While attending the highly successful 7th ECOTS - ESTSS European Conference on Traumatic Stress - May 26-29, 2001, in Edinburgh, Scotland, I visited an important historical site that reminded me of two things: soldiers with traumatic shock have endured abysmal horror; those dedicated to treating soldiers in pain have provided a great benefit to the field of traumatic stress.
On a break from the conference, a colleague and I visited Craiglockhart War Hospital, just outside Edinburgh; it is now part of a university, but once was full of British officers suffering from shell shock during World War I. The renowned Dr. William H.R. Rivers, chief psychologist at this hospital in 1917, pioneered a treatment that acknowledged the horror of war, helping many soldiers including several renowned war poets. As Chaim Shatan reported in the Winter 2001 issue of StressPoints, these war poets gave legitimacy to the psychological effects of war. Two soldiers who returned to battle after being treated at Craiglockhart were war poets Siegfried Sassoon (treated by Rivers), and Wilfred Owen (a friend of Sassoon's who was subsequently killed in action), whose poems were compelling and poignant testaments to the horrors of the Great War.
Generally, treatments for shell shock were experimental, ranging from accusations of cowardice, desertion and malingering, to ignoring the symptoms, to the new technique of psychoanalysis, or to more horrific techniques such as faradism - painful, sometimes torturous electric shock - and other inhumane approaches. However, Rivers provided a humane treatment consisting of rest, recreation, cognitive behavioral therapy avant la lettre, and analysis.
Craiglockhart is a monstrous building with a depressing interior, but located in a lovely and serene countryside. Walking through its dark, deserted corridors, it was not hard to feel the echo of Sassoon's portrayal of the suffering there:
The doctors did everything to counteract gloom. The place had melancholy..., redeemed only by its healthy situation and pleasant view of the Pentland Hills. By day, the doctors dealt successfully with these disadvantages. But by night they lost control and the hospital became sepulchral and oppressive with saturations of war experience. One lay awake and listened to feet padding along passages.... One became conscious that the place was full of men whose slumbers were morbid and terrifying - men muttering uneasily or suddenly crying out in their sleep. Around me was that underworld of dreams haunted by submerged memories of warfare and its intolerable shocks and self-lacerating failures to achieve the impossible.
Sassoon's description of those desolate and terrifying nights in Craiglockhart is typical not only of shell-shocked WWI officers, but of anyone who is traumatized. I was reminded of another historical giant, Pierre Janet, who sometimes visited his patients at the Salpêtrière in Paris during the night as they were in the throes of their terrifying memories. There he reached through their loneliness and terror to offer therapeutically skilled and empathic human contact: another lesson of history I remembered as I sat at the trauma conference and as I walked the Craiglockhart corridors that echo with painful memories.
Onno van der Hart, PhD, is a professor at Utrecht University, Department of Clinical Psychology; chief of research at the Cats-Polm Institute, Zeist; and psychologist/psychotherapist at the Mental Health Center Buitenamstel, Amsterdam.