Week 4 summary: Trauma

Talking Point: Trauma and PTSD

Each week, we’ll be reading through your comments and reflections to collate them into a summary, giving an overview of some of the conversations that have been taking place on the course. You can read the summary for week four below. We know that lots of you have taken part in Jonathan’s other University of Warwick FutureLearn course Shakespeare and His World, and we’re delighted that you’ve decided to join us again! If you’ve taken part in Shakespeare and His World, you’ll be used to watching video round-ups at the end of each week. These round-ups provide an excellent opportunity for us to reflect on the week’s content and comments, but they are time-consuming to produce, and we felt that, for this course, it was more important to spend that time getting involved in the conversations on the discussion feeds. For this reason, we’ll be writing text summaries, based on our collective experiences over the week.

The band of brothers

In the first half of the week, we looked at the origins of our modern-day, medical understanding of Post-Traumatic Stress Disorder (PTSD). Although the human experience of trauma has been explored by writers for over 2000 years, it was only in the military hospitals of the First World War that doctors began to diagnose and treat the symptoms that so often develop following a traumatic encounter. Together, we’ve looked at war poems, journal extracts and old video footage, to gain an insight into the debilitating psychological and physical effects of war trauma on the soldiers who experienced it.

Very few of you were surprised that trauma could manifest itself so physically. Indeed, many of you shared very moving stories of fathers, uncles and grandfathers whose involvement in the war had left them with tremors, tics, speech difficulties and sleeping problems, sometimes for the rest of their lives. Some learners also spoke with incredible openness and honesty about their own experiences of secondary trauma, whereby the behavioural changes sometimes caused by a traumatic experience result in extreme distress and difficulty for a trauma-sufferer’s loved ones. A number of you remarked that the damaging impact of PTSD on close friends and family members is still largely unacknowledged, and that greater support needs to be provided for loved ones, to help them to understand and live with a person who is experiencing the condition.

A few learners this week have, quite rightly, challenged our use of ‘shell shock’ and ‘PTSD’ as semi-synonymous terms, so we thought we say a bit more about the relationship and difference between the two. The point we were making is that the terrible psychological and psychosomatic damage of war was first formally diagnosed in the First World War, and that this was the starting-point on the road that led to the modern diagnosis of PTSD. Flashback or unwanted memory, which Jennifer Wild reminded us is the main characteristic of PTSD, is clearly present in the poetic representations of “shell shock” by Gibson and Owen (and in Virginia Woolf’s remarkable portrayal of the shell-shocked Septimus Smith in her novel Mrs Dalloway), but muscle rigidity and nervous tics were more visible manifestations of “shell shock.”

Medically vague – and yet, circumstantially, specific to the First World War – the term ‘shell shock’ is thought to have originated among the soldiers in the trenches, though its first recorded usage was by psychologist Charles Myers, in his 1915 article for The Lancet. As a diagnosis, shell shock was ill-defined, referring to a variety of psychological and physical symptoms experienced by soldiers as a result of their involvement in combat. It can encompass direct, physical reactions to the noise and chaos of battle (for instance, tinnitus and dizziness), and it need not manifest itself in the traumatic re-experiencing typical of PTSD. Whereas PTSD, as we learned this week, can result from any experience that is traumatic or life-threatening for the individual, shell shock refers to the symptoms triggered by the horrific events of that particular war. The terms are not interchangeable, and PTSD is not simply a modernised term for shell shock. Nevertheless, it is evident that the First World War marked a significant turning point in the medical understanding and treatment of conditions that were psychological rather than physical in origin. Confronted with such extreme symptoms, doctors began to appreciate trauma as a real and debilitating condition, and the work of psychologist W. H. R. Rivers, in particular, pre-empted modern psychoanalytical approaches to therapy.

