Category Archives: War Neurosis

Observations Upon Group Therapy, Dr Paul Dane’s comments and introduction of a new method – MJA, July 1949

27 Saturday Feb 2021

Posted by in 1940s, Group Analysis, Group Analytic Therapy in Australia, War Neurosis, WW2

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And so, on the quest to find how psychoanalysis threaded its way through Australian life and culture, I have been perusing the Medical Journal of Australia in the State Library of Victoria. One year, two volumes at a time, of monthly reports and newsletters. It is close reading material, but worth the time and effort.

Apart from medical reports and photographs that only medical practitioners can understand, there are articles about history, Australian settlement, and anything that any doctor found interesting and decided to write about. They are an eclectic bunch, these medical men. And of course, women. Paediatricians, oncologists, physicians, and all specialties. What made a good ‘medical man’; how medical men were members of a club, participants in a vocation, specialists, separate and apart from the rest of the world, at once akin to God, but like ordinary mortals, trying to work out how to best serve their profession.

I have began to have my favourites. EP Dark’s articles on socialised medicine during the 1940s caused more than a modicum of consternation, often from, no less, Dr Paul Dane from Melbourne. Dane was a staunch believer in the right of medical men to set their fees, and work, without interference, or regulation, from government.

Dane has found his place in the Australian psychoanalytic hall of fame for his earnest work establishing the Melbourne Institute of Psychoanalysis. But his contributions to the understanding of war trauma is not yet recognized as much as it should be. His lovely, compassionate article on War Neuroses published in the International Journal of Psychoanalysis in 1927 is surely an account that draws on his own experience of illness, and relief at being evacuated from the field of war. His image of the rocking motion of the train carrying the wounded soldier to safety after the desecration of battle – the babe’s relief when mother cradles him in her arms, rocking and crooning, summons the memories of most, after some deeply traumatic and humiliating experience. Dane’s years treating war shock patients at the Fifth Australian General Hospital in St Kilda Road in Melbourne, had their dividends in his work to establish psychoanalysis as a clinical discipline.

Dane’s contribution to beginnings of group analysis in Australia is also noteworthy. Such work was probably not long enough for he died in 1950, a little over a year after he published an article entitled ‘Observations of Group Therapy’ in the Medical Journal of Australia ( July 25 1949). Written after a tour of inspection in Washington, Dane recorded his experiences of four groups of psychotic and borderline patients at St Elizabeth’s Hospital over seven months. The work had developed in response to need – as large number of war traumatized patients sought help. Dr JH Pratt of Boston and Dr Moreno of New York were named as pioneers.

Group therapy had emerged in the interwar years, Dane wrote… at least that what we had been told. But sick people had long been treated in groups, he went on to say – in the temples of Diana in Ancient Greece. And so too were members of the Christian faith. Even so the discipline was new; practice was still being established and, he noted, the ideas about groups were extending to family treatments.

Dane went onto discuss small and large groups, the interplay of interpersonal dynamics and instinctual forces, the frequency of treatment sessions, and the management of the group conductor – one or two.

‘The therapist is of course the most important member of the group’, Dane wrote. It is not essential that this person be a psychiatrist, he continued, but should have a sound training in psychoanalysis – ‘he should be analytically orientated and, better still, have undergone a personal analysis. I do not think it is possible for anyone, however skilfull a psychiatrist he may be, who has not become analytically minded to understand the complex interplay of forces that occur in an individual analysis as well as in group analysis. Repression, transference, identification, are among the chief mental mechanisms that must be understood, that must be observed and interpreted, only a person analytically trained is fully competent for these tasks’. Dane was a long time supporter of the medical professional’s claim upon psychoanalysis, at least in mid-twentieth century Australia.

Dane continued, exploring the ideas about shared experience, and the differences, advantages and disadvantages of group therapy in relation to individual therapy. And whether there was danger in this method. Group therapy is not intended to replace individual therapy, he continues. ‘ Ít is a supplement or an aid to such therapy; and both can be conducted simultaneously. ‘We do not yet know its limitations or possibilities, but it is a form of therapy that has come to stay’, he concluded. ‘It should form part of the treatment in all institutions and clinics that deal with psychosis and neurosis’.

