Running head: SHELL-SHOCK 1

Shell-shock in history and the imagination

Anna-Maria Mazy

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Shell-shock in history and the imagination

— These are men whose minds the Dead have ravished. Memory fingers in their hair of murders, Multitudinous murders they once witnessed.... Always they must see these things and hear them, Batter of guns and shatter of flying muscles, Carnage incomparable and human squander Rucked too thick for these men's extrication (Owen, 1918).

The article chosen was "War psychoses occurring in cases with a definite history of

shell shock" by Eager (1918): and it was selected because it is fundamental to the study of

shell-shock. When I began this historical reaction paper I had assumed that shell-shock was

a term for a condition much like (if not identical) to PTSD today. It was not until I read this

article and researched further that I found the term shell-shock was originally used to

describe a reaction to shell explosion - and with a distinct set of symptoms. The use of the

term later become muddied and clouded in the popular imagination, and in the process

moving from a way to describe a psychological condition into a metaphor for trauma. This

paper will focus primarily on Eager's (1918) article and consider the use of shell-shock as a

term within the period and the years immediately afterwards.

Eager was a medical officer in charge of the mental division of a British war hospital

during World War I. He examined over 4000 soldiers and described many cases of soldiers

being exposed to shell explosions and developing what was called 'war psychosis' or 'shell-

shock' (Eager, 1918). The most common symptoms of this war psychosis (according to

Eager) were described as amnesia, melancholia, mental confusion, delusions and

hallucinatory disturbances. Eager believed the primary predisposing cause of this

condition was fear. Fear, he theorized, combined with the prevailing conditions in trench

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warfare contributed to the development of shell shock. Eager also proposed that shell

explosions, existing conditions (such as lack of sleep, cold, wet, and the 'appalling sights at

the front') and even personality variables combined to create shell shock.

This article is one of the first clinical accounts of shell shock: which makes it worthy

of study; it is also interesting because the case presentation by Eager is strikingly modern

in format. Firstly, Eager also does a differential diagnosis between shell shock and 'general

paralysis of the insane'. Secondly, he rules out the effect of medical conditions such as

hypothyroidism and finally he considered a patient's family history. It is also worth noting

that the term 'shell-shock' was used diagnostically during a discreet period: essentially

during World War I. As it will be seen, by the end of the war this term had broadened out in

the popular imagination and was subsequently replaced with terms such as 'battle fatigue'

by the military.

Even before the first world war the industrial revolution in England saw the rise of

traumatic civilian incidents such as railway accidents: and the term 'traumatic neurosis'

was created to describe emotional responses to such incidents (Crocq & Crocq, 2000).

There was some debate in the medical community over the use of this term and whether it

simply described what was then called either ‘hysteria’ or ‘neurasthenia’ (Crocq & Crocq).

Neurasthenia was a term used to describe a rather mysterious condition which had

symptoms of fatigue, muscle weakness, anxiety, headache, neuralgia and depressed mood

(Taylor, 2001). While trauma in civilian life was recognized, it was not until the Russo-

Japanese war that post-battle psychiatric symptoms were officially recognized for the first

time (Crocq & Crocq). The German physician Honigman who served in this war coined the

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term 'war neurosis' for what had previously been dismissed as just 'combat hysteria' or

'combat neurasthenia' (Crocq & Crocq). Honigman also stressed the similar symptomology

in these military cases and the civilian cases of railway trauma (Crocq & Crocq).

What probably contributed to this recognition of combat related trauma in the first

world war was that coincided with the rise of psychotherapy and the use of scientific

psychology (Crocq & Crocq). Psychiatric casualties were reported early in this war and

were initially called 'battle hypnosis'. In the autumn of 1914 newspapers began to write of

the uncanny effect of shells (Bogasz, 2008). Such early references to shell-shock in the

press referred to a mysterious malady of physiological origin which somehow sucked the

life from its victims (Bogasz). As the number of cases of breakdown increased it became

more widely recognized and in 1915, in the Lancet, Dr Charles Myers labeled the term

shell-shock (Feu, 2009). Dr. Myers also reported three cases of soldiers who had been

shocked by shells exploding in their vicinity who presented with symptoms of loss of

memory, vision, smell and taste (Crocq & Crocq). In 1915 a clearer picture of this

mysterious condition began to emerge and it started to become obvious that artillery shells

alone were not responsible for the increasing numbers of breakdowns in France (Bogasz).

