The mass warfare exerted during the First World War is documented as the epitome of medical, psychological and technological innovation at the cost of tumultuous bloodshed. During this time, the combatants underwent excessive mental trauma as a result of the conditions in which they were made to live in. The degree to which their treatment was performed depended heavily upon the attitude of not only the doctors, but also the military and the government, as a result not only affecting the soldiers, but also the entire nation.
The soldiers that participated in the Great War were familiar of the physical dangers that came along side combat and trench warfare, however most of them were oblivious to the mental effects that are spawned during a state of war. Shell shock was one such psychological disorder that originated during the time of war. This disorder primarily aroused as a result of the shell blasts and ‘intense artillery battles that were fought along the muddy trenches causing neurotic cracks to appear in otherwise mentally stable soldiers’. Furthermore, the burden of having to survive under filthy and inhumane circumstances (blood and fecal matter besieged the trenches during World War One) in the trenches coupled with the soldier’s inability to obtain adequate rest dehumanized them, not so much in the ‘mechanical’ or ‘industrialized’ sense as much as its ‘primitive’ features. As a consequence, life in the trenches was demarcated, thus redefining not only the physical, but also the mental boundaries for the men living in it. Soldiers were made to witness their fellow comrades being mutilated and in worse cases, slaughtered causing them to undergo severe shock. Those that later survived the horrors of The Great War were plagued with survivor’s guilt syndrome. As a result of the exposure to such traumatising events, the mind and the body is unable to work cohesively, therefore, restricting a soldier’s ability to fight effectively, whether it is in the offensive or defensive, thus influencing the army’s dexterity to defeat the enemy in battle.
Shell shock drastically diminished the will power in a soldier causing him to descend into a state of depression, consequently, influencing him to resort to self-medication. W. H. R. Rivers, a notable British neurologist and psychiatrist, asserted that it was a natural tendency for soldiers that suffered from shell shock to apply a technique called ‘repression’, wherein they would ‘thrust aside the painful memories of war as if they were avoiding a dangerous or horrible event’ altogether. The soldiers strongly believed that all the distressing memories of war would cease to exist if they applied this method, enabling their mind and body to function normally. However, this treatment did exactly the opposite. The symptoms of shell shock were triggered and exacerbated when the soldier was placed in a situation even remotely similar to that of the war. Rivers claimed that ‘repression may take an active part in the maintenance of war neurosis,’ directly affecting the morale of a soldier. The men at war also were able to vent out their frustrations and fears by writing poems and memoirs enabling them to better cope with their trauma through artistic expression without being accused of being effeminate. The third, and most common, technique soldiers ultimately resorted to self-inflicting wounds by shooting themselves in either their hand or foot. The purpose of this was to escape from the trauma caused by excessive violence during wartime. However, according to the military, this was regarded as a grave offense. The punishment for this offense was death – ‘cowardice shooting’.
Military norms had established a relationship between cowardice and shell shock. The term ‘coward’ was often used to describe the men who were incapable of hiding their fears while at the front, despite their attempts to do so. Exhibiting fear, especially during war, was regarded as a sign of ‘mental and moral infirmity and “pathologised” as a potential symptom of psychological instability’. Fear was primarily aggravated by ‘immobility,’ as opposed to intensive combat, as long hours in the trenches, particularly under bombardment, gave men a chance to ponder over their future. Fear was regarded as the principal reason for both cowardice and shell shock. Hence, at the time, the military had claimed cowardice to essentially be a ‘failure of character’. According to certain military ideologies, the men participating in The Great War were to regard it as an ‘invigorating male experience’ that would revive and even ‘re-masculinize’ them (a man’s virility, along with his patriotism, could only be vindicated by his ability to control his emotions by suppressing the need to express fear or distress. A man who fell victim to shell shock was regarded as feminine, as he was not in complete control of his emotions), while simultaneously reconstructing a deteriorating society. Soldiers were obligated by the military to reinstate their masculinity by abiding by ‘old male codes of honour and military virtues such as personal courage and heroism, but the war laid courage, heroism, honour and masculinity to waste’. Interestingly enough, the 2nd September 1922 issue of ‘The Times’ professed that the ‘members of the shell shock committee had failed to clearly define cowardice’, therefore, it could never have been identified whether those who were subjected to ‘cowardice shooting’ were genuinely a victim of shell shock or not.