There is much more to this article – a contribution to the beginnings of Group Analytic Therapy in Australia. After Dane’s passing Dr Frank Graham took up the mantle, diverting from Dane’s interest in returned soldiers to develop and teach group analytic therapy on broader, analytic principles, in Melbourne. The Australian Association of Group Psychotherapy, an outcome of this work, is continuing.

References

Paul G Dane, Observations upon Group Therapy, The Medical Journal of Australia, 23 July 1949.

Some thoughts on W R Bion, psychoanalysis, shell shock, and the Great War.

11 Thursday Feb 2016

Posted by in Group Analysis, War Neurosis

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This is a summary of a paper delivered to the Australian Association of Group Psychotherapists Annual General Meeting on 14 November 2015.

 

Introduction

The tragic losses on the battlefields of the Great War and the resulting psychological injuries to millions has had long term consequences for families down generations in Europe, Britain and the former Dominions. The Great War has also led to major professional and scientific advances and re-thinking including development of psychoanalysis from the treatment of trauma by doctors in the field and afterwards. During the last decade scholars have mined W R Bion’s autobiographical work as a basis for his contribution to psychoanalytical theory with his, focussing on his experience as a tank commander in the Great War. Terms such as nameless dread, attacks on linking, and ideas about the splintering of the mind emerged from the idioms of war in an attempt to put language to horrific experiences in the field. (Jacobus 2005; Torney 2009; Roper 2009). While this paper follows these developments I suggest that W R Bion’s book, ‘Experiences in Groups’ based on his work at Northfield is has its origins in his military training and experience in the Tank Corps under the command of General John Frederick Charles (‘Boney) Fuller.

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During the first months of the war a quarter of a million were killed and the war had stalled in France where it remained for the next two to three years. By December 1914 A third of the British Expeditionary Force had been evacuated from France, many with shell shock, the result of being ‘blown up’, by a shell or other incendiary device. The symptoms: paralysis, loss of senses, headaches, nervous tremors and nightmares where it seemed the patient relived his traumatic experiences were likened to ‘Hysteria’ by medically trained psychologist Charles Myers.( Myers 1915).

By mid 1916, in letters home from the Somme and the Battle of Pozieres soldiers wrote of conditions worse than the hell they had ever imagined. In letters published in the Australian press in 1916 soldiers observed how shell shock victims were ruined for battle, if not for the remainder of their lives. They wrote of the noise, the din, carnage and losses. Even so fear of the censor’s pen held them back. In his 1919 Memoir Bion wrote of the fear of finding himself walking on corpses of fallen soldiers – a ploy, perhaps, to protect his mother from the realities of the warfield. For Bion, a member of an elite group, the tank command of especially chosen officers, the difficulty of holding himself together in these conditions is expressed in his account of watching, for hours, a clod of earth held by the green shoot of a plant dangling above him – as if an infant holding himself together by focussing on a light or an object. His complete emotional collapse, and an event to which he returned again and again, for the remainder of his life, came with the death of his batman, Sweeting, who, as he lay dying from horrific injuries beside him, called to Bion to write to his mother. Bion, unable to cope, told him to ‘shut up’ and turned away. Indeed, Roper notes, letters home made light of the horrific conditions even as these acted to contain soldier trauma ( Roper 2009). No doubt there were many others who turned away. Too.

