1 Coercive Hospital Spaces in Pat Barker’s The Regeneration Trilogy
ABSTRACT
Pat Barker’s depiction in The Regeneration Trilogy of the psychoanalytical nature of then-ground-breaking medical treatment applied by Dr W. H. R. Rivers to the acclaimed war poet Siegfried Sassoon and his fellow sufferers of psycho-neuroses at Craiglockhart War Hospital during the Great War (1914–18) has deservedly attracted great academic interest. This chapter, however, seeks to concentrate on Pat Barker’s portrayal, especially in Regeneration (1991) and to a lesser extent in The Eye in the Door (1993), of the coercive spaces inside the military hospital, which render the clinical approaches pursued therein especially effective. In line with Foucauldian tenets, especially those put forward in Discipline and Punish (1975) and Madness and Civilisation (1961), these coercive spaces will be shown to favourably predispose both patients and staff to engage with and largely conform to the prevailing value system, and, in so doing, to perpetuate the existing networks of power.
This chapter will make repeated allusion to Pat Barker’s Regeneration, the first volume of The Regeneration Trilogy,1 which focuses on the historically based relationship between Siegfried Sassoon (1886–1967), the acclaimed poet and highly decorated World War I combatant, and Dr William Halse Rivers Rivers (1864–1922), the pioneering neurologist-cum-psychologist. The latter is specifically directed by the reigning political authorities to take personal charge of Sassoon’s treatment at Craiglockhart War Hospital following Sassoon’s unexpected and controversial public declaration of July ← 23 | 24 → 1917. Sassoon’s declaration initially appeared in the Bradford Pioneer2 on 27 July and was then read out in The House of Commons on 30 July and published the following day in The Times:
Finished with the War
A Soldier’s Declaration
I am making this statement as an act of wilful defiance of military authority, because I believe that the war is being deliberately prolonged by those who have the power to end it. I am a soldier, convinced that I am acting on behalf of soldiers. I believe that this war, upon which I entered as a war of defence and liberation, has now become a war of aggression and conquest. I believe that the purpose for which I and my fellow soldiers entered upon this War should have been so clearly stated as to have made it impossible for them to be changed without our knowledge, and that, had this been done, the objects which actuated us would now be attainable by negotiation.
I have seen and endured the sufferings of the troops, and I can no longer be a party to prolonging those sufferings for ends which I believe to be evil and unjust.
I am not protesting against the military conduct of the war, but against the political errors and insincerities for which the fighting men are being sacrificed.
On behalf of those who are suffering now, I make this protest against the deception which is being practised on them. Also I believe that it may help to destroy the callous complacence with which the majority of those at home regard the continuance of agonies which they do not share, and which they have not sufficient imagination to realise. (Barker [1991] 1992: 3)
Sassoon’s declaration, which opens Regeneration, could hardly have come at a more inopportune moment of the War for the British authorities. As documented by Paul Fussell in The Great War and Modern Memory (1975), despite notable Allied success at Messines in June, the year of 1917 was marked by a succession of lamentable military encounters. The battle near Arras, forming part of the 1917 Spring Offensive, in which Sassoon had fallen casualty, recorded 160,000 killed and wounded in exchange for insignificant territorial gains. To make matters worse, French troops mutinied as the French offensive floundered. This debacle was to be followed by ← 24 | 25 → the attack towards Passchendaele, otherwise known as ‘The Third Battle of Ypres’, which was destined to become a repeat of the Somme. Ironically, this ill-fated assault began on the very same day Sassoon’s declaration was published in The Times. Passchendaele epitomized the failure of a strategy employing repeated assaults launched with ineffective artillery support and under excessively inclement weather conditions. The dogged three-and-a-half-month campaign, abandoned in November 1917 with a total advance of only six miles, had claimed 310,000 British dead, many drowning in the liquid mud of No Man’s Land.
The scenario faced by the British authorities on the home front at the beginning of 1917 was no less alarming. As revealed by J. M. Bourne in Britain and the Great War 1914–18 (1989: 209), strikes were becoming ‘commonplace in all major industries’. Serious food and fuel shortages during the severe winter months had led to considerable discontent among the civilian population while ‘a massive wave of industrial unrest’ broke out in England in the spring, which by May 1917 had spread to forty-eight towns, involving 200,000 factory workers and incurring the loss of 1.5 million working days. Dissent and civil unrest had grown to such an extent that a National War Aims Committee (NWAC) was hastily set up by the authorities in June 1917, just one month prior to Sassoon’s declaration, in an attempt to coordinate home front propaganda more effectively. Bourne (1989: 203) argues that the NWAC’s main aim was to foment a clearer sense of national purpose, which could be used as ‘a weapon of moral ostracism against “shirkers” and dissenters’.
It is against this tumultuous background of military ineptitude and social unrest that Sassoon’s declaration and the reigning political authorities’ reaction to it must be charted. Sassoon’s renegade, dissenting remarks proved to be an instant source of embarrassment both at home and on the warring front and thus posed a potential threat to the Government for a number of reasons. Firstly, the declaration came from a well-respected, highly decorated war veteran of the current conflict (Egremont 2005: 103). Secondly, it came from a person of privileged social status and military rank, to all intents and purposes a safe product of the system but one who was prepared to air his opinions on principle and risk grave consequences. Thirdly, it did not contain a philosophically based anti-war pacifist message, ← 25 | 26 → which would have been much easier to counteract on pragmatic grounds. Fourthly, it seriously questioned the real motives behind the perpetuation of and, by implication, entry into the war given that conditions for a negotiated peace settlement with the enemy seemed highly favourable at that juncture (Purdue 2015: 176). Lastly, the declaration – ‘A Soldier’s Declaration’ – was made explicitly on behalf of the individual soldiers at the front, who were dying apparently unnecessarily, thus causing concern on both ideological and logistical grounds. The latter point is linked to a forceful rebuking of the ‘deception’ allegedly practised by the political (not the military) authorities and the ‘callous complacence’ exhibited by the civilian population in wartime Britain.
