By David Flin
No doubt they’ll soon get well; the shock and the 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.
If there is one thing that can be guaranteed to irritate me more quickly than anything else in this world, that is jokes about PTSD, post-traumatic stress disorder. We’ve all heard them: “I’ve got PTSD from the January sales”; “The children gave me shell shock”; “The Teletubbies gave me a lifetime of PTSD dreams.”
The thing is, PTSD, or shell shock as it was called during WWI, is debilitating. There’s no excuse whatsoever for not understanding this today. During WWI, shell shock was a newly recognised phenomenon. Psychological trauma existed prior to 1914, but what was significant during WWI was the sheer numbers involved, many thousands of cases. Both the military and the medical profession recognised it as an issue, although the public were much slower to understand the issue.
Mistreatment and harsh judgements were cast upon shell shock victims by members of the public. The phrase LMF – Lack of Moral Fibre – was bandied about, white feathers were given to those thought to be malingering, and public disapproval at this display of cowardice was rife.
In November 1914, an editorial in the British Medical Journal referred to “mental and nervous shock among the wounded.” The actual term shell shock first appeared in print in February 1915, in an article in the Lancet by Charles Myers. It was then a catch-all phrase that covered a range of issues that could manifest in different ways, such as mental or nervous breakdown, depression, nightmares, physical tremor, crying, or irrational behaviour.
Symptoms can include uncontrollable diarrhoea and unrelenting anxiety. Symptoms often reflect something in one of the events that led to it: soldiers who had shot an enemy in the face might develop facial tics of their own facial muscles; stomach cramps might seize men who bayoneted their foes in the abdomen. Snipers frequently had hysterical blindness. These come and go, often arriving with some trigger event.
And then there are the nightmares. These can strike at any moment. One infantry captain described it in this way: “The dreams might occur right in the middle of an ordinary conversation, when the face of a Boche that I have bayoneted, with its horrible gurgle and grimace, comes sharply into view.”
The dreams are often very intense, very lifelike, involving all the senses, and generally related to the experience that caused them in the first place. They are often set off by a trigger event, which can be something apparently innocuous. In one case, the trigger event is witnessing a bonfire, which induces nightmares of events that took place nearly 50 years before.
Have I mentioned that I don’t care for jokes about PTSD, or shell shock as it was then called?
The number of shell shock cases grew dramatically. By the end of the war, over 80,000 cases of shell shock had passed through British Army medical facilities. As early as 1915, there was a shortage of hospital beds for sufferers. Many county lunatic asylums, private mental institutions, and disused spas were taken over and designated as hospitals for mental diseases and war neurosis. There were over 20 such hospitals in the UK by 1918.
By January 1917, the British Army had established four “forward psychiatric units” close to the front. These assessed shell shock cases closer to the front, to get assessments as soon as possible. This was done so as to enable the cases to be treated more efficiently, so that men could be returned to active duty.
Ethel Dorothy, a nurse in one of these forward psychiatric units, told of her experiences in treating shell shock cases. “They used to dream, have nightmares, and they used to go over the top. They used to go through all the battles screaming and shouting and fighting one against another. You’ve no idea what the noise was like there.”
Traditionally, shell shock from WWI has long been viewed as something that affected the soldiers. However, the women who served near the front were also subjected to psychological trauma. Women were employed as nurses or as voluntary aid detachments. As we saw in my article on Casualty Clearing Stations , these could be close to the front lines.
In addition to being close to the front lines, and subject to bombardment from artillery, with the occasional bomb dropped from an aircraft, or being machine-gunned by an enemy aircraft – all of which were events that, while rare, happened often enough to be regarded as par for the course – nursing is emotionally draining and relentless, especially with the sheer number and extent of the casualties coming in.
In addition, from 1916, women were employed as ambulance drivers. Technically, they weren’t supposed to go near the front lines. However, the front lines were where most of the injured were, and ambulances have to go where they are needed. That meant that the ambulance drivers were exposed to constant collection of the worst wounded, day after day after day.
Inevitably, nurses and women ambulance drivers also suffered from the effects, and found it even harder to return to society after the war. Shell shock was viewed as a masculine disease, to be treated in a masculine way, and women sufferers were airbrushed out of the picture.
After the war, many nurses committed suicide. It’s estimated that more took their own lives than were killed during the war.
Treatment This was a new phenomenon, certainly on this scale. Treatment was primitive, and even the causes of shell shock weren’t entirely understood. Initially, it was thought that shell shock might be either physical or psychological in nature. Physical causes were thought to include damage to the nerves, and treatment might involve prescriptions of milk, general anaesthesia to induce sleep to enable dreams to “work their way out of the system”, or electrical therapy.
If a psychological source was indicated, treatments would include talking therapy, hypnosis, and rest. Notes for treatment said that the patient: “Must be induced to face his illness in a manly way.”
Hope was, however, on the horizon for some. Major Arthur Hurst had some thoughts on treatment, and set up Seale Hayne in Newton Abbot, Devon.
A miracle cure. Hurst made the only film in existence about how shell shock victims were treated in Britain, focusing on his own efforts. One of the films follows Private Percy Meek, who had suffered badly after being trapped for several days in no-man’s land, and subjected to constant bombardment until rescued. When he first came under Hurst’s care, Meek had regressed to a babylike state. He couldn’t walk, and had to be moved by wheelchair; he couldn’t talk; he had to be fed.
Over a period of about a year, Meek recovered the physical functions he had lost, and returned to being able to function normally in society, although he always remained “highly-strung”.
The main treatment was occupational therapy. The patients were given work to do, often on the farm. Another technique Hurst used was to take the men to the peace and quiet of the rolling Devon countryside, especially Dartmoor. The men were encouraged to use their creative energies.
He also directed a reconstruction of the battlefields of Flanders on Dartmoor to help the men relive the experiences, which seemed to have significant therapeutic value.
To help with their creative energies, the men were encouraged to write, and write they did. Letters, stories, memoirs, and reams and reams of poetry. Most of these were destroyed, but enough survived to give an idea of what they wrote about. By and large, they penned their experiences, which Hurst believed gave them a means of releasing the pent-up “darknesses”.
The patients also produced a magazine with a gossip column called Ward Whispers. This was something of a soldiers’ tradition. Numerous trench newspapers were produced during the course of the war; the Fifth Gloster Gazette, The Wipers Times, The Gasper, The Mudlark, and many others.
Not everyone was cured. Indeed, there is generally no such thing as a full recovery. One learns coping strategies, means of minimising frequency and effect, but one’s never fully cured. Still, if one defines success as enabling the patient to more or less be able to function in society, Hurst did have a remarkable success rate, rivalling that of modern facilities.
A great deal was learned about the treatment of shell shock in Seale Hayne, and thousands of people owe a debt of thanks to the discoveries made here.
Now, if only we could get people to stop making jokes about PTSD …
David Flin is the author of the SLP books How to Write Alternate History, Six East End Boys, Tales from Section D, The Return of King Arthur and Other Alternate Myths, and Bring Me My Bow