As Freud remarked in 1918, shell shock by many other names – war neuroses, neurasthenia, war shock – ‘helped put psychoanalysis on the map among medical men hitherto sceptical of its claims’. In the early months of the war diagnoses and treatment of shell shock followed physical definitions and treatment. By 1916 doctors were integrating psychological principles into diagnoses and treatment. In his 1917 work, War-shock, the psycho-neuroses in war: psychology and treatment, psychoanalyst and medical officer to the neurological department in Malta, David Eder observed shell shock to be rare amongst the seriously wounded, as if, he said, ‘the energy taken to deal with it left none to spare for the creation of phantasies'(Eder 1917). In a survey of one-hundred cases Eder noted that shell shock did not differentiate between classes nor between experienced soldiers and new recruits. Careful to differentiate the neurological, physical effects of being blown up from the psychological and asserted argued that shell shock occurred when presence of psychological factors over neurological in diagnosis and treatment. Eder asserted that the experience of war shock with its associations with mental collapse and insanity, was not the province of the weak minded, nor genetically disadvantaged, but resulted from unbearable and consistent terror. Work undertaken by W H R Rivers at Craiglockhart, immortalized by authors Siegfried Sassoon and Pat Barker, followed similar principles. On the German side similar work occurred. In 1918, also at the Fifth Psychoanalytical Congress in Budapest, Sandor Ferenczi’s paper on the treatment of war shock was well received and, according to Judit Meszaros, helped pave the way for his presidency of the International Psychoanalytical Society ( Meszaros 2014). By 1920 psychological interpretations and treatment of shell shock was was widely accepted. Further it was understood that part of the symptomatology of shell shock, was a manifestation of unconscious conflicts. ( Roper 2016, p. 43). In 1920 the Australian Medical Congress devoted an entire section, some eight papers, to neurology and psychotherapy many focusing upon the treatment of war shock.
An invisible wound of war, the effects of shell shock such as long term inability to hold work, marital conflict, family violence – were transmitted down generations. One outcome for Australians, was the emergence of formal psychoanalysis, borne of doctors attempts to understand patients suffering the condition in the post war years. Roy Coupland Winn and John Springthorpe who had enlisted as Medical Officers, returned with experience with shell shock patients the field hospitals. By 1933 after a training analysis in England Winn established the first psychoanalytic practice in Sydney and for the next three decades was a key figure in the establishment of the Melbourne and Sydney Psychoanalytical Societies. Winn’s Melbourne colleague Paul Dane developed his interest in psychoanalysis after working with shell shock patients in Melbourne. He enlisted as as a Medical Officer in 1916 but was invalided home within the year after a serious attack of dysentery and colitis. During the 1920s he went to London where he underwent analysis with Joan Riviere.
While scholars have stressed the place of Bion’s personal trauma in his later work, Bion’s experience in the Tank Corps a remains relatively neglected. Mary Jacobus has pointed out the failure of the containing function of tanks – called various ‘Mother’, ‘Little Willie’ and ‘Big Willie’, highlighting, as Bion did, their danger, noise and at worst, Bion’s experience of them as death traps (Jacobus 2005). He entered the tank Corps, Bion explains, because it was interesting and the secrecy surrounding appealed to him. Headed by Major General John Frederick Charles Fuller, ‘Boney’ Fuller, the Tank Corps was developed in order to break the stalemate and battlefield slaughter extant since late 1914. The Corps was the instrument of the younger generation designed to break the deadlock in France (Freedman 2013). Tanks were the secret weapon, designed to cover ground and defences more efficiently than an army platoon. In his account of the Corps. Drawn from the elite: its members were highly experienced soldiers (Fuller 1920) It members were the veritable ‘best and brightest’, experienced and, like Bion, with potential to lead. Freedman explains that Commanding General ‘Boney’ Fuller, based much of his work on that of le Bon’s theory of crowd behaviour. This stressed the ‘mindlessness’ of crowd behaviour. Freedman explains that Fuller, instead, described a military crowd dominated by a spirit which is the product of the thoughts of each individual concentrated on one idea. It was an organised crowd, contained through training and a common purpose. Nonetheless it was a crowd and could turn when stressed. (Freedman 2013 p. 130).

Serving in the Tank Corps was a pivotal experience for Bion. It influenced his work and his contemplation of leadership and the group in the book, Experiences in Groups. Bion’s analysis of group behaviour addressed the nature of unconscious stressors within the group and the group’s response. Where Fuller stressed leadership and containment of the group through careful and rigorous discipline, Bion took up the latent, unconscious aspects of group behaviour – the reasons why a group might fail. Critical of Freud’s idea that the group seeks a leader to look up to Bion explores the notion of the leaderless group and whether it is possible for such a group to function maturely, without regression. In his discussion of the mental activities of groups Bion recognizes the existence of ‘two groups’ existing within the one entity – the ‘work group’ which tries to retain focus on the task at hand but is constantly perturbed by influences that come from other group mental phenomena ( Bion 1961) and the ‘basic assumption’ group variously dependency, where the group gathers around a leader and appoints a ‘dummy’ that has to he taught; the pairing group: the idea, that two members will produce ‘a new leader figure who will assume full responsibility for the group’s security. The wish, in unconscious phantasy, is that the pair will produce a Messiah, a Saviour, either in the form of a person or an organising idea around which they can cohere’.(Lawrence, Bain and Gould 1996). Fight/Flight suggests there is an enemy to contend with. ‘The
unconscious assumption of the group is that they are met for action which is to preserve itself by fighting someone or something or by taking night from these. The individual is less important than the preservation of the group. Understandably [culture] is profoundly anti-intellectual and will decry as introspective any behaviour which attempts to reach self knowledge through self study’ ( Lawrence, Bain and Gould 1996). Each position, unconsciously held, acts against the group task undermining discipline from without.

