Psychiatry and War

by

Joelle M. Abi-Rached

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0050

Introduction

This article provides an overview of the historiographical—and to some extent, anthropological—literature on psychiatry and war. While the psychological and behavioral sequelae of war have been documented since antiquity, it was in the nineteenth century that these manifestations began to be rearticulated in psychological terms. This medicalization or psychologization of the discourse started to become more visible with the so-called war neuroses, a loosely defined category that peaked during the Second World War, and then was displaced by other conditions, such as shell shock during the Great War (World War I) and the recognition of post-traumatic stress disorder (PTSD) in 1980. While PTSD remains the emblematic war-related psychiatric diagnosis, many other postwar syndromes continue to be the foci of current research. This article traces the emergence and legacies of such diagnostic categories, examining key figures and social and cultural forces that shaped their development. There is a substantial body of clinical literature by psychiatrists, psychologists, neurologists, and psychoanalysts addressing the psychiatric and psychological sequelae of war. The article brings together seminal papers from this clinical literature with crucial secondary scholarship to demonstrate how these diagnoses came to be recognized and what they would eventually mean for the discipline. The piece eschews a strictly chronological narrative, opting instead to trace how wars seem to continuously produce real, yet intangible, symptoms that, once labeled and legitimized, become focal points in subsequent scholarship. Each war, rather than producing a straightforward progression in psychiatric knowledge, instead led to unique sets of symptoms that mental health professionals documented, labeled, and treated, often with great difficulty. The fascination with shell shock and its aftermath reflects both the devastating impact of World War I and the lasting influence of these diagnoses. An important aspect of the scholarship on war and psychiatry is the crucial role of mental health professionals in shaping narratives, including its political meanings and cultural legacies. First, clinicians documented the psychological and emotional impact of war on soldiers, contributing a clinical understanding of wartime trauma. Second, their work helped create a new field: military psychiatry. Third, they authored some of the earliest historical essays on war’s impact, chronicling the evolution of mental health concepts, the rise of military psychiatry, and efforts to address war’s detrimental psychological effects. Strikingly, mental health professionals played a key role—and often led the way—in challenging the practices of psychiatry, particularly during the 1960s and 1970s. These critiques intensified in the 1980s in the face of a rising tide of skepticism regarding PTSD. The relationship between war and psychiatry in this article is hence explored in an interdisciplinary manner to try to make sense of how our understanding about mental health has changed, as it was crafted over time by clinical practices, societal attitudes, and shifting ideas about trauma in relation to war.

Historiographical Trends

Scholars have conducted numerous studies on wartime trauma, examining initial psychological disruptions and diagnoses, therapeutic approaches, as well as the enduring cultural, artistic, and political impacts of conflict. However, the historiography of wartime trauma has changed over time. The journalist Albert Deutsch’s and psychiatrist Edward A. Strecker’s respective historical essays on the Civil War and the two world wars in Hall 1944, commissioned by the American Psychiatric Association, represent examples of early studies primarily written by practitioners or advocates. The critiques of “psychiatric power,” as developed in Foucault 2008, sparked a more critical and less celebratory analysis beginning in the 1960s and carrying on into the 1970s. This view, which questioned the role and authority of psychiatry, was later adopted by historians of war trauma, breaking with narratives that celebrated psychiatry’s progress and achievements. Smith 2001 characterizes the cultural history approach that emerged in the 1970s. Higonnet 1987 and Bourke 1996 introduce a gender studies perspective that developed in the 1980s. In the 1990s, Young 1995 offered a critical analysis of what the author called the “invention” of PTSD that remains influential to this day. This ethnographic and intellectual history study was followed by comparative studies of war’s legacies, as demonstrated, for example, in Cohen 2001. More recently, Lloyd 2000 has emphasized the prominence of postcolonial and decolonial perspectives. With the “global turn” in trauma studies, as discussed in Micale 2017, historians have aligned with the broader global shift in historical scholarship, leading to historiographical and ethnographic approaches that explore how the psychiatric discourse is shaped by war, colonization, and military occupation in conflict-affected regions (as demonstrated, for example, in Abi-Rached 2020 and Varma 2020).

• Abi-Rached, Joelle M. ʿAṣfūriyyeh: A History of Madness, Modernity, and War in the Middle East. Cambridge, MA: MIT Press, 2020.

  DOI: 10.7551/mitpress/12540.001.0001

  Examines the social, political, and institutional history of psychiatry in the Middle East through the prism of one of the first modern psychiatric hospitals in the region, ʿAṣfūriyyeh, or the Lebanon Hospital for Mental and Nervous Disorders, from the late Ottoman period until the hospital’s official closure in 1982. Underscores the ways in which war and political turmoil have shaped psychiatric care in the Middle East, with ʿAṣfūriyyeh playing a pivotal role in introducing Western models of psychiatry while also grappling with local needs and conditions.

