In 1917, following a request from the American Red-Cross which was gathering information to help organize medical care for its troops, the French military medical service established an assessment of the number of men treated for neuropsychiatric disorders: according to this evaluation, since the beginning of the war 2¬6.533 French soldiers had been diagnosed with mental troubles, 16.299 as concussed and 32.644 as psychoneurotic patients.1 Obviously, such numbers are a matter of debate and for several reasons they must not be taken too literally: all soldiers facing mental troubles had neither been identified nor taken charge of by military doctors, the diseases classification varied greatly depending on each psychiatrist, and at that time the distinction between a neurologic and a psychiatric illness was very blurred. But those numbers can at least give us an idea of the scale at which the French army had to deal with mental disorders. A few years little later, when the war was over, a study about the French mutilated veterans published in 1922 and based on statistical data issued by the government, revealed that almost 17.000 veterans were receiving a pension for neurasthenia, mania, confusion, traumatic neurosis or epilepsy.2
The A.B.N.G. was the only association which offered medical and moral assistance specifically to veterans facing those kinds of mental or nervous disorders.3 Although today completely forgotten, the association existed for more than fifty years.4 In 1996, the A.B.N.G. entrusted the management of its institutions to another association, and finally merged with it in 2000.5 After many years and several relocations, most of the archives have been destroyed or have disappeared. The very few documents that remain are now dispersed in different places, which are hard to identify. The articles of the association published in 1917;6 an advertising brochure from 1921;7 and some General Assembly reports, are the only documents produced by the A.B.N.G. that we were able to discover. Research of the press coverage revealed articles about the A.B.N.G. in national daily newspapers and, once we had identified Henri Wallon as the psychiatrist in charge of the veterans taken in by the association, we found a study about these patients which he published in a medical journal.8 Revealing information was also found in the archives of the French National Office for Veterans and Victims of War9 and in the individual file of the Marguerite Hérold, a member of the Legion of Honour.10 Finally, we were granted access to some photographs and documents collected by individuals.11
All these documents are providing important insights into the way the A.B.N.G. was created and evolved throughout the years. This article examines in which context the association was founded and what its original aims were. It shows that the A.B.N.G. quickly rethought the scope of its activities, until nervously disabled veterans became a marginal category among its beneficiaries. Consequently, this paper also tries to explain why the original project of the A.B.N.G. finally phased out.
Founding and aims of the Assistance aux Blessés Nerveux de la Guerre
Many associations dedicated to wounded soldiers appeared in France during the Great War. It was not rare that an association was dedicated to the assistance of a particular category of ill or injured veterans such as blind or tubercular soldiers, or amputees. But before 1917, no one took specific care of the soldiers who suffered from psychological troubles. To retrace the birth of the A.B.N.G., a close examination of the association's articles is necessary.
These articles begin with the list of the association's members. It is interesting to note that Marguerite Hérold, though she was the founder of the A.B.N.G., is presented as a simple member of the association. It was her husband, André-Ferdinand Hérold, who chaired the Board. She probably wanted to put her association under the patronage of a man with political connections and influence. André-Ferdinand Hérold did indeed come from a distinguished family. His father was the secretary of the Government of French Defense in 187012, and became a senator in 1876, and the prefect of the Département de la Seine in 1879. André-Ferdinand was himself a man of letters, a theatre critic and one of the creators of the newspaper L'Européen. He was also the vice-president of the League of Human Rights from 1913 to the end of his life in 1940. Conversely, Marguerite Hérold was born into a rather modest family: according to her birth certificate her father was a farmer and her mother worked as a seamstress.13 Her marriage with André-Ferdinand Hérold helped her to climb the social ladder. Once she had entered the Hérold family, she took a central place within the important social network gravitating around her husband, composed of famous artists, academics, politicians and industrialists. Naturally, she solicited this network to support her association. Therefore, eminent figures are listed as members: people such as Anatole France or Ernest Lavisse from the Académie Française, Edouard Herriot, senator and mayor of Lyon, or Léon Bonnat, director of the Paris School of Fine Arts. The names of Edith Wharton and Mildred Wood Bliss, two women who took part in other charities during the war, also appear in the list, reminding us that the founding of A.B.N.G. is embedded into the specific context of a burst of charity work provoked by the war. For women from wealthy families, involving themselves in these kinds of associations was only a logical extension of the philanthropic activities they traditionally supported in times of peace.