During the Great War, 284 serving British soldiers are officially recorded as being executed for acts of desertion or cowardice, while seventy Commanding Officers died interned in carceral establishments for similar offences (Hynes 1990). Court-martial followed by execution or indefinite confinement was thus not a hollow threat to which Sassoon could consider himself immune. However, given the delicate social and military climate of the time, the authorities declined to accept the role of enemy that Sassoon had so publicly allotted them. Instead, Barker depicts them as evading the binary trap laid by Sassoon in that they choose to neutralize his potentially damaging declaration by proclaiming it fruit of a clinically diagnosed mental disorder, namely neurasthenia or shell shock. This diagnosis, which was tantamount in medical science to a temporary loss of reason or a transient bout of insanity, casts Sassoon firmly into the Foucauldian camp of déraison3 and is presented as such in an artfully worded counter communiqué publicly issued by the Under-Secretary of State for War, Ian MacPherson, and likewise published in The Times: ← 26 | 27 →
MR MACPHERSON With regard to the case of Second Lieutenant Sassoon, immediately he heard of it, he consulted his military advisers, and in response to their inquiries he received the following telegram: A breach of discipline has been committed, but no disciplinary action has been taken, since Second Lieutenant Sassoon has been reported by the Medical Board as not being responsible for his actions, as he was suffering from nervous breakdown. When the military authorities saw the letter referred to, they felt that there must be something wrong with an extremely gallant officer who had done excellent work at the front. He hoped honourable members would hesitate long before they made use of a document written by a young man in such a state of mind, nor did he think their action would be appreciated by the friends of the officer. (Barker [1991] 1992: 69)
The British authorities’ reaction thus took the shape of an apparently benevolent intervention made on medical grounds in an attempt to defuse a politically awkward scenario by denying Sassoon the wider political debating forum he sought. Given the prevailing circumstances, this scathing statement – made by one of the British Army’s most highly decorated serving officers – could only be met by one of two reactions: a potentially damaging high-profile court-martial under Military Law or, alternatively, the scientifically endorsed attribution of his behaviour to a neurasthenic disorder. When considering the psychological impact of the latter imputation on sufferers of such an affliction, it should be borne in mind that social commentators of the time often cast the terms malingering and neurasthenic as interchangeable concepts whilst ‘the popular press argued that neurasthenic men were malingerers who had been born with debased bodies’ (Bourke 1996: 117). Interestingly, Bourke (1996) goes on to point out that as a general rule the medical community did not publicly refute these misconceptions and even published statistical studies that suggested a clear incidence of ‘predisposition of emotivity’ in the ailing soldiers, which implicitly labelled them as weak, unmanly, ‘hysterical’ or neurotic (Showalter 1985: 176). For the authorities, this clinical diagnosis would necessarily lead to confinement in a specialized medical institution, exposure to individualized therapeutic treatment, and ultimately recovery in the form of renewed conformity and eventual social/military reinsertion. Recovery did indeed take place four months after Sassoon’s admission to Craiglockhart when he was medically boarded, found to be fit for active service and ‘discharged to duty’ (Barker 1992: 250) on the Western Front. ← 27 | 28 → This disciplinary modus operandi involving the State’s conscious harnessing of medical discourse is one of the key disciplinary strategies that Foucault identifies in Discipline and Punish (1975) and traces so adeptly in his account of the rise and altogether subtler reign of the human sciences in a predominantly non-warring societal context.
Foucauldian Overtones
This chapter will explore, from a Foucauldian standpoint, Pat Barker’s account of the artful deception involved in the authorities’ public assertion that ‘no disciplinary action was taken’ against Sassoon on interning him in Craiglockhart War Hospital, and will highlight the major spatial disciplinary mechanisms deployed within the fabric of the military psychiatric hospital. Disciplinary machinery will be shown to comprise not only the more physical, coercive architectural elements, but also the artful arrangement of clinical spaces, and the hierarchical classifications established within the hospital staffing structure. All these elements will be shown to unite so as to form a coordinated coercive atmosphere in which power circulates continuously and in the midst of which institutional figureheads, such as the historically inspired characters of Dr Rivers or Dr Yealland, are endowed a propitious, power-full space in which to carry out their patriarchally endorsed duty of returning the psychologically ailing and, more importantly, ideologically dissenting inmates back to the front.
Within the military hospital context throughout the trilogy, the patient’s body becomes the prime target of power from both a physical and psychological standpoint. The deviant body is subjected and objectified, rendered docile and, whenever possible, ultimately transformed into an element of greater utility to the prevailing power network. This modality of control, which imposes ‘a relation of docility-utility’ (Foucault [1975] 1991: 137), implies uninterrupted coercion, which is exercised within an approach that consciously seeks to partition the most basic elements of human life, namely time and space. The erstwhile crushing of dissidence ← 28 | 29 → through extreme physical chastisement in a public arena – the implacable exercise of ‘Sovereign Power’ in Foucauldian terminology (Foucault 1991: 137) – largely gives way in Craiglockhart to more subtle and potentially more effective individualizing strategies of discipline and control. Individuals are fixed in a suffocating mesh of disciplinary and control mechanisms involving the active deployment of a panoply of normalizing strategies, ranging from rational persuasion to manipulation and active coercion. This entire scenario is subjected to serious questioning through Pat Barker’s uncannily Foucauldian portrayal of the institutional management of dissenters and rebels.
