Walking Wounded is a remarkably nuanced debut about the human consequences of war. The term "walking wounded" is used in conflict to describe people who have sustained low priority injuries who are still ambulatory. This novel focuses on the psychological toll of war; those people struggling with mental issues after being scarred for life by their experiences, and those who treat them.
The story is set during 1947 at the military psychiatric Northfield Hospital in England, just months before the founding of the UK’s National Health Service (NHS), which would radically change the workings of the understaffed, struggling military institution. Britain was just recovering from the end of the Second World War. Psychiatry was evolving slowly and Post Traumatic Stress Disorder (PTSD) was a prevalent but misunderstood condition.
Controversial invasive procedures like shock therapy and leucotomy (British equivalent of lobotomy) were gaining in popularity as viable treatments for the disorder. Llewellyn explores these intersecting issues with compelling research and impeccable sensitivity.
Her novel is primarily the story of the interlinked experiences of a patient and a doctor at the hospital. David Reece is a young man who has aspired to be a journalist but his wartime experiences in Burma torment him. Reece has been demobilised but after an altercation at a pub, is sent to the hospital for treatment.
Daniel Carter is a principled psychiatrist who doesn’t believe in just alleviating the symptoms but in understanding underlying factors behind the trauma. He believes that making peace with the past is more effective than drugging patients or using irrevocable physical methods. Hunter, who is only referred to by his first name, is Carter’s nemesis, a supercilious colleague who believes patients with PTSD symptoms shouldn’t be “dumped” at the already-understaffed hospital. He wants to focus on “real cases” – bona fide anxiety states, hysterics or long-term severe depression. More of an orthodox psychiatrist, he scoffs at Carter’s predilection for psychotherapy and experimental group therapy sessions, instead treating patients with deep narcosis and electroconvulsive therapy (ECT).
Institutional treatment and the ways in which mentally ill people were treated as subhuman in those days is scrutinised with piercing insight by the writer. Cooped up in asylums, the veterans were stigmatised and kept in ostensible incarceration.
"I'm imprisoned in a mental asylum. I examine this thought like a disembodied object I'm about to draw, twist it this way and that, check out the shape of it, the weight of it. It's my reality, this thought. It's me," says Reece's internal voice.
The book is revelatory in charting the progress of psychiatry. The writer has herself worked with PTSD sufferers and her experience informs this novel.
In the 1940s, most psychiatrists denigrated psychotherapy and psychoanalysis, and considered physical treatments the most effective methods for psychiatric disorders. Because of the huge influx of traumatised veterans, most psychiatrists considered it practical to deal with them through chemical sedation and ECT, with utter disregard of the long-term effects. Psychotherapy was considered untenable and a waste of time and resources, in an already-inefficient institution.
There was a lot of trial and error, unfortunately at the expense of patients. A few nugatory experimental methods included “compulsory mourning” – inducing trauma as a way to “release residual negative memories” – and abreaction, which involved making the patient relive the traumatic experience. Many doctors treated patients as guinea pigs, which of course had ethical implications.
Carter is traumatised in his own way after witnessing a lobotomy of a 50-year-old woman suffering from “melancholia”, with only a local anaesthetic. Lobotomy involves severing fibres in the prefrontal cortex of the brain, thought to be linked exclusively to higher functions such as emotional expression and cognitive skills. As we now know, the brain is an intricately complex organ, and treating psychiatric disorders involves more than simply cutting nerve connections in the brain.
Carter abhors how doctors make irreversible changes to a person’s brain based on incomplete research. As he stares horrified at the barbaric operation, he wonders “Can it really be as easy as that – to scrape out someone’s depression, their melancholy, their anxiety? To scrape out someone’s emotions?” The story astutely explores the line between research and experiment, specially with doctors on self-aggrandising missions.
This novel is a thought-provoking exploration of the lives of war veterans. Like Reece, most were literally thrust into the firing line and forced to carry out inhumane acts.
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Post-war, they were catapulted back into civilian life and were compelled to carry on. The disconnect that veterans felt on returning home and in making sense of their experiences was daunting. They were expected to be grateful to have returned home safely but there was a heavy mental toll, with years of normalcy taken away from them. Most were haunted by survivor’s guilt and the “randomness of their survival”. “The burden of surviving seemed to be just too much for some of the men.”
Llewellyn also evokes the paranoid wariness of the end of the 1940s with pitch perfect insight. Carter observes that his generation was brought up by parents who were still coming to terms with the magnitude of the First World War. So in a way, they grew up in the shadow of fear and great human suffering, only to go through it again when they got older. "War was always with us, whether we looked behind us or looked ahead. We were primed for it throughout our childhood.''
The crux of the book deals with how human selfishness and the arrogance of doctors have led to callous acts that have irrevocably wrecked so many lives. “It’s as if we come up with a possible solution to a problem, and it doesn’t matter if it’s inhumane, we’ll justify it any way we can, and use it just the same. Atom bombs. Leucotomies. It might not be the right solution – it might not even be the right problem you’ve identified, come to that. But you label it ‘experimental’ and you get away with you it.”
This novel depicts how, when humans play God and carry out devastating acts, backed by flimsy research and a lack of regard for ethical and moral codes, it usually results in collective human suffering.