I haven't had time to write much. I've meaning to write something about Elizabeth Samet's
Soldier's Heart: Reading Literature Through Peace and War at West Point, but instead I will direct you to adapted excerpts in a
New York Times Magazine essay: "
In the Valley of the Shadow." I'm hoping to hold a symposium on war, literature, and psychiatry here at Michigan next semester. It's taking quite the effort to plan this thing, if it's going to happen at all.
I usually like to proclaim my favorite in music and film every year. It's not very meaningful since I've only seen a handful of movies this year and my music selection has been more arbitrary than comprehensive. I will weigh in anyhow with
Rise Above by the Dirty Projectors,
Andorra by Caribou, and
In Rainbows by Radiohead. I also liked Adrian Orange and Her Band's self-titled release on vinyl (just bought a record player this year). As for film, I have literally seen 6 movies this year, almost all of which I liked, especially
Rescue Dawn,
Once, and
No Country For Old Men. I hated
Sicko and had mixed feelings about
I'm Not There. I found the former to be reductionist, and I liked how one reviewer described the latter as a film that didn't do much to illuminate Dylan's life, but was more of a reflection of how people have viewed and want to view the unknowable Dylan.
The concept for an event on war, literature, and psychiatry clicked after reading Dr. Samet's book in less than three days--I never read anything that urgently. She prefaces her book with two quotes that explain the term "soldier's heart" and that perhaps relate to her themes and thesis.
Happy are these who lose imagination:
They have enough to carry with ammunition.
Their spirit drags no pack.
Their old wounds, save with cold, can not more ache.
Having seen all things red,
Their eyes are rid
Of the hurt of the colour of blood for ever.
And terror's first constriction over,
Their hearts remain small drawn.
Their senses in some scorching cautery of battle
Now long since ironed,
Can laugh among the dying, unconcerned.
--Wilfred Owen, "Insensibility" (1920)
In every campaign there are large numbers of soldiers invalided home with the affection of the circulation commonly called "soldier's heart"... The treatment is not that of ordinary heart disease, but should be directed to in every way increasing the general tone, including mental tone, of the sufferers... The patients should not be told, or allowed by our bearing towards them to think, that they have "heart disease," as such is not strictly the case.
--Robert Dawson Rudolf, "The Irritable Heart of Soldiers (Soldier's Heart)," The Canadian Medical Association Journal (1916)
This doesn't pertain to Dr. Samet's book so much, but I am intrigued by how psychiatric illness can be modified by suggestiveness, placebo, and other non-pharmacological interventions, hence the efficacy of cognitive-behavioral therapy. I think this says a lot about the possibility and the power of the will, that much of pathological thinking and behavior can be overcome by insight and the application of that insight. Take this quote from a
blog I've been reading:
When I was a boy of seven or eight I read a novel entitled "Abafi"... The lessons it teaches are much like those of "Ben Hur," and in this respect it might be viewed as anticipatory of the work of Wallace. The possibilities of will-power and self-control appealed tremendously to my vivid imagination, and I began to discipline myself. Had I a sweet cake or a juicy apple which I was dying to eat I would give it to another boy and go through the tortures of Tantalus, pained but satisfied. Had I some difficult task before me which was exhausting I would attack it again and again until it was done. So I practiced day by day from morning till night. At first it called for a vigorous mental effort directed against disposition and desire, but as years went by the conflict lessened and finally my will and wish became identical. They are so to-day, and in this lies the secret of whatever success I have achieved.
--Nikola Tesla
This viewpoint is quite inspiring and has interesting implications. One loosely related idea that is relevant to military psychiatry is the possibly detrimental effects of labeling certain injuries for which the etiology is little understood. Suggestiveness and unconscious motivations can be rather potent and shouldn't be underestimated. I first heard this idea this past summer at a conference, and it seems that there are other people thinking about the same thing in the
American Journal of Psychiatry:
[...] as a study of U.K. troops returning from Iraq shows (N.T. Fear et al., unpublished 2007 data), there is an association between mild traumatic brain injury and posttraumatic stress disorder, with service personnel having a range of symptoms that often meet the criteria for both diagnoses. In states of uncertainty, it may be that contemporary service personnel prefer to be labeled as suffering from mild traumatic brain injury than any psychological disorder, just as shell shock in its initial quasineurological formulation was very popular. It may be that such labels reduce stigma and encourage help seeking, a major issue for the present generation of service personnel (46). But, on the other hand, it may divert attention from more easily treatable disorders, such as depression and posttraumatic stress disorder. Labels themselves affect prognosis. For example, a study of postconcussional syndrome by Whittaker et al. (47) suggested that subjects who believe that their symptoms have lasting and deleterious effects are at higher risk of experiencing an enduring disorder of this kind. In other words, strongly held negative beliefs play a part in maintaining symptoms and functioning—exactly the reasoning that led the British Army to ban the use of the term “shell shock” in 1917.
--Edgar Jones, Nicola T. Fear, and Simon Wessely, "Shell Shock and Mild Traumatic Brain Injury: A Historical Review," American Journal of Psychiatry (2007)
If you don't have access to the journal, I can e-mail it to you. You can also borrow my copy of
Soldier's Heart if you'd like.