Even early in the war professionals started to recognize that fright, emotional shock and

seeing colleagues maimed were a major factor in the development of psychological

symptoms (Crocq & Crocq).

Interestingly the symptoms of shell-shock as originally described resemble mild

Traumatic Brain Injury (mTBI): such as headache, dizziness, insomnia, impaired memory

and/or lowered tolerance for noise and light (Bhaattacharjee, 2008). Additionally many

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cases of PTSD have symptoms such as depression, irritability and attention deficit which

overlap with mTBI and with these original symptoms of shell-shock (Bhaattacharjee).

Veterans with history of blast trauma were much more likely to have later cognitive and

behavioral abnormalities (Bhaattacharjess). In most cases of mTBI the patient returns to

normal functioning in a few months but some may experience lingering symptoms

(Summarall). These symptoms can be grouped into three categories: somatic (headache,

tinnitus, insomnia, etc.), cognitive (memory, attention and concentration difficulties and

emotional/behavioral (irritability, depression, anxiety, behavioral dyscontrol)

(Summarall). In the Boston Transcript of 1915 it was proposed that when a big shell

explodes it creates a sudden and very great pressure in the surrounding air. This pressure

causes "shell shock" from which thousands of soldiers suffered during the war. Though

there was not the slightest sign of a bruise or injury in any way, men were been completely

incapacitated for months after a big shell has burst near them (The Boston Transcript). At

the time this was written doctors lacked the technology to prove that exposure to a shell

blast caused symptoms, it is only now we can provide some evidence of a connection.

In 1916 the Observer reported that shell shock was a nervous injury rather than

physical: and that it may be due to a large number of factors in which shell explosions may

have played a part. The commonest form was said to be concussion due to being close to an

explosive shells, the concussion may cause amnesia (The Observer, 1916). Even in 1916 the

Observer's writers acknowledged that this nervous injury might not always be attributable

directly to a shell, there may be a number of other conditions which were all being labelled

as shell-shock. Clark, as reported in the New York Times in 1918 said a man was described

as suffering from shell shock when his nervous system was so disorganized as to prevent a

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return to a normal life. Clark reported that there were cases of so-called 'shell-shock' where

the patient never heard a shell explosion at close range. He attributed such cases to the

intense nervous strain which preceded battle (Clark, 1918). He also said such conditions

may come from fear producing a state of 'hysteria' commonly diagnosed as malingering

(Clark). Clark used the term to cover any bad case of nervous disorder directly brought

about by participation in the war. In 1921 Cumming in the New York Times reported that

the term shell shock is a misnomer. It was coined by the British early in the war when it

was thought that the presence of a nervous injury was due to physical injury caused by

exposure to shell blasts (New York Times, 1921). Even in 1921 Cumming reported that this

was proved to be incorrect: that while shell-shock sometimes occurred following blast

exposure in rare cases in most cases it was thought to be an attempt to escape the trauma

of war (New York Times, 1921). By this time, as it will be seen, shell shock had moved from

being a description of a physical disorder to a mental: and ultimately became a label to

describe the horrors of the war (New York Times, 1921).

Shell-shock as a nervous condition was ultimately to cause significant impact on

society (Bogacz, 2008). At the time of World War I, men and women had defined roles in

society: for example, notions of masculinity meant that men were expected to be physically

and psychologically strong (Feu, 2009). Men who became soldiers were considered brave

and manly; entering into war enabled a man to show his masculinity (Feu, 2009). As a

result, it was widely held before 1914 that war was the supreme test of character and will

(Bogacz). There was a common belief in the armed forces that training the will-power of

the English solider would allow them to overcome any material obstacle (Bogacz). These

values lead to a belief in mental illness: the attitude towards the hysteric or neurasthenic

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was one of condemnation for their weakness (Bogacz). Consequently, physicians stressed

discipline and punishment as treatment methods for mental illness. Many English placed a

heavy burden on shame on anyone who broke down and believed anyone above the rank of

Corporal had too much dignity to become hysterical (Bogacz). Those disabled by war were

therefore seen as different from disabled civilians. These ideas of masculinity also had an

impact on rehabilitation of shell-shock sufferers (Feu). Men were expected to repress their

emotions, and those who broke down, or cried, or admitted to feeling fear were sissies,

weaklings, failures (Feu). When men began to suffer mental breakdown early on in the war,

doctors were perplexed and diagnosed these men as insane, sending them to lunatic

asylums with little chance of recovery.

