[In the following review, Coles asserts that the story of character Dr. Rivers is the most compelling element of Barker's Regeneration.]

In a previous column I made mention of my experiences as an Air Force psychiatrist—the different ways we were expected to respond to our fellow officers, as opposed to the ordinary men and women who hadn't such high rank to their credit. Again and again some of us doctors, in the military for only two years, were reminded that we had to accommodate our notion of what ought to be the requirements of a large organization with its own traditions, customs, needs and values.

Regeneration, a novel I recently read by Pat Barker, an Englishwoman, brought back that military experience and reminded me of what was often at stake as I first sat with people having trouble with their personal lives and then sat with my fellow Air Force doctors as we tried to figure out what to do, and why.

In the pages of Regeneration we are told of the terrible carnage of the First World War—millions of young lives lost in senseless trench combat over yards of territory drenched in blood. Three years into that human and moral disaster the British poet and army officer Siegfried Sassoon, a decorated war hero, abruptly refused to have any more part of the fighting. His defiant challenge to military authority, called “A Soldier's Declaration,” is put at the beginning of the novel. At one point he insists: “I have seen and endured the suffering of the troops, and I can no longer be party to prolong these sufferings for ends which I believe to be evil and unjust.”

Soon enough this well-known officer was a patient at Craiglockhart War Hospital, classified “mentally unsound.” Such a procedure was supposedly a sign of early 20th-century progress, an effort to understand rather than a quick punitive judgment.

At the hospital Sassoon became the patient of William Rivers, M.D., a neuropsychiatrist who even now is known to people in my profession as one of the pioneers in what came to be called the study of “war neuroses.” He was one of the first doctors to take seriously the subjectivity of soldiers afflicted with all sorts of paralyzing symptoms: terrible nightmares, spells of deep gloom, appetite loss, insomnia and a host of other idiosyncratic complaints that seemed to defy comprehension. He learned that what appears to be bizarre and senseless is in many cases a quite reasonable expression of horror on the part of men who had witnessed and experienced a degree of suffering and vulnerability unimaginable to those who have never been on a battlefield in, say, Ypres or Verdun, where corpses by the thousands covered land meant to grow crops, all in the name of this or that nation's “freedom” or “destiny.”

Thanks to almost a century of psychoanalysis, we readily comprehend now how the mind tries to find symbolic expression for its grave distress, how the unconscious wields its way; but Dr. Rivers came to such knowledge on his own, through careful clinical observation and analysis and without resort to the sometimes ponderous and overwrought theoretical language of today that contrasts so markedly with the marvelously clear-headed and inviting narrative writing to be found in, say, Freud's The Interpretation of Dreams.

In fact, Dr. Rivers belongs to the tradition of British empiricism—a way of seeing things not unlike the approach to people and their behavior that William James, on this side of the Atlantic, called pragmatism. Indeed, had James lived another few years （he died in 1910）, one suspects he would have been much interested in pursuing just the kind of inquiry Rivers made in his many encounters with so-called shell-shocked survivors of those hard-fought battles on French soil during the second decade of this century.

This is a chronicle that summons up a historical scene and probes it deeply, to the reader's considerable benefit. We learn what happens not only to hurt, war-weary soldiers, but to the doctors who must try to heal them—so that, alas, they will return to places of wanton slaughter as participants, as those who aim to kill, while hoping and praying they will themselves be spared. Fiction varies, of course, in its relationship to the actual and factual.

The account in this novel has obviously been made possible by the writer's long-standing and full immersion in historical sources of various kinds, as she readily acknowledges in an author's note at the end—a novel in the documentary tradition and an attempt to evoke through the strategies of the storyteller a long-ago medical and social reality: the psychiatric hospital as a place of 20th-century military decision-making.

But the book is also informed by a moral seriousness not always explicitly acknowledged by some of us psychiatrists as we do our work, in civilian as well as military life. All too easily we may try to address our patients' complaints, the troubles that have brought them to us, while keeping ourselves at a distance from the moral turmoil that has so urgently confronted them.

Dr. Rivers knew that Sassoon's psychiatric hospitalization was a moral dodge for the military, for an entire culture: What to do when a brave soldier has serious second thoughts about a war he hitherto accepted as just and necessary? To call such a person sick is, of course, to concentrate on the singular rather than the general—to call individuals crazy rather than regard a nation as gone mad. Even in times of peace, moreover, there are those who question strenuously the way things are—and get called by many of us all sorts of psychological names.

In Regeneration we are asked to think not only of the protester's motives and actions, but also those of his doctors. It is, in fact, the moral agony of the psychiatrist, Dr. Rivers, that won't let go of us who read of him—probably because his dilemmas remind us of some of our own.