Shellshock: a new understanding

World War I (1914-1918) was one of the great tragedies of the 20th Century. Amongst the thousands of soldiers returning to Britain suffering terrible physical wounds, were thousands suffering from mental injuries on a scale never before seen in conflict. Since the end of the war shellshock has come to occupy a significant place in the popular imagination through TV shows such as Peaky Blinders, books such as Birdsong and the poetry of Wilfred Owen which is often studied in schools. Emphasis is often placed on the cruelty or absence of treatments and the lack of understanding or sympathy of doctors and generals. While this may have been the case in some places, this is by no means the whole story and as is so often the case the diagnosis, treatment, and understanding of shellshock needs to be looked at in a more nuanced way.

The term ‘shell shock’ was coined by Charles Myers, consulting psychologist to the British expeditionary force, and was used as an umbrella term to classify a number of anxiety disorders that troops suffered from with symptoms ranging from depressions and anxiety to blindness, paralysis and uncontrollable muscle contractions. However, after the war there was an inquest into shell shock which found that the term was misleading and according to Ben Shepherd in A War of Nerves: Soldiers and Psychiatrists 1914-1994 it was decided the term shouldn’t have been used at all and that it should be avoided in the future . Nevertheless, the term was used widely by the public and soldiers because it “conveyed the drama of the modern, mechanised battlefield”.

Throughout the war many theories were mooted as to the possible causes of shellshock, these can largely be divided into psychological and pathological theories. Frederick Mott senior officer at the Maudsley Hospital a specialist treatment and research centre argued in a Lecture on The Effects of High Explosives upon the Central Nervous System, delivered before the Medical Society of London that exposure to shellfire brought about structural or pathological changes in the central nervous system. Whereas, other doctors believed symptoms were caused by repressed traumatic memories of highly stressful events. These memories resurfaced when the soldier was anxious and left alone with his thoughts, as often happened when waiting in the trenches. By the end of the war in 1918 there was still no consensus as to the causes of shellshock however new theories were constantly being proposed suggesting medical professionals were eager to help soldiers suffering from shellshock and that the perception of doctors as unsympathetic needs to be reassessed.

Although medical professionals may have been sympathetic towards sufferers of shellshock often the same cannot be said for the military commanders. In the army there was a widespread belief that many soldiers were using shell shock as an easy way to escape service. This led to the distinction between ‘genuine’ and ‘non-genuine’ shell shock through use of the terms shell shocked and shell shy meaning that men were vulnerable to accusations of cowardice, weak will and degeneracy. There was always the possibility that those classified as shell shy could be categorised as cowards or deserters, a clear military offence which was punishable by execution. This horrific prospect shows the lack of understanding of some in the military towards those suffering from shellshock and may well have influenced its treatment, making some medics less likely to treat their patients with empathy and instead turn to painful and cruel treatments to punish those supposedly feigning illness to escape the front lines.

Soldiers suffering from shellshock were treated in a variety of different ways and treatments varied hugely from hospital to hospital depending on the beliefs of the head medical officers and their education. It also evolved over time as medics explored different methods of treatment.

Soldiers with no physical symptoms, or whose symptoms weren’t severe enough to be sent back to England, were treated in France at military hospitals. According to Daniel Roberts in his essay Shellshock and PTSD most of these men were told there was nothing wrong with them and allowed a few days rest before being sent back to their regiment. Others were sent to French farms for a month before returning to the front. Sufferers with more severe symptoms were sent back to Britain and treated in a variety of different ways including electricity, hypnotism and so called ‘talking cures’.

Treatment of shellshock with electricity was common earlier in the war and for those patients suffering from significant physical symptoms. Military psychiatrists Edgar Adrian and Lewis Yelland were innovators of this treatment. Their method was to convince patients that they would get better and then to wheel on electrical equipment as a psychological prop to effect the cure. According to Shepherd the current was not usually very high, but if the patient was resisting or had been unsuccessfully treated with electricity before, a higher voltage would be used to enhance the doctor’s authority. This treatment could be excruciatingly painful depending on the voltage and duration of treatment and although there is some evidence to suggest it was successful at reducing physical symptoms it arguably may have had a detrimental impact on the patient’s mental state as it would have been a terrifying experience.

Later in the war more sympathetic and progressive ‘talking cures’ were developed which focused on psychological causes of shell shock exploring repressed memories and dreams. One place where this was advocated was the Red Cross Military Hospital at Maghull where patients were greeted with sympathy and interest and encouraged to discuss their problems. According to Shepherd Ronald Rows the Medical Superintendent was a passionate advocate for reform in mental hospitals and as a result treatment at Maghull was sympathetic. Rows was very interested in the role of memory in causing shell shock and his favoured method of treatment was individual therapy: the patient’s history would be carefully explored until the cause of the emotion was found; it would then be carefully explained to him. This gentler treatment emphasises that there was understanding and sympathy shown towards sufferers of shellshock.

A comparison of these methods of treatment reveals significant differences, some were more painful and perhaps more what we would expect based on what has imparted on us by popular culture, whereas others were more progressive and sympathetic. In fact, the ‘talking cures’ used at Maghull can be seen to have influenced treatments for PTSD such as CBT and individual and group therapy.

Therefore, when the understanding and treatment of shellshock during WW1 is looked at more carefully it is clear that variation and evolution are key. For while initially understanding was limited and treatment harsh this was constantly changing and by the end of the war the understanding of medical professionals of how to treat shell shock had vastly improved from 1914. There was also significant variation in the perception of shellshock, with medical professional usually more sympathetic than army officers towards sufferers. Therefore, after 103 years we need to look again at an important aspect of WW1, which had an impact on how we treat and understand mental health in the modern day, and ensure that we are not falsely representing it.

Featured image: ‘WW1: Making tea’, Anders via with

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