Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930. By Paul Lerner. Cornell Studies in the History of Psychiatry. Edited by, Sander L. Gilman and George J. Makari. Ithaca, NY: Cornell University Press, 2003. Pp. xiv+326. $39.95.

Hysterical Men is a landmark study of the social and political factors that affect psychiatric diagnosis. The author effectively interweaves an account of late 19th and early 20th century psychiatry, German social welfare policy, and the traumatic effects of World War I to produce an excellent situated account of how “individual suffering is constructed by larger social and medical forces” (p. 10). Those readers familiar with the complex and tendentious history of posttraumatic stress disorder will recognize striking contemporary parallels in Lerner’s story, of which the author, who currently teaches history at the University of Southern California, is very well aware. How are the effects of trauma to be theorized, how treated? German psychiatrists and neurologists grappled with these questions in the context of industrial accident claims and later the wartime mass production of psychiatric casualties. Lerner’s central question is how it was that hysteria effectively replaced traumatic neurosis as the diagnosis of choice for soldiers brought low by paralysis, deafness, stuttering, and other obscure complaints. To this end, he tracks the history of trauma theory in Germany, focusing on a persisting tension between physiological and psychological modes of interpreting functional incapacity. The concept of traumatic neurosis was based on the hypothesis that deeply shocking events (railway accidents, for example) cause subtle nerve damage manifest in such complaints as “railway spine”—disability without obvious injury. Lerner documents how this theory came to be replaced by the notion that the disorders in question are not caused by traumatic events as such but by the patients’ psychological responses to them. Some soldiers break down under bombardment, and others do not. Given this fact, and wartime demands for labor, German wartime psychiatry became increasingly inclined to situate the problem within the patients’ psyches. Trauma was interiorized (p. 189) such that functional complaints became attributable either to constitutional weakness or to subconscious dissimulation. The patients were the basic issue, not the war, and getting them back into active service, or at least productive work, was the principal therapeutic goal. These hysterics had to be convinced by whatever means necessary that they were not really ill (p. 90). “Curing male hysteria meant medically manufacturing proper German subjects” (p. 7); “the goal was to create healthier wills through subordination to medical power, which stood as a representative of the state and the national cause” (p. 128). This was accomplished through a wide range of methods, some of them exceedingly devious—“contrived medical magic” using electrotherapy and hypnosis (p. 116)—and others more focused on the salutary effects of labor (p. 160). Lerner explores, in the context of wider cultural trends, how German psychiatrists envisioned themselves and their social role and how they resolved a tension between “the universalistic-humanitarian aims of medical practice and the particularistic-national demands of the state” (p. 174). Although individual psychiatrists differed in their emphasis (the somewhat marginal influence of psychoanalysis merits a chapter of its own), the practical result of their debates was the victory of hysteria. However, war was not the only factor contributing to that result, since a tendency toward volkish “organicism” was already prevalent in German society and not least among psychiatrists, who tended to see individual misfortune as an expression of the ills of the wider society: “Hysterical soldiers represented the weakness and disobedience that seemed to be increasingly plaguing the body politic and fragmenting the nation” (p. 204). If “constitutional weakness” is at the root of hysterical breakdown, this would seem to support the eugenicist position that German society contains a large pool of hereditary misfits. If, on the other hand, nervous weakness (“neurasthenia”) is a product of modernity itself —as American neurologist, George Miller Beard, had claimed (p. 30)—then war with its purposeful, altruistic, masculine striving might well override the degeneracy that many associated with an urban industrial way of life. The period that Lerner has chosen for his analysis—1890 to 1930—witnessed many changes driven by social insurance legislation, war disability pension policy, and the vicissitudes of war and its aftermath. Psychiatry reflected these events but also influenced them, altering its stance as events unfolded, swinging from patriotic euphoria at the beginning of the war to despair at its ignominious conclusion: “While the 1914 writings of the psychiatrists welcomed war and celebrated its putatively beneficial effects and mental and nervous health, many of the works of late 1918 and 1919 blamed Germany’s devastating defeat and the toppling of the old order on the exhaustion of the nation’s nerves” (p. 209). Recriminations about that result played themselves out in the divisive Weimar hangover. The pension issue remained a lively one as psychiatrically disabled veterans struggled to maintain their level of support, and new claims arose based on the supposed delayed effects of wartime trauma. Lerner has examined the records of adjudication hearings in which “Germans not only struggled over vital financial questions but also began to work out the memory and meaning of the war for the lives and health of individuals and for the nation as a whole” (p. 225). The claimants, sometimes backed up by supportive personal physicians, spoke of their patriotic suffering, while “psychiatric specialists . steadfastly opposed these narratives of trauma with an alternative narrative by positing an inborn psychopathic con-