Three large windows with extensive views dominate the room in which I wrote most of this book. As I immersed myself in the scientific writings of Mary Somerville and looked at the world outside through the lenses her writing provided, those very familiar views took on an entirely new aspect, and the world of nature became much more vast, vivid, and dynamic than I had ever imagined it could be. My own powers of perception had been expanded as I watched Somerville exercise hers. I hope I have succeeded in conveying the power of Somerville's transforming vision. Its power derives in large part from Somerville's ability to use science to heighten perception and stimulate imagination.

The utilitarian goals commonly associated with science often overshadow its other functions.

Physicians have long believed that disturbing experiences arouse intense emotions that can cause illness and disease. Similarly, human behaviors that can be interpreted in the diagnostic language of our own time as post-traumatic pathology date back to classical times. The first medical instances of describing, labeling, and treating such behaviors appeared during the seventeenth century, when army doctors typically regarded the cases as an organic disease of an unknown nature, cowardice, or malingering. Traumatic neurosis as a distinct psychiatric category, however, with an independent diagnostic identity and psychological – or mixed somatic and psychological – origins emerged in Western Europe and North America only during the last third of the nineteenth century.

The period 1870–1910 witnessed an unprecedented burst of creative psychological theorizing in Europe and the United States. This was the founding generation of modern psychology, psychiatry, and psychotherapy during which the sciences of the mind largely assumed the theoretical and professional forms in which we know them today. The observation and theorization of psychological trauma played no small part in this intellectual development. One of the first physicians of this period to explore systematically the idea of posttraumatic pathology and to write extensively about it – and who was a direct and demonstrable inspiration to medical traumatologists in the next generation – was the Parisian neuropsychiatrist Jean-Martin Charcot.

THE BACKGROUND TO CHARCOT'S WORK ON TRAUMATIC NEUROSIS

Charcot (1825–1893) studied trauma during the second half of his career, from the later 1870s through to his death in the early 1890s.

On July 6, 1884, the law of accident insurance, an act with far-reaching consequences, became effective in the German Reich, marking the beginning of a social and legal policy that gave the modern state a new shape as a “société assurancielle.” Following the establishment of private accident insurance in the wake of the expansion of the railways, the introduction of a liability law in 1871, and the implementation of health insurance in 1883, the 1884 legislation created a new conception of what constituted an accident. Thereby the role of the physician was transformed; doctors became “surveyors” [Gutachter] who must establish whether an accident was an “adequate cause” of an injury and then assess its impact on the victim and the insurance company. Trauma as a consequence of accidents occupies a peculiar place in the realm of accident medicine: From “railway spine” and “railway brain” to “traumatic neurosis,” physical injuries increasingly lose importance and attention gradually shifts to the psychic sphere. Henceforth, the accident takes the form of psychic trauma and shock and enters the realm of psychiatry. The clinical picture of traumatic neurosis described in 1884 by the German neurologist Hermann Oppenheim establishes a direct link between accident and injury. It is not a matter of external and corporeal injury, but rather of a “pathologically altered psyche with abnormal reactions” that, according to Oppenheim, derives from a psychic shock.

The last two decades have witnessed the emergence of what some have called a new, decidedly critical “welfare consensus” in Europe and North America. Many politicians, academic observers, public policy analysts, and public and private administrators of social services have come to agree on a relatively coherent set of axioms: that the state is overburdened; that the expansion of the welfare state has hindered economic growth; that the social safety net has created an inflation of needs; that welfare bureaucracy is too big, too inefficient, and more adept at creating problems than solving them; that the sovereignty of the individual and of civil society has been eroded by the proliferation of state welfare activities; that welfare has created institutional and electoral interests that irrationally prop it up; that the entire system is over-professionalized; and that welfare promotes anti-social values.

Criticism and the ensuing retrenchment have not been directed indiscriminately at the welfare state, however. Cuts to date have targeted mostly poor relief and housing programs, but have left pensions relatively untouched. Meanwhile, welfare has been the principal object of the backlash, as social insurance has continued to grow. In fact, throughout the supposedly “anti-welfare state” 1980s, surveys showed that citizens of welfare states overwhelmingly supported the entire range of social insurances that constitute and are commonly referred to as “social security.”

As Ralph Harrington argued in the previous chapter, modern travel, not modern warfare, engendered a novel and hitherto unfathomable ailment, the railway spine. Having gestated for more than a decade, this once unheard of ailment came to life in the spring of 1866. Initially regarded as an exclusively somatic disease, railway spine entered its adolescence in the 1880s as a confusing psychical ailment, began its adulthood in the 1890s in a state of somatic-psychic flux, and suffered an early death in the first decade of the twentieth century. In its short life, railway spine contributed to a fundamental restructuring of the somatic paradigm and to a novel awareness of the capacity of traumatic experience to engender a wide array of physical and psychical symptoms.

Railroad tracks in the United States had grown from 3,000 miles in 1840 to almost 52,000 in 1872. Such a rapid burgeoning was by no means an unmitigated blessing. With the expansion came accidents, injuries, and death. Historian Walter Licht reports that for every 117 trainmen employed in the United States in 1889, one was killed; for every twelve, one was injured. Workers and their families were not the only parties to be adversely affected; passengers and bystanders were also at risk. Although the majority of trainwreck victims experienced commonly expected ailments like broken bones, concussions, and contusions, other apparent victims appeared to escape physically unscathed. But some who literally had walked away from a high-speed wreckage soon found themselves displaying a host of seemingly inexplicable symptoms.