Key elements in ‘the art of distributions’ and ‘the control of activity’,4 as put forward by Foucault in Discipline and Punish (1991: 141–56), become increasingly resonant in Barker’s depiction of the politico-clinical approach to the re-education of dissenting soldiers. Discipline, Foucault contends, proceeds in great measure from the artful distribution of individuals in space through, among others, the following three techniques: firstly, discipline sometimes entails the enclosure of the individual in a protected place; secondly, disciplinary machinery works on the principle of a cellular partitioning of space; and thirdly, discipline involves the calculated designation of a clearly defined individual rank or space to every individual element within a given classification or hierarchy. I shall now discuss Pat Barker’s depiction of the military psychiatric hospital fabric, especially that reigning at Craiglockhart War Hospital, in the light of these three distributive disciplinary techniques. ← 29 | 30 →
The Art of Distributions: Enclosure
‘Discipline sometimes requires enclosure, the specification of a place […] closed in upon itself.’ (Foucault 1991: 141)
The process of alienating Sassoon, aimed at discrediting and ultimately neutralizing the controversial opinions expressed in his declaration, was rapidly put into motion. Sassoon was safely pigeonholed as suffering from a medical condition that successfully alienated him from mainstream society and publicly earmarked him as abnormal. To this label of abnormality was consciously applied the weight of a coordinated medical apparatus by which it was hoped he would be helped to regain his lost reason. Diagnosis was followed by confinement (albeit on a quasi-voluntary inmate basis) in Craiglockhart War Hospital, an institution under military jurisdiction dedicated to the treatment of shell-shocked victims of officer rank.5 Such confinement serves to further discredit and demoralize Sassoon while treatment is administered by an eminently qualified member of the medical community and an unimpeachable pillar of the establishment, namely Dr (currently wartime Captain) Rivers. In such a way, the State manages not to negate the accusations and implications contained in the declaration but rather to completely sidestep the issue by encouraging people to refuse to even contemplate them, arguing that they stem from an abnormal, distorted or sick vision of events. As Foucault so appositely observes in Madness and Civilisation:
Confinement is the practice which corresponds most exactly to madness experienced as unreason, that is, as the empty negativity of reason; by confinement, madness is acknowledged to be nothing. That is, on one hand madness is immediately perceived as difference […]; and on the other hand, confinement cannot have any other goal than a correction (that is, the suppression of the difference, or the fulfilment of this nothingness in death). (Foucault [1961] 1997: 116) ← 30 | 31 →
Echoing Foucault’s premise that ‘confinement causes alienation’ (1997: 227), Barker depicts the authorities’ institutional internship of Sassoon in ‘Dottyville’6 as achieving a great measure of success among the general populace, the military ranks and even among his family and close friends. Indeed, the anonymous inmate of Craiglockhart who composed the following stanza in a poem published in the June 1918 issue of The Hydra7 eloquently expresses this debilitating sensation:
Craiglockhart memories will be sad,
Your name will never make us glad;
The self-respect we ever had
We’ve lost – all people think us mad.
This reaction is perhaps not unduly surprising in that, historically, citizens have been conditioned – as Foucault posits – to align themselves with the normal, non-deviant, official line of thought: ‘That which is called a base action is placed in the rank of those which public order does not permit us to tolerate […]. It seems that the honour of a family requires the disappearance from society of the individual who by vile and abject habits shames his relatives’ (Foucault 1997: 67).
Interestingly, the apparently benevolent application of medical science8 to what the State identified in Sassoon as a scientifically knowable abnormality fails to arouse a rebellious reaction in the dissenter. As a matter of fact, it is Sassoon himself, albeit admittedly as a result of shame, fear of ← 31 | 32 → confinement and out of a sense of loyalty to his comrades at the front, who allows himself to be led into the normalizing process as he reluctantly agrees to be medically boarded and subsequently clinically treated rather than face carceral internment for the duration of the war. It is in Sassoon’s induced complicity – achieved through fear, insecurity and the timely persuasive intervention of his good friend Robert Graves – that we can appreciate how the disciplinary mechanism works so efficiently against Sassoon’s righteous indignation, clearly echoing Foucault’s observation that ‘[i]t is by force that the furies of a maniac are overcome; it is by opposing fear to anger that anger may be mastered’ (Foucault 1997: 180).
If fear is regarded by Foucault as a key feeling to be aroused in the deviant, Craiglockhart War Hospital is depicted as a highly efficient coercive space for the application of medico-scientific discourse. An imposing Victorian building, it was built as a hydropathic sanatorium and was essentially frequented by members of the wealthy classes as a therapeutic drying-out centre, a rehabilitation establishment whose remit was to mitigate the excesses of a privileged lifestyle. The hospital was erected between 1877 and 1880 in a commanding position on the north-west side of Wester Craiglockhart Hill in the village of Slateford (now a suburb of Edinburgh). The building’s west-facing main façade is 280 feet long, Italianate in style and three storeys high, with two blocky end towers.9 During the First World War, the Hydropathic was taken over by the War Office in 1916, made into Craiglockhart War Hospital and placed under military jurisdiction until 1919 (McGowan 2007).
One of the key feelings actively instilled in patients at Craiglockhart is that of fear or dread, leading to a profound sense of insecurity and isolation. Sassoon, from his very arrival at the hospital, is ‘daunted by the sheer gloomy, cavernous bulk of the place’ and must make a conscious effort to achieve a momentary ‘private victory over fear’ (Barker 1992: 8–9). ← 32 | 33 → Craiglockhart’s distance from Edinburgh and its rural location, common for asylums and other psychiatric facilities, further compounded the patients’ feelings of isolation and vulnerability, softening them up and preparing the ground for later treatment of a generally subtler nature involving rational persuasion within the context of psychotherapy sessions. Long, narrow passageways, displaying a gloomy, sinister symmetry and the absence or scarcity of natural light lead the corridors to be likened to ‘a trench without the sky’ (Barker 1992: 17), a description whose authenticity is readily vouched for by Dr Rivers himself. If we appreciate that perhaps the only saving grace of trench warfare was the vision of space above soldiers in their stifling immobility, Craiglockhart is powerfully represented as being devoid of even that relieving perspective.
