Julie Anderson, War, Disability and Rehabilitation in Britain: ‘Soul of a Nation’ (Manchester: Manchester University Press, 2011). 239 pp.
Reviewed by Kellen Kurschinski (McMaster University)
Julie Anderson’s book is an ambitious and timely study of how war and rehabilitation shaped the experience of disability in Britain during the first half of the twentieth century. Relying on carefully selected case studies and fortified by contemporary medical literature, government reports, periodicals, private collections, as well as institutional and national archives, Anderson offers a comprehensive account of how disabled ex-servicemen (and some women) experienced rehabilitation policy during and immediately after the two World Wars. The First World War, Anderson argues, was a watershed moment for the conceptualization of rehabilitation, while the Second World War ushered in new, more sophisticated and uniform policies and approaches. (p. 3-4, 11) Building off recent studies of war and disability by Jeffrey Reznick and Ana Cardon-Coyne, Anderson illustrates how throughout this period Britain’s ideology of rehabilitation purported that even the most severely disabled could be “reconstructed and reused in different contexts.” (p. 2) Rehabilitation was thus a process of physical, economic, social, and psychological healing, one that relied upon increasing intervention on the part of the stat in addition to voluntary organizations, medical experts, and military authorities. Although the outcome of a soldier’s rehabilitation hinged on the severity of their wounds, Anderson, like other historians of war and disability, emphasizes how medicine’s objective remained much the same between 1914 and 1945: to restore war’s waste to physical independence and masculine self-sufficiency.
Anderson begins by providing historical background to the experience of disability during the first half of the twentieth century, concentrating her focus on three groups of disabled most common to the pre-1914 period: the civilian disabled, industrial disabled, and disabled children. Between 1900-1939, the rise of eugenics and public anxieties over racial “degeneration” led the State to take a growing interest in the welfare of disabled children, and to a lesser extent, the wellbeing of workers injured on the job. (p. 14) In effect, disability was evolving into a matter of ‘national interest’, rather than a personal tragedy and responsibility of private charity. Numerous State forays into the management of workplace injury and public health, including the creation of the National Insurance Act (1911) or the Ministry of Health in 1919, illustrate the degree to which this shift was occurring. As Anderson notes, however, the State failed to take a “uniform approach” to the treatment of the disabled. Instead, it relied extensively on voluntary organizations to administer care to the civilian disabled while its own efforts concentrated on the prevention and management of disability especially amongst children. (p. 14-15) The most important point for the reader to take away is that prevailing social, medical, and cultural attitudes towards disability during this period framed disability as something to be ‘cured’ by modern medicine and social reform.
The First World War brought these reform impulses to the fore of British society. Though disability had always existed, the scale and severity of the injuries industrial warfare exacted on men’s bodies served as a “a catalyst in increasing the public’s awareness of disabled people.” (p. 42) Bodies in wartime took on new meaning. They were meant to be heroic and virile, but as Anderson reminds us (citing Joanna Bourke), they were also intended to be mutilated. (p. 43) Rehabilitation thus had to not only assuage personal and collective anxieties over the corporeal legacy of physical maiming, but also its broader military and economic implications. Anderson’s two primary case studies in Chapter 2, St. Dunstan’s and the Star and Garter Home, offer a detailed look at wartime approaches to rehabilitation in practice. While St. Dunstan’s was reserved exclusively for blinded soldiers and the Star and Garter Home for the physically incapacitated (including paraplegics), each utilized similar methods to restore their patients to the greatest degree of independence possible. These methods included nascent forms of occupational therapy, vocational training, and organized recreation. Together, it was hoped that this holistic approach to rehabilitation would help restore a patient’s masculine identity and, where possible, economic independence. (p. 56) Anderson devotes a great deal of attention to the role of sport in this process, providing an array of examples of how organized competition and teamwork fueled a culture of “self-help and heroism in the face of adversity” that became synonymous with the war’s wounded. (p. 49)
The emphasis on bodily fitness and adherence to masculine virtues of stoicism, perseverance, and self-reliance were hallmarks of rehabilitation culture that continued during the Second World War. Although the State had taken an intense interest in the wellbeing of its disabled soldiers between 1914-18, a substantial degree of rehabilitation work beyond military medicine was shouldered by patriotic organizations and private charity. (p. 64-65) Anderson offers several examples of how advances in technology and medical science, in addition to wartime manpower requirements, pushed the British state to take a more active role in the management and rehabilitation of the war’s disabled. What began initially as an experiment in medical science and social reform was by the war’s end a distinct feature of the emerging welfare state. (p. 94) Chapters 4 and 5 offer two case studies to prove this point. In the first example, Anderson shows how the RAF developed a highly technical scheme of rehabilitation that rapidly returned injured airmen to the skies or other forms of military service. RAF hospitals, including the Queen Victoria Hospital in East Greenstead (which specialized in treating burn victims), were especially keen on utilizing sport, recreation, carefully managed leisure, and community engagement to boost the patients’ confidence and collective morale. (p. 109-110) At Stoke Mandeville Hospital in Aylesbury – the primary focus of Chapter 5 – soldiers suffering from paralysis received a similar combination of physical and ‘social’ rehabilitation.
