Regeneration is the first novel in Pat Barker’s trilogy on the First World War. Centred around army psychiatrist William Rivers and featuring real historical persons, it is a compassionate examination of the trauma of shell-shock and the social impact of the war on notions of bravery, free expression and traditional masculinity.

Dr William Rivers, an army psychiatrist stationed at Craiglockhart War Hospital meets with his boss, Bryce, to discuss a new patient arriving today. Siegfried Sassoon is being sent to their hospital specifically to see Rivers. Sassoon, an exemplary soldier and a poet has written ‘A Soldier’s Declaration’ which has been published. In it, Sassoon argues, the War is no longer being fought for defence and liberty but for aggression and conquest. That the War could be ended by negotiation but, Sasson suspects, is being deliberately prolonged.

To discipline Sassoon or charge him with a crime would make matters worse. So, the army has decided to send him to Craiglockhart in the hope that this would help discredit his declaration as the result of a mind succumbing to the impact of life on the front.

The arrival of a high-profile patient, warns Bryce, might bring unwanted attention. It might reinforce the view that such psychiatric hospitals are acting as a shelter for cowards, traitors and degenerates and undermine the work that both Bryce and Rivers believe in.

Rivers reviews Sassoon’s file. Like any soldier who has spent considerable time at the front, it would not be true to say he is suffering no psychological symptoms. He is suffering from hallucinations, waking nightmares. But Bryce and Rivers conclude there is nothing greatly wrong with Sassoon. He is not motivated by trying to avoid his own death, he is neither religious nor a pacifist, and he has a strong dislike for civilians and non-combatants in uniform, something he shares with those who would like to see him punished.

The trouble was, he was finding it difficult to examine the evidence impartially. He wanted Sassoon to be ill. Admitting this made him pause. He got up and began pacing the floor of his room, from door to window and back again. He’d only ever encountered one similar case, a man who’d refused to go on fighting on religious grounds. Atrocities took place on both sides, he’d said. There was nothing to choose between the British and the Germans.

The case had given rise to heated discussions in the MO’s common room – about the freedom of the individual conscience in wartime, and the role of the army psychiatrist in ‘treating’ a man who refused to fight. Rivers, listening to those arguments, had been left in no doubt of the depth and seriousness of the divisions. The controversy had died down only when the patient proved to be psychotic. That was the crux of the matter. A man like Sassoon would always be trouble, but he will be a lot less trouble if he were ill.

Rivers interviews Sassoon and they go over his record and hears Sassoon’s perspective. Their meeting is amicable and they understand each other but Rivers warns – it is his job to send him back to the front.

Sassoon is the least of Rivers’ worries at the moment. One of his other patients is Anderson. An army surgeon, Anderson was averaging ten amputations a day at one point. Anderson is sceptical about therapy and thinks he only needs some rest. But Rivers worries if Anderson will ever be able to return to duty or even work as a surgeon after the war.

Causing Rivers the most anxiety is Burns. A young man, Burns suffered an unfortunate incident with the bloated corpse of a dead German soldier at the front. Since then, he has hardly been able to keep any food down and is slowly wasting away. Rivers has tried everything with him without success and worries about what will become of him.

Cut a chrysalis open, and you will find a rotten caterpillar. What you will never find is that mythical creature, half caterpillar, half butterfly, a fit emblem of the human soul, for those whose cast of mind leads them to seek such emblems. No, the process of transformation consists almost entirely of decay. Burns was young, after all. If today really marked a change, a willingness to face his experiences in France, then his condition might improve. In a few year’s time it might even be possible to think of him resuming his education, perhaps pursuing that unexpected interest in theology. Though it was difficult to see him as an undergraduate. He had missed his chance of being ordinary.

Another new patient is Billy Prior. Not untypical of new patients, it is difficult to know how much Prior is being affected by his experiences and symptoms and to what extent he is simply uncooperative. He is mute and suffering from extreme nightmares that prevent his roommate from sleeping. But Prior claims he can remember nothing of them. When he is communicative, Prior is combative.

But Rivers is suffering from nightmares too, brought on by his own conflicts and moral dilemmas. Rivers believes the War should be fought to a finish, but this conflicts with his sympathy for the suffering of patients like Burns. He believes in the treatment he provides though he knows it causes pain and is experimental and, therefore, may not yield improvement. Most of all, he knows that ‘success’ in treating his patients means they return to the War, likely to be killed.

