On February 5th and 6th, 2016, the conference “Psychiatry during World War I”, hosted by Thomas Becker, Peter Fassl, Heiner Fangerau and Hans-Georg Hofer, was held in Irsee. For an international and interdisciplinary exchange, the conference organizers invited speakers from different disciplines, namely history, psychiatry, psychology and media sciences, and nations, e.g. Germany, Italy, France, Belgium and the United Kingdom. The meeting’s first two sections focused on the war’s impact on the treatment of traumatized soldiers in asylums in various European countries. In addition, the third and fourth division presented the developments in the postwar period after 1918 in terms of the war’s consequences for psychiatry and arousing controversies and interpretations.
The first section was introduced and moderated by PETER FASSL (Augsburg) and presented examples of psychiatric treatment of soldiers in asylums in the southern part of Germany and Austria-Hungary. Shortly after the outbreak of war, the first soldiers were admitted to asylums from military hospitals as they showed completely unknown disease patterns that couldn’t be explained by the military doctors. The psychiatrists in the asylums then had to face and treat these military patients, while trying to find the symptom’s origins and a diagnosis. DAVE BANDKE’s (Linz) study on the Vienna asylum Rosenhügel pointed out the great variety of confirmed diagnoses labeling these new disease patterns. Moreover, his study made clear that a confirmed diagnosis was not ultimate, in fact, the diagnoses of incoming patients changed in several cases during their stay at Rosenhügel. CHRISTOPH BARTZ-HISGEN (Heidelberg) gave a perspective on a special form of military hospitals in Baden, the so called “Beobachtungslazarette”, and their special role in the Baden military system. Their main purpose was to classify soldiers instead of treating them. The doctors in those military hospitals judged the soldier’s ability to work but did not confirm diagnoses.
UTA KANIS-SEYFRIED (Ulm) and CORINNA MALEK (Augsburg) gave a general overview of the soldier’s life and treatment in asylums in southern Germany. The speakers assumed that soldiers were mainly treated by work therapy due to a lack of clear statements in the sources. A deeper insight into work therapy was given by FELICITAS SÖHNER (Ulm) with her presentation of work and work therapy in the asylums of Günzburg and Kaufbeuren-Irsee, both located in Bavarian Swabia. She showed that work therapy was the most common therapy in those days and assumed that soldiers were integrated in the asylum’s already functioning system of work, although she lacked valid evidence, too. Furthermore, Kanis-Seyfried and Malek took up Heinz Faulstich’s thesis on starvation in asylums during World War I and disputed whether Faulstich’s findings could be proven from the examples they gave. Throughout the section it became clear that the treatment of soldiers could differ in huge ways depending on each asylum. Although there were so many differences in treatment and confirming diagnoses between the individual examples, a general dominance of work therapy could be determined.
The second part of the conference took an international perspective to compare the situation in the countries of the Central Powers and the Allies. Unlike Germany, other European nations, like France, the United Kingdom, Italy or Belgium, treated their traumatized soldiers near the front line. Moreover, the attitude of Belgian, British or French doctors towards soldiers suffering from war neurosis was less negative than in Germany or Italy. For the Italian monarchy, VINZIA FIORINO (Pisa) showed that Italian psychiatrists rejected and denied the war experience as an origin for war neurosis. Instead they concluded that the soldiers involved would have been taken ill also without the war experience. To emphasize the Italian opinion of those days, Fiorino presented three labels invented by Italian psychiatrists to describe distinct patterns of reaction of traumatized soldiers. In contrast to that, the Belgian and French psychiatrists were less strict with their judgment. They recognized the war’s impact on the soldier’s psyche and their sufferings from it. SUSANNE MICHL (Mainz) emphasized the French understanding of war neurosis with two contemporary paraphrase models: the “commotionées”, caused by a mechanical shock, and the “émotionées”, caused by a mental shock. Both emphasized emotion as a central element of war neurosis. Moreover, she stressed the opposing developments in Germany and France concerning the explanations of war neurosis and its origins. An expanded French point of view was given by MARIE DERRIEN (Lyon), who focused on the new role of the asylums in France for treating and curing soldiers. The main goal of therapy was a quick cure in order to send back the cured soldiers to the trenches. So soldiers stayed on an average five months in an asylum before they went back to the front line. Furthermore, Derrien pointed out, that French psychiatrists were keen on taking the chance offered to them by the war to distinguish themselves as experts in curing the new disease.