War is a difficult subject to address coherently. Two classic texts read today Clauswitz’s ‘On War’published in 1832 and the work of the Chinese sage Sun Tzu’s The Art of War, sets out the conditions under which war is declared and fought, methods and goals. Freedman’s work on strategy during the Great War shows how officials, generals and strategists drew upon myriad disciplines in their undertakings, not least being group theory. It is to wonder how much the group activity of war was, and can be,disrupted by unconscious assumptions with the resulting stalemate in the Great war. Bion’s work on groups deserves further attention in this light.

REFERENCES:

Bion, W H R, (1919) War Memoir 1917-1919, London, Karnac.

(1961), Experiences in groups and other papers, London, Tavistock.

(1975), A memoir of the future, London, Karnac.

(1982), The Long Weekend 1897-1919, London, Karnac.

(1989), All My Sins Remembered : Another Part of a Life and The Other Side of
Genius: Family, London, Karnac.
Eder, Montague David (1917), War-shock, the psycho-neuroses in war: psychology and treatment, London, Heinemann.

Freedman, Lawrence (2013), Strategy: A History, Oxford, Oxford University Press.

Fuller, J F C ( 1920), Tanks in the Great War 1914-1918, New York, E P Dutton and Co.

Harris Williams, Meg (1985), The Tiger and “O”, Free Associations http://human-nature.com/free-associations/MegH-WTiger&O.html accessed 2 February 2016

Jacobus Mary,( 2005), The Poetics of Psychoanalysis: In the Wake of Klein, Oxford University Press.

Lawrence, W Gordon, Bain, A and Gould, Laurence ( 1996), The fifth basic assumption
Free Associations Volume 6, Part 1, (No. 37): 2855, http://www.acsa.net.au/articles/thefifthbasicassumption.pdf, accessed 10 02 16.
Myers, Charles (1915), ‘A Contribution to the study of shell shock’, The Lancet Vol. 185, February 13, 1915 pp. 316-320.

Roper, Michael, (2009), The Secret Battle: Emotional Survival in the Great War, Manchester, Manchester University Press.

Souter, Kay ( 2009), ‘The war memoirs: Some origins of the thought of W R Bion’, International Journal of Psychoanalysis, Vol.90, Issue 4, pp 795-808.

Shell Shock in the Great War: Letters From ‘The Front’.

24 Tuesday Nov 2015

Posted by in Great War, John Springthorpe, War Neurosis

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The psychological impact of the Great War upon soldiers occupied the thoughts of the leading members of the Australasian Medical Congress in Brisbane held in August 1920. Papers on the use of psychoanalysis in the treatment of neurasthenia was  also noted by London’s Ernest Jones  in the first edition of the International Journal of Psychoanalysis.  The keynote speaker was  John Springthorpe whose paper addressed the lack of psychological components in the syllabus at medical school. the resulting professional ignorance was catastrophic for Australian soldiers at the Front. The final statistics are not in as to how many returned home suffering from shell shock, or endured it for many years afterwards. Nor do we have information about the suicides that resulted although a search through the newspaper archives reveals reportage in 1916, of the suicide of a Mr Peter Hogan, a returned soldier and an inmate of Broughton Military Hospital, who threw himself under a train at Petersham railway station in Sydney.

Springthorpe told the Congress:

We sent men physically unfit to enter upon the strains for which they were temperamentally unsuited, and then back again when their prompt, even immediate breakdown was inevitable. Our medical officers at the front from their ignorance and inexperience, were unable to differentially diagnose the different psychical disabilities incurred, and even more unfit to teat them. Men were punished and even shot ( though not by us), for such disabilities as if they were crimes. After a time the cases got so bad – and dealt with in special hospitals, miles behind the lines but still under shell fire.

