faradisation", that is to say the application of an electric current, particularly to treat somatic symptoms, such as tremors, which reflects the fact that the psychic origin of the troubles was not clearly established for all.

              Faradization at a Red Cross hospital in Villach, Austria, in 1916.
              Österreichische Nationalbibliothek
            The discovery of the possibility of psychiatric treatments that did not require evacuation at the back is also concomitant with the creation of "psychiatry of the front", for which the benefits were largely attributed to the support of other soldiers, but also the presence of the hierarchy and which offered the possibility of returning more easily to combat.

At the beginning of the war, the care chain was the same for the physical wounded and the psychic wounded: the passage by the aid stations and by a sorting center near the front, then the evacuation by train towards the hospitals of the army zone. The alienists and neurologists at the front dealt with acute and rapidly curable cases, while they referred to the rear centers the agitated or violent patients, as well as those who needed long treatment and prolonged observation. .

In reality, traumatized psychic soldiers found their place in the evacuation circuit more difficult. They were scattered anarchically in many medical structures. The reason was that, with regard to the other wounded suffering from numerous and numerous disorders, they were not regarded as priorities. Moreover, they were not always identified, because they also presented other pathologies.

Prefiguring what can be described today as "mobile teams", it was proposed in the French army that psychiatrists be responsible for browsing the various services in search of soldiers treated for a physical injury, but also presenting mental disorders.

Durable trauma

While the armistice of 1918 marked the end of the fighting, it did not put an end to the psychological suffering of the soldiers. This could indeed continue throughout their existence, or also emerge much later, it seems revived by a more contemporary history, or by the appearance of certain vulnerabilities. This is for example the case of the French soldier Georges D., whose story was reported in 1968 by J. Alliez and H. Antonelli.

Wounded for the first time in 1914, at age 20, by a bayonet and shrapnel to the head, it will be a second time in 1915, again by shrapnel. Victim of nightmares in the years following his return to civilian life, the young man relived scenes of fighting during his sleep. The intensity and frequency of these bad dreams were accentuated during the Second World War, then worsened sharply in the mid-1950s. George D. ended up having to be consulted in 1960, at the time of the war. Algeria.

Other soldier, another story than that reported in 1998 by J.D. Hamilton and R.H. Workman. A 19-year-old American, exposed in 1918 to enemy fire while carrying messages, then victim of mustard gas during the second battle of the Marne. This young man manifested his first nightmare in 1919, also reliving an attack by German soldiers in the form of a flashback. His troubles spared over time, but reappeared at the age of 94, plunging him back into the fright of the fighting. The frailties of old age had again confronted him with his trauma …

In the end, the four years of the 1914-1918 war resulted in considerable progress in the management of psychic trauma, marking a decisive evolution towards modern psychiatry. But the price to be paid was high, and the suffering of the fighters did not stop on November 11, 1918: the memories of the horrors lived continued to haunt many of them for the rest of their existence.

Gilles Tréhel, Doctor in Fundamental Psychology and Psychoanalysis, Paris Diderot University – USPC and Emmanuel Monfort, Senior Lecturer in Psychology, Grenoble Alpes University

This article is republished from The Conversation under a Creative Commons license. Read the original article.





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