STEPHANIE LINDEN (Cardiff), SIMON WESSELY (London) and ANDREA VON HOHENTHAL (Freiburg) presented different aspects of a British perspective on war neurosis, or “shell shock”. Von Hohenthal widened the conference’s scope, adding psychology and its viewpoint to the discussion. She compared English and German developments in psychology during World War I and concluded that English psychologists were better integrated in the whole military system than their German colleagues. Linden took up the psychiatric view and presented, in general terms, the British perspective on shell shock. She compared the treatment of a German and an English soldier, who were both mentally affected in a similar way, in order to highlight the differences between both therapies. She also took up Wessely’s explanations on the special history of shell shock in the United Kingdom including the cultural and linguistic changes to its current meaning. The international perspective was rounded off by an insight into the Belgian case given by CHRISTINE VAN EVERBROECK (Bruxelles). She pointed out that the Belgian psychiatrists accepted that war experience could cause war neurosis, but not that it was the only reason for it. Moreover, she showed that the experience of war and occupation not only affected the soldiers at the front line but also society as a whole.
Although the war had ended on 11th November 1918, its aftermath lasted into the 1920s. The society in defeated Germany had not only to face the harsh regulations of the Treaty of Versailles but also a huge number of physically and mentally injured soldiers. The major task of the postwar period was to reintegrate these returning soldiers into society, the economy and working life. In connection with the task of reintegration, a debate on granting military pensions arose. A key issue was the question of granting pensions to mentally injured soldiers, which became a controversy in discussions between the civil and military administration and psychiatrists. With her talk, STEFANIE NEUNER (Berlin) examined whether the social reintegration of the mentally injured had been successful by analyzing the soldiers’ socio-economic situation between 1918 and 1933. Moreover, she linked the soldiers’ state of health to their experiences and efforts to return into society. A second talk dealing with the debate on reintegration, granting of pensions and the social standing of returning mentally disturbed soldiers was given by ANDREAS ENDERLIN (Vienna). He took up the postwar situation and discussion in Austria. His findings corresponded with those of Neuner; both concluded that the efforts of reintegration failed, turning most of the mentally disturbed soldiers into social outcasts. A very late effect was presented by PETER STEINKAMP (Berlin), with selected examples of World War I veterans born between 1894 and 1904 and recruited by the Wehrmacht during World War II.
Beyond the impact on society, psychiatry was highly affected by the war’s aftermath. The war had brought huge progress to the field, especially in terms of forms of therapy, as well as to the development of asylums. Throughout the war psychiatrists had developed a new self-image of themselves and their profession which they wanted to keep in the postwar era. Their new self-image was connected to the innovations in the field of therapy gained throughout the war. Most of the therapies were invented to cure traumatized soldiers and were adapted to civil psychiatric treatment in the postwar period. MAIKE ROTZOLL (Heidelberg) presented some of the new forms of therapy which were transferred to civil psychiatric treatment and showed their further development in the postwar era. Moreover, she tried to explain the emergence of the new psychiatrist’s self-image mainly concentrating on the influence of knowledge gained by war. In connection to the new therapeutic approaches the presentation of disease changed with the availability of new media like film. Psychiatrists, like Max Nonne, used the new medium to visualize symptoms of war neurosis in order to study them. But not only did psychiatrists use the new media, also filmmakers took over the themes of war neurosis as subjects in their films. LENA CHRISTOLOVA (Constance) gave an insight into one of the most famous films of those days with her analysis of Robert Reit’s “Nerven” from 1919 and added a media studies perspective to the conference.
Controversies and interpretations of different topics by contemporary and non-contemporary researchers, such as the origins of symptoms and their confirmation as a diagnosis, were discussed next. JULIA BARBARA KÖHNE (Berlin) examined short movies recorded by military neuropsychiatrists to document different stages of symptoms of hysteria. These films were used among neuropsychiatric experts to compare and standardize symptoms of new diagnoses. With her talk, she showed how neuropsychiatrists interpreted different symptom patterns and confirmed new diagnoses.
In this connection, the therapeutic methods for curing such symptoms were also discussed. PHILIPP RAUH (Nuremberg-Erlangen) traced the success of the psychogenic diagnosis approach with his presentation of the main decisions and findings of the military psychiatry congress held in 1916 in Munich. At the congress, supporters of the psychogenic approach grafted it onto the somatic approach. As a consequence the psychogenic approach became the recognized standard. The struggle between the supporters of the psychogenic approach and those of the somatic approaches played a major role, too, in RALF SEIDEL’s (Mönchengladbach) talk. He gave an overview of neuropsychiatric practice, within a discussion and interpretation of symptoms in which psychogenics or somatics were a central element. His conclusion was similar to Rauh’s.
