Shell-shock was not a new phenomenon in 1914, however, the scale of the war, and the type of fighting would exacerbate the problem. We will discuss how shell-shock manifested itself during the war, and how the army reacted to it before looking at some of the tragedies of men executed for cowardice who were most likely suffering from shell shock. We will then jump into how the doctors of all countries tried to treat the men arriving daily to their hospitals without any physical injuries but obviously greatly injured. Finally, we will look at how the topic of shell shock was discussed and addressed in the post war period. This is an interesting topic because shell-shock, which is now referred to as PTSD or post-traumatic stress disorder, is not a solved problem. 100 years later and soldiers still come back from serving their country irrevocably changed. The fact that service men and women still suffer from problems not dissimilar from those experienced by men in the trenches gives this topic a type of applicability that often is not present in our histories.
The History of the Great war is also available on Stitcher
Shell Shock: The Psychological Impact of War by Wendy Holden
Shot at Dawn: Executions in World War One by Authority of the British Army Act by Julian Putowski and Julian Sykes
Roper, Michael. 2005. “Between Manliness and Masculinity: The “war Generation” and the Psychology of Fear in Britain, 1914–1950”. Journal of British Studies 44 (2). [Cambridge University Press, North American Conference on British Studies]: 343–62. doi:10.1086/427130.
Wessely, Simon. 2006. “Twentieth-century Theories on Combat Motivation and Breakdown”. Journal of Contemporary History 41 (2). Sage Publications, Ltd.: 269–86. http://www.jstor.org/stable/30036386.
The Care and Treatment of Mental Diseases and War Neurosis: ("shell Shock") in the British Army by Thomas W. Salmon
This week we will be discussing the mental distress suffered by soldiers during the war, and how it came by its name, shell-shock. I thought that this quote, from the sister of a soldier who was suffering from shell shock was an appropriate way to start. "My brother, who was also in the army, went out, and he got shell-shock. Of course they didn't understand anything about it at all in those days. He was put on light duty at first, and for, I should think, two and a half years, we had the most terrible life with him. It don't mean because he could help it - he couldn't help it at all - and no doctor seemed to be able to do anything with him at all. About five times a day he'd say he was going to commit suicide. We knew he wouldn't, but he'd got to be watched, all the time, and he would wake up in the night, screaming - and my mother would go and sit with him - saying 'Oh, I can't go back to it'…It was absolutely terrifying when he woke up, screaming and screaming and screaming'" Shell-shock was not a new phenomenon in 1914, however, the scale of the war, and the type of fighting would exacerbate the problem. We will discuss how shell-shock manifested itself during the war, and how the army reacted to it before looking at some of the tragedies of men executed for cowardice who were most likely suffering from shell shock. We will then jump into how the doctors of all countries tried to treat the men arriving daily to their hospitals without any physical injuries but obviously greatly injured. Finally, we will look at how the topic of shell shock was discussed and addressed in the post war period. This is an interesting topic because shell-shock, which is now referred to as PTSD or post traumatic stress disorder, is not a solved problem. 100 years later and soldiers still come back from serving their country irrevocably changed. The fact that service men and women still suffer from problems not dissimilar from those experienced by men in the trenches gives this topic a type of applicability that often is not present in our histories. A special note on the information in our show today though, you will notice that most of what I discuss today is almost exclusively about the British army. This is a limit to my sources but please keep in mind that similar experiences were had by men on all fronts, and in fact in some ways the British had it far better than most other armies due to the greater access to medical care. So just keep that fact in mind while I am discussing the British experiences with shell-shock.
