Christine E. Hallett. Containing Trauma: Nursing Work in the First World War. Manchester: Manchester University Press, 2009. xvii + 259 pp. $89.95 (cloth), ISBN 978-0-7190-7958-0.
Reviewed by Charissa Threat (Northeastern University)
Published on H-Minerva (September, 2010)
Commissioned by Heather M. Stur
First World War Nurses: Healers and Containers of Trauma
How did nurses care for those who were wounded or ill during the First World War? This is the engaging question that Christine Hallett sets out to answer in her monograph, aptly titled Containing Trauma. So often, scholars have approached the topic of women and war, particularly the subject of war nursing, by focusing on the cultural relationship between caregiving obligations and women's work during wartime or the political, social, and economic gains nurses hoped would result from military service. Here, of course, we can look to such works as Jeffrey Reznick, Healing the Nation (2004) or Kimberly Jensen, Mobilizing Minerva (2008) as examples. Using nurses' personal writings, their diaries, letters, and even autobiographical accounts, Hallett chooses instead, to focus our attention on the work nurses performed on a daily basis and how that work aided in the survival of those they cared for. In this way, Hallett’s work is a welcome departure from a notable body of literature dedicated solely to the cultural aspects of women’s wartime service and military nursing during World War I.
Containing Trauma is a book that attempts to illuminate the various ways that nurses helped to “maintain the integrity of the individual,” their patient (p. 5). It is not a book, however, that seeks to evaluate the “efficacy of medical treatments” (p. 13). Nor does the author set out to focus on the relationships among nurses or between nurses and other medical staff, although we get glimpses of it here. It is instead, a book about nursing work. Setting up this premise in the introduction, Hallett assumes a large task, but she does so in a rather interesting way. Taking the concept of “containing trauma” from the title of her book, Hallett organizes the book around the three ways nurses controlled the damage done to individuals during war: first, containing and controlling the physical damage resulting from both injuries and the environment; second, relieving the psychological damage sustained by soldiers; and third, maintaining the emotional and physical well-being of the nurses themselves. All three proved a delicate balancing act for nurses but all were necessary for nurses to complete their work.
In the first decades of the twentieth century, professional nursing and nursing work focused on a holistic ideal of caregiving. This according to Hallett meant that nursing was a practice that combined the skilled knowledge of medical treatments with the overall maintenance and restoration of individual health. For this reason, nursing was much more complex--the author suggests--than any other medical care provided during World War I. The services provided by doctors focused on fixing injuries, in some cases, causing trauma to do it. The services and care provided by nurses, however, not only sustained life, but also created “safe boundaries within which healing could take place” (p. 16). This was a long and arduous process, one that Hallett argues has been given only cursory acknowledgement at best by historians who often focused on the experiences and writings of either doctors or volunteer nurses (VADs) and not on professionally trained nurses. At worst, historians have completely ignored the work and challenges faced by nurses during the First World War. For a fuller and more complete understanding of the reality and meaning of nursing work, Hallett combines the writing of VADs with rare accounts from professional trained nurses and articles focused on nursing practices in the first decades of the twentieth century.
The first half of the monograph, chapters 2 through 4, center on the multiple ways that physical damage was relieved or contained by nurses. Here, Hallett’s attempt at providing a new representation of nursing work from the voices of nurses themselves is most apparent. A note to those who have weak stomachs: these chapters reveal in graphic detail the type and complexity of work nurses did to keep patients alive. For example, in one rather graphic passage a nurses writes, “I found a walled-in pus pocket, and picking up a scalpel.... I had to slit the thing open. At least two cupfuls of pus poured out and his relief was tremendous at once” (p. 48). With these and other passages, Hallett exposes how tenuous the boundary between nurse and surgeon was at times. The severity of the First World War, including the introduction of trench warfare and toxic gas among other methods of combat and environmental elements, challenged this boundary. Out of necessity and out of a belief that nursing was more than bandages and care, Hallett demonstrates, nursing was a “profession whose work was dominated--but not dictated--by medical science” (p. 127). Nurses believed that they were responsible for the total environment in which their patients lived. This meant performing domestic or sanitary work, surgical work when necessary, and learning to adopt their nursing skills to hostile and unforgiving terrains and climates in an effort to “contain” the trauma of war.
In the remaining two chapters and the conclusion, Hallett examines the more emotional or psychological aspects of nursing work. In doing so, she seeks to refashion the image of nurses as cold or detached from their patients. While some scholars have interpreted the stern, “stiff upper lip” behavior of nurses as proof that they were callous, Hallett convincingly argues that their behavior was yet one more way they “worked” to contain the trauma of war. The mere presence of nurses allowed patients a safe space to heal. Within the cultural climate of Edwardian British society in the first two decades of the twentieth century, “‘containment’ was a positive process,” one that valued self-control, self-discipline, and composure (p. 226). The ability of nurses to adopt a persona as sister, mother, therapist; or, as nurse Violetta Thurstan suggested, cultivate “the gift of ‘understanding’” (p.163) while maintaining strict boundaries between nurse and patient, helped lessen the emotional or psychological trauma that soldiers experienced during war. Soldier and nurses, in other words, needed both to help them sustain a sense of wholeness. Nurses especially needed to practice “self-containment” in this relationship but whereas many incorrectly assumed this demonstrated their subordination to doctors or the to general medical establishment, Hallett argues that physical and emotional self-containment was part of nursing work. It helped to “enhance their patients’ sense of safety and well-being” (p. 195).
Hallett’s engaging study on nursing work during the First World War places nurses, not doctors at the center of the medical care provided to soldiers. By showing the myriad ways that nurses engaged in “containing” the physical, psychological, and emotional trauma witnessed and experienced by individuals on the front lines of war, she makes a strong case for the need to reinterpret the meaning and nature of nursing work by using the voice of nurses themselves. If Containing Trauma suffers any shortcomings, they are minor given the work’s stated goals. First, it appears that Hallett hopes for a wide audience; the medical terminology and descriptions, especially in the first four chapters, can be somewhat confusing for readers who are not familiar with the language. Second, while there is some mention of American nurses, this is largely a book about nursing work with the British Expeditionary Force, so those interested in a comparative perspective or more about nursing with the American Expeditionary Force will have to look elsewhere. But these issues do not detract in a significant way from what is overall another important contribution to the expanding body of literature chronicling women and war.
If there is additional discussion of this review, you may access it through the list discussion logs at: http://h-net.msu.edu/cgi-bin/logbrowse.pl.
Charissa Threat. Review of Hallett, Christine E., Containing Trauma: Nursing Work in the First World War.
H-Minerva, H-Net Reviews.
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