Therapy and diagnoses were discussed largely by researchers from the 1970s to the present day. The first study dealing with war neurosis and their practical therapeutic treatment was that of Kurt R. Eissler, published in 1979. Eissler presented and judged the example of the prosecution of Wagner-Jauregg in 1920, asking if his treatment of traumatized soldiers was appropriate. HANS-GEORG HOFER (Münster) used Eissler’s study to exemplify the two main contents of the section in one example. On the one hand he showed within his talk the ongoing controversy on Eissler’s study as well as the 1970’s controversy on appropriate therapy methods concerning traumatized soldiers. On the other hand, Hofer made clear which intention Eissler’s interpretation of the events had and their further impacts on the scientific debate throughout the 1970s. GUNDULA GAHLEN (Berlin) added with her talk another aspect to the controversies on therapy and diagnoses especially in terms of influencing factors. She examined whether social and military rank influenced the confirmation of diagnoses and whether officers were better and less harshly treated than ordinary soldiers. Her central question was to find out if there was a two-tier health system which treated officers better than ordinary soldiers in terms of therapy, confirmed diagnosis and board and lodgings.
Summing up two very work-intensive days, the conference provided a broad program with a wide range of various topics which provoked lively discussion among the participants. Although the events of World War I played only a secondary role, the conference gave a good overview of the war itself, its impact and consequences, especially for the soldiers. Moreover, the presentations of the postwar period opened up perspectives on a longer time period and made it possible to draw topographies of psychiatric practice on an international basis. Although there have previously been many conferences, colloquiums and symposiums dealing with World War I and its consequences, the conference in Irsee opened up new perspectives on the development of psychiatry during World War I and its main actors, and was also enriched by international and interdisciplinary collaboration. The proceedings of the conference will be published in 2017 in the book series “Irseer Schriften” (UVK Verlagsgesellschaft, Constance/Munich) by the Schwabenakademie Irsee.
Thomas Becker (Ulm), Heiner Fangerau (Düsseldorf), Peter Fassl (Augsburg), Hans-Georg Hofer (Münster): welcome and introduction
I. Psychiatric treatment in World War I
Chair: Peter Fassl
Dave Bandke (Linz): Between “finding” and “inventing” – an analysis of “war neuroses” at the mental hospital Rosenhügel in Vienna during World War I
Uta Kanis-Seyfried (Ulm): Traumatised soldiers of World War I in the mental hospitals Ravensburg-Weissenau (Württemberg) and Reichenau (Baden)
Corinna Malek (Kaufbeuren): Treatment of traumatised soldiers in the mental home Kaufbeuren-Irsee and the question of starvation
Christoph Bartz-Hisgen (Heidelberg): The observation hospital for soldiers with mental illness at the Heidelberg University Hospital: military psychiatry expert reports and practical consequences
Felicitas Söhner (Ulm): Work in mental health care during World War I – between treatment and economic aspects
II. Transnational and comparative perspectives
Chair: Hans-Georg Hofer, Thomas Becker
Vinzia Fiorino (Pisa): Hysterical men, regression to childhood, naked men on the run. Some reflections on clinical reports during World War I
Christine van Everbroeck (Brussels): Army, society and war neuroses in World War I in Belgium
Marie Derrien (Lyon): A new role for asylums? Soldiers’ experiences of institutionalization during World War I in France
Susanne Michl (Mainz): “Invalide du courage”. War neurotics in French psychiatry
Andrea von Hohenthal (Freiburg im Breisgau): The development of psychology during World War I – comparison of Great Britain and Germany
Sir Simon Wessely (London): “Happy Birthday Shellshock”
Stephanie Linden (Cardiff): They called it Shell Shock – the British perspective on war trauma in World War I
III. Development after 1918: examination of the consequences of war
Chair: Thomas Becker
Lena Christolova (Constance): The war and “nerves”: contemporaneous documentation of posttraumatic symptoms as sequels of World War I and the film ‘NERVES’ by Robert Reinert (Germany, 1919)
Andreas Enderlin (Vienna): “Broken man” in mental health care: aftercare for mentally impaired World War I conscripts after World War I
Stephanie Neuner (Berlin): On the socioeconomic and health status of soldiers with mental disorders after 1918
Maike Rotzoll (Heidelberg): New tactics on the therapeutic frontline? On the importance of World War I for treatment concepts in civilian psychiatry
Peter Steinkamp (Berlin): “Drafted twice”: life trajectories of World War I conscripts in the Wehrmacht during World War II
IV. Controversies and interpretations
Chair: Heiner Fangerau
Philipp Rauh (Nuremberg-Erlangen): The military psychiatry congress – decisions taken at the Munich conference of May 1916
Gundula Gahlen (Berlin): A two-tier health system? Mentally ill officers in World War I from a medical point of view
Julia Barbara Köhne (Berlin): Hysterical warriors: strategic images in European military neuropsychiatry-cinematography
Hans-Georg Hofer (Münster): Freud, Wagner-Jauregg and the controversy on the treatment of war neuroses
Ralf Seidel (Mönchengladbach): World war and modernity: neuropsychiatric practice and claims of psychiatric interpretation