• Bourke, Joanna. Dismembering the Male: Men’s Bodies, Britain and the Great War. Chicago: University of Chicago Press, 1996.

  A critical analysis of how the Great War affected gender, male bodies, and masculinity in Britain.

• Cohen, Deborah. The War Come Home: Disabled Veterans in Britain and Germany, 1914–1939. Berkeley: University of California Press, 2001.

  DOI: 10.1525/california/9780520220089.001.0001

  Focuses on the experiences of disabled veterans in the aftermath of World War I in both Britain and Germany—two belligerent nations—highlighting the complexities of veterans’ postwar lives and the ways in which their disabilities became a powerful symbol of the war’s lasting impact. Examines the factors that influenced the success or failure of reintegrating disabled veterans in Britain and Germany. Also explores how the states and their citizens came to reconcile the immense human costs of war.

• Foucault, Michel. Psychiatric Power: Lectures at the Collège de France, 1973–1974. Edited by François Ewald, Alessandro Fontana, and Arnold I. Davidson. New York: Picador, 2008.

  Explores how psychiatry evolved as a tool of social control and how it became institutionalized as an authority over deviant behaviors. The 1973–1974 lectures at the Collège de France examined psychiatry’s relationship with power, particularly how psychiatric institutions emerged as mechanisms to enforce norms and discipline individuals deemed abnormal.

• Hall, J. K., ed. One Hundred Years of American Psychiatry. New York: Columbia University Press for the American Psychiatric Association, 1944.

  Celebrates one hundred years of existence of the American Psychiatric Association, edited by a board that includes psychoanalyst Gregory Zilboorg. Contains three chapters on war and psychiatry: two written by Albert Deutsch on the Civil War and World War II, and a chapter on World War I written by Edward A. Strecker.

• Higonnet, Margaret R., ed. Behind the Lines: Gender and the Two World Wars. New Haven, CT: Yale University Press, 1987.

  One of the early volumes to bring together essays on how gender shaped experiences of the two world wars. Examines how psychological trauma was experienced differently by men and women due to gendered expectations and roles in wartime.

• Lloyd, David. “Colonial Trauma/Postcolonial Recovery?” Interventions 2.2 (January 2000): 212–228.

  DOI: 10.1080/136980100427324

  Criticizes postcolonial theory’s propensity to make a clear comparison between the trauma that individuals and entire communities that are or have been subjected to colonial control endure. Argues that this approach might not adequately convey the complexities of colonial violence and its lasting effects. In anticipation of Lazali 2021, cited under (Post)Colonial Trauma and the Decolonial Turn, Lloyd questions whether postcolonial recovery can ever fully address the lingering impacts of colonialism.

• Micale, Mark S. “Toward a Global History of Trauma.” In Psychological Trauma and the Legacies of the First World War. Edited by Jason Crouthamel and Peter Leese, 289–310. Cham, Switzerland: Springer International, 2017.

  DOI: 10.1007/978-3-319-33476-9_12

  Argues that incorporating scholarship from countries like Japan, Korea, Russia, and Australia can enhance our understanding of trauma and its study. Urges Western scholars to move beyond international and cultural boundaries, suggesting that this broader perspective could lead to the next phase of trauma research in a global context.

• Smith, Leonard V. “Paul Fussell’s The Great War and Modern Memory: Twenty-Five Years Later.” History and Theory 40.2 (2001): 241–260.

  DOI: 10.1111/0018-2656.00164

  Revisits Paul Fussell’s influential work, The Great War and Modern Memory (1975), highlighting how it shaped understandings of the war, particularly through its focus on irony, language, and the disillusionment of soldiers. Recognizes Fussell’s book as a seminal work but urges historians to expand the narrative of World War I beyond the literary framework that Fussell deployed, which characterized cultural history and the “linguistic turn” in the 1970s.

• Varma, Saiba. The Occupied Clinic: Militarism and Care in Kashmir. Durham, NC: Duke University Press, 2020.

  DOI: 10.1215/9781478012511

  Investigates the entanglement of health care and militarism in the conflict-ridden region of Kashmir. Drawing on ethnographic research, Varma explores how psychiatric care is influenced and shaped by the ongoing military occupation in Kashmir.

• Young, Allan. The Harmony of Illusions: Inventing Post-traumatic Stress Disorder. Princeton, NJ: Princeton University Press, 1995.

  Now a classic book on the social and political construction of PTSD. Historicizes and critically explores the creation of PTSD as a medical and psychological category. This oft-quoted passage summarizes the crux of the argument: “The disorder [PTSD] is not timeless, nor does it possess an intrinsic unity. Rather, it is glued together by the practices, technologies, and narratives with which it is diagnosed, studied, treated, and represented and by the various interests, institutions, and moral arguments that mobilized these efforts and resources” (p. 5).