Special Report

The Shock of War

World War I troops were the first to be diagnosed with shell shock, an injury – by any name – still wreaking havoc

Most of the 9.7 million soldiers who perished in WWI were killed by the conflict's unprecedented firepower. Many survivors experienced acute trauma. (Hulton Archive / Getty Images)
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Their common status as officers notwithstanding, the men came from many backgrounds. Lt. R. C. Gull had been educated at Eton, Oxford and Sandhurst before receiving his commission in November 1914, for example, while Lieutenant Hayes, of the Third Royal Sussex Regiment, had been born in London, educated in England and Switzerland, and had emigrated to Canada, where he had been engaged in “Business & Farming” before the war. The officers had been Australian station managers, chartered accountants, partners in banking firms and, intriguingly, “a trader and explorer in Central Africa.” The men had seen action in many campaigns, on many fronts, including the Boer War. A number had served at Gallipoli, and all too many had been injured on the Western Front.

Life at Lennel was conducted in the familiar and subtly strict routine of the well-run country house, with meals at set times, leisurely pursuits and tea on the terrace. Lady Clementine’s family mixed freely with the officer guests, her youngest daughter, “Kitty,” who was only 1 year old when the war broke out, being a special favorite. Kept busy throughout the day with country walks, chummy conversation, piano playing, table tennis, fishing, golfing and bicycling, and semiformal meals, each officer nonetheless retired at night to his private room and here confronted, starkly and alone, the condition that had brought him this peaceful interlude in the first place.

“Has vivid dreams of war episodes—feels as if sinking down in bed”; “Sleeping well but walks in sleep: has never done this before: dreams of France”; “Insomnia with vivid dreams of fighting”; and “Dreams mainly of dead Germans...Got terribly guilty conscience over having killed Huns.”

The terse medical case notes, averaging some three pages per patient, introduce each officer by name and age, cite his civilian address as well as regiment and service details, and include a brief section for “Family History,” which typically noted whether his parents were still alive, any familial history of nervous disorders and if a brother had been killed in the war. Education, professional life and an assessment of the officer’s temperament before his breakdown were also duly chronicled. Captain Kyle, for example, age 23 and in service for three years and three months at the time of admittance to Lennel had previously been a “Keen athlete, enjoyed life thoroughly, no nerves.” Brigadier General McLaren had also been “Keen on outdoor sports”—always the benchmark of British mental health—but had “Not very many friends.”

Many treatments abounded for the neurasthenic soldier. The most notorious were undoubtedly Dr. Lewis Yealland’s electric shock therapies, conducted at the National Hospital for Paralysed and Epileptic, at Queen Square, London, where he claimed his cure “had been applied to upwards of 250 cases” (an unknown number of which were civilian). Yealland asserted that his treatment cured all the most common “hysterical disorders of warfare”—the shaking and trembling and stammering, the paralysis and disorders of speech—sometimes in a single suspect half-hour session. Electric heat baths, milk diets, hypnotism, clamps and machines that mechanically forced stubborn limbs out of their frozen position were other strategies. As the war settled in, and shell shock—both commotional and emotional—became recognized as one of its primary afflictions, treatment became more sympathetic. Rest, peace and quiet, and modest rehabilitative activities became the established regimen of care, sometimes accompanied by psychotherapy sessions, the skillful administration of which varied from institution to institution and practitioner to practitioner.

While the officers at Lennel were clearly under medical supervision, it is not evident what specific treatments they received. Lady Clementine’s approach was practical and common-sensical. She was, according to her grandson Sir Ilay, an early advocate of occupational therapy—keeping busy. Painting, in particular, seems to have been encouraged, and a surviving photograph in a family album shows Lennel’s mess hall ringed with heraldic shields, each officer having been instructed by Lady Clementine to paint his family coat of arms. (And if they didn’t have one? “I expect they made one up,” Sir Ilay recalled, amused.) But beyond the nature of the men’s treatment, of course, was the larger, central, burning question of what, really, was the matter.

The symptoms recorded in the case notes, familiar from literature of the time, are clear enough: “palpitations—Fear of fainting...feeling of suffocation, of constriction in throat”; “Now feels worn out & has pain in region of heart”; “Depression—Over-reaction—Insomnia—Headaches”; ner­­vousness, lassitude, being upset by sudden noise”; “Patient fears gunfire, death and the dark...In periods of wakefulness he visualizes mutilations he has seen, and feels the terror of heavy fire”; “Depressed from incapacity to deal with easy subjects & suffered much from eye pain.” And there is the case of Second Lieutenant Bertwistle, with two years of service in the 27th Australian Infantry, although only 20 years of age, whose face wears a “puzzled expression” and who exhibits a “marked defect of recent and remote memory.” “His mental content appears to be puerile. He is docile,” according to the records that accompanied him from the Royal Victoria Military Hospital in Netley, on England’s south coast.

The official Report of the War Office Committee of Enquiry Into “Shell-Shock” made at war’s end gravely concluded that “shell-shock resolves itself into two categories: (1) Concussion or commotional shock; and (2) Emotional shock” and of these “It was given in evidence that the victims of concussion shock, following a shell burst, formed a relatively small proportion (5 to 10 per cent).” The evidence about damage from “concussion shock” was largely anecdotal, based heavily upon the observations of senior officers in the field, many of whom, veterans of earlier wars, were clearly skeptical of any newfangled attempt to explain what, to their mind, was simple loss of nerve: “New divisions often got ‘shell shock’ because they imagined it was the proper thing in European warfare,” Maj. Pritchard Taylor, a much-decorated officer, observed. On the other hand, a consultant in neuropsychiatry to the American Expeditionary Force reported a much higher percentage of concussion shock: 50 percent to 60 percent of shell shock cases at his base hospital stated they had “lost consciousness or memory after having been blown over by a shell.” Unfortunately, information about the circumstances of such injuries was highly haphazard. In theory, medical officers were instructed to state on a patient’s casualty form whether he had been close to an exploding shell, but in the messy, frantic practice of processing multiple casualties at hard-pressed field stations, this all-important detail was usually omitted.

Case notes from Lennel, however, record that a remarkable number of the “neurasthenic” officers were casualties of direct, savage blast force: “Perfectly well till knocked over at Varennes...after this he couldn’t sleep for weeks on end”; “He has been blown up several times—and has lately found his nerve was getting shaken.” In case after case, the officer is buried, thrown, stunned, concussed by exploding shells. Lieutenant Graves had gone straight from Gallipoli “into line & through Somme.” In fighting around Beaumont Hamel in France, a shell had landed “quite close & blew him up.” Dazed, he was helped to the company dugout, after which he “Managed to carry on for some days,” although an ominous “Weakness of R[ight] side was developing steadily.” Ironically, it was precisely the soldier’s ability “to carry on” that had aroused skepticism over the real nature of his malady.

The extent to which blast force was responsible for shell shock is of more than historic interest. According to a Rand Corporation study, 19 percent of U.S. troops sent to Iraq and Afghanistan, about 380,000, may have sustained brain injuries from explosive devices—a fact that has prompted comparisons with the British experience at the Somme in 1916. In 2009, the U.S. Defense Advanced Research Projects Agency (DARPA) made public the results of a two-year, $10 million study of the effects of blast force on the human brain—and in doing so, not only advanced the prospect of modern treatment but cast new light on the old shell shock conundrum.


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