Shell Shock – The Psychological Scars of World War 1 I THE GREAT WAR Special

Shell Shock – The Psychological Scars of World War 1 I THE GREAT WAR Special


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.