One of the reasons that shell-shock became a big topic of conversation during the war was due to the expectations placed on men in early 20th century British culture especially as it related to serving their country during wartime. Stoic endurance, dealing with pain, and stability in emotional situations were all expected from men of all classes, when the fate of their country was at stake they were expected to be mentally unbreakable. These expectations, and how well the soldiers had lived up to them in the smaller conflicts before the war, made the prevalence of shell shock cases such a surprise when they started appearing in September 1914. In the early cases the term "hysterical" was often used when describing the men, and the use of the word hysterical is important because of how the word was used in 1914 Britain. It was used to describe women who were unable to properly control their emotions, which was the exact opposite of what was expected of men, especially in such a great national crisis. When the first cases started to pop up the belief was that it was nothing more than fatigue and that after a short rest of maybe a few weeks the men would be back at the front. The fighting had been going on for a month and the British army had just gotten done retreating from Mons to the Marne, so this belief made some sense. But the cases kept coming in and the War Office turned to doctors from all over Britain and from a variety of specialties to try and figure out what was wrong. The Army's search for the cause, and hopefully a cure, was driven by the desire to get men back to fighting, and if they all could not be cured at least determine some guidelines that would let the men actually suffering from mental disorders and the possible malingerers that were just trying to come off the line. The Doctors were handicapped in their investigation by the fact that there was little historical data to refer to on the topic and psychiatry was a much more niche type of medicine than we see today. It was still new enough that the variety of investigative techniques and treatment strategies were endless. Also, the symptoms of the men that they were looking at seemed endless. Paralysis, partial paralysis, loss of sight, hearing, or speech, hallucinations, memory loss, night terrors, tremors, were just the start of the possible symptoms, and they often came in an endless number of combinations. The lack of common symptoms made determining a cause far more difficult. The most extreme cases were sent back to England and onto insane asylums which at the time were not known for their hospitality. At these institutions the poor souls often deteriorated rapidly and were past saving by the time that it was determined that they could be helped. To further the surprise of the Army leadership, these breakdowns were not just suffered by privates but officers as well. There was a much greater strain put on them than ordinary soldiers and this meant that, proportional to their numbers, officers were three times more likely to suffer from shell shock as an enlisted man. This was a problem for the army hierarchy because officers were men selected for their aptitude and their abilities, who had been given more training, and who were expected to lead their men into battle and to retain order over them in extremely stressful situations. When officers could not be counted upon for these qualities the effect of the shell shock just magnified.
I have been using the term shell-shock a lot, but this was not a term used at the beginning of the war, it came in later. The root of the word comes from one possible explanation of what was happening which in some ways seems like a pretty plausible reason. This explanation centered around the physical toll that the men were experiencing at the front. The number of artillery blasts that the men were experiencing was so drastically greater than at any point in time in history and so doctors began to suspect that this was causing physical damage to the soldier's nerves and tissues. This is how they came up with the word shell shock, their brains were being physically shocked by all of the explosions. This terms seems to have its roots with a Dr. Myers who coined the phrase in a medical journal. Dr Myers would go on to become an expert on the subject. The thought that shell shock was a physical problem was soon abolished when it became clear that there were many cases were the men experiencing the problems were not even under direct shell fire when the symptoms started and it also failed to describe why some men experienced shell shock and others did not, even if they were standing side by side during combat. The German and French came up with different terms kriegsneurose and la confusion mental de la guerre respectively. Both of these end up being closer to the mark with the German phrase meaning literally war nervousness and the French translating into something like war confusion. However, by the time the British had determined that it was not a physical injury it was too late and shell shock was stuck. One of the problems with the term was that it became too popular and started to be used for any kind of mental problem for soldiers. This made it lose all meaning as a descriptive term for its original purpose. It was also used by soldiers when they were knocked unconcious for any reason, which was not part of the original definition. Even as the name shell shock was created, and then found to be inaccurate, the search for the specific cause continued. Even now the question of why the problem was so prevalent during the war continues to be asked. The root cause is generally just the sheer horror of the war, and many men suffered traumatic experiences, but that still does not explain how frequent the problem was in comparison to other conflicts. One possible reason was the type of warfare that was being experienced at the front day in and day out. One possible explanation was that trench warfare, and artillery fire, made men feel completely helpless. They had no control over their own fate, like they would if they were attacking with a rifle or in hand to hand combat, they just had to site in the trenches with the knowledge that each shell, which would be hundreds or thousands during a soldier's time in the line, could be their last and there was absolutely nothing they could do to change it. There was also what happened to soldiers when they were hit by artillery, it wasn't the clean death of a bullet but instead they could be blown to bits. As one French soldier put it ‘To die from a bullet seems to be nothing; parts of our being remain intact; but to be dismembered, torn to pieces, reduced to pulp; this is a fear that flesh cannot support ... The most solid nerves cannot resist for long.’ Regardless of precisely why men were experiencing these mental breakdowns the fact was that they were happening, and in staggering numbers. By the end of 1914 something like 10 percent of officers and 4 percent of enlisted men had experienced breakdowns of some form. By April 1915 almost 12,000 had been sent back to Britain for treatment and during the Battle of the Somme 16,000 more cases would be added to that number.
