Fiona Reid,
Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30
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.
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.
The Eyes Of Madness,
France, Sept 1916
Vintag
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
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.
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24 comments:
This sounds like something I would like, I like listening to audiobooks many about both world wars and such
This is quite interesting. So, UK has mental treatment act done in 1930 long before Australia's mental health act.
It was difficult understanding what caused some panic-stricken men to suffer extremes of trauma. Early in WW1, shell shock was believed to be the result of a physical injury to the nerves. As a consequence, medical officers increasingly began emphasising psychological factors as providing sufficient cause for breakdown. The President of the British Psycho-Analytic Association, Ernest Jones, wrote war constituted 'an official abrogation of civilised standards' in which men were encouraged to indulge in behaviour of a kind that is throughout abhorrent to the civilised mind. Previously forbidden, cruel, sadistic, murderous and hidden impulses, are stirred to greater activity, and the old intra-psychical conflicts which, according to Freud, are the essential cause of all neurotic disorders. The person is compelled to deal with them afresh under totally different circumstances.'
Shell Shock during World War One
BBC
This is an interesting little history. Also interesting is that in modern times a century later, we know how to protect the mental health of soldiers on the battlefront, and treat them if they do succumb. No? We haven't even learnt how to protect the mental health of foreign war correspondents, although efforts are being made.
I'm sure those pioneering doctors had to fight against the thinking that cowardice was the cause of the invisible ills. So many on the battlefield were shot instead of being helped.
Jo-Anne
I agree. Every so often there are references to interesting books that you would not have known about, except for occasional blog posts. Fiona Reid's book, "Broken Men: Shell Shock, Treatment and Recovery in Britain 1914-30" is one of those books.
roentare
shame, Australia, shame :( The Mental Health Act 1962 was amended and finally came into force in 1966.
Even worse, Australia had no conscription in WW1 and should have been very supportive and proud of those volunteers who survived and returned after the truce. To ridicule mentally damaged survivors as malingerers was 1] medically dangerous and 2] not showing national gratitude to volunteers.
Andrew
Psychological trauma experienced in WW1 had an unprecedented weight on ex-servicemen, often suffering for the rest of their lives eg from distressing memories that ex-soldiers couldn't forget.. to extreme episodes of catatonia and terror when reminded of their trauma. They couldn't work, lost their wives and children, and had screaming nightmares every night.
One young Australian soldier was ordered to shoot all German soldiers dead, as soon as they surrendered with their hands in the air. He knew it was obscene but he had no choice. And he had to live with his behaviour for ever, _never_ looking at a male again face to face.
jabblog
even today I imagine that orthopaedics, Ears Nose Throat, urology, dermatology etc are still highly prestigious fields of medicine where junior doctors in hospitals can consult or refer patients to. But imagine in 1914-25 when psychiatry was either not valued or not available to soldiers sent to hospitals. No wonder psychiatric disturbances were misunderstood or ignored.
Joanna
Many thanks. "Previously forbidden, cruel, sadistic, murderous and hidden impulses, are stirred to greater activity, and the old intra-psychical conflicts which, according to Freud, are the essential cause of all neurotic disorders". Interesting, isn't it? I am not sure that soldiers participated in sadistic, murderous impulses from _choice_. If they did, they may not have suffered from war neuroses as badly as those who were _ordered_ to behave immorally.
But then war is always obscene and choice doesn't mean much.
Excellent that the Central Association for Mental Welfare set up an outpatient clinic at Ad¬denbrooke’s Hospital Cambridge late in the war for nervous disorders. But how telling that Cambridge’s Prof of Physic distrusted the clinic and its medicine, and closed it down.
Joe
Sir Clifford Allbutt was appointed Commissioner in Lunacy well before the war, doing his work at the asylum as a medical consultant. He promoted the integration of the management of mental illness into medical practice at large, and the teaching of clinical and theoretical aspects of mental illness to students at Leeds School of Medicine. So he wasn’t dismissive of psychiatry, but he did want it delivered his way.