No stranger to controversy Springthorpe was among friends and supporters on this occasion. Introducing the Congress, its President, Dr William Taylor, noted that in past wars “old time diseases” had usually killed more than were wounded in the field. In the Great War disease  had been replaced by hellish devices of gas and flame throwing which, coupled with the issue of high explosives, renders ti difficult to conceive how anything had escaped destruction. The resulting inferno along with the misery of the trenches caused the nervous system to be worked up to the highest pitch of tension... Is it to be wondered at that a large number iof soldiers should suffer from neuroses of different kinds to a greater or lesser extent, purely functional in many cases and in others [adding] to the effects of injury. ( Taylor, Proceedings, p. 22).

To learn more about the way people thought about shell shock in war time Australia I typed the  words ‘shell shock’ into the search engine of the Australian National Library’s digitized newspaper collection : TROVE along with the dates: 1 January 1914 to 31 December 1916. I discovered not just  accounts of shell shock and its treatment by medical practitioners, but a seam  letters from soldiers in the field. These had  passed, somehow,  through the censor’s hands to reach their destination.  These were from Australian soldiers. In civilian life they were among the legions of  labourers, clerks and bankers who had enlisted to serve the Empire.  These letters were written to family and friends who forwarded them to the local newspaper editor editors for publication.  Most towns throughout New South Wales where I found most of these letters, had their own newspaper. Editors were well known to the community and, moreover, the folk who forwarded these letters to the paper knew that their townsfolk would be interested in the  progress of their men at war.

In these letters  home the men related their experiences at the battle for Pozieres from 23rd July 1916 until the 4th August, 1916. Often a way of assembling one’s mind after terrible events, the letters are vivid descriptions of thier battle experiences.  By the end of 1916 the term ‘shell shock’ was familiar to the soldiers and, increasingly, to the folk at home. ‘Shell Shock’ had emerged early and surprisingly. By December 1914, shortly after the war’s beginning, reports were reaching London that large numbers of soldiers had been evacuated from the British Expeditionary Force  with nervous and mental shock. (Shepherd, 2002: 21). Charles Myers, a psychologist who investigated the condition likened the condition – with its symptoms of paralysis, the loss of senses, loss of speech and/or  hearing – to hysteria ( Myers 1915).  Initially explained as a sign of weakness and fearfulness, if not degeneracy, shell shock was increasingly understood as a condition which observed neither rank or class. It was as difficult to treat as to understand  although generally, views evolved from an emphasis on physical interpretations at the commencement of the war to acceptance of psychological understandings at its end.

The Letters

Corporal Harold Glover was buried when a shell exploded close to him. He was dug out, unconscious for some hours As recorded by his doctor, John Springthorpe, a Melbourne Psychiatrist who was serving in Military hospitals,  Glover reached England suffering from ‘headaches, tremors, bad dreams, fainting attacks, cardiac pain and general nervous excitability’ (NAA B2455, GLOVER H A). His letter written to his brother was published in the Singleton Argus on 12 October 1916.

Words cannot describe what the situation was like… It was not warfare at all but simply murder. One need not be in the front line of the trenches to get wounded or killed: you get it in your dugoput or simply miles behind the lines…. The sight of the dead and wounded soldiers is nearly enough to make one go mad and thes tench from the dead horses and human bodies is absoletly unbearable at times. Big men cry and are absolutely broken- spirited with the scenes of bombardment… Gallipoli was never like this…

Fred Brown, a former clerk, wrote to his sister:

The dead, both British and German, were in many places piled waist high and when gaps were made in the parapet the biodies were thrown in to fill the gap along with empty rifle equipment and bomb boxes. A man who a few minutes previously was your mate was now a barricade for you. Amongst all the dreadful things of war, the most pitiful is a man who has lost his mental balance. You see dozens upon dozens of them without a scratch, yet ruined for life. ( Gloucester Advocate 1916)

Joseph Jackson, born in 1863, lowered his age to enlist in 1915. After the battle at Pozieres he was admitted to hospital in England and subsequently elected to return to Australia. His letter was published in the Maitland Mercury on 17th January 1917.

