Medical Treatment of Shellshock
Shellshock is a medical term first associated with the First World War. As early as the first winter of the war there were indications of a high level of mental breakdown among hospitalised men and officers. By 1916, over 40% of the casualties in fighting zones were victims of Shellshock and by the end of the war over 80,000 cases had passed through British Army medical facilities.
The epidemic was completely unexpected and by 1915 there was a shortage of hospital beds for the 'wounded in mind'. Many county lunatic asylums, private mental institutions and disused spas were taken over and designated as hospitals for mental diseases and war neurosis. By 1918 there were over 20 such hospitals in the U.K.
Shellshock, as the name implies, was first thought to be caused by exposure to exploding shells. Doctors believed that the hysteria observed among men and officers could be traced to an organic cause. However, it was soon concluded that this was not the case. Shellshock began to occur in men who had never come under fire, while some had never even been within hearing range of exploding shells. The breakdown was so gradual that 'shock' was also a misnomer.
At first there was little sympathy for Shellshock victims. Shellshock was so obviously a retreat from the war that many military authorities refused to treat victims as disabled. Some even went so far as to say that they should be shot for malingering and cowardice. Others blamed it on a hereditary taint and careless recruiting procedures. A British General at the time said. 'there can be no doubt that, other things being equal, the frequency of Shellshock in any unit is an index of its lack of discipline and loyalty'.
This was a view shared by many and it made the burden of guilt for Shellshock victims even worse. The symptoms displayed under the term 'Shellshock' were extraordinarily numerous and different. Among regular soldiers hysteria - paralysis, blindness, deafness, contracture of limbs, mutism and limping were the most common, while officers mainly experienced nightmares, insomnia, heart palpitations, dizziness, depression and disorientation.
Mutism and speech disorders were the most common form of war neurosis. They were thought to be symptoms of a soldiers repressed aggression towards his superior officers. The rate of war neurosis, however, was four times higher among officers then among the regular soldiers. Their positions required them to continually repress their emotions in order to set an example for their men. The most severe cases of Shellshock occurred in officers who had made a name for themselves as daredevils. These man were ashamed by their overwhelming fear and performed daredevil acts to show their men that they were not afraid.
The treatments of Shellshock were many and varied. Disciplinary treatment was the most common at the time. The doctors involved with this form of treatment had harsh moral views of hysteria and stressed quick cures as the goal of wartime psychiatry was to keep men fighting. Shaming, physical re-education and the infliction of pain were the main methods used. Electric Shock Treatment was very popular. This involved an electric current being applied to various body parts to cure the symptoms of Shellshock. For example, an electric current would be applied to the pharynx of a soldier suffering from mutism or to the spine of a man who had problems walking.
Another form of treatment consisted of "finding out the main likes and dislikes of patients and then ordering them to abstain from the former and apply themselves diligently to the latter". Patients who had a fear of noise were given rooms looking onto a main road, men who had been teachers or writers before the war were refused access to the library and men who feared being alone were put into isolation.
W. H. R. Rivers was a psychiatrist in Craiglockhart Medical Hospital and it became one of the few hospitals to practice psychotherapy in the United Kingdom at the time. For example, when the famous war poet Siegfried Sassoon was a patient in the hospital, Rivers treated him using psychotherapy. Every day Sassoon would have a session with the doctor during which they would discuss his war experiences. Many doctors refused to use this form of therapy on Shellshock victims as it sometimes took patients years to recover and very few returned to the war.
In the years following the First World War, many war memoirs or novels were written. However, very few were by men. The male veterans were struggling to repress their war memories, to banish the most painful of them from their minds. For some the memories would never go away. As Dr. Jay Winter as pointed out; "Those who couldn't turn off their feelings, internalise them, brought them home with them, dreamt about them and went mad because of them".
(1) Brigadier-General Frank Maxwell, A Memoir (1921)
Yesterday, when I halted in my walk around the men's quarters here, there was one wretched looking scarecrow standing shaking and perfectly senseless amongst the others of his section. The kind fellows were going to send him to hospital, and all that, but I told them not to, pointing out that he only wanted rest and food and quiet to be perfectly all right; whereas, if they sent him to hospital, wouldn't all the doctors say that he was a funk, which would be bad luck on him, and bad for the regiment.
(2) Stephen Foot, an officer in the Royal Engineers, wrote about his experiences in the First World War in his book Three Lives published in 1934.
Whenever I was in serious danger I was almost completely paralysed by fear. Only too well I remember sitting with Coffin (a fellow soldier) on the fire-step of a trench during an intense bombardment, when it seemed certain that we must be killed. Shells fell all about us; each moment threatened to be the last. I was conscious of biting on the stem of my pipe to prevent my teeth from chattering. If I had been alone on that occasion I believe that I should have been cowering at the bottom of the trench in hopeless terror; it was the presence of others that saved me.