Malingering, the OED tells us, is something originally done by the armed forces: ‘To pretend illness, or to produce or protract illness, in order to escape duty; said esp. of soldiers and sail-ors.’ To avoid conscription (the first usage is recorded in 1820), or to escape the horrors of what the military authorities have referred to since at least the 17th century as ‘engagement’, has always required a certain amount of ingenuity. And the onus has usually been on the medical profession to decide when someone is pretending, producing or protracting an illness to avoid their duties: the implication being, as the definition suggests, that the malingerer is responsible for his condition. His illness is an artefact, and the escape artist is a weak character. ‘Genius’, Sartre said, is the word we use for people who get themselves out of impossible situations: so is ‘malingerer’.
From one point of view the malingerer is clearly a coward; from another point of view he is someone who really knows himself, knows the limits of what he can bear, of what is morally and emotionally acceptable to him. From one point of view, his talent for pretending is a sign of his authenticity; from another point of view it proves his duplicity. The actor who pretends to be Hamlet is not really Hamlet but may be as much Hamlet as anyone is ever going to be; the person who pretends to an illness – a so-called mental illness – may not really be ill, but can be as ill as anyone can be. At the very least, pretending to be ill, or producing or protracting an illness, suggests that something is wrong: even though the actor in this situation may be dependent on the audience, so to speak, to help him find out what it is.
If the ‘actor’ was a serviceman invalided out of the Great War for ‘lunacy’, as it was then called, and the audience was a psychiatric profession that believed, as most German doctors and many of their British colleagues apparently did, that, in Peter Barham’s words, ‘the so-called war neuroses were for the most part not causally connected with the circumstances of the war at all, but were essentially psychological reactions in terrified and weak-willed individuals unwilling or unable to place the national interest above their selfish desires,’ he would be unlikely to get a sympathetic hearing. And by the same token, if you worked for the Ministry of Pensions you wouldn’t want to be paying out money to people who didn’t deserve it. You wouldn’t want to reward selfishness and fear. If you are a government at war, or recovering from a war, and you run a pension scheme for servicemen who are casualties of that war, and some of them have lost their limbs and some of them have lost their minds, you have to be able to tell the difference, and you have to believe that there is a difference between pretending to be wounded and actually being wounded. Fortunately for the pension scheme, a person can only in a very limited sense pretend to lose a limb, and no one in a war is likely to lose one on purpose. But with minds, or personalities, and their so-called mental illnesses, the doctor often can’t see what the patient is talking about, and the patient is utterly dependent on what the doctor can hear in what he says.
The emotional crises of the war lunatics were also, as Barham shows in this fascinating, eloquent and well-researched book, a crisis for the medical profession and for governments. The noisy exchanges between ordinary soldiers (and their families), and the presiding authorities (medical, psychiatric and economic) are used by Barham as signs of a sea-change in the wider culture. Once the so-called malingerers and their supporters took on their critics, many of the great issues of the day – to do with social welfare, distributive justice, democracy, masculinity and patriotism – found a new focus. For men, or rather for modern soldiers, weakness could be the new strength; and some members of a newly enlightened psychiatric profession would encourage these soldiers to have the courage of their vulnerability. The ‘forgotten lunatics’ are Barham’s test-cases for modern democracies, in which governments are forced to assess who they can afford to listen to and look after, and who they must disparage and discard.
Barham’s book, in other words, is partly a social history of all those previously unheard of servicemen invalided out of the Great War for ‘mental’ reasons in a political ethos supposedly committed to at least a degree of egalitarianism: ‘a historical moment’, Barham writes, ‘in which solidarity with the whole community of serving soldiers counted for more than birth, merit or worth’. It is also, largely by implication, an unpushy though sometimes facetious manifesto for what a good mental health service should be in a genuinely democratic society. The cost of war may be difficult to assess – it is, in a sense, unending – but at least nominally, in democracies, every adult has and keeps an account. As Barham shows in instructive detail, it saved the British government money, both during and after the war, to believe that soldiers were either cowards or they were not; that the brave are people who cause only the enemy trouble; and that war was not necessarily the cause of lunacy. There was, though, a bind here: if the war had not produced these symptoms, then the army must have been recruiting people who were already ill. Either way, it seemed, they bore some responsibility. It was clearly neither impressive nor patriotic to enlist ‘inadequates’, but if the lunatic soldiers were not inadequate then a patriotic government should surely take care of people who had lost their wits fighting a war to defend their country. ‘It is a truism,’ Barham writes,
that wars mutilate minds and bodies, but throughout the 20th century the nature and ‘reality’ of war traumas (especially psychological traumas) have been the subject of heated controversy. Acrimonious stand-offs between aggrieved ex-servicemen and the state in the prolonged afterlife of wars are the stuff of modern life, involving the competing claims of war pensions agencies, veterans’ associations and divergent medical authorities.