We had three go luny ( loony) from sehh shock… It was painful to realize how many good fellows had gone whilst the memory of the agonizing sights of the wounded linger with you… Talk about Hell. wll, if it’s any worse than Pozieres then I don’t want to assist old Nick.

According to Harry Bedford,  some men could not stand the strain. They went off their heads. Holding on until the end of their turn at the front was worst: it is then a man sees a chance of getting out safely and he begtins top think, “Onlu a few more hours to go: I wonder if I will get knocked”.

Springthorpe’s Intervention

At the Congress Springthorpe who had been  embattled with the Repatriation Department since June 1920 asserted that in the field hospitals  psychological treatment for these men was a poor relation to physical treatment.  The hospitals were not especially staffed, he explained. Many men were sent to places not equipped to treat these men. Many remained ‘for months, misunderstood and uncared for until finally disharged, often without any pension, because an uninformed board could find no disabilities’. When they returned to Australia the first arrivals were dismissed, without pension, as malingerers; the next batch dealt with as requiring isolation and restraint. And ever since until the last few weeks, all have been under the triple control of the Defence, Pensions and Repatriation ( Government Offices) without any nexus or comprehensive scheme. 

Legacies of war, apart from names engraved upon country town memorials throughout Australia, were the ongoing trauma of disability, the shattered minds of the traumatized soldiers which in turn tore apart the lives of many families over many years anf generations ( Larsson 2009).
Returned soldiers found they could not simply slip back into their old lives, nor could families make room for them as they had expected.

References:

Charles Myers ( 1915) ‘A Contribution to the study of shell shock: being an account of three cases os loss of memory, vision, smell and taste, admitted into the Duchess of Westminster’s War Hospital, Le Touquet’, The Lancet, 2  February 1915, pp. 316-319.

1916 ‘OUR BOYS AT THE FRONT.’, Singleton Argus (NSW : 1880 – 1954) , 12 October, p. 2, viewed 24 November, 2015, http://nla.gov.au/nla.news-article80448930

Gloucester Advocate 4 November 1916, p. 3.

Ben Shepherd ( 2002) A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century, London, Pimlico ( Random House).

John Springthorpe: Australasian Medical Congress, 1920, Section VIII: Neurology and Psychological Medicine, pp. 402-404.

‘John Springthorpe’s Memo on Cardiac and War Neurosis’,National Archives of Australia http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=4794937

Dr W Taylor,  Presidential Address, Australasian Medical Congress, 1920, p 22.

1916 ‘Returned Heroe’s Death.’, National Advocate (Bathurst, NSW : 1889 – 1954), 26 August, p. 2, viewed 24 November, 2015, http://nla.gov.au/nla.news-article158525008

 

Mental Hospitals for Returned Soldiers -WW1

28 Sunday Sep 2014

Posted by in John Springthorpe, Shell Shock, War Neurosis

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Further to my previous post about psychiatric treatment of shell-shocked soldiers in  Australia after the end of the Great War I notice that an exhibition about this has been opened in Melbourne.The AGE announced it today under the heading: “Family Tells of WW1 War Hero’s 35 Years as a Mental Patient in Bundoora Hospital”. A life wasted….You can read about it here….

On the 100th Anniversary of the ANZAC landing at Gallipoli – 25 April 2015

25 Thursday Sep 2014

Posted by in John Springthorpe, War Neurosis

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 Marina Larsson, Shattered Anzacs: Living with the Scars of War, Kensington, NSW, UNSW Press, 2009.

In what way, I wonder, will the psychoanalytic fraternity in Australia acknowledge the  the Great War a century ago, the emergence of psychoanalytic treatment amongst the medical profession? For Australians next year marks the centenary of the landing at Gallipoli on 25th January 1915. Although psychoanalysis in Australia had its origins in these wartime hospitals and in the treatment of shell-shocked soldiers as historian, Joy Damousi also points out, I am slightly surprised to find this has been somewhat overlooked by the professional community – and others. I could be wrong here and am certainly open to correction.In 1919 three psychiatrists – or were they called ‘neurologists’ in those days?- returned to Australia from the Military Hospitals  where they had worked alongside British colleagues, including, perhaps, W.H.R. Rivers whose work with shell-shock victims is recorded in Pat Barker’s Regeneration Trilogy published from 1991.  They had discovered Freud’s ideas of the ‘talking cure’ in the treatment of shell shock- Paul Dane, John Springthorpe and Roy Coupland Winn among them. On the other side of the fence at the fifth Psychoanalytic Congress at Budapest in 1918  Hungarian psychoanalyst Sandor Ferenczi had presented his findings on War Neurosis. Ferenczi was subsequently elected President of the International Psychoanalytical Association – before the war turned and the Austrian-Hungarian Empire was defeated.

