“These are the men whose minds the dead have ravished”

One hundred six years ago today, on December 4, 1917, the Scottish psychiatrist W.H. Rivers first delivered his report titled The Repression of War Experience. It wasn’t published until several months later, by which time the title had been “borrowed” by WWI poet Siegfried Sassoon, in his poem of the same name: Repression of War Experience:

Now light the candles; one; two; there’s a moth;
What silly beggars they are to blunder in
And scorch their wings with glory, liquid flame—
No, no, not that,—it’s bad to think of war,
When thoughts you’ve gagged all day come back to scare you;
And it’s been proved that soldiers don’t go mad
Unless they lose control of ugly thoughts
That drive them out to jabber among the trees.

Now light your pipe; look, what a steady hand.
Draw a deep breath; stop thinking; count fifteen,
And you’re as right as rain …
Why won’t it rain? …
I wish there’d be a thunder-storm to-night,
With bucketsful of water to sluice the dark,
And make the roses hang their dripping heads.

Books; what a jolly company they are,
Standing so quiet and patient on their shelves,
Dressed in dim brown, and black, and white, and green,
And every kind of colour. Which will you read?
Come on; O do read something; they’re so wise.
I tell you all the wisdom of the world
Is waiting for you on those shelves; and yet
You sit and gnaw your nails, and let your pipe out,
And listen to the silence: on the ceiling
There’s one big, dizzy moth that bumps and flutters;
And in the breathless air outside the house
The garden waits for something that delays.
There must be crowds of ghosts among the trees,—
Not people killed in battle,—they’re in France,—
But horrible shapes in shrouds–old men who died
Slow, natural deaths,—old men with ugly souls,\
Who wore their bodies out with nasty sins.

*          *          *

You’re quiet and peaceful, summering safe at home;
You’d never think there was a bloody war on! …
O yes, you would … why, you can hear the guns.
Hark! Thud, thud, thud,—quite soft … they never cease—
Those whispering guns—O Christ, I want to go out
And screech at them to stop—I’m going crazy;
I’m going stark, staring mad because of the guns–Siegfried Sassoon

W.H. Rivers practiced at the Craiglockhart War Hospital for Neurasthenic Officers, near Edinburgh in Scotland. Both Sassoon and Wilfred Owen were treated there after their combat experiences. (Which probably explains how Sassoon got hold of the phrase he used for the title of his poem.)

I wrote about Craiglockhart before, a couple of years ago.  Still, upon reviewing it, finding myself on team Owen, not team Yeats.

You? (If you’re not sure you can make that call right now, perhaps read a bit?  Following the links would be a start.)

Rivers’ description of the ill-effects of combat on those experiencing it was known–at the time–as “shell shock.”  It’s been described in many other ways over the years: combat disorder, hysterical neurosis, combat fatigue, war neurosis, PTSD, and many more.

But it’s not, exactly, a new thing.  The effects of war upon the men fighting it have never been something each generation, even “our” generation, have discovered afresh, and recognizing them for what they are is not something over which we should congratulate ourselves.

Gilgamesh, a character in the epic from about 4,000 years ago, was devastated by the death of his friend Enkidu (who is killed in a battle with the gods).  His reliving of that event, and his nightmares resulting from it affect the story from that point on.  Many later works in Greek and Roman literature describe the same sort of effects from battles and war. Europeans in the seventeenth and eighteenth centuries (plenty of wars to go around there!) also studied the phenomenon, and came up with terms to describe the debilitating effect upon their soldiers.  Ditto for the mid-nineteenth-century American Civil War.

In 1952, the American Psychiatric Association described something called “gross stress reaction,” having to do with mental issues relating to traumatic events.  Over subsequent decades, the terms and the descriptors were refined in the APA’s DSM (Diagnostics and Statistical Manual) and re-explained through 1980, at which point something called “Post Traumatic Stress Disorder” was included for the first time.  It included the experiences of people who survived traumatic events such as war and sexual trauma, differentiating itself from other forms of trauma (financial, marital, medical, etc) which people also faced on a regular basis.

The official diagnoses for PTSD has changed somewhat over the years, but as of the most recent DSM-5 Edition, here they are:

All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

1. Direct exposure
   -Witnessing the trauma
   -Learning that a relative or close friend was exposed to a trauma
   -Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: intrusion symptoms (one required).  The traumatic event is persistently re-experienced in the following way(s):

1. Unwanted upsetting memories
   Nightmares
   Flashbacks
   Emotional distress after exposure to traumatic reminders
   Physical reactivity after exposure to traumatic reminders

Criterion C: avoidance (one required). Avoidance of trauma-related stimuli after the trauma, in the following way(s):

1. Trauma-related thoughts or feelings
   Trauma-related external reminders

Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

1. Inability to recall key features of the trauma
   Overly negative thoughts and assumptions about oneself or the world
   Exaggerated blame of self or others for causing the trauma
   Negative affect
   Decreased interest in activities
   Feeling isolated
   Difficulty experiencing positive affect

Criterion E: alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

1. Irritability or aggression
   Risky or destructive behavior
   Hypervigilance
   Heightened startle reaction
   Difficulty concentrating
   Difficulty sleeping

Criterion F: duration (required)
Symptoms last for more than 1 month.

Criterion G: functional significance (required)
Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion (required)
Symptoms are not due to medication, substance use, or other illness.

Two specifications:

Dissociative Specification In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1. Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
2. Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Crikey.  Quite a checklist there (even absent the formatting challenge, LOL).  Perhaps a bit over the top. Perhaps more designed to cover the asses of the “professionals” than it is to care for those afflicted.

Imagine my surprise.

I’m reminded of one of the (very few) wise mental health counselors I’ve had truck with who once said something to the effect that, “when your response to excessive trauma is anxiety, and when you have actual anxiety-inducing things to be anxious about, then your anxious response isn’t disordered or ill–it’s perfectly normal.

To all those combat veterans I’ve known (many in my own family) who’ve dealt kindly and heroically with your struggles over the years, who’ve done the difficult work, who’ve stuck with those who love you, who’ve finished the race: God bless.  I love you, and I salute you.

To those who’ve taken a different road:  I pray for you, and hope that one day you stop chasing false gods, and that you get the help you need and deserve to return to to a real life and a  real family before it’s too late.  God Bless you too.  I know it is hard.

And yet.

When we put our minds to it, life really is this simple, this loving, and this beautiful.  May you all, one day, embrace it:

 

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The title of this “Quote of the Day” post is taken from Wilfred Owen’s Mental Cases