This insightful book offers a welcome focus on the Canadian experience of psychological distress in the wars of the twentieth and early twenty-first centuries. While the historiography of battlefield trauma in the twentieth century is well-rehearsed (the customary ‘shell shock to Post Traumatic Stress Disorder’ trajectory), there is now scope to begin integrating the consequences of the peacekeeping missions of the last decades of the twentieth century and the War on Terror into this lineage. The Canadian experience is particularly instructive in this regard, insofar as that nation’s military history encompasses not only the psychological damage done to soldiers by conventional warfare but also the unique stresses of peacekeeping work. As Montgomery argues, while historically the Canadian response to military trauma has been influenced by British and American approaches, it has also been shaped by distinctly Canadian circumstances—not least the national self-image of Canada as a ‘peaceable kingdom’ in which participation in peacekeeping missions ought to be a noble rather than traumatising enterprise. In this way, The Invisible Injured confirms the necessity of interrogating the contexts in which psychological distress is acquired, manifested and treated in order to appreciate its social and cultural resonances. The Invisible Injured proceeds chronologically and is therefore unavoidably a book of two halves. The first two chapters cover conventional but necessary territory: the railway spine of the mid to late nineteenth century; the shell shock of the First World War; the post-war concern over pension liabilities; the newfound prestige of psychiatry in the interwar period; the optimistic focus on pre-selection and psychometric testing in the Second World War—all episodes with Canadian iterations. The inclusion of material on the Korean War is an important addition to this section. Chapter 3 is a cogent and compelling discussion of the emergence of Post Traumatic Stress Disorder (PTSD) in the United States and the resulting scepticism of Canadian psychiatry towards what was regarded as a distinctly American, post-Vietnam War pathology—a stance that created problems not only for the sizeable cohort of Canadians who fought with the Americans in Vietnam but also for suffering veterans in general throughout the 1980s and 1990s. The final three chapters of The Invisible Injured are concerned in the main with the psychological toll of peacekeeping missions and the Canadian military’s response to this distress. Just as Canadian psychiatry had resisted the notion that PTSD was a disorder of general application, so too did the military question whether peacekeeping work could generate psychological symptoms equivalent to those of wartime, despite evidence of peacekeepers’ distressing experiences in Somalia and the former Yugoslavia. Old fears about malingering and outsize pension liabilities resurfaced. Nevertheless, from the mid-1990s increased public awareness of PTSD, publicity around so-called Gulf War Syndrome and a spate of suicides amongst former peacekeepers kept the possibility of psychological trauma in returned soldiers in the public consciousness. More recently Canadian participation in the War on Terror and in particular the Afghanistan War has played a role in maintaining this awareness, as well as prompting certain therapeutic innovations. Montgomery provides valuable insights into the successes and frustrations of seeking to change military culture in the context of this long-running conflict (in fact Canada’s biggest deployment since the Second World War). A change in nomenclature to emphasise that psychiatric symptoms are akin to a battlefield wound—an ‘Operational Stress Injury’ (OSI)—has had some success, as has the development of peer support and mentoring networks. An important change to employment conditions allowing sufferers to return to duty if they had recovered sufficiently is also aimed at ending stigma. In these final chapters of the book Montgomery makes effective use of interviews with veterans to outline the genesis and effects of these changes, as well as to explore in often moving detail the disillusionment and isolation some veterans experience after returning from deployment. This kind of analysis is invaluable for moving our conception of PTSD beyond the clinic. As one of Montgomery’s interviewee’s astutely pointed out, ‘trauma sufferers do not live in their doctor’s offices’; the challenge is to see ‘how trauma affects one’s social life and worldview, rather than just how it is diagnosed and viewed in medical terms’ (p.25). In this regard, the experience of Lieutenant-General Roméo Dallaire, the Canadian commander of the doomed UN peacekeeping mission in Rwanda, is emblematic. As noted by Montgomery, in the aftermath of that catastrophe Dallaire emerged as an influential advocate for mental health reform and support for peacekeepers, despite his own ongoing struggles with PTSD. As his most recent memoir makes clear, Dallaire has come to view his suffering as many-sided, comprising not just his ‘operational brain injury’ but a pervasive sense of a divided self that emerged in the wake of this injury—a duality that ‘causes an eternal crisis’.1The Invisible Injured is an important contribution to our understanding of such crises and their manifestations. Footnotes 1 Roméo Dallaire with Jessica Dee Humphreys, Waiting for First Light: My Ongoing Battle with PTSD (Toronto: Random House Canada, 2016), xv–xvi. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
Social History of Medicine – Oxford University Press
Published: Aug 1, 2018
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