It is a complementary truism, in modern societies committed to science and technology, that whoever has the dominant vocabulary of causation – whoever seems to be telling the strongest story about how things happen as they do (how, say, shell-shock causes the symptoms that it does) – wins. And that modern governments, and not only modern governments, invest in stories about causation that suit them.
The experience of the First World War, as Barham makes clear, cast a long shadow for subsequent governments. ‘It is not possible,’ he quotes a Ministry of Pensions memorandum saying in 1939, ‘to convince the man in the street or a great part of the medical profession that the war was not responsible for every attack of insanity which had its onset during war service.’ The reason of course that this mattered to the Ministry of Pensions – and it is part of the subtlety of this book to look at the lunacy question through the prism of government pension plans – was that it was responsible for whatever the war was considered to be responsible for. Pensions were war by other means. In a democracy the man in the street has to be convinced. For the first time, in Barham’s view, ‘civilian values and institutions . . . penetrated . . . deeply into the life of war, forcing the closed fiefdoms of military institutions into a dialogue with the wider society, and producing compromises . . . inimical to military values.’
Before the Great War, he writes, Britain was divided into ‘the community of citizens’ and the ‘outcasts in lunatic asylums’, and there was no discernible connection between them. The all too visible and sometimes voluble lunatics invalided out of the war with their ‘ravaged minds’ and strange stories changed all that. The lunatics coming home spelled the collapse of military values; these were the people for whom the language of the military institutions didn’t work. And this mattered to the government, Barham intimates, only because society was less tolerant than ever before of sending people to the wall, especially people like soldiers who were willing to work; and because morale during wartime depended on confidence in the military. And the military, in turn, needed to have confidence in the medical profession, which usually meant the medical profession had to use the modern language of science to legitimate traditional military values. What Barham calls ‘the divisive and condemnatory rhetoric of psychiatric orthodoxy’ had no time for ‘shirkers’. Forgotten Lunatics of the Great War is a series of artful and evocative stories by and about ordinary lunatic servicemen, punctuated by the kind of social history that makes them at once intelligibly representative case-histories, and poignant and persuasive individual testimonies. And Barham tries, though he is not always successful, to avoid writing the usual heroes-and-villains history of mental health practices. ‘The historiography of the “silent working-class soldier”,’ he says, ‘has obscured much of what were actually very noisy encounters. Even though to some extent the Blimp class got its own back on liberal modernisers and social justice enthusiasts, the psychiatric aftermath of the war was far from petering out.’ There is no tradition of passionate and incisive writing – the equivalent of E.P. Thompson’s or Roy Porter’s work on social history – about the links between class and mental health in British culture.
One of the many interesting things about Barham’s book is his attempt to find a tone that is neither too earnest and worthy on the one hand, nor too fluent and blithe on the other. There are many harrowing accounts of individual soldiers’ anguish and their families’ horror and dismay, of people left to drift with their heads full of war dread; and so there are many temptations to ascribe blame for official heartlessness, to suggest that the officials and the Blimp class are either less complicated than their victims, or that affluence so mitigates emotional suffering as to make it negligible. Barham is a social justice enthusiast, but his occasional jauntiness is a refuge from the sheer difficulty of his material. If you don’t redescribe the starkest forms of suffering in Frankfurt-School-type academic abstractions, you run the risk of sounding either simple-mindedly sentimental or simply deranged by the material. But Barham manages not to speak too much on behalf of the silent, and avoids suggesting that really to know what the war was like in terms of emotional terror we should read Ford Madox Ford or Siegfried Sassoon. Though he is clearly torn between his literary inclinations (many of his epigraphs are from Ulysses, and he writes with particular clarity about Ivor Gurney) and his wish to speak plainly for the plain man, Forgotten Lunatics never lets us forget that in many ways we would rather not know what it wants to tell us, and so how the telling is done matters. Barham’s forgotten lunatics were forgotten partly because very few people could bear to listen to them.
‘The Ministry of Pensions largely conducted its business,’ Barham writes, ‘on the side of the virtuous, hard-working patriotic public against the ranks of sundry malcontents, inefficients, malingerers and exaggerators for whom a war disability pension had become a preferred lifestyle.’ During the First World War and the interwar period more and more people were losing confidence in willpower as the key to human character, and couldn’t really think of anything to replace it with. The death of willpower was far more of a problem culturally than the supposed death of God. Barham has surprisingly little to say about religion – or indeed about patriotism as ersatz religion – but a great deal to say about a politics organised around the scapegoating of unhappiness. The ranks of those who found the war unbearable – there is a difference, of course, between saying something is unbearable and actually, like the lunatics, being unable to bear it – were forging, in his view (though they didn’t know it), a new kind of heroism: they were the prophets, one might say, though Barham doesn’t quite spell this out, of the forthcoming politically sanctioned welfare state. It was the mental health casualties rather than the ‘physical invalids’ of the war, Barham intimates, who raised the question of whether a case could be made, in political terms, for the value of vulnerability. Could emotional fragility be any use to society?
