The emergence of shell shock in the First World War

There are many colloquial phrases that are used in modern language. Today the phrase shell shock is used to describe being in a state of severe disbelief or surprise. However, did you know that the origin of the phrase goes back as far as the First World War?

The inception of the phrase

The term shell shock was used to describe a range of psychological afflictions that affected members of the armed forces during the First World War as a result of their war experience. In particular it was associated with the infantry who faced 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 and the growing recognition of the issue by both the military and the public.

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, 1916-1918 talked about 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 the psychological impact of the war was not fully understood. 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 and during the war the British Army executed a total of 150 soldiers for cowardice. The very nature of this highly mechanised war demanded a large amount of man-power and the military forces were reluctant to lose front-line soldiers that 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 and 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.


Those who fell through the gaps in the system might not receive adequate medical treatment and could end up spending years challenging the decision over their status and their right to a pension. It could be difficult to return to civilian life, particularly if the individual had to overcome their symptoms in order to work for a living in a community that might not understand their situation.

In response to growing numbers of shell shock cases, the British military provided new facilities and from October 1916 there was a military hospital 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 1915-1919 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.

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