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Shell shock was a term used to describe the reaction of soldiers in World War I to the trauma of battle. During the War, the concept shell-shock was ill-defined, with the term being used to describe physical, psychological and social or disciplinary problems. While the term 'shell shock' is no longer used in either medical or military discourse, it has entered into popular imagination and memory.

History

The name "shell shock" was given during World War I due to a belief at the time that the condition resulted from trauma to the nervous system caused by shock waves from artillery shells. The history of combat stress reactions has shown a remarkable variation and subvariation in the interest and knowledge of those whose tasks it has been to deal with them. Kardiner and Spiegel writing in 1947 stated:

The subject of neurotic disturbances consequent upon war has, in the past 25 years, been submitted to a good deal of capriciousness in public interest and psychiatric whims. The public does not sustain its interest, which was very great after World War I, and neither does psychiatry. Hence these conditions are not subject to continuous study...but only to periodic efforts which cannot be characterised as very diligent... Though not true in psychiatry generally, it is a deplorable fact that each investigator who undertakes to study these conditions considers it his sacred obligation to start from scratch and work at the problem as if no one had ever done anything with it before.

During the American Civil War two conditions, "soldier's heart" and "nostalgia", were basically CSRs. Various epidemics of psychological disorders (e.g. passengers with railway spine) were recognised in the 1800s.

The Russians in the Russo-Japanese War (1904-1905) were the first to specifically diagnose mental disease as a result of war stress and try to treat it. It was not until World War I that the high level of cases with "shell shock" (also referred to as traumatic war neurosis and neurasthenia) really surprised commanders and doctors.

World War I

In 1915 The British Army in France was instructed that:

Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it was due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe'. If, however, the man’s breakdown did not follow a shell explosion, it was not thought to be ‘due to the enemy’, and he was to labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension.

In August 1916 Charles Myers was made Consulting Psychologist to the Army. He hammered home the notion that it was necessary to create special centres near the line using treatment based on:

• Promptness of action.
• Suitable environment.
• Psychotherapeutic measures.

He also used hypnosis with limited success.

In December 1916 Gordon Holmes was put in charge of the northern, and more important, part of the western front. He had much more of the tough attitudes of the Army and suited the prevailing military mindset and so his view prevailed. By June 1917 all British cases of "Shell-shock" were evacuated to a nearby neurological centre and were labelled as NYDN – Not Yet Diagnosed Nervous". "But, because of the Adjutant-General’s distrust of doctors, no patient could receive that specialist attention until Form AF 3436 had been sent off to the man’s unit and filled in by his commanding officer." This created significant delays but demonstrated that between 4-10% of Shell-shock W cases were "commotional" (due to physical causes) and the rest were "emotional". This killed off shell-shock as a valid disease and it was abolished in September 1918.

During the war, 266 British soldiers were executed for "Desertion", 18 for "Cowardice", 7 for "Quitting a post without authority", 5 for "Disobedience to a lawful command" and 2 for "Casting away arms", some of whom may have been victims of shell shock. Controversially, on 7 November 2006 the government of the United Kingdom gave them all a posthumous conditional pardon.

Proximity by circumstance

Because of the delays AF 3436 was producing, medical officers started keeping their men in their units. This was perhaps the practical beginning of the concept of proximity. Col. Rogers, RMO 4/Black Watch wrote,

You must send your emotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the men and they know you and you know them (and there is a good deal more in the man knowing you than in you knowing the man) … you are able to explain to him that there is really nothing wrong with him, give him a rest at the aid post if necessary and a day or two’s sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him.

Cultural references

Author Pat Barker explored the causes and effects of shell shock in her Regeneration Trilogy, basing many of her characters on real historical figures and drawing on the writings of the first world war poets and the army doctor W. H. R. Rivers.

See also

• Combat stress reaction
• Posttraumatic stress disorder

References

1. ^ Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914-1994. London, Jonathan Cape, 2000.
2. Taylor-Whiffen, Peter (2002-03-01). "Shot at Dawn: Cowards, Traitors or Victims?".
3. "War Pardons receives Royal Assent". ShotAtDawn.org.uk. Archived from the original on 2006-12-06.