Regeneration in a living organism is defined as the process of re-growing of new tissues after loss or damage. It has become synonymous for example, in theology, with the revival of one’s soul, and in socioeconomics, with investment into areas of deprivation. This reminds me of Regeneration, Pat Barker’s novel, of the use of this term to describe the process of recovery from psychological trauma in soldiers during the First World War. In this novel, historical figures and some fictional characters are interspersed to recreate an account of embattled soldiers receiving treatment at Craiglockhart War hospital, near Edinburgh.

Psychological trauma, feelings of entrapment, attachment to significant others, relationships and healing are all core experiences of humanity, both during war and in peacetime. Neurotic disorders arising out of feelings of entrapment and powerlessness were usually considered to be confined to the female population, who were, so to speak, left behind at home to manage the prevailing circumstances. But in the trenches, the soldiers experienced unprecedented feelings of powerlessness, and of indefinite entrapment. Conversion symptoms such as mutism, phobias, nightmares and dissociative behaviours, appear to have been frequently observed in soldiers having treatment in the war hospital.

Needless to say, it is evident that the physical, social, psychological, emotional and spiritual impact of trauma resulting from wars of any kind or proportion is enormous. The consequent internal vacuum within an individual and society remains a battlefield for conflicting experiences; but where enemies were visible and fought against in a war, the enemy was now undoubtedly invisible and within the self.

I think that for many, the challenges of modern life may feel like an entrapment, but the present pace of life does not allow the time, space and opportunities for people to talk about their difficulties, and to be heard. I also encounter people who simply have no words to describe their suffering. It seems to me the mutism exhibited by some of the soldiers in the novel, and by my patients today, is conceivably a marker of the depth of the unspeakable pain and anguish they have experienced.

I am intrigued by Dr W. H. R. Rivers, an English anthropologist, neurologist and psychiatrist who worked at Craiglockhart during 1916-17. Previously he had conducted experimental research into nerve regeneration, apparently even using himself as a subject. His interest in the origin of symptoms or experiences clearly was not restricted to a biological model; given his background, he was also deeply aware of the social and psychological reasons for the varying expressions of distress. He faced a battle to convince his superiors about the morality of enforced treatment to ‘regenerate’ the soldiers in order to return them to battle. He observed treatment approaches which on the surface appeared harsh. He dealt with empathy the potential painfulness for an already troubled mind, of enduring his seemingly gentler and kinder treatment of talking, recounting the experience of trauma. His approach helped his patients to move on to develop a trusting attachment, and thus begin the process of regeneration. It illustrates the power of a therapeutic relationship to aid in recovery.