Dora Vargha’s forthcoming talk, ‘After the End of Polio: Local and Global Consequences of Disease Elimination’, is open for scholars anywhere to participate online. The talk will take place at the next meeting of the Medicine and Health Working Group of the Consortium for the History of Science, Technology, and Medicine on Friday, April 15, at 3.30 ET. Daniel Wilson (Mulhenberg College) will provide commentary.
The discussion text is now up on the Medicine and Health working group site. The History of Medicine and Health Working Group of the Consortium for the History of Science, Technology, and Medicine meets monthly to discuss a colleague’s work in progress or to discuss readings that are of particular interest to participants.
Scholars anywhere can participate online. There are two opportunities to participate face-to-face. At the Consortium offices in Philadelphia, 431 Chestnut Street, Philadelphia, PA 19106, and at the New York Academy of Medicine, 1216 Fifth Avenue (@ 103rd Street), New York, NY 10029. The Philadelphia and New York meetings are patched in by teleconference, as are singleton scholars.
Dora Vargha and David Bryan have written an article on the recent appearance of diphteria in Spain. The re-emergence of this infectious disease, which had not been recorded in the country in the last 28 years, has instigated heated debates regarding the impact and legitimacy of the anti-vaccination movement, and Vargha and Bryan have addressed this topical issue in the context of the general history of vaccination as well as of Spain’s troubled legacy of authoritarianism and public health. The article has been published in English on the UK website The Conversation, and in Spanish in El País.
‘Strangling angel’ of diptheria caught Spain off guard – here’s how
The return of diphtheria in Spain after nearly three decades highlights the challenges posed by infectious diseases that had been mostly eliminated from Europe.
Falling vaccination rates, complex population movements, and the disappearance of international health practices perceived as redundant, all contribute to the emergence and spread of infectious diseases that were thought forgotten. At the same time, such public health crises throw light on the delicate relationship between state and citizens, and competing concepts of responsibility for health.
A six-year-old boy from the Catalan town of Olot was admitted to hospital suffering from diphtheria last week. This was the first case of the disease recorded in Spain for 28 years. The boy, who is in a critical but stable condition in a Barcelona hospital, had not been vaccinated due to his parents’ concerns about the safety of the vaccine. They now say they feel tricked by the anti-vaccination groups which had originally stoked their fears.
Diphtheria, now a rare disease in Europe, is a serious, potentially fatal disease caused by bacteria that can cause heart failure, pneumonia and paralysis of the muscles used for swallowing. Up until the 1920s it was one of the leading cause for death in children, sometimes referred to as “strangling angel”, because the bacteria can create a pseudo-membrane in the airways, causing death by choking.
It was widespread in Spain during the first half of the 20th century, particularly following the physical and economic devastation caused by the Spanish Civil War. Over 27,000 cases of diphtheria were recorded in 1940 alone. Improving infant health was officially a priority for the new Franco regime, and cases did reduce significantly in the post-war era. However, Spain’s impoverished and fragmented public health system failed to make the rapid progress towards eradication achieved by its western European neighbours, with almost 250 new cases a year still reported in the late 1960s. A comprehensive vaccination programme was finally implemented in 1966 and until last week, there had been no diphtheria cases recorded since 1987
Russia to the rescue
As diphtheria had been eliminated in Spain for the last three decades, stocks of the anti-toxin needed to treat the disease are no longer available in the country. This anti-toxin, listed as an “essential medicine” by the World Health Organisation, is increasingly unavailable due to the disease’s rarity and because, as a blood-derived product, its production is highly regulated.
For instance, in the US there are no licensed anti-toxin products available in the whole country, and in case of diphtheria an unlicensed Brazilian product is used by the CDC under investigational new drug status, which basically provides an exemption from federal regulation. In Europe, some public health experts have called for the establishment of a central EU stockpile that all countries can access in times of emergency.
This time, Spanish health authorities were forced to look abroad for supplies, which were personally flown in from Moscow by the Russian ambassador to Madrid. The difficulties in locating and supplying the relevant anti-toxins highlight how quickly international structures can break down once a disease has been eliminated in a particular country and has disappeared from the authorities’ radar.
The recourse to diplomatic channels and the ad hoc supply of medication echoes the chaotic situation more usually associated with times of war and international emergency. A look into the Spanish government archives reveals that during the World War II, for example, Spain’s small West-African colony in what is now Equatorial Guinea faced a dangerous outbreak of Yellow Fever. Facing the collapse of its economy and wartime disruption to international supply, the Spanish government struggled to secure basic medication and to distribute the relevant vaccines both at home and in its overseas colonies.
Help eventually arrived from the local British Consul who agreed to fly to Lagos and bring back supplies of the vaccine in thermos flasks. While these kind of ad hoc solutions may have been a necessary during a time of international conflict, they seem profoundly out of place in today’s apparently more orderly international system.