So we have talked a bit about what shell shock was, and how it went against societal expectations so the next step is to talk about how the army handled it. The official policy of the British Army, which was backed up by public opinion, was that if a soldier forgot his duty it was considered cowardice and treason. The punishment for this dereliction of duty was, in some cases, death by firing squad and that is exactly what ends up happening to a number of soldiers. Now, not all men who were executed in this method had shell shock, and the number of shell shock victims that were executed was extremely small, but it did happen. The following information comes from a book called Shot at Dawn by Julian Putowski and Julian Sykes which going through every military execution from the war to tell the story of the soldiers that were killed. Most of the cases involved willful desertion from the soldier's units, the soldiers were then captured by British authorities, often while dressed in civilian clothes, before being tried by a court martial and sentenced to death. The first case of a man with shell shock being tried for such an offense was in March 1915. His name was Lance-Sergeant William Walton and he was one of the original British soldiers that came over in the BEF and fought at Mons, months later after the Battle of Ypres he went missing. Awhile later he was detained by British authorities while showing signs of shell shock. He admitted during interrogation that he had undergone a nervous breakdown and it was obvious that he had problems answering the simplest questions about his situation and his actions. Even though he was in such a condition it was not considered grounds for dismissal of his sentence, which due to his desertion was death by firing squad, a sentence that was carried out on March 23rd. The sadness of the story does not end on March 23rd though, at this time the policy of the British army was to inform relatives of the men both the cause of death and also the offense. This meant that family of Lance Sergeant Walton was told that he had been killed by a military firing squad and that he had been convicted of desertion. This is tragic, knowing what we know now, that he family would be told that he was a deserter instead of a man that was mentally ill. The topic of telling the families of the offense was hotly debated during the war, especially later in the war. There were always instances of family notifications being softened by individuals in a show of compassion, but this was not the policy of the army. Here is a specific example of a message sent after a Private of the Middlesex Regiment as killed for desertion. "Sir, I am directed to inform you that a report has been received from the War Office to the effect that No. 11/1799, Pte Harris, A ., 11th Battalion Middlesex Regiment, G.S., was sentenced after trial by Court Martial to suffer death by being shot for desertion, and the sentence was duly executed on 20th March, 1916" While the story of all of these men suffering for shell shock and then executed for desertion is tragic, the men claiming to have shell shock after being caught for desertion was not helping the situation. There are instances of men lying and trying to emulate symptoms, or really do anything to get away from the firing squad. The challenge of the determining between the men who were and were not actually experiencing some symptoms of shell shock was a long and imperfect process, and was one again not a British problem. On the German side there were several published works focused on the problem. The neurologist Professor Gaup was one of the men who tried to alter the German view of the disease. He tried to prove that the men could have been the bravest souls in the world, but sometimes the mind just cannot cope with the situations in which they found themselves. Here is a quote from the Professor's article "The exhausted mind then feels that it is no longer master of the situation and therefore takes refuge in disease." Regardless of the work of this doctor and others, the execution of soldiers by all armies for cowardice and desertion continued until the end of the war, in fact that last British soldier was executed just 3 days before the armistice on November 11th, 1918. While the army was trying to come to grips with what to do with shell shock on the front line, back in England there were whole teams of doctors trying to figure out a way to help the men whose minds seemed to be broken.