Elements of light and darkness – the calculated denial and provision of light – are constantly juxtaposed in descriptions of hospital spaces within the trilogy. The oscillations between areas of light and shade are not arbitrary, but rather reveal disturbing, sinister situations that either expose or conceal, as best befits the clinical objective. In Craiglockhart, ‘that living museum of tics and twitches’ (Barker 1992: 206), the gloomy appearance identified by Sassoon at first sight and Dr Rivers’s allusion to the darkness of the corridors and lack of natural light in certain areas – ‘dark, draughty, smelling of cigarettes’ (Barker [1993] 1994: 218) – are counterpointed by the occasional, timely imposition of intimidating light and the use made of its directional source, especially during patient examination. Light, coming disturbingly from behind the Medical Board members, startles the exposed patient under examination: ‘He [the patient] got himself into the room somehow, and managed a salute. He couldn’t see their faces to begin with, since they sat with their backs to the tall windows […]. There was a great deal of light, it seemed to him, floods of silver-grey light filtered through white curtains’ (Barker 1992: 132). Likewise, in Regeneration, in another unspecified hospital for convalescing servicemen, the brightness of the light outside stands in sharp contrast with the dimness of the conservatory, in which severely injured soldiers were shamefully ‘hidden away’ from public view: ‘Shadowy figures sat inside […]. She was still dazzled by the brightness of the light outside and the relative dimness of the interior, and so she had to blink several times before she saw them, a row of figures in ← 33 | 34 → wheelchairs, but figures which were no longer the size and shape of adult men’ (Barker 1992: 160). This female civilian onlooker is outraged by the authorities’ deliberate removal of these soldiers from public visibility and she savagely indicts this premeditated act of concealment: ‘If the country demanded that price, then it should be bloody well prepared to look at the result’ (Barker 1992: 160).
The National Hospital in London, where severe cases of war neuroses in enlisted ranks were treated during the Great War, betrays similar architectural elements, including long corridors, ‘immensely long wards, lined with white-covered beds packed close together’, windows on both sides which ‘reached from floor to ceiling’ while the entire clinical space was ‘flooded with cold northern light’ (Barker 1992: 224). In this case, however, the inmates are deliberately exposed and rendered painfully visible to the penetrating medical gaze, clearly echoing Foucault’s disturbing adoption and extension of Jeremy Bentham’s Panopticon model (1791),10 whose architectural and hierarchical configuration sought to ‘induce in the inmate a state of conscious and permanent visibility that assures the automatic functioning of power’ (Foucault 1991: 201). Invasive light and visibility, apparent in this scene, are later set against the horrific atmosphere of the brutal re-education session in Regeneration (1992: 229–33), conducted with apparent relish by Dr Yealland. The scenario for Private Callan’s breaking – ‘the removal of the physical symptom was described as a cure’ (Barker 1992: 224) – is based on Dr Yealland’s own account of this real-life case study in his book Historical Disorders of Warfare (1918) and is an account marked by the employment of darkness and carefully calculated illumination, all of which is designed explicitly to instil fear and insecurity. ← 34 | 35 → In addition, selective forms of physical restraint and verbal counter suggestion are systematically applied, which serve to severely limit the patient’s liberty and autonomy. The binding of his arms, the locking of the door and the ostentatious retention of the key are specific, localized extensions of the global spatial control unerringly imposed on the rank-and-file soldiers, who are exposed to a faster, more brutal approach to re-education than the officers at Craiglockhart (Leese 2002: 85–99).
The Art of Distributions: Cellular Partitioning of Space
The aim of disciplinary space was […] to know how to locate individuals, […] to be able at each moment to supervise the conduct of each individual, to assess it, to judge it, to calculate its qualities or merits. It was a procedure, therefore, aimed at knowing, mastering and using. Discipline organizes an analytical space. […] The disciplinary space is always, basically, cellular. (Foucault 1991: 143)
Craiglockhart’s inmates, all of officer rank, are depicted in Regeneration as being forced to entertain conditions to which they were not accustomed. The bedroom doors were consciously rendered unlockable while personal privacy was impinged upon to an even greater degree by an absence of locks in the bathrooms. Sassoon’s realization that locks were indeed provided in the guest room, in which his close friend and comrade Robert Graves makes a brief stay, compounds his frustration. This difference in spatial privilege acts as an unarticulated offer or subliminal incentive that seeks to foment the patient’s desire to cooperate and thereby regain such civilized privileges. Craiglockhart is thus represented as a clinical space, endowed with total power by the State, in which the lack of locks and virtual absence of brute physical restraint are the keynote, echoing Foucault’s poignant observations on the calculation of openings in more modern disciplinary mechanisms:
[…] an architecture that is no longer built simply to be seen […] but to permit an internal, articulated and detailed control – to render visible those who are inside it; in more general terms, an architecture that would operate to transform individuals: ← 35 | 36 → to act on those it shelters, to provide a hold on their conduct, to carry the effects of power right to them, to make it possible to know them, to alter them. Stones can make people docile and knowable. The old simple schema of confinement and enclosure – thick walls, a heavy gate that prevents entering or leaving – began to be replaced by the calculation of openings, of filled and empty spaces, passages and transparencies. In this way the hospital was gradually organized as an instrument of medical action. (Foucault 1991: 172)
Craiglockhart is an area in which self-regulation by the inmates is fomented by their internalization of determined rules/norms by which they are encouraged to abide. The patients largely follow the prescribed regime whilst any prospect of deviation from the established norms is threatened and, if necessary, ultimately met with physical confinement, as illustrated by Dr Rivers’s rather less humane treatment of Captain Broadbent, who persists in infringing the hospital rules:
‘I hope it doesn’t happen this time. Because last time, if you remember, you had to be locked up. Why don’t you go to see Major Bryce now?’
‘Yes, all right.’ Broadbent stood up, reluctantly, and spat, ‘Thank you, sir’.
(Barker 1992: 60)
Freedom of movement within the enclosed hospital setting is thus largely conceded at Craiglockhart providing the patients comply with the obligations dictated by the medical and nursing staff, such as attendance at consultations, participation in therapeutic activities embracing outdoor pursuits or, in the case of Dr Brock’s patients, activities that sought to actively re-establish their links with the surrounding environment (Brock [1918] 2012). One of the few physical spaces which is strictly out of bounds for inmates is the terrace at the top of the building, which Dr Rivers categorizes as being potentially too ‘tempting’ (Barker 1992: 19) a means of suicidal escape for the patients. Indeed, escape is not to be contemplated on any account, as structured channelling and reinsertion remain the prime objectives of this disciplinary regenerative space. Permission to go beyond the limits of Craiglockhart and its immediate rural surroundings, and thus enjoy the luxury of socializing with normal people, is awarded on the basis of appropriate behaviour. The suspension of this privilege is a source ← 36 | 37 → of chastisement, implemented as a direct consequence of non-compliance with internal norms or with more far-reaching military regulations.