A lingering presence
It was no coincidence that the anti-toxins were available in Russia. Diphtheria cases had begun to fall in the Soviet Union following the introduction of universal childhood immunisation in 1958. By the mid-1970s they had plummeted to an all-time low, approximately the same level as the US. However, changing immunisation schedules contributed to a rise in diphtheria in the 1980s, partly because of reduced levels of public support stoked by a strong anti-vaccination movement that channelled distrust in the state during the period of perestroika. With the collapse of the Soviet Union and much of its public health services, especially in the newly independent states, a severe epidemic broke out in 1993.
Shortages in vaccine supply, economic hardship and mass population movements all contributed to the outbreak and the difficulties authorities faced in controlling it. Eventually diphtheria in Russia and the former Soviet states was brought under control through international cooperation between governments, NGOs and UN agencies. Since then, the former Soviet republics and Russia have remained the only area of Europe where diphtheria is still a public health concern. Although no longer in epidemic proportions, the lingering presence of the disease led Russian authorities to keep stocks of diphtheria anti-toxin readily available.
Spain’s fascist past complicates the debate
Long-forgotten diseases that make a comeback also bring to light problematic relationships between citizens and the state. Recent American anti-vaccination movements highlight conflicting ideas of individual and public health, while Spain’s authoritarian legacy has coloured the vaccination debate in the country. This week Luis Garciano, economic spokesman for Spain’s new centrist party Ciudadanos (Citizens), said that unvaccinated children should be withdrawn from school and their parents fined and stripped of benefits.
Garciano’s comments have been denounced as “neofascist”, and anti-vaccination campaigners have frequently drawn parallels between the idea of obligatory vaccination and Spain’s fascist past. For them, the right to reject vaccination is a freedom that should be protected in the era of democracy.
The return of diphtheria to Spain mirrors the measles, TB and other infectious diseases in Europe and the US. When diseases disappear due to high vaccination coverage, the national and international public health infrastructures needed to deal with them often also whither away.
When distrust in public health organisations and practices or the break-down of relationship between state and citizens give way to faltering vaccination rates (whether through anti-vaccination movements or through lack of access to vaccines), forgotten diseases can make a quick comeback. The case of diphtheria reminds us of the very real stakes at hand when infectious diseases re-emerge and throw light on the personal, national and international consequences of declaring the end of a disease.
Academic life, as I have learned, makes you painfully aware of the many different regimes of immunization across the globe. Moving between fellowships and jobs, our first son got his vaccines in four different countries – that means four distinct healthcare systems, vaccination schedules, payment structures and vaccination records in three different languages. I think it is safe to say that he has become a reluctant internationalist in his own way. As for us, parents, we pretty much did what we usually do in our working life. We spent hours after each vaccination appointment to analyze the microcosm of public health systems: the doctor-patient encounter. We have been fascinated by the carefully crafted pro-vaccination speech prepared by our American paediatrician, the kind, but firm approach of the German doctors, the inescapable abundance of posters and leaflets on vaccination in the British surgery, and the lack of any kind of publicity and a matter-of-fact discourse in the district paediatrician office in Hungary.
This personal experience has also made me particularly interested in the way childhood immunisation is conceptualised and the points when it is contested or even seems to break down, such as the current ‘anti-vaxx’ controversy prompted by the Disneyland measles outbreak. As I am currently finishing a chapter on debates surrounding the Salk vaccine in Eastern Europe in the 1950s, I started thinking about how communist public health officials would have made sense of debates like this.
An excellent analysis by Jennifer Reich, published in Gender& Society has brought up an important point that would surely have sparked the interest of the communist vaccinators. In this study Reich is speaking to a debate that, in broad brushstrokes, posits crazy and irresponsible people (mainly women) against rational and responsible parents, physicians and public health experts. Reich is arguing that the ‘anti-vaxxers’ are far from being ‘crazy’: in fact, they base their decision on time-consuming research and their choice reflects their social and economic privilege. Not only is this analysis important in understanding current American anti-vaccination movements and their consequences, it also makes clear that behind this potential public health crisis is the primary role of the patient-consumer and an interpretation of personalised medicine. According to Reich’s study, mothers who decided not to vaccinate their children were unconvinced by arguments that they should be participating in public health and expressed that their responsibility was to their own children, not others’. This is along the lines of what popular satirical outlets, such as The Onion have picked up on.
Responsibility for health was exactly the thing in the crux of Cold War attitudes towards public health. Eastern European party dignitaries and public health officials were always happy to boast that countries like Czechoslovakia and Hungary triumphed over polio years before the West and about a decade before the United States did. Their Western colleagues acknowledged the feat, and explained this with totalitarian state organisation – effective epidemic management tends to be authoritarian. The Eastern Europeans had a different explanation, however: the socialist model of organising public health, where prevention is seen as key to the health of the population, healthcare is available to all, vaccines are free, and the paternal state takes responsibility over children’s health. They pointed to the ‘backwardness’ of America for sacrificing the health of children to selfish and market-driven agendas.
