Pat Barker's Regeneration contains references to people, places, and cultural elements of particular significance to her themes as well as to the study of the First World War. One cultural reference, that of shell shock, is made early in the novel. On page four, Dr. William Rivers learns that Siegfried Sassoon is being sent to Craiglockhart War Hospital with a case of shell shock. To prevent shell shock from crippling the patients, Craiglockhart emphasizes the value of therapy, a theme in the novel, as a way to fight back against the mental battles.

The term shell shock was first coined in 1915 by C.S. Myers in The Lancet to describe the disorder found on the battlefield in soldiers who had been exposed to an exploding shell (Spiller). During the beginning of World War One, the disorder was common only among soldiers. Victims were often mocked and labeled cowards by their peers, causing many to desert the army. Around three hundred of these men were shot, and hundreds more were imprisoned for their apparent cowardness (Storr). Soon officers began falling ill as well, and by 1917, the ratio of shell-shocked officers to shell-shocked enlisted men was an astounding 1: 6 (Bourke). With this shift, shell shock became recognized as a legitimate medical disorder.

The symptoms of shell shock were numerous and varied from soldier to soldier. Physical effects ranged from trembling, sweating, insomnia, diarrhea, and minor twitches to paralysis, blindness, and muteness. Victims also experienced anguish, anxiety, and the inability to control their emotions. As a result, most were unable to separate their past from reality. During the war, psychologist Karl Bimbaum observed "great weariness and profuse weeping, even in otherwise strong men" (Spiller). Many of the soldiers exhibited what Sigmund Freud termed conversion disorders, which were subconsciously-formed problems such as the inability to walk, talk, see, or hear (Stuttaford). These symptoms were beyond the patients' control.

Shell shock had devastating effects on the British Army. Over 80,000 cases of shell shock were treated during World War One (Bourke). Even after the war, symptoms continued to surface in a majority of the victims. Years later, many veterans still complained of frequent nightmares and hallucinations. In 1927, over 65,000 men remained in mental hospitals suffering from shell shock acquired during the war (Spiller). In every military conflict since World War One, shell shock has been a problem among combat forces. Throughout the years, the disorder has been reclassified various times, with names including combat fatigue, war neurosis, neurasthenia, and most recently, post traumatic stress disorder (Spiller). Although the terminology has changed, the disorder remains a threat to the mental and physical well-being of troops.

In Barker's first reference to shell shock, Siegfried Sassoon is classified as a victim, although the diagnosis is a convenient excuse to silence him. The scene on page four opens with Dr. William Rivers and Dr. Bryce discussing Sassoon's case, specifically in regard to his recent Declaration. Sassoon is a decorated officer, having already won the Military Cross upon his entry into the hospital. He sends his anti-war statement not only to his commanding officers, but also to the House of Commons, where it is read aloud and publicly debated. Sassoon is highly respected among his peers and fellow soldiers. By defying the government and accusing the military of prolonged warfare, he is a threat to the union of the troops. Others are concerned that his influence could produce a whole generation of pacifists and conscientious objectors. The Board ignores the opportunity to try Sassoon for treason and instead sends him to Craiglockhart War Hospital. The officials excuse his behavior as temporary insanity caused by the atrocities of war and prolonged shell shock. He could easily have been sent to prison and perhaps even have achieved the martyr status. Rather, Sassoon is quietly removed from society until he can be redeemed from his unconventional perspective. Although Sassoon experiences some symptoms of neurasthenia, Rivers realizes that Siegfried is no ordinary shell shock case. This man is not mad. He has just been suppressed, in the form of a medical disorder, for freely expressing his innermost opinions of the military and the war.

The value of various forms of therapy, a theme in Regeneration, becomes instrumental in combating shell shock. Rivers maintains a calm attitude when dealing with his patients. He encourages them to talk about the war rather than forget the horrific images and "to let themselves feel the pity and terror their war experience inevitably evoked" (Barker 48). Rivers is even willing to perform hypnosis on Billy Prior in order to help him retrieve his repressed memories. Unlike many of his peers, who turn to electric shock therapy, Dr. Rivers encourages rest and relaxation for his patients. His ultimate goal is to see all of the men return to the front in good health, prepared to fight once again for their country. To achieve that goal, Rivers maintains a gentle, therapeutic approach.

The success of River's methods can be seen in the outcome of his patients. At the beginning of the novel, Billy Prior has a conversion disorder of muteness. However, through Rivers's patient prodding, eventually Prior begins to speak again. River's gentle demeanor enables him to pull Prior out of his mute state. Another patient, Willard, is mysteriously paralyzed, although nothing is wrong with his spine. With time and Rivers's encouragement, Willard is able to stand and walk again. Again, Rivers's kind approach allows him to be successful. Rivers also supervises another form of therapy by allowing interaction among the patients and the staff at Craiglockhart. The friendships among the patients, like that of Owen and Sassoon, provide the men with a means of talking and sharing deep experiences with each other. Rivers's father-like relationship with his patients also is a form of therapy, because the men are able to freely open up to him. As the patients progress toward healing, many of them take over their own therapy. Owen and Sassoon find outlets in the art of poetry. The success of the various therapeutic methods presented in the novel proves how valuable therapy is to mental and physical recovery from shell shock.

Shell shock plays an enormous role in the development of Regeneration. Without this cultural element, there would be few if any patients in Craiglockhart. Shell shock exposes readers to a world of madness conquered only by therapy. The disorder captures young and old, rich and poor. The characters discover that the bravest of men can break down and the strongest can falter, but through therapy, all can survive.

Barker, Pat. Regeneration. New York: Plume, 2003.

Bourke, Joanna. "Shell Shock During World War One." World War One. 3 Jan. 2002. BBC. 8 April 2003 <http://www.bbc.co.uk/history/war/wwone/shellshock_01.shtml>.

Spiller, R.J. "Shell Shock." American Heritage May/June 1990: 74+. MAS Ultra School Edition. EBSCOhost. 3 April 2003 <http://search.epnet.com>.

Storr, Anthony. "When Sanity Comes Under Fire." The Times 8 Nov. 2000: 12+. MAS Ultra School Edition. EBSCOhost. 3 April 2003 <http://search.epnet.com>.

Stuttaford, Dr. Thomas. "Mad or Malingering?" The Times 22 Aug. 2002: 4+. MAS Ultra School Edition. EBSCOhost. 3 April 2003 <http://search.epnet.com>.