In the list of the A.B.N.G. members, two other names require special consideration, those of Justin Godart and Louis Mourier, who both served as Undersecretary of State for War in charge of the armed forces' medical service. The attention of Justin Godart had been drawn to the plight of soldiers with nervous troubles in September 1916: the Société de Neurologie de Paris appealed to him by expressing their wish that special establishments should be opened to take care of nervously disabled men unable to support themselves, and who were a significant burden for their families.14 No sources allow us to establish a direct connection between this initiative from the Société de Neurologie de Paris and the founding of the A.B.N.G. Nevertheless, the fact that Justin Godart took part in the founding process might indicate that these were not two separate events. Furthermore, a close reading of the arguments underpinning the wish expressed by the Société de Neurologie de Paris, on the one hand, and in the call for donations included in the articles of the A.B.N.G. on the other, shows a large overlap.
The call for donations provides us with a better understanding of the goals of the association. Its mission was twofold: to offer medical care to nervously disabled veterans, and to facilitate their reintegration into society. To complete this task, the association intended to open agricultural centres and workshops throughout the national territory where the men could train for a job without being separated from their families. This confirms that already in 1917 the A.B.N.G. was designed to continue its action after the war. It seems to have been successful; yet there was not enough money to carry out the original, ambitious project. During the war, far from being able to create centres around the country, the A.B.N.G. could only rely on a small location in Paris where offices and an examination room were installed.
Due to this lack of space, it is very likely that the number of veterans taken in by the association was very small during the war. It was only after the armistice that the A.B.N.G. seems to have developed properly and begun to fulfill its goals on a larger scale.
A rapid reorientation: from nervously disabled veterans to retarded children
Due to its advertising brochure published in 1921, we know that the association moved to new premises: a dispensary was opened in the 18th arrondissement of Paris where veterans were provided with medical care. According to the brochure, veterans and their families could see a doctor twice a week, and three times a week they had the possibility to eat there and do some work with the aim of training for a new job. Moreover, the dispensary was considered as a place where the veterans could find comfort and encouragement, and this moral support was intended for their spouses, too. Finally, the association wanted to help veterans to claim their rights, especially when a pension had been denied to them. In addition to the dispensary, the association now had a reeducation home where veterans could stay when it was not possible for them to remain living alone or with their families. This reeducation home was settled in a castle bought by Marguerite Hérold and located at Arnouville-lès-Gonnesse, in the north suburb of Paris. The castle was in the heart of a huge park measuring twenty-five hectares. It could accommodate 150 residents who could practice horticulture, basketwork or farming. The castle also had facilities for hydrotherapy treatments and, according to the brochure, a doctor was living there to take care of the veterans at any time.
Beyond what can be concluded from the advertising brochure, it is difficult to make out how the association really worked. In order to find out how many veterans were received at the dispensary or at the reeducation home, we can only rely on a few General Assembly reports.15 According to them, the number of men who frequented the dispensary each year between 1923 and 1926 fluctuated from 1.798 to 2.078; and 30.000 to 40.000 meal tickets were provided. Most of the veterans who came to the A.B.N.G. where seeking moral and financial help, rather than medical care. Indeed, since the number of medical examinations at the dispensary varied in the same period from 636 to 700, it is obvious that not every veteran was asking for a doctor. But these data show that the activity of the dispensary was maintained at a fairly high level until 1926. This was not the case for the reeducation home, where the numbers of residents reduced over the years. In 1923, there was a monthly average of 93 veterans living in the castle, only 73 in 1925, and 45 in 1928. The reeducation home, which was supposed to receive 150 veterans, never functioned at its full capacity. Given that situation, the association decided to expand the scope of its activities to the care of "unstable and retarded" children. In 1924, in addition to the castle, the association opened a new establishment in Limours, exclusively reserved for younger children – from three to fourteen years old. In 1927, one of the castle's wings was dedicated to children from fourteen to eighteen years old. Little by little, this new category of residents increased, and in 1929, the few veterans who were still living in the castle were moved into another place in Gonesse. In 1930, around 40 veterans were living there, according to an inspection report presented to the prefect.16 Even if the association never changed its name, its original purpose had been phased out.
