Shell shock from WW1 - terrible war neuroses or mere malingering?

Fiona Reid, 

Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30

After WW1, tragedy continued for a lifetime for British families who never saw their men again. Even for those soldiers who returned home alive, the armistice off­ered little consol­at­ion to those who were indelibly wounded. After 1918, there was a war-wrecked gener­ation crippled by physical and psych­ological scars. 

Absent limbs sometimes enabled crippled soldiers to be hailed as heroes. 41,300 British soldiers had one or more of their limbs amputated. That did NOT include Australians, New Zealanders, Canadians, South Africans and Indians supporting the Motherland. 

New Zealand plastic surgeon, Dr Harold Gillies, had worked in wartime France with the Red Cross. With a team of artists and sculptors back in post-war Brit­ain, he developed plastic surgery techniques on 5,000+ sol­diers. Gillies slowly rebuilt the human wrecks in Queen Mary’s Hospital in Roehampton! His limbless patients were fitted with artificial limbs such that, with con­val­es­cence and phys­io­ther­apy, the men could re-join other citizens as near equals. 

The Royal Pavilion Brighton became The Pavilion Hos­pital for Limb­less Men, and opened in 1916 to accommodate the sudden influx of men. Modelled on the Roe­ham­pton House Hosp­ital, a workshop was built on the grounds so patients could learn carpentry, engineer­ing and sport skills. 

Now to mental health. Before the war, few doctors knew how to deal with those suffering from mental ill-health. Anyone seeking advice about their anxiety or depression was sent away with a bottle of valerian-bromide. But as early as the Battle on Mons in 1914, the first soldiers suf­fered from war neuroses: tics, functional paralysis, hysterical blind­ness and deafness, stuttering, mutism, extreme anxiety, depression, vomiting and endless diarrhoea. Worst of all were total amnesia and the fixed “glare of madness”. 

Until the war neur­ologist Hugh Crichton-Miller combined his Harley St practice with a res­id­ential nursing home at Harrow-on-the-Hill. After vol­unteering for the Royal Army Medical Corps in 1914, he was posted to Alexand­ria’s 21st General Hospital. In Egypt they were happy to trial Freudian psycho­therapy on soldiers. 

Fiona Reid, in Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30, found that the men suffering shell-shock had the most difficult recovery, because their wounds were invisible. Note although the term “shell-shock” wasn’t used until 1917, by Dec 1914, c10% of British officers and c4% of enlisted men were severely in­jured by mental shock. The first medical study of shell-shock appeared in The Lanc­et, Feb 1915. 

Yet many British military commanders believed shell-shocked soldiers were simply malingering, while civilians at home thought the wide eyed, jittery men were lunatic. Post-war the situation was worse be­cause many shell-shocked men strug­gled with un­stable pensions. 

The Eyes Of Madness, 
France, Sept 1916 
Vintag

Psychotheraputic techniques were promoted as early as 1917, in a book called Shell-Shock and its Lessons written by Australian anat­om­ist Sir Grafton Elliot-Smith & British psychologist Tom Pear. They had worked with Ronald Rows at Maghull Milit­ary Hospital near Liv­er­pool. Elliot-Smith and Pear argued that if the lessons of war were to be be­neficial, psycho­theraputic techniques would be essential.

Free mental health care began after WW1, when these doctors es­t­ab­lished clinics & hospitals that used tal­k­ing therapies to treat shell-shocked sol­diers. One of the first outpatient psycho-therapy units was the Tavistock Clinic Bl­oomsbury, opened in Sept 1920 by neur­ologist Hugh Crichton-Miller. By 1923, ev­ery Brit­ish gen­eral hospital would have its own psycho­ther­apeutic clinic.

In the mean­time, Crichton-Miller and six other doctors worked for free, treating early mental illness. Crichton-Miller was influenced by the writings of Freud and Jung and by then, the Tavi­st­ock had treated 2,500+ patients! Rather than being closed, it soon ex­panded to larger premises. The doctors wanted to bring modern treat­ments to those who could not afford special­ists’ fees.

  
Dr Helen Boyle had been one of the first doctors to focus on mental illnesses in women and children. A decade earlier in Brig­hton she had op­ened a 10-bed hosp­ital providing free in-patient care to wo­m­en. But in WW1 Dr Boyle had serv­ed as an army doctor in Serbia. When she ret­urned to UK in 1918, she attained fund­ing for a larger ver­s­ion of her hos­pital. Lady Chichester Hosp­ital for Treatment of Early Mental Dis­orders opened in 1920 in Hove. By 1928 it had grown to a 50-bed unit, with out­patient & community care, the only UK hospital then to provide such services. 

A range of practices was inspired by psycho-analytic theory. In 1917 Dr William Rivers introduced the talking-cure at Craig­lockhart Edin­burgh, an Officer Hospital. There were also attempts to promote talk therapy in men from the other ranks. The clinic at the Red Cross Hospital at Maghull Liverpool opened in Sept 1919, sup­p­orted by Dr Charles Myers who created the term shellshock, and Dr Rivers.

Lady Ida Darwin was a Cambridge activist who’d co-founded Cen­tral Association for Mental Welfare in 1913. In 1918 she organised a local com­mittee to set up an outpatient clinic at Ad­denbrooke’s Hos­pital Cambridge for the treatment of functional nervous dis­orders. But Cambrid­ge’s Prof of Physic, Sir Clifford Allbutt, was dis­missive of the new psychology and the clin­ic closed after 3 years. Nonethe­less Darwin, Crichton-Miller and Boyle continued on the committee of the new National Council for Mental Hygiene in London.

 

Shell-shocked soldier has electrotherapy from a nurse

War Hospital, Epsom

US National Museum of Health and Medicine

Humanitarian doctors like Boyle and Crichton-Miller were very unus­ual in dedicating their post-war medical careers to bringing prog­ressive mental health care to the community. But NB that it was not until the Mental Treatment Act of 1930 that provision was made to treat mentally ill civilians without certifying them in asylums.