This project began as a scholarly conference on the history of medicine and psychological trauma at the University of Manchester, England, on March 29–30, 1996. At the University's Centre for the History of Science, Technology, and Medicine, John Pickstone provided material and intellectual resources for the event while Joan Mottram helped with the organization. The British Academy, The Wellcome Trust, and The Wellcome Unit for the History of Medicine at Manchester gave indispensable financial assistance. We also wish to thank everyone who attended the conference for making it such a successful and memorable occasion. Our thanks, in particular, to Roy Porter for lending his support.

During this project's long passage into print, Charles Rosenberg provided important scholarly guidance and professional encouragement. Gerald Grob gave the project a valuable, preliminary endorsement, and Jay Winter supported it with contagious enthusiasm. Roger Cooter, John Pickstone, Roy Porter, and Charles Rosenberg offered valuable critical readings of the introductory chapter, and Lisa Cardyn shared with us her thorough knowledge of the burgeoning bibliography on psychological trauma. The British Academy and the Department of History at the University of Manchester provided timely subventions for an ambitious publication.

Frequent exchanges with colleagues and friends – particularly Peter Barham, Eric Caplan, Hans Pols, and Wolfgang Schäffner – continually inspired and challenged our thinking about trauma.

In the waning months of the Great War, Tübingen psychiatrist Robert Gaupp was alarmed by the widespread belief that “war is a source of severe nervous or mental illnesses.” This view, he protested, “[is] for God's sake, incorrect.” “Even doctors,” added Gaupp's Berlin colleague Ewald Stier, “frequently succumb to the erroneous assumption that attributes to war a ‘damaging’ effect on the nerves.”

Gaupp and Stier were not unaware of the numerous cases of nervous and mental breakdowns observed during the World War – both were, in fact, actively involved in the diagnosis, treatment, and administration of Germany's nearly 200,000 “war neurotics.” However, like the majority of the nation's neurologists and psychiatrists, they attributed these numbers neither to the intense psychic and nervous demands of prolonged combat nor to the resounding impact of modern weaponry. Rather, both men looked within the psyche, blaming the wishes and fears of those soldiers who, they argued, lacked the strength of will and patriotic conviction to resist fleeing from the unpleasant conditions of war into the “comfortable bed of neurotic symptoms.”

As Stier wrote shortly after the war, “compensation for nervous disorders is not just the most difficult part of pensioning, but is, in short, the central problem of the whole war pension issue. It is impossible to overestimate its significance for the national economy.”

In 1918, the final year of the First World War, American playwright Eugene O'Neill, then twenty-nine years old, went to Provincetown, Massachusetts, where a summer colony of writers congregated. Each year, some of the group, calling themselves the Provincetown Players, staged a series of original one-act plays. O'Neill had contributed plays for this series before, and this year he had written one called Shell Shock, which explored the dramatic possibilities of this psychological phenomenon that was in the news. He was better suited than many writers to tackle such a project. With one suicide attempt behind him, good friends having already succeeded, and having had to deal with the problems of his morphine-addicted mother, O'Neill was no stranger to psychological problems.

In this dramatic venture, he failed. The play was stilted, the setting forced. The protagonist is a war hero, Arnold, who believes his heroic actions have been misunderstood and that he is unworthy of the respect and honor given to him. Disgusted by the carnage he has seen and his own feelings of guilt, he is anxious and distressed. His doctor can only advise the hero “to try and forget those unavoidable horrors.” When the doctor can produce evidence of Arnold's true heroism, his symptoms of distress and anxiety instantly disappear. The play was never performed and remained unpublished in O'Neill's lifetime.

In each of the belligerent countries of the Great War, military trauma, emotional suffering, and daily exposure to violence and death caused mental distress beyond all expectations. Psychiatrists in each country were called on to observe, select, and cure, and were forced to re-examine their views of mental illness in light of the war experiences. Italian psychiatrists, who since 1915 had taken a unified stance in favor of intervention, held positions of authority during the war both within the military and in society as a whole: Augusto Tamburini, president of the psychiatric society, was in charge of the neuropsychiatric service in the army; Leonardo Bianchi, professor of psychiatry in Naples, was minister without portfolio responsible for the coordination of war health services; and Enrico Morselli headed an important section of the Union of Italian Doctors for National Resistance.

The Italian debate on the nature and treatment of war neuroses was directly influenced by the role of psychiatry in national mobilization, by the tendencies that dominated psychiatric thought and practice, and also by the social and political tensions caused by the war. Italy, of course, was the only Western European country to enter the war without mass consensus; indeed, the war, although fought with persistent aggression until the end of 1917, never met with support from the Italian people, who maintained a consistently hostile attitude. Italy's intervention was, in fact, forced on the country by a small political elite that sought economic and territorial expansion and the restoration of domestic authoritarianism.

When H. G. Wells suggested in 1901 that “The nineteenth century, when it takes its place with the other centuries in the chronological charts of the future, will, if it needs a symbol, almost certainly have as that symbol a steam engine running upon a railway,” his comment reflected not only the economic, social, and industrial importance of the railway in the nineteenth century, but also its significance as an expression of a characteristic Victorian ideology in which engineering achievement was identified with economic expansion and social progress. However, from the point of view of the modern historian – and particularly the historian of trauma – as a symbol of the nineteenth century a steam engine running off a railway and dragging its train to destruction behind it might serve equally well. The railway accident was as much a product of the industrial nineteenth century as the modern, sophisticated, steam-powered railway itself, and it embodies and symbolizes many of the age's apprehensions about progress, technological development, and modernity as surely as the speeding express, the soaring viaduct, and the bustling station express its positive belief in such concepts. Just as the Victorian railway was a vast, dramatic, and highly visible expression of technology triumphant, so the railway accident constituted a uniquely sensational and public demonstration of the price which that triumph demanded – violence, destruction, terror, and trauma.