The therapeutic regime instilled by Colonel Balfour-Graham at Craiglockhart in April 1918, six months after Dr Rivers’s departure, is overtly alluded to in A. G. Macdonnell’s satirical novel England, Their England (1934), which makes clear reference to the spatiality of disciplinary power:
It consisted of finding out the likes and dislikes of each patient, and then ordering them to abstain from the former and apply themselves diligently to the latter. For example, those of the so-called patients, for the Commandant privately disbelieved in the existence of shell-shock, […] those who disliked noise were allotted rooms on the main road. Those who had been, in happier times, parsons, schoolmasters, journalists, and poets were forbidden the use of library and driven off in batches to physical drill, lawn tennis, golf and badminton. […] Those who were terrified of solitude had special rooms by themselves behind green-baize doors at the ends of remote corridors. (1934:17–19)
Although the clinical approach favoured by Dr Rivers is not so aggressively focused on deliberate spatial harassment, compulsory room-sharing at Dr Rivers’s Craiglockhart (late 1916 to November 1917) nevertheless serves to increase the unwanted invasion of privacy and to exert further psychological pressure. The mixing of patients with different degrees of affliction is seen to seriously affect patients’ mental stability and Dr Rivers expresses his surprise that Sassoon is able to ‘tolerate being cooped up with “wash-outs” and “degenerates” even as long as he had’ (Barker 1992: 118–19). Foucault highlights just such a danger for the inmates of carceral institutions and earmarks it as a conscious weapon at the disposal of a dominating power: ‘First, confinement causes alienation: prison makes men mad’ (Foucault 1997: 227–8). The reader of Regeneration is therefore made privy to the force with which the hospital environment can contribute to the disintegration of a patient’s emotional integrity. Sassoon soon succumbs to fear and appears on the brink of psychological ruination: ‘He knew he was shivering more with fear then cold, though it was difficult to name the fear. The place, perhaps. The haunted faces, the stammers, the stumbling walks, the indefinable look of being “mental”. Craiglockhart frightened him more than the front had ever done’ (Barker 1992: 63). In this unfamiliar, unsettling scenario, he acutely suffers the physical incursions of confinement, even under such a ← 37 | 38 → relatively liberal regime. His hospital bed’s institutional ‘rubber underlay’ causes him to sweat unnaturally, which, in turn, imbues his skin with ‘a clinical smell that made his body unfamiliar to him’ (Barker 1992: 63). He is made to suffer both external alienation (from society) and self-alienation as he feels seriously out of sorts even with his own body. Sassoon’s lack of identification with his body at this stage, however momentary, is relevant in that, as Foucault highlights, the interned subjects’ control over their own bodies substantially changes in the institutional context: ‘At the heart of the procedures of discipline, it manifests the subjection of those who are perceived as objects and the objectification of those who are subjected’ (Foucault 1991: 184–5). The body becomes the object of clinical interest and is consequently appropriated by the network of power to be converted into a docile body, ultimately malleable, subject to the will and dictates of external sources arbitrarily invested with power.
The Art of Distributions: Hierarchical Hospital Structure
Discipline is an art of rank, a technique for the transformation of arrangements. It individualizes bodies by a location that does not give them a fixed position, but distributes them and circulates them in a network of relations. (Foucault 1991: 146)
For Foucault, the key unit that defines the distribution of individuals within a disciplinary space is rank. In unwitting consonance with this idea, Pat Barker provides a poignant account of the working of the human hierarchy that regulates the medical milieu at Craiglockhart. The members that constitute this hierarchy, through their niches in the prevailing chain of command, are guardians of the system, maintaining its balance and ensuring the enforcement of the norms at the different levels. The hospital personnel, whether they be military representatives on the Medical Boards, consultant doctors, junior doctors, ward sisters, nurses, VADs (Voluntary Aid Detachment members) or orderlies, are co-ordinated – although more in on-going antagonism than in perfect harmony – to act in consonance. Each ← 38 | 39 → rank within the classification plays an integral part in providing updated knowledge on the patients and thus in producing situations where power can be more effectively deployed. As Foucault posits, ‘in organising “cells”, “places” and “ranks”, the disciplines create complex spaces that are at once architectural, functional and hierarchical’ (Foucault 1991: 148).
It is worthy of note that allusions are constantly made in the narrative to the relationships maintained between the various members of staff within the hospital setting. Interestingly, the reader is provided a picture which, instead of presenting each faction as a harmonious cog in the overall well-oiled disciplinary machine, highlights the antagonism and constant jockeying for position prevalent within the system. The system is not a static hierarchy – it is subjected to a continual, fluctuating tension, marked by constant minor readjustments and repositionings made on the basis of the self-interest of each of its members linked to their level of identification with the reigning political authorities’ projection of national or collective interest. The system – in terms of maintenance of discipline – is presented as working efficiently to the extent to which these mini-resistances and conflicts are resolved. In line with Foucauldian premises, relationships within the hierarchy are thus in flux, subject to being constantly redefined, reaffirmed and consolidated.
Despite the tension existing between and within the different levels that constitute the hierarchical structure, power distribution within the hospital context is clearly pyramidal in shape, roughly configured from top to bottom in the order of positions of responsibility previously mentioned, namely military administrative authorities (Major Huntley); senior consultant doctors (Dr Rivers, Dr Yealland, Dr Bryce, Dr Head, Dr Brock); junior doctors; Ward Sisters/Matrons; career nurses; VADs; orderlies and voluntary pacifist orderlies. In the National Hospital, where Dr Yealland practises, doctor-patient contact during the daily rounds is described as being kept to the curt, inexpressive, impersonal minimum while ‘frightened’ junior doctors are subjected to strict cross-questioning from the senior doctors in front of the accompanying medical entourage until they provide correctly framed answers, ‘a fear Dr Rivers remembered only too clearly’ (Barker 1992: 225) from his own training days at Bart’s Hospital. Foucault ([1976] 2007:150) identifies this ‘codified ritual’ as a clear example of the ← 39 | 40 → spatiality of disciplinary power at work within hierarchies: ‘the ritual of the visit: the almost religious procession, headed by the doctor, of the whole hierarchy of the hospital: assistants, students, nurses, etc., at the foot of the bed of each patient’.