During the 1920s Both Dane and Winn returned to England for further psychoanalytic training. Melbourne based Dane was analysed by Joan Riviere and, in 1939, sent his daughter to England for treatment with Anna Freud. Winn who lived in Sydney was was a patient of Dr Noble. In 1931 he set up the first private practice as a psychoanalyst in Australia. On the eve of the Second World War both liaised with the Australian Government and with Ernest Jones for the resettlement of European psychoanalysts displaced by war in Australia.

In the immediate post war period, when it was becoming clearer that soldiers were returning suffering from shell shock as well as other severe medical conditions, a third doctor, Melbourne based John Springthorpe, set about trying to ameliorate the situation – or at the very least establish a method of treatment for them. Before the war Springthorpe was one of the most senior medical practitioners in the neurological field with considerable experience in treatment of the insane. In February 1919 Springthorpe was appointed as the Commonwealth Medical Referee for Neurological cases. By mid 1920 his services were terminated.

On 14 July 1920 he wrote to the Commonwealth Repatriation Commission to express his views about the way ‘neurological cases’ in the cohort of returned soldiers were being managed. His letter, discovered in the National Archives of Australia is sharply critical of the attitude of local medical practitioners who had no experience of war conditions. People who suffered from war trauma were far more numerous and complex than his other concern, the cardiac cases but, as Springthorpe wrote, ‘ the local Medical Boards ( without any experience at the front) had discharged many as malingerers and without any pension. They have been coming back ever since. Later on they were quite wrongly treated with isolation and restraint’. At ‘Mcleod’, a Repatriation Hospital in Melbourne to which he was placed in charge  in February 1919, Springthorpe  discovered that ‘cases were then all over the hospital and elsewhere, without any differential diagnosis and with but very little treatment’. He continued:

‘I separated, classified, and treated them…By August I had treated 111 shell-shock and hysteroid and 132 neurasthenic,  with 51 complicated by gas poisoning, a number also cardiac and 26 confusional or mental. The treatment occupational, Home or other Leave, physical and psychotherapy drugs etc is summarized in a report to the DGMS ( Director General Medical Services) in November’ 1919.

Springthorpe was relieved of his duties in August 1919, even though, he noted,  he was ‘well on the way to the establishment of a satisfactory scheme’ but there was no provision for follow up after discharge from hospital’. Why this was so is not clear from the records I have looked at so far… perhaps he was a thorn in the side of the Commissioners. Springthorpe wrote:

Feeling that not all was being done for neurological cases (many were under no treatment and wandering about dissatisfied) I brought the matter under the notice of the Repatriation Department and also before the DGMS who, at my suggestion gave me an outpatient clinic one afternoon a week at the Base Hospital. I found, however, that another clinic was in prior operation, practising simply by hypnotism ( the use of which is now limited by experts to cases of amnesia and terrifying dreams and so out of place at this stage for outpatient treatment) and that there was no publicity whereby cases requiring treatment could learn of our existence and no official attempt to extend our influence’.

Despite his efforts the Repatriation Commission had decided not to ‘utilise my services’ despite support for him from the Minister and from the Returned Soldiers League. Be that as it may Springthorpe continued, ‘the obligation to action remains and all concerned to look to it to restore these most distressing of cases’.

In its response to Springthorpe’s letter the Repatriation Commission was having none of it. It rejected Springthorpe’s views on treatment and defended its authority and the knowledge if the doctors it had appointed – all senior, experienced, and recognised leaders in their fields.