Vaccine coverage of course is a marker of superiority only in Cold War rhetoric. It does not reveal much about the quality of healthcare, access to it, or the overall health of a population. Coverage rates can also quickly change due to political unrest and/or economic problems, like in Ukraine, where vaccination has hit critically low rates in the past decade. However, when comparing politically and economically stable countries in the Global North, this difference between East and West does reveal Cold War legacies and attitudes towards the responsibilities of citizens. In much of Eastern Europe, the state expects physicians and parents to comply with vaccination policies without much debate or contestation, and parents expect the state to provide free vaccine and to guarantee its safety. The ‘social’ in medicine is very much still present and high vaccination rates are still a point of pride for Eastern European governments.
Vaccine resistance is also not a new phenomenon. Since there had been vaccines, there has been resistance to it – revealing a wide variety of reasons, usually connected with a much larger issues regarding power relations, distrust, religious integrity, etc. In some societies, like Britain, vaccine resistance has a long history, since the introduction of Jenner’s vaccine.But resistance to vaccines is not even something particularly Western, even if we limit our view to the Global North, although it is slightly more difficult to spot on the Eastern side of the Iron Curtain in the Cold War era. Archival sources give a glimpse of resistance to the Salk vaccine in Hungary, which had to do mostly with opinions that the state was not fulfilling its public health provider role adequately, either by following the ‘wrong’ method of injection, or supplying vaccine lacking in quality and quantity.
There are, of course, new aspects of today’s vaccine resistance in the Global North. Parents have easy access to information online and can establish ties with each other over social media. These ties and the flow of information does not stop at borders, making vaccine resisters at once national agents – in that they respond to a particularly local set of problems of state, public health and culture – and internationalists who participate in shared networks across the globe. Over 25 years after the fall of the Berlin wall, the wind of change might finally reach public health organisation and vaccination in Eastern Europe. In Hungary, where vaccination is compulsory and free, the voice of vaccine critics seems to be growing steadily, drawing mostly on social media, supported by arguments based on translations from English language materials. With a healthcare system that perpetually seems to be on the verge of breakdown – another Cold War legacy -, questions of responsibility for health keep bubbling up to the surface. But for now, the legacy of a previous century is imprinted on my child’s body, who has moved with ease back and forth between East and West, unknowingly becoming a vaccine cosmopolitan.
The New Yorker magazine recently published a piece, titled “The political fight against polio”. This article, reviewing current challenges in polio eradication in Nigeria and conflict ridden areas in general, argues that the polio prevention “plot [got] messy” and has become at least as much of a political, as an epidemiological issue because of its geography. But has polio ever been anything but political? And has it always been a fight?
Polio is a relatively new disease. It started to appear in epidemic waves in the late 19th and early 20th century, and by the 1950s it became a global issue. By then, the epidemic waves became more and more severe and vaccine development saw funding and international cooperation as never before. The stakes were high: this disease spared no-one, it affected rich and poor all the same. Most importantly, polio was (and is) primarily a childhood disease, hence its older name, infant paralysis – a name that is still the official term used in a number of languages. It’s a disease that can cause permanent paralysis, most often in the limbs and occasionally in the respiratory muscles.
Polio’s threat of debilitating future generations was most acutely felt in post-war societies, especially those that suffered a significant blow to their population in World War II. In countries scrambling out of destruction, bracing themselves for a new, albeit Cold War, polio decidedly became political as well as a fight. It is this, post-war setting that ultimately set the tone for the last 60 years of polio. The prevention of contagious diseases became proxy-wars in the Cold War, as in the case of malaria, as Marcos Cueto’s and Randall Packard’s work show. Polio treatment also became a “fight”, whether, as David Serlin points out, encapsulating ideas of heroic masculinity in the West, or as a struggle with the state and its ideologies in the East.
Political agendas have also been ever-present in preventing and treating the disease. These politics are, on the one hand, part of broader perceptions of disease and vaccination, and on the other, are particular to polio. Susan Sontag’s and Emily Martin’s work on AIDS show how contagious diseases are inseparably intertwined with politics. This is, of course, nothing new, Foucault would tell us, pointing to the plague. Even on the level of international disease control, the politics have long played the leading role, as João Rangel de Almeida demonstrates in his research on 19th century efforts.