If there exists a marked tension within the ranks of the medical practitioners, then the subsequent stratum of hierarchical power – the nursing staff – betrays no less antagonism. Matrons or Ward Sisters wield considerable power within the hospital regime and maintain a delicate – at times indulgent and ambiguous – relationship with the senior doctors. Their antagonism or occasional chiding of the senior doctors helps to maintain the required distancing and occupational compartmentalization between Doctor and Sister/Matron whilst also enabling them to form a more intimate and privileged relationship with the immediately superior stratum of power:
Rivers went into the hall, smiling, only to have the smile wiped off his face by the sight of Matron standing immediately inside the entrance. She’d observed the entire incident and evidently disapproved. ‘You could have sent an orderly down to push the chair Captain Rivers.’ Rivers opened his mouth, and shut it again. He reminded himself, not for the first time, that it was absolutely necessary for Matron to win some of their battles. (Barker 1992: 119–20)
Such scenes are a recurrent feature in the trilogy, especially in Regeneration (Barker 1992: 59) and The Ghost Road (Barker 1996: 19, 52) and illustrate that the surveillance/supervision component operating between different layers of the institutional power system does not always work solely along a dominant-subordinate axis. Instead, the interaction is subtler and more fluid, allowing for variations and compensations which paradoxically lead to a more compact and stable system. Resistance, or minor antagonism, serves to momentarily challenge or even breach the regulated status quo, but successfully managed resistance subsequently fixes the relationships more deeply within the areas of flux necessarily inherent in the overall infrastructure, as Foucault so perceptively highlights:
By means of such surveillance, disciplinary power […] was also organized as a multiple, automatic and anonymous power; for although surveillance rests on individuals, its functioning is that of a network of relations from top to bottom, but also to a certain extent from bottom to top and laterally; this network ‘holds’ the whole ← 40 | 41 → together and traverses it in its entirety with effects of power that derive from one another; supervisors, perpetually supervised. (Foucault 1991: 177)
Within the nursing staff stratum of what Foucault would term ‘the continuous, individualising pyramid’ (1991: 220), comprising career nurses and VADs, we witness a curiously less flexible interaction, which perhaps indicates that the organizational structure is a combination of a hierarchical and divisional model. It would appear that the further down the power pyramid, the more rigid the power relations necessarily become. This configuration is in full consonance with Foucault’s premise that disciplinary mechanisms ‘use procedures of partitioning and verticality, that they introduce, between the different elements at the same level, as solid separations as possible, that they define compact hierarchical networks’ (1991: 220). Voluntary nursing staff become the butt of a series of derisory remarks throughout the trilogy, whether the narrative voice emanates from the nurses, the doctors or from the standpoint of the omniscient narrator. VADs are characterized in Regeneration as ‘clucking, fussing, flapping ineffectually’ (17), speaking ‘in that bracingly jolly way of theirs’ (224) and as being useful only for the ‘consoling’ of downhearted patients (139). Their usefulness is constantly devalued as they are relegated to a superficial, unskilled role within the body of the nursing staff. Indeed, Miss Banbury – a VAD at Craiglockhart – is dismissed by Sister Roberts as a ‘silly woman’: ‘She [the VAD] was … Sister Roberts’s bête noire, for no better reason then she was well-meaning, clumsy, enthusiastic, unqualified and upper-class’ (Barker 1996: 62).
It is noteworthy that the career nurses, especially those having worked in pre-war asylums, generally emanated from the more impoverished sectors of pre-war society and as such quite rightly valued their hard-won position of authority and logically resented unskilled labour, above all coming from middle-class or upper-class volunteers (Hallett 2013). This fierce guarding of rank, acquired through arduous pre-war endeavour, paradoxically leads the career nurses into a more faithful, inflexible support of the overall system in which they have found a niche that endows them with globally limited, albeit locally significant power. It is precisely these components of the system that have most to gain in the perpetuation of ← 41 | 42 → the status quo and their standpoint is ironically portrayed by Barker: ‘She [Sister Roberts] had climbed her way out of the Gateshead slums and therefore felt obliged to believe in the corrosive effects on the human psyche of good food, good housing and good education’ (Barker 1996: 62). Indeed, Foucault astutely points out that the overall power structure, despite not being a static framework, does not seek to encourage excessive alliances between different factions operating within the same stratum for fear of potential challenge to and ultimate imbalance of the overall network: ‘That is why discipline fixes; it arrests or regulates movements; […] it establishes calculated distributions […] it must neutralize the effects of counter-power that spring from them and which form resistance to the power that wishes to dominate it: agitations, revolts, spontaneous organizations, coalitions – anything that may establish horizontal conjunctions’ (Foucault 1991: 219).
The following echelon in the hospital staff hierarchy is occupied by the regular orderlies and voluntary orderlies, the latter being able-bodied men who carried out non-combatant work owing to their status of conscientious objectors to the war. No dialogue with either faction is entertained by the nursing staff as this rung of the hierarchical ladder is depicted as being mere order-takers, with very limited autonomy or influence. Nevertheless, within this rank significant tension does become apparent: ‘The nurses and the existing orderlies – men who were either disabled or above military age – did their best […]. What was desperately required was young male muscle, and this the pacifist orderlies – recruited under the Home Office Scheme – supplied. But they also aroused hostility in the staff obliged to work with them’ (Barker 1994: 149). The regular orderlies in Craiglockhart are unexpectedly given short shrift by Pat Barker as she unmercifully reveals the depths to which human nature can descend in its zeal to occupy any rung, however humble, of the power ladder: ‘He [Orderly Wantage] was a fat, jolly man with a limitless capacity for hate. He hated skivers, he hated shirkers, he hated conchies, he hated the Huns, he hated the Kaiser. He loved the war’ (Barker 1994: 150). This intra-level tension is portrayed as being caught up in an upward spiral of intensity until Dr Rivers feels obliged to intervene so as to re-establish order by forcefully rebuking the orderly who has deliberately left his pacifist counterpart in a compromising ← 42 | 43 → situation in which he has exposed an officer inmate to unscheduled suffering and humiliation (Barker 1994: 215).