‘All neurological cases were treated by physicians who are experienced and well qualified to do so’, an officer, Dr J F Agnew, opined in Minute Paper to the Commission’s Chairman.   None had been treated with restraint and isolation other than ‘definite mentals who have been certified insane by Lt Col Jones Inspector General of Mental Hospitals* and Major Hollow, Mental Specialist and Superintendent at Mont Park Asylum’, he continued.  Indeed the whole matter had been discussed by senior officials at the Medical Advisory Board. Agnew named these distinguished personages:  Sir Henry Maudsley, Lt Col. R R Stawell, Col Geoff. Syme and Lt Col. James Ramsay Webb – ‘all of whom are specialists with war service and experience’.

The Commission’s position is summed up in para 12 of the Minute:

Expert opinion is definite as to the best method to be adopted in the treatment of neurological cases as to the best method to be adopted in the treatment of neurological cases, and it is clearly laid down that the concentration of these men in a clinic is productive of more evil than good and in the best interests of the men they should be placed in suitable employment as the best and readiest means of their final rehabilitation… When these men are kept for unlimited periods in Hospital  in such clinics as Dr Springthorpe suggests they suffer from “Hospitalitis” and very often in the course of such treatment develop new symptoms owning to their proclivities to imitate the symptoms of their fellow patients.

It appears that  Springthorpe, drawing on his experience in the field hospitals,  recognized the degree of suffering caused by shell shock as something little known until the Great War and which affected all classes. The Commissioners on the other hand appear to have maintained a belief in a class distinction between themselves and, apparently, the  ‘lower classes’ that were the patients.

In August and September this year the Australian Broadcasting Corporation finished televising a 4 part series, ‘The War That Made Us’, tracing through the diaries of those who were there – a nurse, Kit McNaughton, an Officer, ‘Pompey Elliott’ and a trooper, Archie Barwick, their impressions and the psychological changes occurring within them as a result of their experiences at the Front. Elliott, we were told, did not recover from the war: he suicided in 1931. Kit McNaughton had her own suffering, too. Although she returned to her home at Little River south of Melbourne and married her long time beau, she remained torn between the life she had left behind on the fields of war and the conventions to which she returned. I have reviewed Janet Butler’s elegant biography of Mc Naughton ‘Kitty’s War’ here.

One of the historians featured on the program, albeit briefly, was Marina Larsson whose book, Shattered Anzacs: Living With the Scars of War published in 2009, takes up the problem of post war suffering.

Front Cover

Death did not occur only on the battlefields, she points out, but often many years later as a result of wounds and illness. Death also occurred through suicide as a result of mental distress and trauma – Post Traumatic Stress Disorder.  Larsson also points to the cost to families when a loved one returns home and slowly reveals their depth of scarring. The insidious onset of alcoholism, heavy smoking and domestic violence are all responses to unbearable pain and terror. The casualties of war are far reaching across time. They may be held for generations within the family’s unconscious.

What became of Springthorpe and of the men who returned from war with such shocking psychological injuries is something to look at further. Marina Larsson has made a very good start.

References:

Australian Broadcasting Corporation ( 2014) ‘The War That Changed Us’ Television Series, televised August-September 2014.

Pat Barker,(1991) Regeneration, Sydney, Penguin Books.

Janet Butler (2013), Kitty’s War:The Remarkable Wartime Experiences of Kit McNaughton, St Lucia, University of Queensland Press.

Joy Damousi (2005), Freud in the Antipodes: A Cultural History of Psychoanalysis in Australia, Kensington, UNSW Press.

Marina Larsson ( 2009), Shattered Anzacs: Living With The Scars of War, Kensington, NSW, UNSW Press.

Dr John Springthorpe’s Memo on treatment of Cardiac and War Neurosis, 14 July 1920. Series No A2489, Control Symbol 1920/ 4166, Barcode, 4794937, Canberra, National Archives of Australia.http://recordsearch.naa.gov.au/scripts/Imagine.asp?B=4794937, accessed 25 September 2014

Commonwealth of Australia, Department of Repatriation, Minute Paper, re Dr Springthorpe’s memo. on Treatment of Cardiac and war Neurosis, dated 23 July 1920, Series No A2489, Control Symbol 1920/ 4166, Barcode, 4794937, Canberra, National Archives of Australia.http://recordsearch.naa.gov.au/scripts/Imagine.asp?B=4794937, accessed 25 September 2014.

* W. Ernest Jones, Inspector General of the Insane was given an honorary post in the Army.