Thursday, July 7, 2016

Shell Shock Explodes in WWI

by M.K. Tod

Now working on my third novel set during WWI, I’ve had plenty of time to consider the horrific conditions and consequences for those who served. With trenches that were hellholes, deafening, bone-shaking noise, inadequate equipment, gas attacks and the prospect of death from shelling at any moment, it’s hardly surprising so many soldiers suffered from shell shock. Given this year’s centennial commemorations for World War One, it seems fitting to explore the topic.

Victorian and Edwardian times that preceded the war celebrated a particular masculine ideal, one where men had absolute power over the family, on the grounds that men were not only stronger but also nobler than women. Society expected men to rule the home with wisdom, benevolence and compassion. In the late Victorian period a renewed emphasis was placed on the physical elements of manliness linked to the state of fitness and alertness needed to defend and extend the empire. Hard work and thrift, the desire to improve one’s circumstances, self-reliance, duty and strength of character were seen as desirable attributes for men. Charles Darwin’s work popularized the notion of self-help and survival of the fittest; public school education instilled values of military discipline, duty, service and team spirit. These were the expectations of those who went to war.

In the medical realm, psychiatry had emerged as a specialty; however, medical schools offered little in the way of instruction or practical experience. Those deemed to suffer from mental illness were often incarcerated in asylums and the prevailing attitude was ‘once a lunatic always a lunatic’. Compared with other countries, Britain lagged behind most of the civilized world in the treatment of mental disease.

As early as December 1914, the British army estimated some 7 to 10% of all officers and 3 to 4% of other ranks were casualties of nervous and mental shock. Captain Charles Myers of the Royal Army Medical Corps first used the term shell shock in February 1915 citing symptoms of reduced field of vision, loss of smell and taste, and loss of memory. These symptoms were thought to be caused by severe concussive motion of the brain brought on by exploding shells. In other words, a physical condition.

In contrast, by May 1915, Dr Aldren Turner, dispatched by the War Office to investigate, offered this description of shell shock:
“ . . . a form of temporary 'nervous breakdown' scarcely justifying the name of neurasthenia, which would seem to be characteristic of the present war . . . ascribed to a sudden or alarming psychical cause such as witnessing a ghastly sight or a harassing experience . . . the patient becomes 'nervy”, unduly emotional and shaky, and most typical of all his sleep is disturbed by bad dreams . . . of experiences through which he has passed. Even the waking hours may be distressful from acute recollections of these events.” A nervous condition.

In late 1915, the Army classified shell shock as a wound and rather than risk ‘lunatics at the rear’ organized rapid evacuation of such cases from the front. However, as war progressed, shell shock reached epidemic proportions such that after the Battle of the Somme in July 1916 where some 40% of casualties were deemed to be shell shock, the need for prevention and rapid treatment became paramount otherwise the very success of the war effort was threatened. The British government of the time favoured a psychological model that blamed the individual rather than conditions of war, while the Army considered shell shock a condition of the weak. The medical profession, divided on causes and treatment protocols, was inadequately prepared to handle the volume of cases.

By 1917, medical officers were told to avoid the term shell shock and to refer to cases as Not Yet Diagnosed (Nervous). If the disorder was nervous rather than physical, soldiers did not warrant a wound stripe, and if unwounded, could return to the front as quickly as possible.

As a general statement, the British army considered those affected to be weak and cowardly; the ideal soldier was heroic, masculine and fearless. Veterans of earlier wars such as the Boer War – often senior officers or NCOs – felt that shell shock was simply a loss of nerve. Similarly, the French army considered traumatized soldiers to be malingerers, while the German army considered them unworthy and unpatriotic. Beyond military concerns, and in some ways even more galling, the British government worried about long term pension implications for those suffering shell shock.

Alcohol was used to combat fear and prevent the build up of horrible memories. Colonel JSY Rogers, 4/Black Watch stated that 'Without the rum ration we would have lost the war'. Passchendaele was another case of wholesale slaughter. For soldiers suffering shell shock during that battle, the army took speedy action to evacuate them away from the front so they could have temporary respite from battle, quieter conditions, sleep, food and a modicum of comfort. Within a few days they were returned to active duty.

Shell shock was very real. Symptoms included palpitations, fear of fainting, feelings of suffocation, throat constriction, depression, insomnia, nervousness, lassitude, loss of memory, diminution of self-confidence and self-control, and terrifying dreams. Some were struck with physical symptoms such as blindness, loss of hearing, facial and body tics, convulsive movements similar to epileptic fits, and limbs that could not move. As noted earlier, treatment protocols varied not only as war progressed but also physician to physician and facility to facility. Treatments included electric shock therapy, electric heat baths, milk diets, hypnotism, clamps and machines that physically forced limbs out of their frozen positions, rest, peace and quiet, calming activities and psychotherapy sessions. In a 1917 article written by Dr. G.E. Smith, the author describes an ideal treatment plan: firmness and sympathy, limited periods of isolation, suggestion and hypnosis, rational treatment (by which he means probing the individual to discover fundamental causes of the condition), and the therapeutic value of work. Sadly, many of those who suffered were not given the benefit of this approach.

Otis Historical Archives National
Museum of Health and Medicine
The numbers are staggering. By the end of World War One, the British army had dealt with approximately 80,000 cases of shell shock. Four out of five cases were unable to return to active duty.  A decade after the end of the war, over 74,000 cases were registered with the Ministry of Pensions. As estimated 10% of over 1.6 million military wounded of the war were attributed to shell shock. Shocking to say the least.

During the war, Siegfried Sassoon was sent to Craiglockhart Hospital, a treatment centre for officers suffering from shellshock. He wrote many poems, one of which is called Survivors.
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 their pride…
Men who went out to battle, grim and glad;
Children, with eyes that hate you, broken and mad.


This is an Editors' Choice post, originally posted on Tuesday, December 2, 2014 and now updated by the author.

Shell shock, Gordon Holmes and the Great War, by A.D. Macleod in JRSM

The Shock of War, by Caroline Alexander in Smithsonian Magazine, Sept 2010

Shell Shock during World War One, by Professor Joanna Bourke,

Shellshock and Its Lessons, by G.E. Smith and T.H. Pear, Manchester University Press, 1917

Masculinity, Shell Shock, and Emotional Survival in the First World War, by Dr Tracey Loughran, Reviews in History,

M.K. Tod writes historical fiction and blogs about all aspects of the genre at A Writer of History. Her latest novel, TIME AND REGRET will be published by Lake Union on August 16, 2016. Mary’s other novels, LIES TOLD IN SILENCE and UNRAVELLED are available from Amazon and in e-book formats from Amazon, Nook, KoboGoogle Play and iTunes Mary can be contacted on
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  1. I can highly recommend Suzie Grogan's recently published book Shell Shocked Britain

  2. Thanks for having me on your excellent blog, Debbie.

  3. An excellent overview, Mary. I've bookmarked this post.

  4. On a personal note, my grandmother was one just a handful of nurses trained to handle shell-shock for the U.S. army. The U.S. Army decided that the need to treat shell shock victims sooner rather than later was so compelling that her unit was moved to France, where she served about one year. She, naturally, had very vivid memories of this experience until her death at age 98.

  5. So appalling to consider that shell shock was treated by shock therapy.


Comments with opposing viewpoints are allowed if they are not written in an unnecessarily confrontational or arrogant manner.