As we filter down towards the lower order of the power pyramid – no less important nonetheless in the overall concept of power maintenance and perpetuation – we encounter the objects on which power and disciplinary control is to be more formally and visibly applied, namely the inmates or patients. Whereas the reader is presented with a markedly ambiguous picture of medical treatment prescribed by the various doctors (from the largely more humane practices of Dr Rivers to the more brutal, unrelenting, impersonal aggression of Dr Yealland), nurse-patient interaction is almost universally characterized by a tendency towards active domination and control. Nurses take their role in the chain of command very seriously and are key elements in the maintenance of stability within the hospital fabric. They are a vehicle of constant surveillance and information collation and quickly earn the epithet ‘spies’ (Barker 1992: 67) for their nightly vigilance and subsequent reporting back to their superiors. Sassoon is continuously reminded of his exposure to unrelenting clinical observance and finds ‘the lack of privacy almost intolerable’ (Barker 1992: 145).
Even beyond the hospital confines, in Edinburgh town centre, and outside her working hours, Matron sees a patient who has contravened regulations by removing the conspicuous hospital insignia from his greatcoat and proceeds to report this transgression to the hospital authorities with great relish (Barker 1992: 95). The valuable information provided ultimately leads to the patient’s obliged confinement on hospital premises for a fortnight. In similar fashion, the nurses also play a key role in regulating access to unbecoming commodities, such as alcohol or razors (Barker 1996: 61) through their regular, unscrupulous searching of patients’ private lockers. The reader is thus never allowed to entertain any doubt as to where their loyalties ultimately lie – self-interest in the quest for professional advancement or survival within the existing power network is clearly revealed as being their prime motivating force. Nurse Pratt is depicted as continuing to mete out the same kind of attention as she did ‘on the locked wards of large Victorian lunatic asylums’ prior to the war, while ‘in any altercation between a member of staff and a patient, the patient was automatically and indisputably wrong’ (Barker 1994: 213–14). Empathy shown to ailing ← 43 | 44 → patients is in scarce supply as nurses enact ‘a necessary suspension’ (Barker 1996: 146) of their sense of humanity so as to be able to unquestioningly carry out the role they have been allotted or have willingly assumed within the system’s hierarchy. The reader is likewise led to equate this level of emotional suspension with that invoked by both self-conscripted doctors (Captain Rivers) and frontline wartime soldiers (Second Lieutenant Sassoon) so as to be able to carry out their prescribed duty effectively. Both inmates and staff must be brought – whether consciously or unconsciously – to understand and internalize Foucault’s far-reaching insight: ‘In short, one should have a master, be caught up and situated within a hierarchy; one exists only when fixed in definite relations of domination: […] it is a question of order to be maintained’ (1991: 291).
Conclusion
Rather uncannily at times, given that she has never publicly acknowledged Foucault as a significant source of inspiration, Barker’s narrative clearly echoes a number of key Foucauldian tenets in its portrayal of the distributive disciplinary apparatus applied to the inmates of military psychiatric medical institutions during the Great War. The fear and shame instilled by the patients’ mere presence in such intimidating establishments, added to the emotional coercion applied by family and friends, are compounded by elements of intimidating physical architecture, by strategies involving calculated clinical spatial partitioning and by the insertion of inmates into a fixing, individualizing mesh of institutional hierarchy. As Foucault (2007: 149) argues when referring to hospital architecture in its broadest – not solely physical – sense: ‘[T]he hospital constitutes a means of intervention on the patient. The architecture of the hospital must be the agent and instrument of cure’. Confinement becomes analogous – at least for Sassoon – with potential moral, social and military ruination, while intolerably low levels of privacy and forced cohabitation unite to further increase the coercive tension. Inmates are objectified, exposed, examined ← 44 | 45 → and kept under constant surveillance in architecturally manipulated spaces ensuring maximum visibility and accountability, echoing what Foucault came to denominate as ‘the intelligence of discipline in stone’ and ‘the gentle efficiency of total surveillance’ (1991: 249).
Barker seems to coincide with Foucault in emphasizing the heterogeneous nature of the apparatus that exercises power in that it includes not only human agents, but also instruments or vehicles of power (such as buildings and documentation production, processing and recording), as well as the regulations, norms, rituals and practices through which power is successfully deployed (Rouse 2007). These mechanisms – so evident locally within the confines of a particular institution, whether it be penitentiary, educational or medical in nature – are those presented by Foucault as having been dispersed into more subtle relationships of power within the context of a non-warring society in a process which he denominates ‘the swarming of disciplinary mechanisms’ (Foucault 1991: 211).
In Pat Barker’s account, not only was Siegfried Sassoon successfully normalized and reabsorbed into the ideological fold after four months of treatment in ‘Dottyville’, but the State was also able to further strengthen its controlling hold as a direct consequence of identifying, scientifically discrediting and eventually neutralizing the element of resistance encountered. As Foucault so appositely highlights, power is the result of the on-going struggles to challenge and maintain networks of domination. Barker’s narrative demonstrates, in accordance with this idea, that there is paradoxically no power without resistance and that power relations are strengthened not weakened by the threat from a certain level of manageable resistance against which reinforced unity can be brought to bear. There is no more unifying force, especially in times of national adversity, than collective outrage about or condemnation of an event, person or group projected as being detrimental, threatening or dangerous to the common good. As Barker’s trilogy fictionalizes, a society’s willingness to accept this approach and become actively involved in its often brutal and callous implementation is essentially based on individual members’ well-developed awareness of self-interest inextricably linked to an often flawed conception of national or collective interest, the latter being the product of exposure to subtly manipulative disciplinary power networks. ← 45 | 46 →
Bibliography
Barker, P. (1992 [1991]). Regeneration. London: Penguin.
