Regeneration, by Pat Barker

Early in Pat Barker’s moving, thoughtful novel Regeneration, Dr. William Rivers reflects on an experiment he assisted with when he was a much younger man. He and a colleague, Henry Head, wanted to know whether it was possible for severed nerves to regrow. Head cut a nerve in his arm and Rivers would probe the arm to see if sensation had been restored. Head suffered agonies during the tests, but they kept going because of the medical possibilities. Rivers thinks about this after a particularly grueling session with one of the men he is treating for war shock (now called post-traumatic stress disorder). Rivers has to probe, with questions, at these men’s worst memories and anxieties, in an effort to make them “fit for duty” so that they can return to the trenches of France. Rivers has to hurt them to heal them—a terrible thing for a sensitive man. 

In addition to William H.R. RiversRegeneration prominently features other actual historic figures. One of Rivers’ actual patients and one of the main characters of this book is poet Siegfried Sassoon. Wilfred Owen and Robert Graves, two other writers and British soldiers, also make significant appearances. In 1917, Sassoon began protesting the war, even as he was a soldier and an officer in the trenches. His protest centered on his belief that the war was being prolonged and could, if the politicians got their act together, be ended almost immediately. But his protests, culminating in a declaration that was eventually read before Parliament, lead to Sassoon being sent to Rivers in Scotland. Graves pulled stings to keep his friend from being court-martialed. Sassoon and Rivers consequently end up in the absurd position of a psychiatrist having to read a sane man in order to convince that sane man to return to the insanity of war. 

Drs. Head and Rivers in 1903, experimenting with nerve regeneration. (Image by Cambridge University Department of Psychology, via Wikicommons)

The most interesting parts of Regeneration, for me, were all the moments when Rivers* takes a step back to think about what is variously called war neurosis, malingering, shell shock, or war shock. For most, it’s a kind of weakness. Rivers is faced not just with his patients’ traumas, but also their resistance to psychotherapy. These men feel so much shame for what they see as their inability to cope with war, which many of them believe is their duty to find. World War I was so traumatic, for so many reasons, that in hindsight I can only feel sympathy for these men. They were put in unbearable, toxic, dangerous, and absurd situations and told they were cowards if they broke down under the strain. Not only that, Rivers feels a certain amount of peer pressure from his colleagues. Some are of Rivers’ mind and treat the soldiers as though their mental injuries were as serious (or more so) than physical injuries. Others, like Dr. Lewis Yealland, “treat” soldiers with something that is indistinguishable from torture. Yealland would administer electric shocks to men suffering from mutism or other physical symptoms of mental trauma until they started speaking or moving normally again. 

Like another recent read of mine, The Verdun Affair, this novel is about the aftermath of one of the worst conflicts humans have ever devised for themselves. Regeneration looks deeply at the mental aftermath and all the complicated thoughts it engenders, the lack of knowledge on the part of the psychologists about what they were up against, and the big question of the ethics of fighting the war at all. Rivers and Sassoon both wrestle with this question. Sassoon struggles with his guilt at being safe in Scotland while others fight on, and with his anger at the people in charge for keeping the fight going. Rivers has what I think is a worse dilemma: working to heal men only so that they can go back to a war that has devolved into little more than a meat grinder. Is it ethical to help men only to send them out to possibly die? 

I really enjoyed Regeneration. Even though the content is rough, especially since it’s based on actual history and medicine, I felt like I learned a lot from reading it. We’ve learned a lot about post-traumatic stress disorder in recent decades, mostly since the Vietnam War. Looking back further, it’s impossible not to see that the same disorder emerged in other conflicts. There was so much suffering and mental anguish in the decades (centuries) before that before we started taking a hard look at what it means to draft a man; order him to take a weapon and try to kill another human being before that human being can kill him; all while running the risk of being killed by gas, friendly fire, illness, etc.; and keep him there until he’s dead or so damaged that he can’t keep trying to kill other human beings. Sassoon, though he signed on in good faith that his government knew what it was doing when it went to war, had to speak up against its prolongation. Anything else would have been madness. 

* I looked up Rivers’ 1918 paper in The Lancet, about the mental symptoms of war trauma, in a fit of curiosity. 

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