By: Megan Brush
It is often said that the study of history helps us to understand the present. We live in the aftershock of historic events. The ideas we have, the inventions we create are all ripples in time, influenced by past experience. So often looking at the past gives us insight into society and the culture around certain current issues.
Post-traumatic stress disorder (PTSD) is what some would call a hot-button issue in military circles today. Headlines are filled with calls for help and the creation of government initiatives to help those veterans who are suffering. Medically, new research grants and institutions have sprung up across Canada to study the cause and effect of the disorder. The Canadian government has even gone so far as to create a phone app to help sufferers manage their symptoms. But the government has not always been so willing to help with the mental effects of war.
Shell Shock is mistakenly seen as the first instance of PTSD. Although they are different illnesses, shell shock and PTSD are both common to soldiers and have been so throughout history.
Shell shock treatments during and after the First World War varied, from the idea that patients would be cured from psychoanalysis to harsh and sometimes cruel “suggestive” methods.
By the end of the First World War, the British army had dealt with approximately 80,000 cases of shell shock or war neurosis. In 1917, one-seventh of discharges from the British military for disabilities claimed war neurosis as the cause. Four out of five cases of shell shock were never able to return to service. At the time, symptoms of shell shock varied from spasms, paralysis, mutism, deafness, and nightmares to uncontrollable trembling.
Videos of soldiers experiencing shell shock symptoms which can be seen by a quick search on the internet are often disturbing to watch. These are videos of men who are unable to stand or walk; their bodies in uncontrollable spasm, tremors ignited by the fight to control their actions. Photographs of victims are equally eerie, with the infamous thousand-yard stares that often plague sufferers. Their gazes are forever locked into history by the photographers. They stare off into some distant world, unable to return to the horrifying realities that surrounded them.
At the time, it was indeed a disease unlike any other before the Great War. It is popular consensus that the term “shell shock” was first used in 1915 by Charles S. Myers. He published the term in a prominent medical journal called The Lancet. Myers first article describes similar symptoms all displayed by different patients. He lays out plainly the cause of these ailments: shell fire.
Ted Bogacz wrote in an article entitled War Neurosis and Cultural Change in England, that some of the earliest beliefs were that war neurosis resulted from concussions received as a result of shell fire, hence the name “shell shock.” But there were other theories of its origin that existed as well. In fact, since its emergence seemed as sudden as that of the war itself, shell shock was treated with a caution at first, which often mutated into suspicion.
There was an ideal type of soldier that dominated popular beliefs – one of masculinity and fearlessness. Sufferers of shell shock were seen as to not fit this mould, and so conclusions were drawn that they were unusual and perhaps had pre-existing conditions.
According to Bogacz’s article, there was a general acceptance among English psychologists that “insanity was a disorder of mind resulting from structural or functional lesions of the organ of mind” or brain. It was because of this theory, that insanity was merely a physical ailment, psychologists ignored the mental symptoms of shell shock to focus solely on the physical. The dreams, delusions, and sometimes hysteria were thought of as beyond rationality and held no importance to therapy, according to Bogacz.
Notable historian Joanna Bourke has written quite a lot on the topic of shell shock. In her article “Effeminacy, Ethnicity, and the End of Trauma: The Sufferings of Shell Shocked Men in Great Britain and Ireland,” she quotes an article titled “Are You a Post-War Criminal?” The name alone screams of the negative feelings toward shell shock. Bourke wrote, “... in 1920, shell shock was seen as simply ‘an excuse for crime,’ made by men who were ‘accelerated degenerates’ even before the war and were too ‘lazy’ to find employment.” These disgruntled feelings toward shell shock victims were inherently common.
Many believed in the idea that men were often prone to shell shock before the war due to mental softness or even personality disorders. Victims were accused of exaggeration of the impact of shell shock to gain compensation or benefits. In his book War Neurosis, which was published in 1918, John T. MacCurdy noted that although one soldier may not have experienced symptoms before the war, he still displayed an abnormality in his “make-up.” MacCurdy described soldiers who were often tender-hearted, shy, and introverted would often be the ones to suffer.
MacCurdy also wrote that these men had an aversion to seeing animals killed and a shyness toward women. This was the belief of the time: the soft hearted men were the ones who suffered from shell shock, not the heroic warriors. This mindset spawned the often harsh treatments soldiers would receive in the name of curing shell shock.
The treatment of shell shock sparked a great debate within the psychiatric field, which continued for nearly ten years after the conclusion of the war. Some men were treated with a version of then-controversial psychoanalysis treatment, where the sufferer would be encouraged to talk about his dreams to determine the cause. Others received electric shock therapy. Sadly, others were left untreated, at times facing execution for desertion.
In 1922, the British War Office Committee was tasked to report on the notion of shell shock in the First World War to look into its impact within the British Army. Interestingly, there is a chapter that deals with the idea of cowardice vs. shell shock. The report gives voice to a man identified as Major Pritchard-Taylor, who said, “The front-line medical officer should be a man rather than a doctor, and as true ‘shell shock’ cases cannot be distinguished from others in the turmoil of battle, they are all better suspected as malingerers and a large number will be saved.”
The report is not entirely harsh however, and does advise that soldiers who appear to be shaky should be given a “soft job.” It accepts the idea of shell shock, but states the impracticality of believing all who claim symptoms. It does also conclude that those who have displayed cowardice may have done so beyond their control. This is when, according to the report, experienced medical opinion is needed to decide if a case is genuine shell shock or not.