Regeneration is the first novel in Pat Barker’s Regeneration Trilogy. It is followed by The Eye in the Door and The Ghost Road, which won the Booker Prize in 1995. I don’t do much research before choosing fiction to read, so I was completely unaware before reading Regeneration that many of the characters – main ones such as Rivers and Sassoon, and minor ones like Wilfred Owen – are recreations of real historical people. It only dawned on me, early in the novel when the reader meets Robert Graves – author of I, Claudius – a friend of Sassoon.

I’ve always been a reader who responds well to seeing structure in a novel. I liked the structure in Regeneration, built around River’s sessions with his patients. Each one a dive into their psyche and their conflicts. Each mired by the dilemmas of separating the real from the unreal, the subjective from the objective, where Rivers cannot stand as an impartial observer but is a participant whose own psychology, beliefs and methods are being scrutinised as well.

The vast majority of his patients had no record of any mental trouble. And as soon as you accepted that the man’s breakdown was a consequence of his war experience rather than his own innate weakness, then inevitably the war became the issue. And the therapy was a test, not only of the genuineness of the individual symptoms, but also of the validity of the demands the war was making on him. Rivers had survived partly by suppressing his awareness of this. But then along came Sassoon and made the justifiability of the war a matter of constant, open debate, and that suppression was no longer possible.

As mentioned, although Sassoon’s arrival at Craiglockhart is more a political decision than a medical one, he is suffering some psychological symptoms. But unlike the majority of Rivers’ patients, Sassoon’s roadblock to his recover is more a moral objection – the difficulty of reconciling his beliefs with his participation in the war. Rivers’ treatment of Sassoon is less about attending to physical symptoms and their emotional causes than it is in bringing him around to see how he can bring himself to voluntarily return to the war.

Perhaps even more than the war, masculinity is on trial in Regeneration. The forms masculinity takes in this era is one where expression of emotion is a sign of weakness and succumbing to the trauma of frontline experiences is to shirk one’s duty. But the First World War was a somewhat transitional war between the hand-to-hand combat of all previous warfare and the more mechanised wars of the future. Societal values of the ideal man and soldier had yet to catch up with the experiences of the frontline soldier in this new context.

Much of the soldier’s psychological issues stem from the inability to reconcile their efforts to conform to the ideals society places on them with their horrific experiences at the front. The rational part of their mind insists they are loyal, patriotic, brave and manly. But their subconscious has ceased to comply. Rivers’ task is in part to challenge their preconceptions of the ideal man and ideal soldier and encourage them to participate in a therapy many of them would find effeminate.

Another challenge to traditional masculinity arrives in the feelings of affection the men have for their fellow soldiers at the front. Their close proximity, their loyalty, their empathy for each other’s suffering, creates an emotional connection that can only be described as love. For some, these feelings are not merely platonic. For some the discovery that they may have homosexual feelings for their fellow men is a confusing surprise. Less of a surprise for others. But being told that some forms of love are acceptable and others not, exacerbates the moral dilemma leaving them wondering just what freedom they are being asked to make the ultimate sacrifice for.

One of the paradoxes of the war – one of the many – was that this most brutal of conflicts should set up a relationship between officers and men that was… domestic. Caring. As Layard would undoubtedly have said, maternal. The Great Adventure. They’d been mobilised into holes in the ground so constricted they could hardly move and the Great Adventure- the real life equivalent of all the adventure stories they devoured as boys – consisted of crouching in a dugout, waiting to be killed. The war that had promised so much in the way of ‘manly’ activity had actually delivered ‘feminine’ passivity, and on a scale that their mothers and sisters had scarcely known. No wonder they broke down.

Regeneration is a short exquisitely written novel. In this review I have barely scratched the surface of the themes it explores and their complexity. Yet it is written with a strict economy. We’ve all read novels that are overburdened with the details the author wishes the reader to digest and understand. Regeneration is at the other extreme. No less full of complexity but delivered with subtlety and left for the reader to infer and appreciate without direction. Though satisfying on its own, I look forward to reading the next in the series – The Eye in the Door.