Perhaps one of the most interesting aspect of the political in the case of polio is its perception as being non-political. In some ways similarly to the smallpox eradication campaign, as Erez Manela’s research shows, conflicting sides made an effort to cooperate in global campaigns of disease prevention. While this seemingly apolitical enterprise was, of course, heavily laden with Cold War politics, it brought together scientists, diplomats and public health officials from both sides in meaningful ways. The intense decade of polio research shows us a different face of the Cold war, and, not in the least, the effort did curb the disease on a global scale. As importantly, in the course of polio vaccine development, key players emerged as guarantors of the “apolitical”: the WHO became a major mediator between East and West when it came to the evaluation of the Sabin vaccine based on Soviet results. With this, the agency was making a strong statement against something the Soviets knew all too well: they were the first to demonstrate the importance of politics in the international organization, when they left it on political grounds shortly after it came to life.
The global “fight” against polio therefore has been represented, and, genuinely perceived by many as being apolitical. That this view is not universally shared, though, should not come as a surprise. While many of the issues that contribute to the challenges of today’s eradication efforts are complex with backgrounds of a wide variety, the history of the disease tells us that fears of polio vaccination and reservations about the international agencies behind it are hardly new. But then, this same history also shows that solutions to polio prevention have cropped up in unexpected spaces, and the last 60 years have resulted in a tangible result: that for millions, polio has become a distant memory.
In November 2013, possibly the largest mass grave from the recent Bosnian war was discovered in the village of Tomasica in the vicinity of the East Bosnian city Prijedor – over 470 bodies of Bosniaks and Croats killed by the Serbian forces have been excavated so far, and the excavations are continuing. It is now estimated that the grave contains between 700 and 1000 bodies. The discovery of the Tomasica grave, in a country where over 8000 people are still missing and many war-related issues remain painfully unresolved, provoked a potent reaction of horror, grief, and anger; it forced thousands to re-live their wartime experiences, loss of family members, memories of mass murders and tortures conducted in eastern Bosnia in the early 1990s. In a divided country, the Tomasica events once again brought to the fore the silence of the Serbian political structures on the issue of war crimes, and directed the public’s attention to the numerous problems in the recent functioning of the UN’s ICTY [International Criminal Tribunal for Former Yugoslavia] in The Hague (which, in 2013, marked twenty years since its foundation in). But Tomasica, quickly becoming a most powerful symbol for the trauma of the Bosnian war, has also been symptomatic of the persistence of mental suffering in the war’s aftermath: the person who led the International Commission of Missing Persons investigators to the site of the grave was a Serbian witness – an army conscript ordered to unload dead bodies into the grave from a truck in 1992. He reportedly testified that he could not bear to fight his own demons any further, that he had been seeing a killed Bosnian man’s open eyes following him everywhere, and that his testimony brought him relief. How have the Bosnian and other former Yugoslav societies dealt with psychological traumatization caused by the 1990s wars? How has war trauma shaped the development of those societies in the aftermath of the conflicts?
From the beginning, the Bosnian war has been coached in clear psychiatric terminology. The ideological explanations of the outbreak of the war were tightly related to the discourse of psychiatry and psychoanalysis, and, at the beginning of the conflicts, the central role was played by psychiatrist politicians and their references to trauma and insanity. Serb war politics in both Croatia and Bosnia-Herzegovina was designed by a prominent psychiatrist of Freudian orientation turned Croat Serb leader Dr. Jovan Raskovic and his protégé in Sarajevo Dr. Radovan Karadzic. It was within a decidedly psychiatric and psychoanalytic discourse that both Raskovic and Karadzic conceived of their respective political roles. Both attempted to introduce madness and trauma as central political categories, with the result that post-Communist politics in Yugoslavia became defined as a form of ‘mass psychiatry.’ In Raskovic’s view, ‘For the Serb, the unconscious desire for nation is paramount and has been suppressed by the ideology of class consciousness;’ post-Communist politics thus needed to forge a proper ‘path to the Serbian Oedipal emancipation.’ A proper psychiatric political leadership was thus critical for the success of this project of political transition and national liberation. Within such a carefully crafted medical discourse, even a planned and coordinated act of genocide could be interpreted as the final expression of ‘healthy madness,’ an irrational delirium which emancipated the nation from its own archaic, primitive Other – the Ottoman legacy, the Muslim presence – and set it firmly on the road to modernity and healthy nationalism.
In a very different context, the psychiatric language has persisted well after the war’s end: the interpretations of the conflict and its aftermath still revolve around the theme of open wounds and psychological re-traumatization. The universality of psychological discourse about the Bosnian war has indeed been one of its most striking characteristics: almost every war crimes-related legal decision in both local and international courts tended to provoke a psychologically-termed response from different victims’ groups. The recent acquittals of high-ranking Serbian and Croatian military and political functionaries at The Hague Tribunal led to a number of negative reactions, especially from Bosniak associations, who reported their loss of faith in the tribunal and considered its decisions an insult to their traumatic experiences. The November 2013 decisions of the European Human Rights Court in Strasbourg and the Constitutional Court of Bosnia-Herzegovina to release ten Bosnian Serb war crime convicts – six of whom were accused of participation in the Srebrenica genocide – due to a procedural issue and re-try them, further reinforced the negative atmosphere among survivors: Munira Subasic, who lost twenty-two male family members in Srebrenica, said that she felt victimized all over again, and that the criminals ‘could even be standing behind [her] back.’
