Monday, November 22, 2021

Railway Spine and the Origins of PTSD

In an interesting Harper's essay, Will Self explores the origins of Post Traumatic Stress Disorder. He connects it to the stresses of our modern, mechanized age, and says one of the first prominent forms was the mid-nineteenth-century phenomenon of "railway spine". After train crashes, many passengers who were not physically injured nonetheless suffered debilitating illnesses:

The very notion of the “accident”—not an unlucky coincidence, such as being struck by a hurricane, but rather a wholesale collapse of a functioning system—also owes its inception to the technologies of the era. These were technical apparatuses capable of self-destruction, and it would seem that the human apparatus was similarly affected: many victims who appeared to have suffered minor injuries—or none at all—succumbed nonetheless to psychic and physical symptoms that proved highly debilitating, if not fatal.

The hedging of personal and corporate liability by means of insurance—what Arthur Schopenhauer described as “a public sacrifice made on the altar of anxiety”—is also a product of the second industrial revolution. In order for some claimants to be compensated, they needed an etiology that allowed for physical causes to produce only psychic effects. Just as traumatized Vietnam veterans and activists would campaign to have their psychological symptoms recognized to qualify for compensation, victims of railway accidents made a similar case to insurance companies. Both groups faced the same problem: Without evidence of organic damage, how could they prove a particular event had so grievously affected them? The initial explanation of the psychic injury suffered by some railway-accident victims was indeed physiological: “railway spine” consisted of supposed microscopic deterioration of the spinal cord caused by the accident’s impact, a physical trauma that had psychic effects.

These were the sort of effects that Charles Dickens suffered when he survived a railway accident in June 1865; seemingly unhurt, he hurried to help those who’d been injured. However, when he was recounting the incident in a letter a few days later, symptoms arose: “But in writing these scanty words of recollection I feel the shake and I am obliged to stop.” Which he did, abruptly, with the appropriate valediction: “Ever faithfully, Charles Dickens.”

The question of why we moderns suffer so much from past traumas, or at least attribute so much of our suffering to past trauma, is fascinating and difficult. Could it be that people in the past actually did suffer lingering effects of trauma, but did not talk about it in those terms? Could it be that their psychic coping mechanisms (e.g. religion) worked better than ours? Or could it be, as Self argues, that something about the charging machines, and battlefield explosions of our age makes for worse psychic damage than hand-to-hand combat or acts of god like earthquakes?


szopen said...

I think I read about PTSD symptoms in some African tribe, where young warriors often participated in cattle raids; plus few articles about PTSD in roman soldiers, with several examples (excessive drinking, nightmares etc) of symptoms which could be interpreted as PTSD. It might be that pre-modern people suffered the same, but lacked vocabulary to express it.

David said...

It seems to me the question of whether pre-moderns experienced similar effects is the most important, and one that needs serious, lengthy consideration. The question of whether modern machines, explosives, etc. leaving unique or new effects unseen in premodern times also needs taking seriously. All this before we go too far down the "we decadent moderns" path.

The premodern sources I know seem to me to have their share of wailing, grief, fear, paranoia, and the out-of-control emotion that used to be called hysteria. Certainly they weren't all sober and uncomplaining. A hypothesis, and only a hypothesis: perhaps in premodern conditions those with strong emotions or what we would call PTSD simply died faster, and so our sources give the impression (or be used to give the impression) of a tough blandness because those were the people who survived to generate written material in middle and occasional old age.

szopen said...

The idea that modern explosives leave unique effects has strong backing in facts. There was this article wondering about whether PTSD is simply about brain traumas, results of concussions etc.


Susi said...

When telling about trauma I start shaking, too. My husband had reoccurring debilitating dreams that affected him in his work afterward. He, and other military men I know just suffered through. I think it’s part of the human experience, not anything new.

G. Verloren said...

The idea that modern explosives leave unique effects has strong backing in facts. There was this article wondering about whether PTSD is simply about brain traumas, results of concussions etc.

Modern explosives may well produce unique affects, but PTSD clearly isn't one of them, given the sheer and staggering amount of PTSD which has absolutely nothing to do with explosions, concussions, or brain trauma.

risa m mandell said...

re "The hedging of personal and corporate liability . . . — is also a product of the second industrial revolution." a book, Insurance in the Halacha by Rabbi Menachem Slae A Legal-Historical Study based upon the Responsa Literature and other Jewish Legal Sources (The Israel Insurance Association, 1982) indicates that such liabilities and their remedies have be sought long before the industrial revolution.

David said...

@risa m mandell

That's very interesting. It puts me in mind of the way hedging of liability, as well as a rhetoric of complaint and a passion for reclaiming damages, can also be found in medieval Christian society. In the sources I know best, from 14th-century Aragon, a routine step in mustering any army was the valuation of everyone's horses (called taking "estimes" in the sources), with the expectation that the Crown would reimburse the owners if the animals were lost on campaign. People wouldn't fight until their estimes were taken.

I think Self's conflation of PTSD and changing ideas about accident and liability--with a Laschian "we decadent moderns" bite in the mix--is at best premature. The first thing is to separate the two issues. PTSD, it seems to me, is a place where we can and should "stick to the science" before we start trying to do cultural history with it.