Talking Point: Trauma and PTSD

Especially in relation to the photograph above, the phrase ‘band of brothers’ was one that occurred to a number of learners during the first half of this week. This image of the wounded soldiers, united in adversity, reminded many of you of Henry V’s appeal – in Shakespeare’s play of the same name – to the indissoluble bond forged between men who fight together in battle:

This story shall the good man teach his son;
And Crispin Crispian shall ne’er go by,
From this day to the ending of the world,
But we in it shall be remember’d;
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition:

Henry V, Act 4 Scene 3, l.2291-2298

Several learners questioned the motivations behind the photograph: why was the picture taken, and did the men choose to be there? Some of you suggested that this image of a ‘band of brothers’, who appear so serene and composed despite their life-changing physical injuries, might have been used for propaganda purposes, to boost morale and dignify the carnage of war. Henry V’s speech too, of course, is a kind of propaganda, which plays on a collective yearning for legacy and camaraderie to urge courage in battle against all the odds. But while the notion might sometimes have been exploited for the purposes of propaganda, there is no doubt that a ‘band of brothers’ did exist in the trenches (though it may not have transcended class boundaries in the way Henry V’s speech envisions). Following the war, stories emerged of soldiers on the frontline helping to hide their shell-shocked friends, in the hope that this might spare them, for a short time, from the horrors of battle. These soldiers, it seems, appreciated the importance of peace and rest in the recovery process, and understood that the debilitating symptoms exhibited by their fellows were evidence not of cowardice, but rather, of a human mind pushed to the very limits of endurance.*

For Lavinia?

We aimed, in the second half of the week, to modernise and expand our notions of trauma, recognising PTSD as a condition that can be triggered by any distressing or life-threatening event. We looked together at an extract from Shakespeare’s early tragedy Titus Andronicus, which provided the literary inspiration for Peter Robinson’s poem ‘For Lavinia’. Titus Andronicus is a notoriously bloody play, and it has sometimes been dismissed as little more than a gratuitous display of violence. Given this reputation, we were incredibly pleased to see learners responding so sensitively and insightfully to the extract from Act 2, Scene 4, in which Marcus discovers and describes his brutalised niece.

The extract from Titus divided opinion among learners. A number of you recognised Marcus’ speech as a human and humane response to Lavinia’s suffering, sometimes citing your own experiences to suggest that uncontrollable talking is a natural reaction to shock. Some of you also found the language of Marcus’ speech immensely touching, commenting that it conveys his love for his niece and his desperation to reverse her horrific mutilation. Other learners, by contrast, found the monologue deeply troubling. The stark contrast between Lavinia’s gruesome physical suffering and Marcus’ beautiful language was insurmountable for a number of you, who felt the speech was insensitive and inappropriate, and suggested that the scene would be almost unbearable to watch in performance. Some of you also took issue with the way in which Marcus seems to foreground his own emotional response, overlooking Lavinia’s experience even as it attempts to speak for her. As we heard from Peter later in the week, such concerns were present in the writing of his poem, cutting the text off at its conclusion; ‘Lavinia’, the poem ends, ‘I’ve said too much already’.

Another interpretation offered by learners acknowledged the problems with Marcus’ speech, but suggested that the moment isn’t supposed to be a realistic one. Referencing the language of sleep and dreams employed in Marcus’ opening lines, some of you suggested that there was an unreal quality to the monologue. The detailed, oddly beautiful description was suggestive of a slow-motion moment, in which Marcus registers – or, perhaps, fails to register – the extent of the horror before him. Later in the week, Kate Behrens talked about the way in which a terrible shock can interfere with perception, making everything appear unusually vivid, and seeming to slow down time; for learners who interpret Marcus’ speech as a moment of slowed down and intensified perception, Kate’s insight seems a particularly illuminating one.

Whereas Marcus’ speech garnered a mixture of responses, learners were almost unanimous in their understanding of Titus’ laugh. Some imagined it as a wild, hysterical cackle, while others felt that a hollow, ironic laugh was a more likely response, but almost everyone was in agreement that laughter is an entirely natural, perhaps even necessary reaction to the kind of trauma that Titus endures.