However, in spite of the potency of such language of psychiatry, the post-Yugoslav states have consistently demonstrated their disregard for the actual psychological problems of their populations. In the aftermath of such a brutal war which primarily targeted civilians, psychological traumatization has remained the subject of non-governmental organizations or autonomous victims’ associations and mainly depended on personal initiative, while no organized or systematic state medical assistance was ever implemented; as a result, a great majority never received any psychological help whatsoever. No meaningful policy for dealing with the war trauma was ever formulated, and masses of traumatized citizens were rarely offered any help in dealing with their persisting mental issues – other than the diagnosis of PTSD and meagre financial aid in the case of certain groups of military veterans.
Part of the reason has been, of course, that the wartime destruction has left these states economically impoverished, with state medical services shrinking, of low quality and increasingly corrupt (particularly in Bosnia, whose complex institutions are often paralyzed as a result of manipulations of ethnic politics). But perhaps even more importantly, the countries most deeply involved in the conflicts of the 1990s – Bosnia and Serbia – have failed, for a number of structural reasons, to integrate the memory of the war into their post-conflict self-image and identity narratives. As a consequence, no stable politics towards understanding and treating the 1990s war trauma has emerged: medical interpretations of war-related mental wounds exist in specific social and cultural contexts and tend to be determined by the collective memory of the conflicts in question, reflected through a collective understanding of the place of those conflicts in the society’s history.
Psychiatric and psychological definitions of war trauma in any particular society tend to reflect the dominant socio-political narrative, and are symptomatic of the most pressing problems the society is dealing with. Dealing with psychological traumatization after war involves attempts to fit potential solutions to lingering problems within the dominant narrative. Twentieth century war psychiatry has proven this numerous times, not least in Yugoslavia itself. For example, in the aftermath of WWII, when various Yugoslav populations were dealing with different forms of profound psychological traumatisation, it was soldiers’ trauma that attracted the state’s undivided attention and became the symbol of wartime psychological suffering. What became known as ‘partisan hysteria’ or ‘partisan neurosis’ was a complicated and apparently unique psychiatric condition, which, according to leading Yugoslav psychiatrists of the era, only affected the victorious soldiers of the Communist resistance movement. While in other combatant countries soldiers’ neurosis mainly comprised anxiety states, shivering or combat fatigue, ‘partisan hysteria’ presented a radically different clinical picture. British, American, Canadian or French soldiers, although on the winning side, suffered from a psychiatric disorder which signified their wish to withdraw from the frontlines, and was symptomatic of their fear of and emotional distance from the battles; by contrast, the Yugoslav partisans’ dedication to the war’s causes was reportedly never compromised, not even when they clearly suffered mental consequences: ‘partisan hysteria’ consisted of epileptiform trance-like seizures, during which soldiers re-enacted their battle experiences, yelled, ‘shot’, ran, even gave political speeches, and thereby expressed their ‘fighting spirit’. Once they recovered from their attacks, the ill partisans would usually not remember anything they did or said during the seizures.
According to Yugoslav psychiatrists and members of the political authorities of the new socialist state, the most striking feature of ‘partisan neurosis’ was that it revolved around this ‘fighting spirit’, the partisans’ continued willingness to fight and re-live battlefield experiences. Instead of being a symptom of fear or exhaustion, it demonstrated the Communists’ continued dedication and courage. The constructed uniqueness of partisan neurosis served very well to underline the uniqueness of Yugoslavia’s postwar political and military position – as a socialist country which bred a large, independent and ultimately victorious Communist resistance guerrilla movement. In many ways, the official interpretation of ‘partisan hysteria’ was an advertisement for Marxist politics and what it could do for the military morale: it created soldiers whose commitment did not falter even when they were facing the worst of their demons. While Western armies conscripted soldiers and forced them to the frontlines to fight for the interests of the capitalist state, the Yugoslav partisans were volunteers in a uniquely egalitarian people’s army and their interests were identical to those of their new socialist homeland.
