“In Working in a World of Hurt: Trauma and Resilience in the Narratives of Medical Personnel in Warzones,“ Carol Acton and Jane Potter expertly and innovatively explore the diaries, letters and memoirs of selected medical personnel from the First and Second World Wars, the Vietnam War and the Iraq War. The examination in this book utilises a multidisciplinary approach incorporating life-writing theory and a literary-critical close reading of the texts (p. 16). This methodology allows the authors to draw out concealed details, not just from within what is written by the traumatised medics, but equally, from what they choose to omit, and how they use certain literary styles and techniques to reflect their differing responses to the emotional trauma of their situation. Moreover, Acton and Potter draw on psychiatric and psychological approaches to trauma so as to highlight the plurality of responses individual’s present to witnessing such suffering. This allows for a greater understanding of the relationship between the immediate context in which the individual is writing and their emotional response, in particular, the different interpretations of silence, resilience and breakdown.

The prevailing historiography on war and medicine is extensive, particularly regarding the major conflicts of the twentieth century. However, by utilising the aforementioned methodological approach, Acton and Potter have added to the vast historical discourse in a way which now appears striking by its absence. The existing work on war and medicine frequently explores this relationship in terms of war’s impact on medical innovation; in relation to abstract notions of modernity when analysing organisational developments to the structure of medical provisions and the industrialised warfare of the twentieth century; and with regard to medicine’s contribution to military success, such as is evident in Mark Harrison’s contention that, “In an age of total war, with manpower at a premium, all resources had to be used to their fullest extent and good medical services were essential if the maximum benefit was to be derived.” 1 When wartime nursing, doctoring, surgery, psychology or physical therapy is studied, it is invariably the combatant-patient who is central to the narrative. Therefore, any analysis of writings from medical personnel generally serve to further understand either, the changing modes of treatment for specific injuries; the changing societal understanding of the injuries on display; or, since Joanna Bourke’s seminal work “Dismembering the Male: Men’s Bodies, Britain and the Great War,” the changing understanding of the male anatomy and its relation to traditional constructions of masculinity.2 The traumatic experience of witnessing the destructive capacities of modern mechanised warfare, and the futility which has frequently attended individual attempts to counteract the brutality of such industrialised weaponry, is effectively concealed by wartime narratives which prioritise the physical and psychological trauma of the combatant. Redressing this omission appears fundamental to Acton and Potter as they successfully foreground the experiences of medical personnel, even if, in many cases, the writings of the personnel themselves, attempt to conceal their own experiences and emotions.

Thematically, the ambitious approach adopted in Working in a World of Hurt, is akin to that offered by Ben Shephard in his broad study of Soldiers and Psychiatrists between the years 1914 and 1994. Shephard examines the continuation of a cross-conflict dialogue within twentieth-century military psychology, between those he terms as the “Dramatists” and their opponents, the “Realists”.3 Similarly, Acton and Potter achieve a broad analysis which successfully considers each personal text individually; with the contemporary understanding of psychological trauma in mind, and comparatively; where similarities in emotional responses are highlighted. The first and second chapters impressively address the response of medical personnel to the trauma of the First World War. They contextualise and contrast the diaries and memoirs of nurse’s, such as Mary Borden, Enid Bagnold and Kate Finzi within the restrictive conditions of wartime censorship and in relation to post-war disillusionment at the scale of the industrialised slaughter. These chapters are supportive of the work of Christine E. Hallett, who contends that First World War nurses’ identified their work as “a process of ‘containing trauma’ – of creating safe boundaries within which healing could take place.”4 The discipline and efficiency this process necessitated appears conciliatory to Acton and Potter’s assessment that “Within the context of 1914–18 […] constructions of endurance and resilience were central to how individuals perceived their roles during the war.” (p. 46) Moreover, the literary analysis which underscores each of the chapters in this book is reminiscent of the approach taken by Santanu Das in his powerful work on “Touch and Intimacy in First World War Literature”. Das recognised a “crisis of experiencing” in the letters, diaries, and correspondence of medical personnel in the First World War; a crisis resulting from the feelings of intimacy and despair which accompanied the emotional attachment between a nurse and her patient, feelings which were exacerbated by the physical contact these situations demanded.5 Acton and Potter acknowledge this closeness as they summarily conclude that “the intimacy between the carer and the sufferer is the common element in all of the narratives discussed here and the source of the emotional pain that we find represented throughout, whether directly or indirectly” (p. 242). Therefore, this work provides a valuable expansion on what Das masterly achieved with his exemplary study of First World War literary texts.

“Working in a World of Hurt” is an innovative and an extremely creditable addition to what is already an impressive series of works on the Cultural History of Modern War. It provides an alternative perspective to the traditional historical fascination with the combatant-patient in the field of war and medicine. Furthermore, it offers cultural and medical historians of any major conflict a replicable template from which to build a textual analysis of the letters, diaries and memoirs of individual’s whose traumatic experiences might otherwise remain concealed.

Notes:
1 Mark Harrison, Medicine and Victory: Military Medicine in the Second World War, Oxford 2004, p. 1.
2 Joanna Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War, London 1996, p. 11.
3 Ben Shephard, A War of Nerves: Soldiers and Psychiatrists 1914–1994, London, p. xxii.
4 Christine E. Hallett, Containing Trauma: Nursing Work in the First World War, Manchester 2009, p. 16.
5 Santanu Das, Touch and Intimacy in First World War Literature, Cambridge 2008, p. 193.