Barker, P. (1994 [1993]). The Eye in the Door. London: Penguin.
Barker, P. (1996 [1995]). The Ghost Road. London: Penguin.
Bentham, J. (1812). The Panopticon versus New South Wales. London: Robert Baldwin.
Bourke, J. (1996). Dismembering the Male: Men’s Bodies, Britain, and the Great War. Chicago: University of Chicago Press.
Bourne, J. M. (1989). Britain and the Great War 1914–1918. London: Edward Arnold.
Brock, A. J. (2012 [1918]). ‘The Re-education of the Adult: The Neurasthenic in War and Peace’. In Sociological Review a10 (1), pp. 25–40. London: Wiley.
Egremont, M. (2005). Siegfried Sassoon A Life. New York: Farrar, Straus and Giroux.
Foucault, M. (1991 [1975]). Discipline and Punish: The Birth of the Prison, trans. A. M. Sheridan Smith. London: Penguin.
Foucault, M. (1997 [1961]). Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard. London: Routledge.
Foucault, M. (2007 [1974]). ‘The Incorporation of the Hospital into Modern Technology’, trans. E. Knowlton Jr, W. J. King and S. Elden. In J. W. Crampton and S. Elden (eds), Space, Knowledge and Power: Foucault and Geography, pp. 141–51. Aldershot: Ashgate.
Fussell, P. (1975). The Great War and Modern Memory. Oxford: Oxford University Press.
Hallet, C. E. (2013). ‘Emotional Nursing: Involvement, Engagement and Detachment in the Writings of First World War Nurses and VADs’. In A. S. Fell and C. E. Hallet (eds), First World War Nursing: New Perspectives, pp. 87–102. New York: Routledge.
Hynes, S. (1990). A War Imagined: the First World War and English Culture. London: Bodley Head.
Leese, P. (2002). Traumatic Neurosis and the British Soldiers of the First World War. Basingstoke: Palgrave Macmillan.
Macdonnell, A. G. (1934). England, Their England. London: Folio Society.
McGowan, P. (2007). Edinburgh Survey of Gardens and Designed Landscapes. Edinburgh: City of Edinburgh Council.
Purdue, A. W. (2015). The First World War. London: Palgrave Macmillan.
Rouse, J. (2007). ‘Power/Knowledge’. In G. Gutting (ed.), The Cambridge Companion to Foucault, pp. 95–122. Cambridge: Cambridge University Press.
Showalter, E. (1985). The Female Malady: Women, Madness and English Culture, 1830–1980. New York: Pantheon. ← 46 | 47 →
Slobodin, R. (1978). W. H. R. Rivers. New York: Columbia University Press.
Stoler, A. L. (2013). ‘Reason Aside: Reflections on Enlightenment and Empire’. In G. Huggan (ed.), The Oxford Handbook of Colonial Studies, pp. 39–66. Oxford: Oxford University Press.
Webb, T. (2006). ‘Dottyville – Craiglockhart War Hospital and Shell-shock Treatment in the First World War’, Journal of the Royal Society of Medicine 99 (7), pp. 342–6.
Yealland, L. (1918). Hysterical Disorders of Warfare. London: Macmillan. ← 47 | 48 →
1 The Regeneration Trilogy, written by Pat Barker, comprises Regeneration (1991), which was made into a film of the same name, The Eye in the Door (1993), which won the Guardian Fiction Prize, and The Ghost Road (1995), which was awarded the Booker Prize.
2 The Bradford Pioneer was a socialist journal published in Bradford from 1913 to 1936 under the auspices of the Bradford Independent Labour Party.
3 Foucault’s key term déraison (often translated as unreason) is to be understood as a ‘relational concept with respect to a changing norm […]. Déraison may be a way of marking that which recedes from and rejects conventional demands: when unquiet minds can no longer be trusted to be predictable; when they/we become unreliable guardians of common sense’ (Stoler 2013: 61).
4 Foucault’s concept of ‘the control of activity’ (1991: 149–56), despite being highly relevant in terms of strategies employed in deviant re-education, lies beyond the scope of this chapter.
5 Approximately 80,000 shell-shock cases were officially registered by the British forces during the Great War, although unofficial sources set the figure at nearer 200,000 (Hynes 1990: 186).
6 An epithet used to describe Craiglockhart War Hospital, coined by Sassoon in a letter to his good friend Robbie Ross. Sassoon Private Papers (London: Imperial War Museum, 26 July 1917).
7 The Hydra was the Craiglockhart Hospital Magazine, produced by inmates as a therapeutic activity and noteworthy for being edited by Wilfred Owen for six issues in 1917 and for featuring poems by Siegfried Sassoon.
8 Dr Rivers’s therapeutic ‘talking cure’ approach – a ‘treatment that he [Dr Rivers] knew to be still largely experimental’ (Regeneration, 147) – was not generally endorsed by the medical establishment, which favoured more physically brutal methods employed by practitioners like Dr Yealland. As a testament to this fact, see Lt Colonel E. Farquhar Buzzard’s zealous advocacy of electric shock therapy in his Preface to Historical Disorders of Warfare (Yealland 1918).
9 There exists an eerie architectural similarity between Craiglockhart Hydropathic Sanatorium (<http://www.geograph.org.uk/photo/2009472>) and the 1676 purpose-built lunatic asylum of Bedlam Bethlehem Hospital (<http://www.roberthooke.org.uk/batten4a.htm>), sited in the rural suburbs of London and designed by Robert Hooke (1635–1703), the prominent architect of institutional buildings.
10 Panopticon is a term coined by the English philosopher and social theorist Jeremy Bentham (1748–1832). It refers to the design of a type of institutional building, especially penitentiary, which, thanks to its artful architectural configuration, can assure imperceptible, omniscient surveillance and thus produce efficient (self-)regulation of behaviour (Bentham 1812). In Discipline and Punish, Foucault transcends Bentham’s strictly physical, architectural concept of Panopticon to convert it into a central paradigmatic motif for modern power deployment within a variety of social networks.