Anderson concludes her book by analyzing how women’s bodies fit into the predominantly male-centric culture of rehabilitation in Britain, then moves on to broadly survey the impact the war had on State rehabilitation policy in the postwar period. Although women were granted access to most of the same rehabilitation benefits as their male counterparts, Anderson contends that they were largely supplanted by prevailing conceptions of rehabilitation as a process of restoring masculine traits. Indeed, in the postwar period few women war disabled were able to use these benefits as a springboard to self-support and independence compared to their male counterparts. Although disparities in experience still existed between male and female, as well as military and civilian disabled, the Second World War ushered in a new era of legislative reform that solidified the State’s relationship with disabled people. More to the point, the war enshrined rehabilitation as a central tenet of the burgeoning welfare state, allowing disabled people increased access to the necessities of life and bolstering the continued work voluntary and charitable organizations. (p. 201)
One of the most intriguing features of Anderson’s study is her use of the ‘body’ as a concept to illuminate the experience of the disabled in war and peace. Throughout the book she strikes a delicate balance between recognizing the cultural and medical ideas that help define ‘able’ and disabled’, while simultaneously granting her subjects agency within spaces of healing and the public sphere. At times this approach is problematic because Anderson tends to focus almost exclusively on the physically maimed, blinded, or disfigured, and in the process misses an important opportunity to illuminate how similar approaches to rehabilitation were applied to the scores of other war disabled. Indeed, only a small portion of Britain’s disabled soldiers in both wars suffered from disfigurements, amputations, blindness, or paralysis. The vast majority among all combatant nations suffered from ‘invisible wounds’, including diseases like tuberculosis, bronchitis, arthritis, rheumatism, and the lingering effects of improperly healed wounds or exposure on the battlefield. The author’s reticence to engage directly with the treatment of psychological trauma (which has its own extensive historiography) is not surprising, but even a brief overview could have offered some insight into how rehabilitation for these men intersected or diverged from the experiences of more ‘visibly’ wounded during each war. Recent work by historians such as Edgar Jones and Simon Wessely, or Terry Copp and Mark Humphries suggests that many parallels did indeed exist.[1]
Anderson’s reliance on institutional case studies has a number of strengths and weaknesses. On the one hand, these case studies offer readers a window into the lives of the disabled and how they experienced rehabilitation in specific medical and social spaces. At times, however, the focus on specific institutions comes at the expense of a more balanced look at how the disabled were treated by other institutions, or in the case of the Second World War, other services. Readers familiar with the literature on war and disability and the rehabilitation work of other combatant nations during both World Wars – especially the French, the Dominions, and the United States – might also yearn for a more substantial explanation of where Britain’s approach fell into the broader international effort. As is common with studies that chart the trajectory of complex, multivalent subjects such as war and disability, the questions raised – and some of the omissions Anderson was no doubt forced to make for the sake of economy – reveal that we have only just begun to scratch the surface of this exciting topic of historical inquiry.
Such shortcomings are symptomatic of a book that is both ambitious and pioneering in its approach. Even so, readers will be impressed by the poignant insights in Anderson’s narrative, as well as the quality of her painstaking research. Ultimately, what Julie Anderson has produced is an unparalleled and very detailed investigation into the physical legacy of modern warfare along with the social, cultural, and medical responses to it. What is most impressive throughout the book is her ability to strike a balance between exploring the ideology and objectives of rehabilitation while simultaneously illuminating the ‘patient experience’. The disabled in this book are not mere objects of medical science to be cured, but ordinary men and women who struggled with the indelible marks of war, many for the remainder of their lives. As such, this book will certainly endear itself to students of the social and cultural history of war and medical history alike, offering an excellent model for future studies of disability and war in the twentieth century.