However, the postwar revolutionary Yugoslav realities were also fraught with a series of problems as reflected in political and psychiatric interpretations and clinical treatment of partisan neurosis. While the ‘partisan hysterics’ were heroes, they also became a symbol of the pitfalls and complexities of an increasingly socially mobile society. One of the most pressing concerns of the postwar period concerned massive social and economic dislocations and elite turnover – this was indeed what made the Yugoslav postwar transformations into a veritable social revolution. But difficulties were still rather formidable, and the Communist Party worried about some of its own members, including those with little education and of peasant origins, and their capacities for contributing their fair share to the revolution. This became particularly important since the new political and military elite was now to be recruited from the ranks of peasants and workers. So it turned out that ‘partisan hysteria’ reportedly only affected partisan soldiers of peasant origin and with little if any formal education – precisely those about whose potential the Party itself was so ambivalent. As psychiatrists and psychoanalysts explained, and the Party tended to agree, it was those undereducated and immature (‘primitive’) young soldiers who simply could not deal with the pressure of their new high-ranking positions, and then broke down, using their neurotic seizures to remind others of their past military achievements and abilities. ‘Partisan hysteria’ was thus portrayed as the pathology of the social revolution. Therefore, the psychiatric understanding of WWII soldiers’ trauma and its treatment reflected the official narrative of the war and resistance, and ‘partisan hysteria’ was seen through the lens of Yugoslav society’s main preoccupation. The concept was a symptom of its time, and its psychiatric and political connotations served socio-political and economic functions in the turbulent postwar times.
However, fifty years later, the political and social situation following the wars of Yugoslav secession was radically different, and the wars’ effects, meanings and interpretations remain far from clear. In Bosnia, the divided state structure prevented the emergence of a unified narrative of the conflict, as different groups and political alliances within the country constantly challenge each other’s interpretation of war events and wartime suffering, while victims’ associations remain in the lurch, manipulated, impoverished, forced to regularly re-live their worst experiences and to prove the authenticity of their pain. Indeed, the post-1995 set-up of Bosnia-Herzegovina did not do much to alleviate the re-traumatizing feelings of injustice: the political leadership of one of the two entities, Republika Srpska, remains stubborn in its chauvinistic rhetoric and refusal to take responsibility for wartime massacres and crimes against humanity, and regularly strives to prevent commemorations of the dead and memorializations of war crimes sites (such as former concentration camps) on its territory (in the most recent example of this trend, Hatidza Mehmedovic, of the association ‘Mothers of Srebrenica’, was summoned to the police of the Serbian entity to make a statement regarding her ‘illegal entrance of private property’ after she went to the agricultural cooperative’s hangar in the village of Kravica to pay respects to over one thousand Bosniak men and boys killed there in 1995). Wartime concentration camp internees can still run into their former guards and interrogators in the streets, because only the highest-ranking perpetrators have ever been legally prosecuted. Hundreds of families have been unable to close the war chapter in their lives because the remains of their missing relatives – children, parents, siblings, spouses – have not yet been found or identified. During the war, the Serbian armed groups conducted a campaign of systematic rape, but this crime remains somewhat of a taboo, even now that rape victims have finally been recognized as civilian war victims, after the 2006 Berlin Golden Bear winner film ‘Grbavica’ by Sarajevo’s Jasmila Zbanic brought the issue to the forefront of the country’s political debate.
In Serbia, war veterans from the recent conflicts face similarly formidable obstacles to reintegration in civilian society and especially to receiving sustained state-sponsored medical and psychological help. In this country, the role of perpetrators and questions about individual and social responsibility for mass war crimes has complicated the process of dealing with the memory of the wars. The Serbian state’s ambivalence about its own role in the 1990s wars has resulted in its failure to address the responsibility issues squarely; instead, the country’s governments have continuously chosen to distance themselves from past military involvements and human rights violations, and focus on the (rather uncertain) future of European integration. But this does not only harm the country’s relations with the rest of the region but also leaves former Serbian soldiers in the lurch. Many of the veterans who are now in dire need of psychological assistance have been struggling unsuccessfully with what they saw and did in Bosnia, Kosovo and Croatia, as well as with developing a stable self-image. How do perpetrators mourn their losses and suffering, and how does a society come to terms with its own citizens whose war participation has been marred by mass war crimes? According to her recent PhD dissertation on Serbian war veterans with PTSD, Belgrade clinical psychologist Olivera Markovic noted that the majority were extremely dissatisfied with their current social and economic position, and resented the state’s neglectful treatment of them as a group (as one of her interviewees said, ‘I defended my country as a patriot and became war invalid, but now I see that this is of nobody’s concern …’). The core problem, in Markovic’s opinion, is that their own relationship to their war activities has become deeply ambivalent, due to the Serbian society’s negative evaluation of the wars of Yugoslav secession, and in particular of the wars’ achievements. This in turn shaped the veterans’ perception that their suffering was in vain, which was reinforced by the state’s sustained neglect of their needs or indeed of their existence. In the absence of any sustained official attempt to come to terms with the wars, war veterans have largely remained unable to make much sense of their involvement in the conflict and of their role in postwar society. Quite ironically, it is one of the most staunchly anti-war non-governmental organizations in Belgrade that developed the only meaningful program aimed at war veterans, and helping them deal with their own psychological issues.
