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. While the celebration of the centenary of the end of the First World War is in full swing, it should be remembered that the knowledge and legitimacy of the trauma owes much to the tremendous progress of the Great War. The massive nature of the horror of the world war really represented a turning point in its understanding, but also in the care provided.
Victims of a new type
In 1914, the armies were unprepared for the occurrence of these internal wounds. As Dr. Jean Lépine said in 1917,
"There was a new generation of victims, often with severe symptoms, with no apparent injury.This was not a good time for detailed observations, specialized centers did not yet exist, everyone interpreted what they saw based on their medical knowledge and his personal temperament, and it was only slowly that some of the order started in this chaos. "
The questions that emerged were first dictated by military demands and above all by the goal of restoring men to their effectiveness, to send them back to the front. It was a rapid evolution of practices, to clarify and systematize the diagnosis of mental disorders, on the one hand to identify possible simulators and, on the other, to treat those whose pathology was recognized.
Recognize the devastating effects of the war
The fears were as frequent as they were intense: the fear of being torn apart, even reduced to nothingness, of bombs of constantly renewed power, the expectation of death before the assaults … All this, combined with the exhaustion moral and greater physics.
Considering war as a form of madness in relation to peace, some doctors wondered what it was producing. For example, the doctor and psychologist Georges Dumas recognized that the war could give a particular character to certain disappointments, but also that it could be the origin of mental disorders themselves.
In the medical community, the debate first of all concerned the origin of these disorders. Were they induced by the war itself or were they the result of some pre-existing vulnerability? Is the psychic pathology emotional or concessive, that is, of psychic or neurological origin?
Evolution of recognition and diagnosis of symptoms
As reported by French neurologists Gustave Roussy and Jean Lhermitte, authors in 1917 of the book Psychoneurosis of the war (Paris, Masson et al.), War "gave birth to a series of psycho-neuropathic manifestations, with which the doctors were not familiar".
This novelty of psycho-traumatic symptoms has caused great uncertainty about the physical or psychological nature of the symptoms observed in the soldiers without evident bias.
At the beginning of the war, the terms "shock shell" in British doctors, or "battle of hypnosis", which were used to describe the soldiers who suffered from it, were reflection. These remained in the end always quite close to that of the "ball wind", which was used during the Napoleonic wars and which supposed a physiological origin of these disorders. The psychic origin nonetheless prevailed during the war years.
In 1915, the British physician David Forsyth published a The Lancet a description of the traumatic neurosis of war, in which he has clearly described the fact that it is associated with apparently neurological disorders (loss of memory, vision, smell and taste). In 1917, the French doctor Gaston Milian described stupid states, generalized tremors, convulsions and incidents of unconsciousness in the soldiers, whose origin was attributed to fear and anxiety experienced by the explosions. and the death of the other soldiers and in 1915, the French psychiatrist Emmanuel Régis recorded 88 cases of war neurosis, of which 80% was not associated with any physical injury. In all these situations, it was the vision of the death of the comrades that imposed itself as a cause of problems.
To explain these situations, the term "war neurosis" was quickly imposed on both sides of the front line. There was, however, a true count of these psychological wounds among the soldiers of the French army, which was made impossible after the fact, because of the many movements of soldiers supported by the health services, the situation was very variable , with some soldiers being sent back to battle, others back home, while others, whose problems were the most serious, were transferred to hospitals in the back. However, 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 that proposed its first treatments: hypnosis, sedatives and narco-analysis, psychotherapy for suggestion or persuasion, or adverse conditioning.
The First World War also saw the spread of the use of "faradizzazione", ie the application of an electric current, in particular to treat somatic symptoms, such as tremors, which reflects the fact that the & # 39; psychic origin of the problems was not clearly established for everyone.
The discovery of the possibility of psychiatric treatments that did not require evacuation from behind is also concomitant with the creation of "front psychiatry", for which the benefits were largely attributed to the support of other soldiers, but also the presence of the hierarchy and that offered the possibility to return more easily to the combat.
At the beginning of the war, the chain of care was the same for the physical injured and the mentally wounded: the passage from the rescue stations and a sorting center near the front, then the train evacuation to the hospitals of the army area. The strangers and neurologists of the front dealt with acute and rapidly treatable cases, while referring to the posterior center the agitated or violent patients, as well as those who needed long treatment and prolonged observation. .
In reality, the traumatized psychic soldiers found their place more difficult in the evacuation circuit. They were dispersed anarchically in many medical facilities. The reason was that, as regards the other wounds suffering from numerous and numerous disorders, they were not considered priorities. Furthermore, they have not always been identified, because they have also presented other diseases.
Foreshadowing what can be described today as "mobile teams", it has been proposed in the French army that psychiatrists are responsible for navigating the various services in search of soldiers treated for a physical injury, but who also present mental disorders.
Long lasting trauma
While the 1918 armistice marks the end of the fighting, it does not put an end to the psychological suffering of the soldiers. This could really continue throughout their existence, or even emerge much later, it seems awakened 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.
Injured for the first time in 1914, at the age of 20, from a bayonet and a grenade to the head, it will be a second time in 1915, again from a splinter. 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 abruptly in the mid-1950s. George D. ended up being consulted in 1960, at the time of the war. Algeria.
Another soldier, another story of the one 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 flashbacks. His problems were spared over time, but they reappeared at the age of 94, causing him to plunge into the scare of fighting. The weaknesses of old age had again confronted his trauma …
In the end, the four years of the war of 1914-1918 brought considerable progress in the management of the psychic trauma, marking a decisive evolution towards modern psychiatry. But the price to pay 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 for the rest of their lives.
Gilles Tréhel, doctor in fundamental psychology and psychoanalysis, Paris Diderot University – USPC and Emmanuel Monfort, Senior Lecturer in Psychology, Grenoble Alpes University
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