Memory, war and traumaRichard Balon, MD
Wayne State University, Detroit, MI, USA
By Nigel C. Hunt. New York, NY: Cambridge University Press; 2010; ISBN 978-0-521-71625-3; pp 239; $34.99 (paperback).
My first glance at Memory, war and trauma was a bit sceptical, something along the lines of “God, yet another book on PTSD.” As we know, one should not judge a book by its cover and therefore I looked inside, started to read, and my scepticism gradually dissipated. This actually is not another book on posttraumatic stress disorder (PTSD), but a different, more complex book on topics reflected in the title—memory, psychological trauma, and war. The author is a British psychologist, therefore the book is written from the British and psychologist point of view. That is not a criticism, but rather a framing of the text or putting it into context.
The book consists of a Preface and 14 chapters. After the first 2 introductory chapters, as the author writes (p 12) the book is split into 3 main sections, the first exploring current trauma and memory; second “concerned with the centrality of narrative to the understanding of trauma” (p 13); and the last one focusing on practical examples of how to help people improve their lives, eg, how to use the narrative scientifically to explore war trauma.
The first chapter, “Background and purpose,” helps to understand the concept of this volume. As the author explains, “This book is an account of the psychosocial impact of war in its broadest sense—that of understanding memory not just as individual memory, but also as the ways in which other people, society and culture, and history, all affect how we remember. It considers the relationship between memory, war, and traumatic stress. Many people have psychological problems as a direct consequence of war; many have terrible memories of these experiences that they find difficult to deal with; and many never do learn to deal with these memories” (p 2). However, not to lose a broader or complete perspective, the author also notes that “the majority of people who go through these experiences do not have serious long-term problems, and that they are able to handle their memo-ries and emotions and get on with their lives, more or less successfully. Many still experience intense emotion when they think of what they have been through, but that does not mean they are traumatized” (p 2). The author asks himself, “Why is this so? What is it about memory, war and traumatic stress that make it so difficult to fully comprehend?” (p 2). He also reminds us that “Memory is flexible, permeable, changeable, and—critically—affected by the social and cultural world in which people live” (p 2-3) and that “Low perceived social support is seen as a predictor of traumatic stress” (p 3). In another part of this chapter Nigel C. Hunt emphasizes that narrative, social discourse, and collective memory are central to the arguments presented in his book. Individual narratives, as defined by the author, are what we all have as explanations of ourselves, our immediate environment, and the world. Social discourse is the way people interpret events; and “collective memory is information about society that is accumulated over the years and develops into a kind of ‘social fund,’ and is drawn upon in the development of social discourses and individual narratives” (p 5). The second chapter, “Historical perspectives,” provides a number of historical and literary examples of traumatic war experiences drawing from the Bible, Homer, Shakespeare, Dickens, and others. The author notes that the essentially random nature of battle has led many soldiers to acknowledge the instability of life (p 16). The author presents some fascinating historical information, eg, that the Russo-Japanese war of 1904 to 1905 was the first time psychiatrists served near the front (Russians actually had a psychiatric hospital where they treated 2,000 casualties). The author also emphasizes that we have to be careful in imposing modern ideas historically and thus attempting to change history. Events have to be viewed in their historical context.
The third chapter, “Methods and ethics,” reviews methods used in trauma research and problems associated with them (eg, problems associated with various measures and scales), and ethical issues involved in trauma research (eg, causing distress to traumatized participants, self-exposure, and visiting war zones and dangerous places by researchers). The fourth chapter, “Current theory: post-traumatic stress disorder,” is a solid overview of the development of the concept and diagnosis of PTSD (using the DSM criteria) and also its critique. The fifth chapter, “Approaches to understanding trauma,” discusses various approaches to understanding trauma, such as cognition and emotion (people who are traumatized are more likely to pay more attention to, and be more perceptually aware of, environmental stimuli that remind them of the traumatic event than people who are not traumatized [p 61]); learning theory; the dual representation of memory (implicit and explicit); neuropsychological understanding; physiology and narrative processing; psychodynamic approaches; existentialism and humanism; and coping.
The sixth chapter, “Positive outcomes of traumatic experiences,” reiterates that most persons who go through traumatic or stressful situations are not traumatized. The text then focuses on what is called in different terms posttraumatic growth, stress-related growth, benefits, thriving, blessing, positive by-products, or positive readjustment. According to the author, the next chapter, “Memory and history,” together with the following chapter, “Personal narrative and social discourse,” form the thesis of the book (p 96). The author weaves through the complicated relationship between memory and history, and discusses shifting perspectives from memory to the past to history. The discussion includes an interesting part on the impact of collective memory on individuals. The author concludes that “Memory is crucial. People need to remember the past in order to have a successful present and future, in order to be able to interpret what has happened to them in the past” (p 113).
The ninth chapter, “Illustrating narrative as a scientific technique: The role of social support,” describes the use of narrative in scientific research of war trauma. The tenth chapter, “Ageing, trauma and memory,” is based on the author’s study of the very long-term effect of war, and points out that “the effects of traumatic stress on the older population are exacerbated by developmental changes, which themselves are stressors” (p 140). In this study, some veterans still experienced problems with their memories years after the war. The following chapter, “Literature and trauma,” is basically a discussion of the WWI novel All Quiet on the Western Front by Erich Maria Remarque. The following 2 chapters, “Memorialisation and commemoration” and “Battlefield tours” show, as the author mentions, “how memory, narratives, social discourse, and history are interlinked via the remembrance of war, and how people have a psychological need and a social duty to remember those who died in past wars” (p 172). The battlefield tours are interesting, because by walking “in the footsteps of the soldiers” (p 186) “one can improve one’s understanding of war, and try to understand something more of what people go through when they fight” (p 186). The last chapter, “Conclusion and future directions” is your usual wrap up.
This is a much more interesting book than I expected. It provides a different, novel view of the topic of memory, war, and trauma. It is well thought out and well written. Some parts are enjoyable reading, other parts may be a bit dry. I think that anyone interested in the topic of trauma of war will enjoy reading this book. Those treating veterans of recent and past conflicts would find this useful in better understanding their patients.
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.