The treatment of ‘partisan hysteria’ in the 1940s Yugoslavia demonstrates the extent to which perceptions of and programs for psychiatric treatment of war trauma depend on the political understanding of wars. In the twentieth century’s culture of universal psychologizing of society and the self, memories of wars tended to be formulated and reinterpreted through the lens of psychological trauma, so that perceptions and the fate of traumatized war veterans or civilians were tightly related to their societies’ collective understanding of the conflicts in question. What happens, though, when the war, which has left hundreds of thousands of victims with severe psychological wounds, has no place in the official memory? Or when, as in Bosnia, over twenty years after it started, the war hasn’t quite ended for so many of its victims? The close relationship between historical memory and treatment of psychological trauma helps to explain the official disregard of mass psychological suffering in the aftermath of the Yugoslav wars in the 1990s. Neither Serbia nor Bosnia has created a stable and coherent political framework for understanding the war, which would make it possible to integrate the issue of war trauma and psychological victimization in the life of the two societies. Certainly, the example of ‘partisan hysteria’ is not one to be followed, but it nevertheless shows that society’s relevance for providing psychiatric and psychological help to war victims and veterans can be intensive and sustained. Maybe there is a way to avoid the overtly political implications of such involvement, and to change the relationship between the politics of memory and the politics of war trauma treatment. It would have to result in the provision of meaningful and considerate psychological assistance to troubled individuals, which would also equip them to become fully-fledged democratic citizens and gain their voice in public discussions of the wars, and it might help these societies overcome their own collective traumas, confusions and denials. This might happen through activities of both the states and a variety of NGOs active in the field of psychology or war memorialization. In this way, re-thinking the meaning and implications of the 1990s war trauma on an individual level could eventually re-shape the collective understanding of the war in a more constructive way.
When we started to think about ways to visually present the concept of internationalism for the purposes of our research project, we faced a number of difficulties. What do we mean by ‘internationalism’, and who is the most appropriate to represent it? What exactly does ‘internationalism’ do?
In order to resolve these questions, we realised that we must first understand and contextualise the multiplicity of meanings assigned to the concept. In historiographical literature, we have regularly come across the assumption that internationalism is bound to represent a force of good, a benevolent process predicated on humanitarian assumptions, and meant to increase mutual understanding and respect between nations. However, such scholarly readings seem to omit a very important point: in the course of the nineteenth and twentieth centuries in particular, internationalism came to denote a number of different and often unrelated processes and efforts which included governments, non-governmental institutions, politicians, experts of all kinds, refugees and stateless people, etc. Moreover, internationalism appeared in a number of different guises, and proclaimed radically different ideological, social and political aims and goals, some of which were indeed far from humanitarian, democratic or cosmopolitan. Even more importantly, internationalism was perceived in a variety of ways by different audiences. And while the globe of the world seems to be rather popular as a positive symbol of internationalism, a number of scholars dealing with the history of this phenomenon have often tended to overlook the globe’s cynical or sardonic uses (and their broader implications). Such uses, though, have been equally important for articulating critical appraisals of some particularly negative effects of certain forms of internationalism. It is, therefore, our aim to explore alternative visualisations of internationalism, and to use them as a tool for understanding and historicising radically different visions and interpretations of this concept.
Figure 1 (Source: Bowman Gray Collection of World Wars I and II, Rare Book Collection, Wilson Library, University of North Carolina Chapel Hill)
It was in the course of WWI that different visions of the international order clashed causing a veritable global explosion, while the orgy of what came to be seen as purposeless violence and chauvinism provoked disappointment in the ranks of those who hoped that a more tightly interconnected world would lead to more stable peace. Interestingly, while WWI marked the failure of nineteenth-century liberal internationalism, it was also the origin of a new and highly ambitious concept of ordering international relations. In a series of Italian postcards from WWI, several cartoonists and painters, such as R. Ventura and Aurelio Bertiglia, articulated this profound disappointment with some of the predominant agents of internationalism at the time, and used the image of the globe in imaginative, sarcastic and unusual ways in order to reinforce their political message.
