By Suzie Grogan

Millions of men worldwide (and indeed many women too) suffered psychological damage caused by their experiences in the First World War.

In Great Britain, the official number of those treated for ‘shell shock’ was around 80,000. More than 60,000 were still receiving care a decade after the Armistice was signed. And since thousands of others broke down for the first time years after the war ended, the true figure of those afflicted must be considerably higher.

Even within months of the start of the war, the number of fighting men suffering from nervous collapse was becoming a serious problem for the military. Soldiers stricken with the little-understood condition exhibited a wide variety of symptoms consistent with what we would today call Post Traumatic Stress Disorder (PTSD).

The term ‘shell shock’ was first used in an article in the medical journal The Lancet as early as 1915. Initially, medical experts believed that the nervous disorder was brought on by the physical effects of artillery blasts on the human body. Yet within months, even the doctor that coined the famous phrase doubted that was actually the case. This was not a condition with a physical explanation. The facial tics, the nightmares, the inability to speak, the paralysis – victims were wounded in mind, not body.

The confusion within the army to deal with this growing epidemic was by no means unique to Great Britain. Although there was no umbrella term such as shell shock in either France or Germany, there was a recognition of something known as male ‘hysteria’ — in Britain nervous maladies were supposedly confined to the female sex. In both countries, psychiatry was a well developed field of medicine, properly funded and respected worldwide. Yet this did not result in better or fairer treatment of those who had broken down. On the continent, it was never respectable to collapse, whatever your class or rank.

The French military considered traumatized soldiers to be malingerers. As such, the top brass were determined to keep those with symptoms as close to the front as possible, lest it encourage others to follow suit. Eventually it became obvious that many of those suffering simply weren’t responding to the bullying, coercion and discipline that characterized the military’s official response to shell shock cases. Another approach was required. Dr. Clovis Vincent provided an apparent solution with his use of torpillage or ‘torpedoing’. This involved using electroconvulsive treatments. Vincent’s seemingly cruel therapy fell out of favour however when one of his patients attacked him. The subsequent court case horrified civilians and public opinion forced the French medical corps to adopt kinder (but not necessarily kind) methods.

Lewis Yealland in London used a similar treatment regime. ‘Faradization’, the application of electric shocks to the affected parts of a soldiers’ body (the tongue if the patient could not speak or the arm if he was paralyzed, for example), produced results that could be called a success, if a simple return of sensation or speech was a cure. Yealland, like Vincent, was a man driven by his own theories to commit acts that we would now consider very cruel.

In some British hospitals, ‘talking treatments’ were employed. These involved exploring the reasons  why a man may have broken down, rather than simply dealing with the symptoms. Such methods were developed by psychiatrists such as William Rivers, and Thomas Hatherley Pear. However, there was no cohesive response from military psychiatrists — a patient’s treatment depended largely on which hospital he was admitted to. Meanwhile, Frederick Mott at The Maudsley Hospital pursued his conviction that shell shock was caused by microscopic physical damage to the brain, rather than psychological damage.

This was also a theory favoured by German psychiatrists at the start of the war, such as Hermann Oppenheim. Such methods were quickly debunked however in favour of treatments that relied heavily on psychological pressure and electric shock, such as the notorious “Kauffmann regime” ( Überrumpelingsbehandling) or the more benign theatrical hypnosis techniques undertaken by Max Nonne.

In Germany, more than 100,000 men went through field hospitals in the first year of the war suffering from symptoms of ‘hysteria’ or the more genteel ‘neurasthenia’ (a term with which the officer class was much more likely to be labelled). In general, Germany considered emotional breakdown to be unworthy of a fighting man as well as unpatriotic – it was something from which French soldiers suffered. Accordingly, emotionally shattered infantrymen in the Kaiser’s army were removed from the trenches to ensure they didn’t contaminate morale. Following a harsh treatment regime, they were rarely returned to the line, but sent to work on the home front. Although there is not much published research, it is known that the German treatments killed at least 20 soldiers and caused many others to commit suicide.

When comparing these different approaches to dealing with what we have since realized is a universal human response to severe psychological trauma, the French and German methods seem cruel in comparison to the almost gentlemanly outlook of the British medical establishment. But where in Britain and France, thousands of men were left to suffer in army hospitals without specialist treatments or consigned to county lunatic asylums, German troops were treated and sent home to work. Still, more than 3,000 British shell shock cases were sentenced to death for cowardice — 307 were executed. In France 2,000 men were similarly sentenced, with 700 actually shot. In Germany the figure was just 150 condemned and 48 executed. This suggests that the mysteries of a shell shock diagnosis, the stigma surrounding mental breakdown and nervous collapse and the purpose of treatment – to cure or seemingly to punish – are complex and always worthy of close study.

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Suzie Grogan is a London-born writer and researcher published on the subjects of mental health, women’s issues and social history. She is currently working on two commissions for Pen and Sword Books on the emotional impact of WW1 for publication in 2014 and 2015 and has a successful blog at No Wriggling Out of Writing. Visit her website at suziegrogan.co.uk.