Shell shock: The mental health crisis of WW1

We use many colloquial phrases in Britain today, but have you ever wondered where they come from? The phrase shell shock is a good example, understood in general terms to describe a state of severe disbelief or surprise. It’s one of many phrases that dates back to the First World War.

The inception of the phrase

The word shell shock was a term coined to describe a range of psychological afflictions that affected soldiers, nurses and many others working in a war zone during WW1. In particular, it was associated with the infantry who saw death on a daily basis, and the trauma of incessant bombardment by enemy artillery in the cramped and inhospitable trenches.

Psychological trauma from military service existed prior to 1914, but what was significant during WW1 was how many thousands were affected. Though recognition of the issue grew swiftly among both the military and the public, mistreatment and harsh judgements awaited shell shock victims who displayed its symptoms.

In November 1914, an editorial in the British Medical Journal referred to ‘mental and nervous shock among the wounded’. The actual term shell shock first appeared in print in February 1915, in an article in the Lancet by psychologist Charles Myers. It was an ambiguous catch-all phrase that covered a range of issues that could manifest themselves in different ways, such as a mental or nervous breakdown, depression, nightmares, a physical tremor, crying, or irrational behaviour.

John Duffield, a British officer who served as a chaplain with the Lancashire Battalion Bantam Brigade on the Western Front, publicised his views on shell shock during the early stages of the Battle of the Somme:

“we had such a lot of casualties and that night I was in charge of about fifty or sixty men, all badly shell shocked lying on the ground waiting for ambulances.”

Symptoms of shell shock

Initially, there were huge misunderstandings around the psychological impact of the war. This is demonstrated by the range of early treatments offered to those afflicted, which included prescriptions of milk, general anaesthesia, electrical therapy and lobotomies. Those who lacked physical symptoms were accused of being cowards. During the war, the British Army executed 150 soldiers for cowardice. The very nature of this highly mechanised war demanded a huge amount of manpower, and the military forces were reluctant to lose the front-line soldiers they so desperately needed to a seemingly invisible illness.

A soldier at the Somme who was believed to have been suffering from shell shock © IWM (Q 79508)

There was a great confusion and lack of consistency over how to classify those suffering from shell shock. Towards the end of 1915, the Army Council declared that those presenting symptoms as a result of enemy action were technically wounded, and as a war casualty entitled to a military pension. Those whose condition was not caused by enemy action were classified as sick, and not eligible for a pension. The classification system was revised a number of times after accusations of unfairness. By 1918, those classified as wounded had to appear in front of a medical board which decided whether or not they were a battle casualty.

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Those who fell through the gaps in the system might not receive adequate medical treatment, and may spend years challenging the decision over their status and their right to a pension. Returning to civilian life could be very difficult, particularly if the individual had to overcome their shell shock symptoms in order to work for a living. Not an easy feat in a community that doesn’t understand their situation.

In response to growing numbers of shell shock cases, the British military provided new facilities. From October 1916, a military hospital was dedicated to the psychiatric treatment of officers - the Craiglockhart Hospital in Edinburgh - and Maghull Hospital offered treatment for Other Ranks. In January 1917, the British established four ‘forward psychiatric units’ with a view to assessing and treating shell shock cases closer to the front, with the possibility of returning them to active duty sooner rather than sending the men several days’ away to a base hospital.

Ethel Dorothy, Red Cross VAD, 20th General Hospital, Camiers, France, told of her experiences treating those with shell shock:

“they used to dream, have nightmares and they used to go over the top, they used to go through all the battles, and one against another, you’ve no idea what the noise was there.”

Women's experiences of shell shock

Shell shock has long been viewed as something that affected men, but the women who served near the front were also subjected to psychological trauma. The main employment of women was as nurses or voluntary aid detachments. Usually they were stationed in relative safety behind the front lines, but this did not mean they were not affected by dealing with large numbers of casualties with horrific injuries. Nursing could be emotionally draining and relentless, with nurses sitting up with patients in their final hours whilst yet more casualties arrived at the door.

From 1916, when women were employed as ambulance drivers behind the Western Front, they saw firsthand the devastation of war and had to drive under harsh conditions. Developments in aerial power and long-range artillery meant that the base hospitals and the ambulance routes were increasingly at risk of bombardment or aerial bombing raids. Even if the hospital avoided a direct hit, the impact of a nearby explosion could send broken glass flying and knock hospital staff to the floor.

Shell shock post war

In 1922 the War Office produced a report on shell shock, and it proposed that many of those who had enlisted or were called up under conscription were not suited for military service.

The report recommended that future cases could be prevented by adapting the selection and training of new recruits, to ensure only those who could manage the stress of war were selected and following this the term shell shock was officially discarded. Today, we call it PTSD.

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