This eloquent statement against the madness of war is the first novel in a trilogy that includes The Eye in the Door (1993) and finally The Ghost Road (1995), which was awarded the Booker prize. The story is closely based on the publications and annotated literary papers of three real men who met at Craiglockhart in 1917: psychiatrist W.H.R. Rivers (1864-1922) and two poets: Siegfried Sassoon (1886-1967) and Wilfred Owen (1893-1918). Owen wrote some of the most moving war poetry and the knowledge that he would be killed in action at age 25 simply adds to the poignant sense of futility.  

Pat Barker (b. 1943) probed the tenacious role of class within the military hierarchy, while the society, which the military purports to defend, is rapidly being transformed by the converging lives of domestic servants and aristocrats. Her descriptions are powerful: the yellow skin of women who work in the munitions factory; the surgeon who can no longer bear the sight of blood; the young soldier who cannot eat because his nose and mouth had once been filled with rotting flesh when he was hoist by a grenade into the decomposing belly of a dead German. Rivers helps the men to recall and to understand the origins of their ailments by gentle, patient conversation–a treatment that he described in Lancet, 2 Feb 1918. 

Regeneration
Pat Barker
London: Viking Press
New York: Plume
1991, 256 pages)

From the Vault: In these times, certain works of literature seem to be as relevant to us now as when they were published — possibly more relevant than the times that they depict. From the vault of the now closed Literature, Arts and Medicine Database, we will pluck a few items for their power and timeliness. 

Web image by  National Library of Medicine

The Eye in the Door, the second in the trilogy, turns its attention to the Home Front, and more specifically describes the rampant paranoia during the war, as the government targets two groups:  homosexuals and “conchies,” or conscientious objectors.  While it too is tethered to historical fact, it is more of a fictional narrative concentrating on the state-sponsored witch-hunt, refracted through the story of Billy Prior, a patient of Dr. Rivers.  Billy is bisexual; he also grew up with childhood friends who became pacifists and objectors, and who may or may not have been involved in a plot to assassinate the Prime Minister, and so he moves in both of these marginalized and persecuted worlds.  He also has fallen in love with a woman whom he wants to marry.  During his ongoing treatment of Billy, Rivers confronts his own repressed childhood memories.   

The Regeneration Trilogy has much to recommend it in considering works of literature in the area of medical humanities.  First—and obviously—it is about the psychological damage suffered by young men pressed into military service during wartime, and the way in which medicine approaches their resultant illness with the tools it has at hand.  Each one of these soldiers has a story, each one has a trauma, and there are no pharmacological options. Much like Freud (a contemporary whose work was well-known to him), Rivers felt that the way to treat the shell-shocked soldiers was a “talking cure,” making the traumatic events unrepressed and having the patients recognize and address them.  The stories of the soldiers’ treatments are engaging, Rivers’ warmth and compassion for his charges is unmistakable, and the nature of physician-patient interaction during treatment is explored.   

Barker also poses questions about gender; more specifically, about the nature of manhood and the role of women in a male-dominated society turned upside down by a cataclysm.  Being a man in England during the war means being in uniform and preferably fighting in France; the conchies and the gay men are seen by many, including many women, as being “less than” men, and in their otherness, as subversive.  Women, for their part, have had to step up and assume the roles in the workforce that men have vacated to go off to fight.   It is supposedly the love of their fellow men that allows the soldiers to fight as a unit, to want to enlist and to want to re-up after they are wounded, and this comradeship is trumpeted by those in command.  But it is crucial that everyone understand that this must be the right kind of love; the wrong kind of love is ferreted out and made example of. 

There are many paradoxes, and many instances of doubling or of opposites, in the novels.  Rivers wants to cure his patients, although curing them will render them fit to be sent back to combat and likely be killed.  Several bisexual men lead bifurcated lives.  And underlying all of it is a society rigidly divided along class lines, with the WC’s—the working classes—distinguished not only by their living and working conditions but also by the idiomatic speech put into their mouths by the author.   The war may be in some ways a great “we’re all in this together” moment, but it can’t erase class distinctions.   

It is worth noting that Barker’s style can range over to the gritty and realistic, as well as the graphic, whether describing the events occurring on a battlefield in Picardy or in a bedroom (or back alley) in London. The writing style is crisp, and the narrative moves along nicely.  The author’s characterizations are on point, especially William Rivers and Billy Prior.  Barker has a great feel for language, although some of the words and expressions several of the characters use are distinctly British and may be unfamiliar to American ears.  She conveys an England—or at least, a segment of England—tired of war, tired of being bombed, often living hand to mouth in cold water flats with faded wallpaper and trying gamely to carry on despite being ground down. 

And underlying it all, The Great War—its idealization, its senselessness.  The three volumes of this trilogy are beautifully written, hold the attention, and move quickly, and its relatively spare language has a lot to say. 

The Eye in the Door
Pat Barker 
Dutton: 1994, 288 pages 

Photo of Chester from  The Cleveland Museum of Art 

As The Ghost Road begins, Prior has been cured of shell shock and is preparing to return to the front in France. Rivers takes care of his patients and his invalid sister, amid memories of his experience ten years earlier on an anthropological expedition to Melanesia (Eddystone Island). He befriended Nijiru, the local priest-healer who took Rivers on his rounds to see sick villagers and also to the island’s sacred Place of the Skulls.

Rivers entertains very un-British thoughts about the morality of these headhunting people, and about the power of symbolic healing. As these thoughts intrude upon his consciousness, Rivers is himself in the process of curing by suggestion a soldier with hysterical paralysis. Meanwhile, Billy Prior returns to the front. It is the autumn of 1918 and the last inhuman spasms of the war are in progress. In a futile battle that takes place a few days before the Armistice, Billy and his friend Wilfred Owen are killed.

To me The Ghost Road, which won the Booker Prize in 1995, is the most gripping and fastest paced of Pat Barker’s trilogy. The first two novels are Regeneration (1991) and The Eye in the Door (1993). As W. H. R. Rivers reflects on the culture of death on Eddystone Island, World War I, a culmination of the culture of death in Europe, grinds to a close, taking with it the poet Wilfred Owen. Of course, the characters in The Ghost Road are unaware of the new heights (or depths) that the culture of death will attain later in the 20th Century.

The Ghost Road
Pat Barker
Dutton, 1995
New York, 256 pages

Web image by  Claudio Carrozzo 

Mental Cases by Wilfred Owen

Carol Donley Aug 11, 2025

Owen’s stark poem portrays shell-shocked soldiers haunted by war, exposing both their torment and society’s complicity in their suffering.