Hello Hels, What awful experiences all soldiers underwent, and often how little support they received after the initial ticker-tape welcome home parade. As you know, I collect old letters, and during the 19th century, although we might think of depression as a newer problem, parents were constantly advising their (away at school) children to avoid low spirits at all costs. Your post thus brings up some questions, such as incidence of similar mental shocks in other wars, including the American Civil War, because of new technologies the first of the "modern" wars. As you pointed out, treatment of shell-shocked soldiers has to be fitted into the timeline of mental health treatment, for which WWI was kind of the hinge pin between the old asylums and the new treatments--psychoanalytic, drug and even electric and surgical (as we remember from your post on Rose Kennedy!).
--Jim
jim
many thanks for a thoughtful response. I agree that timing was critically important, given that 1914 and on were the key years in the change from the old asylums to the new psychiatric treaments. But my argument remains: if a nation sends its young men away, ends their education, causes them to lose their jobs, breaks up their families and pays for their burials, that nation must look after survivors with honour.
Boa tarde minha querida amiga. Obrigado pela excelente matéria e aula de história. Bom início de semana.
Luiz
the history lesson is still important, yes. I am never sure that people receive the complete mental health care they need, whether we are faced with shell shock or post-traumatic stress disorder/PTSD.
I do believe we're waiting for the big breakthrough in an understanding of mental illness which will make sense of our various observations and efforts to help so far.
Jenny
I agree. I have seen report after report on the mental ill health of soldiers, throughout the 20th century. So the 1914-8 war was only the start of a long learning process.
Or perhaps asking young soldiers to kill other soldiers and civilians is always doomed to mental crisis.
When reading this I think of my great grandfather who got a bullet in the head and was forever after a psychological basket case who was very difficult for his wife and children after having been a nice man who worked as a master baker before being called up . His wife and children ,like many at that time, stayed out of loyalty and recognition that his suffering and war experiences were horrendous and they felt they owed him their support . And so the war trauma rolls on . The biblical saying about the sins of the fathers being visited unto the children is truer than we ever knew especially now we are starting to understand epigenetics .
mem
Yes I have heard that story from others of our generation and it is still a heart breaker. Your ancestor, when he was young and loving, volunteered to serve his nation and miraculously survived. But at what price? A bullet in the head, long lasting psychological damage, an alienated wife and children, unemployment and often poverty etc etc. He needed endless support, not community resentment.
This is really interesting. I think it is something world leaders who can see beyond their own egos should read about. I didn't know about all the "issues" after WWI until recently. In fact, we hardly learned about that war at all in school. Not only are the injuries from that war very tragic, but it is sad how little it is/was taught. Thanks for sharing this book with us.
Erika
Children here always had an ANZAC Day memorial service in their schools and were taken in a school bus to the Shrine of Remembrance each year. So there was never a problem teaching history in school and honouring the thousands of Australian, New Zealanders, South Africans and Indians who were buried in Europe.
But you are right. The soldiers we knew nothing about were those who came home after the 1914-8 war but was so damaged they lost their wives and children, were unemployable and medical care was grossly inadequate.
When chlorpromazine/Thorazine became available in the iarly 1950s, many shellshockees--some from WW1--were broughtout of it and made able to again communicate. That drug emptied American asylums and a side effect made a song about Purple People Eaters part of pop culture.
Hank
“It was a one-eyed, one-horned, flying purple people eater” :)
I suppose that, after the anti-psychotic drug Thorazine was first prescribed to individuals diagnosed with schizophrenia after WW2, it was an accidental finding re shell shock. Especially in older men. But sometimes the best results were sometimes unpredictable. And emptying asylums for the mentally ill, after anti-psychotic medications were introduced, was an amazing event. Not as good for the spouses and children at home, necessarily.
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