The Great War, in Barham’s account, turned the traditional questions around. He uses D.W. Winnicott, one of the new breed of psychiatrists willing to listen to their patients rather than merely to instruct them, to voice the new view prompted by the lunatics. ‘It is as if Winnicott,’ Barham suggests, ‘had posed the question: “Suppose we treat the shell-shocked not as inferiors or as oddities but as everyman, and try to remake our understanding of ourselves in their image, where would that take us?”’ If we can see ourselves – or rather, previously unacknowledged versions of ourselves – in whoever or whatever seems most alien; if we can waylay our apparently natural inclination for a them-and-us view, for a set of mutually exclusive alternatives, then we are by definition at odds with the ‘military values’ that Barham needs to keep referring to. Wars work only if you have enemies; the new psychology works only if you believe the enemy is your (disowned) self. Treating the shell-shocked, the wounded and vulnerable and mad, as we treat ourselves is relatively easy (though for many people virtually impossible); the really tall order – at once nonsensical, and yet with a certain logic to it – is to live as though there is no such thing as an enemy. What the new psychology, informed by psychoanalysis, was saying – at odds with the military ethos required by the war effort – was that people tend to repudiate their vulnerability and the extremity of their aggression and then try to abolish it in others. We go to war against the versions of ourselves that we can’t stand: ‘we’ are brave and patriotic, ‘they’ are degenerate and claim to be shell-shocked; ‘we’ are only fighting to protect our civilised values, ‘they’ are ruthlessly brutal Fascists; and so on. What Barham is promoting, taking his cue from Winnicott among several remarkable psychiatrists described in his book, is a new way of describing the modern individual. As the external world becomes more and more intolerable, the modern individual is seen to be living somewhere else, somewhere more real that is called the internal world. Modern warfare, Barham seems to suggest, helped to give birth to this inner world. And though this inner world was bereft of willpower, it seemed, perhaps by the same token, to be full of far more interesting things: feelings, thoughts, impressions, desires, an unconscious mind etc. It was not merely one’s actions and their consequences that mattered now, but the relationship between a person’s actions and this putative internal world. This complicated the idea of heroism and, as the war hero and psychoanalyst W.R. Bion once said, made courage more a question of which direction you ran in. For obvious reasons soldiers couldn’t afford to have too much of this newfangled inner world: violence requires a certain narrow-mindedness, it requires focus, it requires the ability not to identify with the enemy. ‘Trivial though the subject’s personal anguish might be by comparison with events in the public domain,’ Barham writes,
the experiencing subject was the centre of his own world, not merely a pawn in someone else’s – his subjectivity was his world, and the ‘war-business’ might sit very uncomfortably in it. What did the war mean to George? What did George mean to the war? The answer to the first question has usually been ignored in favour of a critical riposte to the second. Traditionally, of course ‘inner worlds’ were supposed to adapt to ‘public events’, but here perhaps the lesson was that public events were obliged to concede to subjective realities.
Once public events are ‘obliged’ to concede to subjective realities, the risk is that there are no longer any events, only individual experiences; that in taking the individual seriously in the name of genuine community you destroy the very possibility of there being a community. At worst you create a society of atomised individuals, fascinated by the utter idiosyncrasy of their inner worlds. In Barham’s sympathetic account, the liberal modernisers and social justice enthusiasts – reactive to the ‘Blimp class’, the bureaucratic pension-mongers and the military authorities – can sometimes sound like poets against Fascism.
As Barham knows, the wishing away of the economics of mental health and the dogmatism of the inner worlders about the importance of the internal world have in their own way done as much damage to the cause of enlightened mental health policy as those who want the malingerers to get on their bikes. If all the unhappy people who need to be listened to are to be, then people are going to have to be taxed. And if the listeners are going to listen they are going to hear things that don’t sound like the inner world as it has traditionally been conceived. In short, the only blind spot of this important book, a book that should be widely read and discussed, is that it underestimates the way in which prejudice is evenly distributed. Those committed to inner worlds can, in my experience, be quite as divisive and bigoted as those who believe that people should stop complaining and get on with their lives. Forgotten Lunatics makes it more than clear what the issues are, and the suffering that is caused when the debates involved are not properly entered into.