When the number of men affected by Shell Shock grew to numbers that were too large to handle in France, they were sent back to England. Unfortunately there were no special facilities waiting for them when they arrived and so they were dispersed to all kinds of establishments. Some went to hospitals, some to insane asylums, some lucky officers were sent to compassionate volunteer's homes to recover. The Army brought in Doctor's from all over England to exam and experiment on the men. Those that were success grew to be quite popular. In Shell-Shock the Psychological Impact of War Wendy Holden talks about why the Army was so concerned "The Army’s sudden interest in the new methods was not entirely altruistic. With no armistice yet in sight and conscription bringing fresh blood for the war machine, a new concern was looming: the government was panicking over how much money it was going to have to pay out in pensions after the war if these men didn’t get better. Doctors whose wages were being paid by the military and who were already under pressure to get the men back to the front were made aware that they now had an additional function - to cure those with no hope of going back or to organize their discharge so that they would no longer be a burden on government resources." The ideas that the doctors came up with were all over the place. Some of the doctors tried to provide the opposite of what was experienced at the front, which meant a lot of peace, quiet, and relaxation often in the country side. Then on the very other end of the spectrum was electro shock therapy. Some of the doctor's went a bit too far with these electro-shock treatments. There was one doctor that used several minutes of electro-shock on any paralyzed limbs until the paralysis left, then if the paralysis moved to other areas of the body, which sometimes happened, he would chase it all around the body. The sad thing about the entire situation was that often times the electro-shock treatments were seemingly more successful than the more humane methods. However, there are very few records of what happened to the men who got "better" after electro shock therapy. It is completely possible they just did not what to get shocked anymore. All of these treatments, the good and the bad, were administered in England and this is how it stayed for a good portion of the war, however there was a big change in the last 2 years of the war on how British troops were treated for Shell Shock. This change was the movement of treatment closer to the front lines, much closer, all the way to regimental aid posts that were often still within hearing distance of the guns. Another key change was that throughout the entire treatment process at the aid post the men were kept both in military dress and to military discipline standards. Upon arrival the men would be separated into groups based on the severity of their illness. The more mild cases would be kept at the aid stations for a few weeks and if they did not improve they would then be sent on down the line, however if they did improve, and more of them did they were sent back to their units. This change in the location of treatment was a big breakthrough for British doctor's. The recovery rate for men improved dramatically and most of that seems to be attributed to where and how the men were treated, they were treated like soldiers instead of patients. Dr. Myers, the same one that had coined the term Shell Shock, also summarized the new method of treatment with the acronym PIE which stands for Proximity, Immediacy, and Expectations, which is all of what we just discussed. The PIE model is still the basic model for treatment of PTSD to this day. While these advances were being made in the later stages of the war, the end of the war did not mean the end of discussion about shell shock and what its continued effects on the soldiers.
The total cost of the war, in terms of men suffering from Shell Shock, was huge. The British seem to have reported the numbers quite low in the official records. But since 1918 a good estimate has come around to about 200,000. There were more suffered by France and Germany, with the Germans recording over 600,000 cases of "disorders of the nerves", but the discrepancy in the numbers probably comes down to simply the number of soldiers involved in the fighting for the duration of the war. These numbers of course a drop in the bucket of total casualties for the war, but when the war ended these men were not magically cured of their illnesses. With the rules of the time each man who was injured during the war was entitled to an army pension after the fighting ended. And after the war the total amount that was being paid out in pensions was about 10 million pounds sterling each year. It is of course difficult to exactly convert money over the course of a century but it is likely that this is somewhere in the range of a billion modern day British pounds, or 1.3 billion Euros or 1.45 billion US Dollars according to current exchange rates. So if the conversion is even sort of accurate that is quite a bit of money. Because of this outlay of money on a yearly basis a committee was created in 1920 by Lord Southborough. During his opening address he would say "The subject of shell shock cannot be referred to with any pleasure, All would desire to forget it – to forget…the roll of insanity, suicide and death; to bury our recollections of the horrible disorder, and to keep on the surface nothing but the cherished memory of those who were the victims of this malignity. But, my lords, we cannot do this, because a great number of cases of those who suffer from shell shock and its allied disorders are still upon our hands and they deserve our sympathy and care." For the next 2 years the committee would discuss the topic of shell shock and it would come to the following conclusions. The best way to prevent this from occurring in the future was to increase training, leadership, and discipline, that the army should stick with the PIE method of treatment in the future, and that it should be made clear to all soldiers that the loss of nerves would not be a free pass to allow them to not do their duty. So, the end result of this committee was that when the British entered World War 2 in 1939 its regulations in regards to shell shock were actually more stringent than at the end of the war in 1918. The disciplinary responses from the army were increased and, most importantly, the possibility of pensions for those suffering from shock were removed. Essentially, the men were treated more like deserters than wounded. In Germany the situation was the soldiers after 1918 was even worse. After their nation lost the war the German people began to blame the traumatized men, they pointed to their weakness as the reason that Germany lost the war. This anger and resentment made these soldiers, already broken by the war, social outcasts. So, while in some ways the medical treatment of shell sshock and other mental problems during the war represented a step forward, in other ways it resulted in a step back, in a recognition of the disease but a placement of blame on the soldiers themselves.
As I mentioned last week I will be making a book recommendation every episode this year and this week that book is Shellshock the Psychological Impact of the War by Wendy Holden. This book is a great resource if you want to learn about shell shock and how armies have reacted to it in the 20th century. Unlike most of my forthcoming book recommendations that cover strictly the period between 1914 to 1918 this book spends just the first 1/3 of its length on the events of the first world war before moving on to summarize how shell shock, and later PTSD for the rest of the century. It does a great job of both giving the history of the disease as well as how much we still do not understand its true nature.