The reorientation of the A.B.N.G. activities was partly due to financial difficulties. Although since 1922, the association was recognized for its public utility, it always had trouble raising enough funds to ensure its correct functioning. In order to get more publicity, the A.B.N.G. decided to open the doors of the reeducation home to the public and invite people to enjoy the park while helping the association with donations.17 Marguerite Hérold also organized events to call for contributions, such as a concert, and tea-time, she held in the rooms of the Claridge Hotel in 1922.18 As an association dedicated to veterans, the association was mostly subsidized by the National Office of the Mutilated and Reformed. But this was not sufficient. In 1923, the association was investigated by the Ministry of the Interior. The enquiry did not reveal any irregularities but insisted that the A.B.N.G had to find other spheres of action.19 This became all the more urgent as the National Office refused to allow the A.B.N.G. more money, as the deficit of the association began to increase. Even worse, as fewer and fewer veterans were taken charge of by the association at its reeducation home, the National Office decided that the subventions should decrease correspondingly. Consequently, in 1923 the A.B.N.G. decided to renounce one of its founding principles: free care. From now on, almost three quarters of the pension allowed to each veteran who was admitted to the castle of Arnouville-lès-Gonesse, were taken to pay for their stay.20
Why did the A.B.N.G. face so much difficulty in finding nervously disabled veterans who would stay in its reeducation home? It was certainly because the association dedicated itself to a very imprecise category of potential beneficiaries, composed of very different medical cases. For many of them, the model of the reeducation home proved to be not suitable at all.
The end of the reeducation home: a medical failure?
What exactly was a nervously disabled veteran? This was a thorny issue. The expression "blessés nerveux" might lead us to believe that the association intended to take care of veterans with neurologic diseases. But this would be a mistake for at least two reasons. As said in the introduction, at that time the frontier between psychiatric and neurologic disorders was permanently called into question. Moreover, the term “nervous” was often used to avoid other words considered as stigmatizing, such as "psychiatric" for example. In the advertising brochure published in 1921, the A.B.N.G. claimed its intention to take care of veterans who suffered from concussion or mental confusion or who had endured trepanation. The association became gradually aware of the ambiguity of these diagnoses.
In fact, the A.B.N.G. seems to have been quickly overwhelmed by the difficulties inherent in the care of disabled veterans. General Assembly reports indicate problems of violence and alcoholism among the veterans. Some suffered from mental troubles with severe seizures, like those described in a medical article by doctor Henri Wallon, who worked in the reeducation home. Let us have a look at the clinical picture he drew of a veteran he called "Lh":
"He was admitted in Arnouville on September 23, 1923. He is calm, with a regular conduct, but he has seizures, especially when he feels upset. It begins with convulsions, the usual posturing and often continues with mockery which looks more like combat on training ground than war. He hides his head behind a heap of grass, crawls about 10 meters, mimes an attack and a defense. Sometimes he adds cries to his acts: 'here they are, the Boches, we have to kill them!' In his room, he uses the beds to do his exercises, jumping from one to the next. The seizure ends with repeated calls for 'Mum' and sobs."21
The problem was that the reeducation home never had the staff necessary to take care of patients who needed continuous surveillance. In 1924, the A.B.N.G. requested a subvention from the National Office for Mutilated and Reformed in order to install seclusion rooms in the castle. The association had to cope with very difficult and sometimes even dangerous cases. In his article, Henri Wallon explains why some of the veterans had to be institutionalized after serious incidents. He points to several cases of patients running away, such as the following:
"He spends six weeks in Arnouville, from January 12 to the February 27, 1921. Since the first days of his stay, it is noted that he gets up while sleeping […]. On February 8, he disappears and comes back only at three o' clock during the night, saying to the concierge that he has gotten lost […]. On February 27, he runs away again and does not come back. Following a medico-legal report he had been arrested for theft and violence against police officers and was institutionalized."22