A measure of the importance of shell-shock is the reaction of the English

government and army (Bogasz). By July 1918 there were six special army neurological

hospitals for officers and thirteen for other ranks (Bogasz). By the armistice the army was

concerned about wastage and the effect on morale of shell-shock (Bogasz). The government

was drawn in since it needed to create military mental hospitals and provide pensions for

disabled soldiers. The medical profession was involved in debate over the validity of

mental explanations of war neurosis and the public had been bombarded with an array of

stories about war neurosis for the length of the war (Bogasz). There was additional debate

over whether men who had been charged with cowardice and often executed had actually

been shell-shock victims and thus unfairly sentence to death (Bogasz). The war committee

of 1922 met to debate these issues. There was considerable dissent over the origins of

'shell-shock': to what extent there was a physiological basis; whether there were organic

wounds; and whether there was an emotional basis (Bogasz). There was much ambivalence

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over the mental explanation of shell-shock: in light of the numbers of men killed in the war

many found it difficult to forgive those who had seemingly faltered in their duty (Bogasz).

Ultimately the committee was unable provide definite conclusions and was forced to

recognize that shell-shock challenged some of their fundamental conclusions as to how a

man should act (Bogasz). Shell-shock was no respecter of class or background: everyone

was vulnerable (Bogasz).It stressed the difficulty in determining whether someone had a

genuine mental breakdown or was malingering. Ultimately the war committee determined

that there should be a suspension of the moral code in terms of cowardice: that seeming

cowardice might be beyond an individuals' control (Bogasz). This shows the power of the

shell-shock phenomenon. to undermine traditional values.

Even at the time when the war committee met the term 'shell-shock' had begun to

lose much of its original meaning. In the Observer in 1920, the writers stated the world was

suffering from a nervous disorder and that the war's explosion had left the nation's

sufferers in varying degrees of shell-shock. In the Manchester Guardian of 1920 the writers

already referred to the people of Paris suffering shell-shock from having witnessed enemy

gunfire at night. In the Irish Times of 1922 the War Office was quoted as saying the term

shell-shock is to be abolished since the term was too vague and had come to imply in the

public mind any condition that arose during the war (The Irish Times, 1922). Shell shock

ultimately was a term that moved from the medical world to the metaphysical (Winter). It

began as a label for a precise set of medical symptoms: this then broadened to become a

term to describe the war itself (Winter). As a result the original meaning was lost within a

few years and later the term passed into the common vernacular as a phrase to describe

any traumatic reaction. Well before World War II the term 'shell-shock' no longer had much

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of its original meaning and was replaced by the term 'battle fatigue': a term that has been

updated and replaced as times have changed.

Shell-shock began as a label for a mysterious set of symptoms: a condition that

affected not only the ability of a soldier to function but ultimately affected British notions of

manhood. Shell-shock and mental breakdown seemed a betrayal of values that the public

and military held dear: such as courage and self-sacrifice. As a condition that respected no

class, rank or cultural divisions it forced a reappraisal of the very concepts of manhood.

Eager's paper was fundamental to the study of this disorder: which may only have been

considered as a valid diagnosis for a brief time but entered the popular imagination in a

way that could not have been anticipated at the time. It is a term that is still used today,

but not as it was originally conceived: and 'shell-shock' as a physical and mental condition

had enduring effects in England and the Western World.

No doubt they'll soon get well; the shock and strain Have caused their stammering, disconnected talk. Of course they're "longing to go out again,"-- These boys with old, scared faces, learning to walk, They'll soon forget their haunted nights; their cowed Subjection to the ghosts of friends who died,-- Their dreams that drip with murder; and they'll be proud Of glorious war that shatter'd all their pride ... Men who went out to battle, grim and glad; Children, with eyes that hate you, broken and mad (Sassoon, 1917).

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Eager, R. (1918). War psychoses occurring in cases with a definite history of shell shock.

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Photo, M. S. (1918, Jun 16). Preparing to care for shell-shocked men. New York Times (1857-

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