The study revealed that limited traumatic brain injury (TBI) may manifest no overt evidence of trauma—the patient may not even be aware an injury has been sustained. Diagnosis of TBI is additionally vexed by the clinical features—difficulty concentrating, sleep disturbances, altered moods—that it shares with post-traumatic stress disorder (PTSD), a psychiatric syndrome caused by exposure to traumatic events. “Someone could have a brain injury and be looking like it was PTSD,” says Col. Geoffrey Ling, the director of the DARPA study.
Differentiation between the two conditions—PTSD and TBI, or the “emotional” versus “commotional” puzzle of World War I—will be enhanced by the study’s most important find: that at low levels the blast-exposed brain remains structurally intact, but is injured by inflammation. This exciting prospect of a clinical diagnosis was presaged by the observation in World War I that spinal fluid drawn from men who had been “blown up” revealed changes in protein cells. “They were actually pretty insightful,” Ling says of the early medics. “Your proteins, by and large, are immunoglobulins, which basically are inflammatory. So they were ahead of their time.”
“You can never tell how a man is going to do in action,” a senior officer had observed in the War Office Committee report of 1922, and it was this searing truth of self-discovery that the patients at Lennel feared. They were betrayed by the stammering and trembling they could not control, the distressing lack of focus, their unmanly depression and lassitude. No list of clinical symptoms, such as the written records preserve, can do justice to the affliction of the shellshocked patient. This is more effectively evoked in the dreadful medical training films of the war, which capture the discordant twitching, uncontrollable shaking and haunting vacant stares. “Certainly one met people who were—different,” Sir Ilay recalled gently, speaking of damaged veterans he had seen as a boy, “and it was explained of their being in the war. But we were all brought up to show good manners, not to upset.”
Possibly, it was social training, not medical, that enabled Lady Clementine to assist and solace the damaged men who made their way to Lennel. If she was unsettled by the sights and sounds that filled her home, she does not seem to have let on. That she and her instinctive treatment were beneficial is evident from what is perhaps the most remarkable feature of the Lennel archive—the letters the officers wrote to their hostess upon leaving.
“I am quite unable adequately to express my gratitude to you for your kindness and hospitality to me,” wrote Lieutenant Craven, as if giving thanks for a pleasant weekend in the country. Most letters, however, run to several pages, their eager anecdotes and their expressions of anxieties and doubt give evidence of the sincerity of the writer’s feeling. “I got such a deep breath of ‘Lennel,’ while I was reading your letter,” wrote one officer from the Somme in December 1916, “& I’ll bet you had your tennis shoes on, & no hat, & a short skirt, & had probably just come in from a walk across the wet fields”; “Did you really and truly mean that I would be welcome at Lennel if I ever get the opportunity for another visit?” one officer asked yearningly.
A number of the letters are written from hotels while awaiting the results of medical boards. Most hoped for light duty—the dignity of continued service but without the dreaded liabilities. “The Medical Board sent me down here for two months light duty after which I must return to the fray!” writes Lieutenant Jacob, and, as a wistful postscript; “Did you ever finish that jolly Japanese puzzle picture?!” For some, the rush of the outside world came at them too fast: “I have been annoyed quite a lot at little things & my stammer has returned,” one officer confided. Several write from other hospitals; “I had not the remotest idea of how & when I came here,” Lieutenant Spencer wrote to Lady Clementine. “I do not know what really happened when I took ill but I do sincerely hope that you will forgive me if I was the cause of any unpleasant situation or inconvenience.”
At war’s end, the legions of shellshocked veterans dispersed into the mists of history. One catches glimpses of them, however, through a variety of oblique lenses. They crop up in a range of fiction of the era, hallucinating in the streets of London, or selling stockings door to door in provincial towns, their casual evocation indicating their familiarity to the contemporary reader.
Officially they are best viewed in the files of the Ministry of Pensions, which had been left with the care of 63,296 neurological cases; ominously, this number would rise, not fall, as the years passed, and by 1929—more than a decade after the conclusion of the war—there were 74,867 such cases, and the ministry was still paying for such rehabilitative pursuits as basket making and boot repairing. An estimated 10 percent of the 1,663,435 military wounded of the war would be attributed to shell shock; and yet study of this signature condition—emotional, or commotional, or both—was not followed through in the postwar years.
Following the Great War, Major Waring served as Parliamentary private secretary to Winston Churchill. For her work at Lennel House, Lady Clementine was made a Commander of the British Empire. She died in 1962, by which time the letters and papers of her war service were stored in the Lennel House basement; there may be other country houses throughout Britain with similar repositories. Lennel House itself, which the family sold in the 1990s, is now a nursing home.
The fate of some officers is made evident by Lady Clementine’s correspondence: “Dear Lady Waring...my poor boys death is a dreadful blow and I cant realize that he has gone forever....Oh it is too cruel after waiting three long weary years for him to come home.” Very occasionally, too, it is possible to track an officer through an unrelated source. A photograph that had been in the possession of Capt. William McDonald before he was killed in action in France, in 1916, and which is now archived in the Australian War Memorial, shows him gathered with other officers on the Lennel House steps, with Lady Clementine. Some later hand has identified among the other men “Captain Frederick Harold Tubb VC, 7th Battalion of Longwood,” and noted that he died in action on 20 September 1917; this is the same “Tubby” who had written to Lady Clementine a month earlier, at the completion of an 11-hour march, heading his letter simply “In the Field”: “An aeroplane tried to shoot us last night with a m[achine] gun besides dropping sundry bombs around. It rained a heavy storm last night. It is raining off an[d] on today. The weather is warm though. My word the country round here is magnificent, the splendid wheat crops are being harvested....”