Not all doctors were sympathetic to the plight of shell shock, however. By medical standards of practice today, they were indeed very harsh. Dr. Lewis Yealland was born in Canada, received his degree from the University of Western, and moved to Britain to practice medicine during the First World War. He is known for his belief in strict discipline when treating soldiers for shell shock.
His published work gives insight to how his beliefs in cowardice affected his treatment of shell shock. Within the first few sentences of one article, Yealland’s method of treatment can be summed up in a disturbing set of three words: suggestion, re-education, and discipline. Not entirely the sympathetic doctor who you would hope would treat the mentally ill. Yealland and his co-author E.D Audrian, published an article about treatments of shell shock, dictating the need for discipline, a stern attitude, and at times, “a little plain speaking accompanied by a strong faradic [electrical] current.”
Yealland wrote that doctors must act strict and that any man left uncured is the result of poor doctoring. Yealland’s writings offer a disturbing insight to the practices surrounding shell shock during and after the First World War. He wrote that once a patient walks into a room, the doctor should immediately take on a mildly bored persona. They are to act perfectly familiar with the illness, as though they have seen a case of shell shock thousands of times. Yealland wrote the doctor should act as though each case is “a perfect example of the type of case which is cured in five minutes by appropriate treatment.”
His words are often riddled with condescension, using instructions such as depriving a patient of his audience, particularly when dealing with functional tremors or pseudo-chorea – when a patient experiences bodily movements beyond their control. “…The patient becomes quiet as soon as he is deprived of his audience,” wrote Yealland.
Most disturbingly, Yealland encouraged the threat of turning up the current for electrotherapy – which was often used as treatment for shell shock. At times, a patient would come in experiencing paralysis in a limb. Yealland described what to do with a patient plagued with paralysis of an arm. Again, he instructed, a doctor should appear mildly bored and insist the patient will be cured in no time whatsoever. “He is not asked whether he can raise his paralysed arm or not; he is ordered to raise it,” wrote Yealland. Others who have written on Yealland describe most seemingly torturous methods of treatment.
Author Tom Slevin wrote in his article, The Wound and the First World War, that Yealland treated a patient, known as Private M. This soldier had lost his ability to speak after experiencing combat in the war. He had been in a series of “horrific battles, including Mons, Marne, and Ypres.” Yealland strapped Private M to a chair, robbing him of the ability to move, and for twenty minutes at a time, would apply strong electric currents to his neck and throat. Paired with the electric currents, Yealland applied the treatment of lit cigarettes to the tip of the private’s tongue and placed hot plates in the back of his mouth. Meanwhile, Yealland used “suggestive techniques to inscribe ideologies of duty, control, and masculinity,” wrote Slevin. The private was eventually cured by this method after about an hour of treatment when he uttered a sound.
It would be unfair to say that this was the sole treatment shell shocked soldiers received during and after the First World War. Some patients were treated quite differently, urged to discuss their nightmares and experiences during the war to gain some sort of peace. William Halse Rivers, an English doctor who practiced mainly at Craiglockhart War Hospital during the Great War, practiced this talking cure. In his article, Repression of the War Experience, he wrote about how damaging avoiding discussing their experiences can be for men. “I hope to show that many of the most trying and distressing symptoms from which the subject of war neurosis suffer are not necessarily the result of the strain and shock to which they have been exposed in warfare,” he wrote, “but are due to an attempt to banish from the mind distressing memories of warfare…” His prose is almost compassionate, packed with the need to help. He wrote empathetically, describing each soldier’s situation as “distressing” and “painful.”
Rivers also goes into great detail about his treatment of several soldiers with psychoanalysis – or the talking cure. One patient he treated experienced recurring nightmares about discovering his good friend’s mutilated body as a result of an exploding shell. Rivers suggested this patient attempt to look at the death in a different light – the brutal arrangement of his friend’s body parts means a quick, probably painless death. This suggestion helped the patient eventually, wrote Rivers. The nightmares evolved from evoking blinding terror to sadness – an emotion Rivers wrote is much easier to bear.
Unlike Yealland’s writing, Rivers admits the ineffectiveness of his cure. He is humble – rather scientific in his work, acknowledging his faults as well as his successes. “Sometimes the experience which a patient is striving to forget is so utterly horrible or disgusting, so wholly free from any redeeming feature which can be used as a means of readjusting the attention,” he wrote, “that it is difficult or impossible to find an aspect which will make its contemplation endurable.”
One such case was that of a patient who had been blown by a shell into a days-old rotten corpse of a German soldier. Upon impact, his face struck the swollen belly of the German. The patient lost consciousness, but not before feeling his mouth and nose fill with the decaying insides of the dead soldier. The taste and smell of the foul entrails still haunted him in his dreams.
Rivers found his situation was incurable within a short time frame, and he wrote that he thought it would be best that the patient “should leave the Army and seek the conditions which had previously given him relief.”
Rivers continue his treatment of shell shock and war neurosis long after the war. Pat Barker wrote a wonderful historical fiction novel on Rivers time at Craiglockhart, titled Regeneration. A character of Yealland even makes an appearance as an evil doctor brutally treating shell shock sufferers.
Rivers predicted that psychiatry would emerge from the war in a very different state. “Above all,” he wrote, “it will be surrounded by an atmosphere of hope and promise for the future treatment of the greatest of human ills.”
In the wake of the difficulty currently surrounding the Canadian Armed Forces and PTSD, Rivers’ optimistic words are even more necessary today than they were at the conclusion of the Great War.