They Called It Shell Shock: The Great War’s “Epidemic of Trauma”

Consultant Psychiatrist and Clinical Research Fellow at Cardiff University Dr Stefanie Linden reveals her plans to examine the Great War’s “epidemic of trauma” and how it manifested on both sides of the conflict, following her Edmonds Prize win.

National HospitalExactly a century ago, on 8 December 1915, Private Leonard C. from the South Staffordshire Regiment was admitted to the National Hospital at Queen Square in the heart of London (pictured left) – one of the greatest neurological hospitals of the world (then as now). Leonard was paralysed from the waist down. According to the admission records:

‘This youth with brown hair and brown eyes and a well-nourished physique and pleasant features is almost inaccessible. He will only answer questions asked him in monosyllables or marking a motion with his hands. He lies in a rather stuporous condition and frequently makes grimaces as though he had great fear of something. He is restless in his habits, tossing himself from one place to another on his bed and, if he is moved, he falls back as though he were lifeless. When aroused he jumps with a startle, looks at one confused, looks the opposite way frowning and grimacing as though he were in great agony.’

Leonard was the youngest shell shock sufferer treated at Queen Square during the war years. Although we do not know the exact circumstances of his breakdown because he did not manage to provide his doctors with a history, this case shows how the horrendous experience of combat in the Great War could paralyse soldiers (both literally and mentally) – even if they had not actually suffered any direct injury to their brains.

Leonard was one of the estimated 80,000 British servicemen who suffered severe psychological reactions to combat experience in the Great War. This was a considerable number, amounting to an equivalent of the manpower of four Army Divisions. Even larger estimates have been produced for the German and French armies. Yet the importance of this epidemic of nervous breakdown amongst servicemen to the military and political leaders becomes even more obvious when we consider that, when the first patients started to flood the base hospitals in autumn 1914, it was by no means clear what the ultimate scale of this problem would be.

The trauma of war produced a great variety of unfamiliar psychological reactions in servicemen of all combatant countries, which could include paralysis, blindness, deafness, constant shaking, frequent fits, aggressive outbursts and severe depression. Initially, the debate circled around the question: were mental and neurological combat reactions caused by hidden physical effects of shell explosions, that might lead to microscopic lesions of the brain or spinal cord? These “organic” models gave rise to the terms “shell shock” in Britain and “traumatic neurosis” in Germany, which remained popular – even after the majority of the medical profession had adopted the view that they were caused by psychological rather than direct physical trauma.

Leonard was the first patient treated by Lewis Ralph Yealland – a young Canadian doctor who had just arrived at Queen Square. Yealland soon became famous for his use of electrotherapy. He was criticised for it already by his contemporaries and in later semi-fictional accounts – such as that provided by Pat Barker in her novel Regeneration. In Leonard’s case, however, Yealland prescribed bed rest, milk diet and massages, as well as the standard drugs of the time – bromide salts, strychnine and belladonna together with some pain medication. After nine months of inpatient treatment, Leonard’s condition was recorded as ‘improved’, and he was recommended for discharge from the army.

They Called it Shell Shock will draw on a large body of unpublished medical records from British and German shell shock centres. The reader will enter a world which – since the last veterans of the Great War have passed away – is now inaccessible through living memory. The book describes the individual soldier’s combat experience; his mental breakdown; and his journey through the medical system in his respective home country.

When reading through the patient records of shell shock hospitals in London and Berlin, I often encountered soldiers who were traumatised in the same battle – just on different sides of the frontline. They had all witnessed immeasurable suffering and had been psychologically scarred. They were victims of the epidemic of trauma that at some point threatened to overshadow all other medical problems of the war.

Stefanie Linden

Dr Linden is pictured at London’s Oriental Club collecting the Edmonds Prize

These individual histories reveal the human condition; the basic human reactions to fear and loss that transcend all political and ideological differences. During the many months of reading the individual medical records, it became clear to me that the interaction between doctors and their military patients was certainly more complex than depicted in most fictional accounts. I also came across some often-neglected topics of war history, including the stigma of mental illness, desertion and suicide.

I am very pleased that Helion & Company Ltd and the Western Front Association (WFA) has selected my work on comparative history for this year’s Edmonds prize. Comparing traumatic reactions across countries and cultures is certainly of great interest for the medical historian and I am glad that this approach is also useful to the military history community.

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