We ended the week by talking to two contemporary poets about their own experiences of PTSD, and listening to some of their poems in which these experiences are addressed. Peter’s metaphor, characterising traumatic encounters as ‘a kind of currency you can’t exchange’, was mentioned multiple times in the comments section, striking several learners as a potent and apposite way of describing these experiences, which seem heavy to carry and impossible to share. So many of you commented that the conversation between Paula, Kate and Peter had been immensely moving and reassuring to listen to. For some learners, this was because they recognised elements of their own experiences of PTSD in the discussion, but for a significant number of you, it was Kate and Peter’s acknowledgement of the differences between their symptoms that offered a source of comfort. Many learners commented on how helpful it was to hear that the symptoms of PTSD are specific to the individual, and to their particular trauma. As we discovered in our conversation with Dr Jennifer Wild, moreover, an event that does not trigger PTSD in one person may still trigger it in another; there should be no shame associated with an individual’s reaction to a traumatic event, and no pressure put on a person to respond in a particular way.

Coming soon

Next week, we’ll be looking at two related conditions: depression and bipolar disorder. Again, we’ll be exploring literary accounts of these conditions that pre-date formal medical diagnoses, and we’ll be speaking to Dr Andrew Schuman to find out more about how depression and bipolar disorder are understood and treated today.

As well as considering these conditions from a medical perspective, we’ll be talking to Rachel Kelly, Melvyn Bragg and Stephen Fry about their own experiences of depression, and about how literature has been a source of solace and support for them during difficult times. We’ll also be thinking about how literature can help friends and family members to understand a loved one’s experience of depression or bipolar, and we’ll be talking to the writer Mark Haddon about his play Polar Bears.

We’ll once again be addressing some sensitive and potentially upsetting topics over the next week of the course. Several learners have already chosen to skip certain steps, and we’d encourage all of you to continue to exercise your own judgement, leaving any material that you think may be distressing rather than helpful to you.

Talking Point: Trauma and PTSD

Final thought: ‘3pm. Cured.’

Our final thought, this week, takes as its starting point a phrase that struck a number of learners as both unsettling and ironic. A title-card in the video of ‘War Neuroses’ symptoms, filmed at Netley and Seale Hayne military hospitals, declared that one particular soldier was ‘cured’ after just one hour of treatment. His physical improvement was remarkable, and whether or not this piece of footage was a re-enactment, it is undoubtedly the case that doctors at military hospitals during the First World War performed incredible and unprecedented work to treat the more obvious symptoms of trauma in many soldiers. But the severe psychological distress that triggered these symptoms is unlikely to have been erased by 60 minutes of therapy. As a number of learners have observed this week, PTSD is a difficult condition to treat, with traumatic flashbacks sometimes plaguing a sufferer for many years after the original event.

While there may be no straightforward and guaranteed cure for PTSD, however, there has been considerable discussion among learners this week about various different strategies for managing the condition. We often assume that talking about a traumatic experience is essential to recovery, but a number of learners have emphasised the importance of time, and the possible value of avoiding or ‘burying’ a trauma memory for a period after the event. Other learners, meanwhile, have described how helpful writing and talking therapies can be in exorcising or, at least, modifying traumatic recollections, so that they no longer cause so much anxiety. Cognitive behavioural therapy, occupational therapy and pharmaceutical treatments have also been discussed in the comment sections. PTSD is a severe and debilitating condition that cannot be cured in an hour, but there are, as we have learned together this week, a variety of treatment approaches available, that can and do help sufferers to manage and, even, to master their symptoms.

*If you would like to find out more about trauma in relation to the First World War, you can sign up to FutureLearn’s Open University course ‘World War 1: Trauma and Memory’ when a start date for a second run of the course is announced.

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Literature and Mental Health: Reading for Wellbeing

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