Doctors struggled to understand the role of war with regards to war neurosis; as a result they formulated several theories that could have been potential solutions for this conundrum. Majority of the doctors claimed such cases to be fraudulent. In an attempt to prevent wartime ‘malingering,’ (the idea that soldiers were pretending to be a victim of war neurosis, when in actuality they were just faking their symptoms) the military authorities proclaimed that doctors should view all cases of shell shock with suspicion; consequently ‘punishments were thinly disguised as treatments’. By providing treatments such as electric shocks doctors were able to single out the men that were bluffing. Similarly, Joseph Babinski, a French neurologist, claimed that shell shock developed from ‘false suggestions implanted in the minds of patients’ as opposed to ‘organic lesions,’ therefore it could not have affected the nervous system. Babinski claimed the appropriate form of treatment was for an ‘authoritarian doctor’ to make ‘strong counter suggestions’ in order for the shell shock symptoms to disappear. Paul Sollier, a French psychologist, considered shell shock to be a ‘psychological disturbance of the brain’ that could be cured by ‘awakening the brain from its somnolence while the patient is in isolation.’ Although Sollier’s premise was different to that of Babinski’s, he too endorsed the use of an authoritative attitude in order to ensure the quick recovery of a patient. Interestingly enough, several doctors were influenced by Ernest Dupré’s idea of “mythomaniac” personality types. He asserted that shell shock victims were essentially ‘wilful liars.’ Compulsive lying, in his opinion, was an inherited trait that is deeply embedded in the personalities of those types of men. In contrast to these theories, Sigmund Freud, an Austrian neurologist, claimed that the foundations of war neurosis is located in ‘unconscious psychological conflicts.’ He asserted that shell shock was the product of ‘one’s ego protecting himself from both the physical dangers of war as well as the danger of psychological disintegration.’ Although this was a revolutionary idea, it was highly unpopular especially amongst the French doctors. Freud had argued that most neurotic men were merely ‘succumbing to the irresistible forces of their unconscious mind,’ for this reason treatment via the use of electrical shocks would not provide a permanent solution. French Doctors rejected Freud’s assessment primarily because it contested ‘malingering’, hence disregarding man’s ability to fake the symptoms.
However, providing treatment for the victims of shell shock meant that war neurosis was an acknowledged problem. There were institutions set up for shell shock patients ‘with programs of marching, indoor recreation, outdoor games and manual occupations’. Its purpose was to get the soldiers to relax and strengthen their bodies in order to return to the front later. Naturally, many men favoured these activities over fighting in the trenches causing the depots to become congested quickly. The drastic increase in shell shock patients was reducing manpower on the front; therefore treatment was the only way of rebuilding the troops.
Some regarded the First World War as an opportunity for the nation to overcome its perceived enervations by ‘culling the weak and degenerate,’ leaving only the strong to survive. Therefore, those who were weak and unmanly – the victims of shell shock – would be expelled from society, either by the means of war or ‘cowardice shooting,’ as an attempt to cleanse the nation from its ‘malingers.’ The Social Darwinism Theory claimed that nature, as well as societies, regulated according to survival of the fittest regime. The War Office Committee members in Britain did not operate any differently. They were mostly of the conservative cast from the middle and upper strata of the society. During the war, majority of them held influential positions in the government or military. They reflected the ideals of the eugenics movement and racial degeneration. It was anticipated that the nation would revive and flourish by expelling the so-called malingers, instead the war brought to light its hidden defects. Those who did not fall victim to the atrocities of war or the cowardice shooting were left physically and psychologically disabled. For this reason, their inability to work compelled them to remain unproductive members of society surviving, majority of the time, only on state pensions.
Shell Shock was essentially a ‘bodily protest against the war’ to which the doctors did not have much understanding about. Majority of the treatments and theories that were devised was tainted by the idea that shell shock was not an organic injury, but instead a form of ‘malingering.’ The sudden incline in shell-shocked soldiers was reducing manpower on the battlefront; therefore treatment was the only way of rebuild the troops. It could be deemed that shell shock was unsuccessfully addressed by health professionals as the nation, post-war, was funding those who were once productive members of society.