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U.S. GIs will confront their toughest enemies here: Psychiatrists

Blindness. Deafness. Amnesia. Paralysis. Vomiting. Hallucinations. Impotence. Stuttering. Uncontrollable twitching. Inability to taste, smell or urinate. Funny walks.

These are just some of the crushing psychosomatic symptoms that have afflicted soldiers during the era of modern warfare, from the trenches of World War I to the Kuwait desert in 1991. Over the past century, military medicine has coined a variety of terms to describe the psychological costs of combat—shell-shock, war neurosis, effort syndrome, battle fatigue, acute combat stress, post-traumatic stress disorder (PTSD) and, most controversially, Gulf War syndrome—but they all essentially describe the same phenomenon: the human mind buckling from intolerable stress and the psychic wear-and-tear of witnessing and committing dehumanizing acts.

The current war was supposed to be different—swift, surgically precise, almost bloodless. "This will be no war," liberal-hawk cheerleader Christopher Hitchens asserted earlier this year at a public debate. "There will be a fairly brief and ruthless military intervention. . . . [The attack] will be rapid, accurate and dazzling." Delivered from on high, "shock and awe" was supposed to eliminate or disable the bad guys, leaving invading ground troops the feel-good task of rounding up grateful Iraqi soldiers and basking in the warm welcome offered by an overjoyed populace.

Instead of this slick 21st-century war, our boys (and girls) find themselves back in the messy 20th, waging old-fashioned tank battles and girding themselves for street-to-street fighting through the bazaars of Baghdad and Basra. Instead of the disengaged, remote-control war that was sold to the American public and rank-and-file alike, the reality is turning out to be horribly intimate and potentially prolonged.

The current situation now points to calamitous historical reference points: the Battle of Stalingrad, Vietnam, the occupations of Northern Ireland and the West Bank. In these conditions—rife with civilian casualties, suicide bombers and death by friendly fire, not to mention the potential of chemical attack (a flashback to World War I-era mustard gas)—it's not just the physical injuries that threaten to escalate, but the psychological damage, too.

British writer and documentary producer Ben Shephard spent 10 years researching the history of military psychiatry for his book A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century. Shephard believes there are certain conditions that improve the chances of soldiers coming away from battle mentally intact.

"It's a good thing to feel it's a just, necessary war," he explains over the phone from England. "It's a good thing to feel your comrades did not die in vain, and it's a good thing that they should not face the prospect of chemical or nuclear warfare. And if you get the ending right, that's good, too. If you had a messy ending, like Germany in 1918 or Vietnam, you'll have a terrible poisonous aftercloud hanging over soldiers. All of those things are basics, and if you get the basics down, you'll have a lower incidence of psychiatric casualties."

When asked about the current situation, Shephard offers, "It's all very well for the military to say, 'We're going to get it right this time.' If the fundamentals are wrong, they're still going to have problems, and in this case—well, the fundamentals are not great."

Already three British soldiers have been sent home to face court martial, allegedly for complaining about the way the war is being fought and refusing to endanger more Iraqi civilians. And just days after the bombing began, an American sergeant tossed four grenades into officers' tents, killing two men and wounding more than a dozen others.

"That was pretty common in Vietnam, when it was called fragging," says Shephard. "But it's not a sign of good morale. Not at all."

* * *

Shephard didn't write A War of Nerves with Iraq in mind; the bulk of it focuses on the two world wars and Vietnam, with a short section on the Falklands and the 1991 Gulf War at the end. But its unflinching look at the awkward intersection of psychiatry and the military offers a fascinating left-field perspective on war and its hidden costs. Weaving together a panoramic array of source materials (official reports, soldiers' diaries, interviews with doctors, Pentagon memos, snatches from novels and academic treatises), he catalogs 20th-century attempts to lessen the agony of war, at least for the troops—an unenviable task.

War excited and appalled psychiatrists over the past century, Shephard writes in his book's introduction, because it provided "a laboratory in which every theory could be tested literally to destruction. . . . [E]ven as the doctors record the horrors, they marvel at the way the mind refracts and mediates them." Writing to a colleague in 1915, less than a year into World War I, an Oxford professor of medicine said, "I wish you could be here in this orgy of neuroses and psychoses and gaits and paralyses."

Initially, doctors dubbed the mysterious assortment of symptoms that gripped huge numbers of soldiers "shell-shock." For a while, they assumed it was a physical condition caused by the unprecedented intensity of bombardment enabled by all kinds of newfangled explosives before switching to a psychological diagnosis that painted shell-shock as a kind of male hysteria. In World War I, Freudian ideas entered the fray. One World War I military hospital became "a society in which the interpretations of dreams and the discussion of mental conflicts formed the staple subjects of conversation."

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