These postcards were an essential part of WWI political propaganda, and contributed to the extremely extensive propaganda campaigns undertaken by the Entente governments to discredit German military conduct and involvement. One of the most striking phenomena related to WWI was the importance political governments attached to public mobilization through atrocity reports and similar psychological techniques to demonize the enemy; moreover, from the very beginning of the war, different governments worked to revise or falsify original documents in order to place the blame for the outbreak of WWI on the enemy side, so that historiographical debates regarding the origins of WWI began as early as 1914. In 1918, Germany was forced to accept full responsibility for ‘all the loss and damage’ caused to the Allied countries; however, throughout the conflict, the Allied governments carefully worked toward this placing of the full burden of war guilt on Germany (and her allies). The ‘guilt clause’ was carefully prepared through numerous propaganda campaigns, which depicted Germany in particular as a brutal and even demonic force. It was this strong anti-German sentiment that informed the theme and style of the Italian postcards. The postcards were created in 1915 or 1914, around the time the Italian government negotiated joining the war on the side of the Entente against her former allies in the Triple Alliance – Germany and Austria-Hungary – which explains the political edge of the postcards. As is clear from Figure 1, the postcards also expressed a strong anti-Austrian feeling, which was hardly surprising given Italy’s long-standing territorial pretensions to large parts of the Habsburg Empire.
The first postcard, from about 1914, depicts a ‘bloody handshake’ between the leaders of two Central Powers: Austria-Hungary’s Franz Joseph and Germany’s Wilhelm II. It is captioned ‘The Pact’, and uses the globe to articulate a pithy critique of the German- and Austrian-led attempts at (re-)ordering the international affairs: through their particular vision of internationalism, the Habsburg Emperor and the German Kaiser have plunged the entire world into a bloody conflict. The alliance between the two powers is then held solely responsible for the outbreak of the conflict, and their incompetent leadership as well as the malicious effects of their political friendship are exposed to ridicule and contempt. Yet another postcard, from 1915, communicates a very similar political message, but, in addition, emphasizes the Central Powers’ criminal negligence towards the rest of the world, with which they toyed for their own selfish purposes and self-aggrandizement. In Figure 2, Wilhelm II and Franz Joseph play football with the globe before an assortment of international onlookers. The caption says ‘How small the world is’, and captures perfectly the cartoonist’s message regarding the two leaders’ self-centredness, ignorance and inadequacy.
In a number of postcards, Germany, represented by Wilhelm II, was depicted as extremely militaristic, aggressive, ruthless and greedy for world power. In a series of pictures, Wilhelm II endeavours to take possession of the world in a number of ways. In Figure 3, dressed in a full military uniform and also wearing a helmet, the Kaiser actually reaches to grab the globe, while war and violence rage behind his back. The map of Italy is quite prominent on the globe itself, while the cartoon implies quite forcefully that the conflict was a result of Wilhelm’s obsession with ruling the world. Interestingly, the sun itself is against Germany’s (unnatural?) expansion, and warns the Kaiser in the caption that it will burn his hands.
In Figures 4 and 5, the same interpretation of Germany’s relationship with the rest of the world was expressed, and German militarism and aggression singled out as the primary culprits for the contemporary global catastrophe. In both postcards, Wilhelm II attempts to actually eat the globe. In Figure 4, the caption calls him ‘the glutton’, and he obviously finds his food of choice a bit too hard to crack.
In Figure 5, in which Wilhelm II actually cuts into a watermelon in the shape of the globe, the postcard similarly warns him: ‘Mind you, this might give you indigestion.’ This cartoon further emphasized the supposed bloodthirstiness and criminality of Germany’s wartime conduct and ambitions: on Wilhelm’s table, the globe of the world is accompanied by a baby with French and Belgian flags sticking out of its belly, and a bottle of wine filled with ‘Latin blood.’ The Kaiser’s sword and helmet, the ultimate symbols of his and his country’s aggressive militarism, rest by his feet.
Figure 5 (Source: Bowman Gray Collection of World Wars I and II, Rare Book Collection, Wilson Library, University of North Carolina Chapel Hill)
It was these and similar critiques that aimed to contribute to strengthening public support for the war, and to foster and encourage nationalist, even chauvinistically anti-German and anti-Austrian, sentiments. Quite paradoxically, however, they also provoked a far-reaching rethinking of possibilities, limitations and potential meanings of political internationalism in Europe during and after WWI, and gave an important impetus to implementing a new, more ambitious vision of world governance, which was to be institutionalised and developed in the interwar years. It was in this context of the war, destruction and vicious nationalist propaganda that the project of internationalism was infused with renewed significance, and brought back to the centre of political discussions. These postcards articulated powerful criticisms of Europe’s pre-war alliance system and pointed out its deleterious consequences; their messages were part of a broader movement that emphasised the shortcomings of pre-WWI forms of international cooperation, and encouraged a political and intellectual search for a different postwar order which would ensure permanent peace.
Recently the Hungarian government declined to grant emergency aid for the Pető Institute, an internationally renowned institution for training and providing conductive education in early development, primarily for children whose central nervous system has suffered damage. While the Institute denies claims to its dire financial situation and maintains that its relationship with the government is sound, journalists and opposition politicians call attention to the unclear legal situation of the Institute’s valuable real estate assets and opposition members speculate that the background of the denial of funds is the government’s desire to put their hands on the building sites and villas situated in the elegant Buda district. (more…)
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