Before being admitted to the reeducation home, veterans had to be examined by the doctor of the association at the dispensary. For those who did not live near Paris, this meant they had to pay for the trip, without knowing if it was worth the effort. Little by little, the admission criteria seem to have become stricter and stricter. The A.B.N.G. quickly decided that all veterans with too serious pathologies should be excluded from staying at the reeducation home. As a matter of principle, and to avoid putting itself in a difficult situation, the association refused to take in veterans who were institutionalized but who could have been released if they had found a place to stay. Furthermore, it is true that psychiatrists seem also to have been reluctant to confine their patients to the A.B.N.G. Among the medical files that have been kept by the former asylum of Bron, which is now the Centre hospitalier du Vinatier, documentation about three patients who applied to stay at the A.B.N.G reeducation home can be found. None of them was accepted. The association rejected their requests because of their psychiatrists' negative opinions, and was compelled to stick to the evaluations because the director of the asylum refused to let the patients go to Paris in order to pass a medical examination at the dispensary: he did not agree to spend money on a trip that might lead nowhere. In these three cases, the psychiatrists appear to have had doubts as to whether the association was really able to take care of men with mental troubles, even mild ones. For example, in 1938 when Hippolyte T. considered leaving the asylum to stay at the A.B.N.G. reeducation home, the doctor opposed his plan by writing the following certificate:
"He is calm and harmless but still delirious, with periods where he writes rambling letters to the authorities and becomes really insistent. Given his oddities, he would risk to be laughed at by others and, because of the freedom he would enjoy, he would bother the authorities constantly and without purpose."23
The members of the A.B.N.G. not only discovered that the veterans they had originally targeted were more difficult to take charge of than had been anticipated, but they also realized that most of the time their objective of reeducation was very hard if not impossible to achieve. The establishment's change of status, from reeducation to retirement home, is significant: in direct contradiction to the founding principles of the A.B.N.G., this meant that the association was renouncing the idea that those men would someday reintegrate into society. The members of the association did not see this as a failure, but rather considered that they had made a mistake by thinking those men could benefit from a reeducation. Already in 1923, the General Assembly report pointed out that:
"The mutilated men who are not reeducated by now will never be so. Concerning the mutilated of the skull, it must be said that this method never corresponded to reality. One year has been enough to convince us: a brain damaged man, when he is lightly affected, does not need reeducation […]. When he is seriously affected, he cannot be reeducated. He needs accommodation or hospitalization […]."24
For all these reasons, the castle of Arnouville-lès-Gonesse finally failed to accommodate those who could have benefited from its services, that is to say the veterans who were unable to live by themselves but did not come under institutionalization.
The purpose of the A.B.N.G. was to apply the same methods and solutions to nervously disabled men as to other categories of wounded veterans. Just like the ordinary reeducation schools which multiplied in France after the First World War, the reeducation home installed in Arnouville-lès-Gonesse was supposed to be a place where veterans could learn how to manage with their disability and how to make a living despite of it. Their stay was thought to be temporary. The idea was to facilitate the transition between war and the return to civilian life by making sure that the veterans would be able to find jobs in order to support themselves. But the basic premise of A.B.N.G. proved wrong because it was based on a misunderstanding: taking care of psychological war trauma was not equivalent to handling physical damages. It only took the association a few years to realize that the dispensary could be sufficient only for those who suffered from mild disorders. For the others the reeducation home was not a realistic alternative to asylum. In most cases, institutionalization indeed remained the only answer to severe psychological suffering.