Notes from “The Repression of War Experience” by W.H.R. Rivers, M.D. Published in The Lancet, Feb. 2, 1918
NB: This document is reproduced from and held at the The Napier University War Poets site.
“I hope to show that many of the most trying and distressing symptoms from which the subjects of war neurosis suffer are not the necessary result of the strains and shocks to which they have been exposed in warfare, but are due to the attempt to banish from the mind distressing memories of warfare or painful affective states which have come into being as the result of their war experience.”
“…if patients were left to themselves most would naturally strive to forget distressing memories and thoughts. They are, however, very far from being left to themselves, the natural tendency to repress being in my experience almost universally fostered by their relatives and friends, as well as by their medical advisors. Even when patients have themselves realised the impossibility of forgetting their war experiences and have recognized the hopeless and enervating character of the treatment by repression, they are often induced to attempt the task in obedience to medical orders. The advice which has usually been given to my patients in other hospitals is that they should endeavor to banish all thoughts of war from their minds. In some cases all conversation between patients or with visitors about the war is strictly forbidden, and the patients are instructed to lead their thoughts to other topics, to beautiful scenery and other pleasant aspects of experience.
“To a certain extent this policy is perfectly sound. Nothing annoys a nervous patient more than the continual inquiries of his relatives and friends about his experiences of the front, not only because it awakens painful memories, but also because of the obvious futility of most of the questions and the hopelessness of bringing the realities home to his hearers. Moreover, the assemblage together in a hospital of a number of men with little in common except their war experiences naturally leads their conversation far too frequently to this topic, and even among those whose memories are not especially distressing it tends to enhance the state for which the term “fed up” seems to be the universal designation. It is, however, one thing that those who are suffering from the shocks and strains of warfare should dwell continually on their war experience or be subjected to importunate inquiries; it is quite another to attempt to banish such experience from their minds altogether. The cases I am about to record illustrate the evil influence of this latter course of action and the good effects which follow its cessation.”
“a young officer…he was nervous and suffered from disturbed sleep and loss of appetite…he reported that it always took him long to get to sleep at night and that when he succeeded he had vivid dreams of warfare. He could not sleep without a light in his room because in the dark his attention was attracted by every sound. He had been advised by everyone he had consulted, whether medical or lay, that he ought to banish all unpleasant and disturbing thoughts from his mind. He had been occupying himself for every hour of the day in order to follow this advice and had succeeded in restraining his memories and anxieties during the day, but as soon as he went to bed they would crowd upon him and race through his mind hour after hour, so every night he dreaded to go to bed.
“…I asked him to tell me candidly his own opinion concerning the possibility of keeping these obtrusive visitors from his mind. He said at once that it was obvious to him that memories such as those he had brought with him from the war could never be forgotten. Nevertheless, since he had been told by everyone that it was his duty to forget them he had done his utmost in this direction…I agreed with him that such memories could not be expected to disappear from the mind and advised him no longer to try to banish them…
“We talked about his war experiences and his anxieties, and following this he had the best night he had had for five months. During the following week he had a good deal of difficulty in sleeping, but his sleeplessness no longer had the painful and distressing quality which had been previously given to it by the intrusion of painful thoughts of warfare. In so far as unpleasant thoughts came to him, these were concerned with domestic anxieties rather than with the memories of war, and even these no longer gave rise to the dread which had previously troubled him.”
“It is not always, however, that the line of treatment adopted in these cases is so successful. Sometimes the experience which a patient is striving to forget is so utterly horrible or disgusting, so wholly free from any redeeming feature which can be used as a means of readjusting the attention, that it is difficult or impossible to find an aspect which will make its contemplation endurable. … [in this case] His only period of relief had occurred when he had gone into the country far from all that could remind him of the war, and this experience, combined with the utterly horrible nature of his memory and images, not only made it difficult for him to discontinue the repression, but also made me hesitate to advise this measure with any confidence. The dream became less frequent and less terrible, but it still recurred, and it was thought best that he should leave the Army and seek the conditions which had previously given him relief.”
“Another form of catharsis which may have been operative in some of the cases I have described. It often happens in cases of war neurosis, as in neurosis in general, that the sufferers do not repress their painful thoughts, but brood over them constantly until their experience assumes vastly exaggerated and often distorted importance and significance. In such cases the greatest relief is afforded by the mere communication of these troubles to another.”