You weren’t hit by any bullet or shrapnel. You survived multiple battles, even charges
into no-mans land and trench raids, and yet you’re still a real casualty of war and
suffer a variety of terrible physical and mental problems, for you have shell shock.
I’m Indy Neidell; welcome to a Great War special episode on Shell Shock.
In the First World War, it was as early as the first battles, such as Mons, that military
and medical authorities faced what would become a familiar feature of the war - men with no
physical injury showing real medical problems, many of which would persist long after the
war: headaches, cardiac irregularities, blindness, amnesia, depression, anxiety, loss of appetite,
nightmares, and many more. By 1915 the symptoms had a name in English, shell shock, but while
the name was new, it had been around for a long time, and becoming unhinged during war
is as old as war itself. It’s mentioned in Gilgamesh and the writings of Herodotus
and it goes under a variety of names throughout history. In the Napoleonic Wars it was a “bullet
wind” when soldiers would have reactions to nearly being shot. In the American Civil
War, “soldiers’ heart” was the name given to persistent cardiac problems. In more
recent times it would be called Battle fatigue, Gulf War Syndrome, or today PTSD to a certain
extent, although that refers only to psychiatric symptoms and not the unexplained physical
symptoms. What WAS new in WW1 was the scale of it - as many as 80,000 British soldiers
suffered, for example, and 100,000 Germans were treated for “hysteria” in field hospitals.
Shell Shock and its treatment would help shape the relatively new fields of neurology and
psychology and would challenge traditional ideas about madness and normality.
War syndrome and its possible treatments were first studied systematically in the Russian
wars with Turkey in 1877-88 and Japan in 1904-05. In the second one, Russian doctors prescribed
“forward treatment”, which meant close to the frontline, the idea being to intervene
before the condition became fixed and the men could no longer fight. Doctors compared
symptoms they saw to those of survivors of man-made disasters, such as train wrecks,
and the symptoms were often the same. There was even a name for them, “railway spine”,
and in the 1860s and 70s there was a series of court cases in Britain and Germany about
compensating victims of railway spine, and the issues of cause and compensation would
define the WW1 debate about shell shock.
Now, everyone agreed that the symptoms were real, but what were they caused by?
Was it actual damage like micro-lesions on the brain? Or was it purely emotional or psychological?
And were sufferers pre-disposed to it, did they have a weak character, or latent epilepsy?
Well, whether physical or mental, it was generally agreed that the external cause was the force
of modern artillery. Belgian doctor Octave Laurent believed that speeding projectiles
caused variations in pressure that affected the inner ear, and initially the physical
cause idea prevailed in general. Part of this was pure practicality - there was a great
reluctance to accept the psychological root since this would lead to an explosion in compensation
claims - but slowly but surely psychological explanations were accepted as well, or instead.
But how do you treat something so nebulous?
Well, you tried a variety of things. There was disciplinary treatment, such as Faradism
named after Michael Faraday, which was electric shock treatment. There was analytical treatment,
the idea that the patient was suffering from internal conflict and a close relationship
with a therapist could help. There were talking cures based on re-experiencing repressed memories,
but along with any kind of treatment there were ethical questions and doubts.
Shell shock was pretty easy to fake, and easy enough to get off duty once you faked it,
but how do you tell fakers? And what do you do once someone is cured anyhow? Do you send
him back to the frontline where the whole thing could just get re-ignited?
It was a big problem, and it was a big international problem, and the medical world WAS international.
Germany was the international leader in medicine, for example, while the pioneer figure in neurology
was the Frenchman Jean-Martin Charcot, but though the questions and issues were the same
all over, there were differences in treatment and interpretation.
In Germany, it was Kriegshysterie, and the Kriegszitterer were the trembling veterans
who begged on street corners. Now, here’s something to keep in mind; back in 1884 Bismarck
had passed accident insurance legislation, which compensated for medical and nervous
effects of industrial accidents. Got it? Well, what this led to 30 years later was the rejection
of psychological causes of shell shock for clearly stated economic reasons - it would
cost the state too much money to compensate people if it was psychological. In fact, some
German psychologists saw it as their job to protect the state from “a proliferation
of mental invalids and war pension recipients,” so Germany set up a system based on containment,
preventing men who might be susceptible from returning to the front and giving them work
as their psychiatric treatment. These men were treated just like industrial workers.
The factories and shop floors were seen as therapeutic environments and were near treatment
centers. Entire villages for the nervously ill were constructed so that, under the direction
of nerve doctors, men could take all sorts of jobs, and they were real paid jobs that
had value, not just make-work. There was no room for sympathy or pity; that was effeminate
and pathogenic.
There were, of course, more active and bizarre treatments, Faradism, barking military orders
at patients, the sudden singing of the national anthem to shock men into regaining their hearing.
It was different for the French.
The French believed in treatment at the front, and “intentionally obstructed the easy evacuation
of such casualties.” Many French doctors believed that shell shock was caused by suggestion,
though they recognized that it was unconscious, but they used often-brutal methods to bring
it out so that they could then create the will to overcome it. There was a famous legal
case in May 1916 when a soldier was arrested for assault when he hit his doctor who was
trying to apply an electric shock. Apparently, the shock he had already been given was strong
enough to move a streetcar and he would rather be court-martialed than repeat the experience.
This led to the issue of whether injured soldiers had the rights of private citizens or were
under military command and thus could be forced to be treated.
Italians believed that going home triggered it; that the stress of seeing how women and
children struggled with the men away at war sent men over the edge, and psychiatric intervention
was geared toward unmasking malingerers.
In Russia they were quite forward thinking, and in 1916 doctors called for special hospitals
and treatment centers, and then the Revolution ended all that.
In Britain the psychological explanation was more readily accepted. Interestingly enough,
officers were affected- percentage wise - more often than enlisted men in the British army,
and some of the numbers are staggering; during the Battle of the Somme, in some areas as
high as 40% of casualties were nervous disorders and it apparently was “contagious” in
some units. The army was worried, though, that seeing it as psychological made “weakness”
acceptable, though treatment changed when it began to be seen as a medical problem and
not a disciplinary one, and by mid 1918 there was a whole network of British hospitals dedicated
to shell shock. W.H.R. Rivers was a key figure for treatment of shell shock in Britain. He
emphasized patients helplessness and lack of control, and saw an interior conflict between
“...their emotion of honest fear and their sense of duty as men,” and that “three
assumptions about personal invulnerability were shattered: the world as meaningful, as
comprehensible, and seeing oneself in a positive light.”
Amazing how differently it was seen from country to country.
But Long term and post war, shell shock created a new understanding that circumstances could
cause mental breakdowns, which had nothing to do with moral fiber, and that mental illness
was something that could be transient and wasn’t necessarily genetic or degenerate.
This was the first step toward the idea of psychological causes for mental symptoms being
acceptable, made talking cures a part of regular life, and took away some of the stigma of
psychotherapy. Indeed, shell shock became a metaphor for the war; a recurring nightmare,
images that would not leave, transient madness that struck the entire world.
This topic could and should be an entire documentary series in itself. Today was just touching
the basic points of perception, cause, and treatment during the First World War.