{"id":850,"date":"2016-11-11T09:11:51","date_gmt":"2016-11-11T09:11:51","guid":{"rendered":"http:\/\/blogs.cardiff.ac.uk\/mental-health\/?p=850"},"modified":"2016-11-11T09:13:05","modified_gmt":"2016-11-11T09:13:05","slug":"shell-shock-lessons-for-today","status":"publish","type":"post","link":"https:\/\/blogs.cardiff.ac.uk\/mental-health\/shell-shock-lessons-for-today\/","title":{"rendered":"Shell Shock \u2013 Lessons for Today"},"content":{"rendered":"

On 1 November, to commemorate the centenary of the Battle of the Somme, one of the defining events of World War One (WW1) – I talked at a meeting of the Glamorgan Family History Society about my research on psychological trauma and combat stress. The centenary of the Great War has frequently reminded us of the tremendous suffering in the trenches and the enduring impact it had on the soldiers\u2019 physical and mental health. In my journeys through the WW1 medical case records of the National Hospital for the Paralysed and Epileptic<\/a> (today the National Hospital for Neurology and Neurosurgery) and the Charit\u00e9 Psychiatric Department in Berlin, I came across hundreds of shell shock cases, soldiers who had been psychologically scarred by their war experiences.<\/p>\n

The case records provide a harrowing account of soldiers\u2019 experience of trench warfare, their physical and mental exhaustion. They allow us to enter a world which \u2013 since the last veterans of World War One \u00a0have passed away – is now inaccessible through living memory. The nature of modern industrialised warfare \u2013 with its new weapons, bigger armies, increasing casualty figures and anonymity of fighting \u2013 had considerably increased the stresses imposed on the individual soldier. Static or trench warfare, as opposed to mobile warfare, often forced the soldier to remain in one position for days \u2013 sometimes barely able to move, because any twitch turned him into an easy target for enemy snipers. Boredom and monotony, passivity and a lack of distraction were the result; the soldier was left alone with his thoughts and fears. There was also the sight of destruction, of mutilated bodies and of corpses; and the relentless shelling \u2013 sometimes going on for hours and hours, day on day. Men exposed to these stresses were under continuous pressure.<\/p>\n

When the pressure became unbearable \u2013 which could occur after a single particularly traumatising event or as a cumulative effect of the many weeks and months in the trenches \u2013 many soldiers collapsed mentally and were admitted to casualty clearing stations and field hospitals. It is estimated that more than 80,000 British servicemen suffered such a breakdown. Some of them \u2013 probably the more severe and enduring cases \u2013 were admitted to specialist hospitals at home.<\/p>\n

Some men who were admitted to the National Hospital at Queen Square had developed the typical symptoms of shell shock: paralyses, shaking, stuttering, deafness and fits. Others, unable to get away physically from the enemy fire, had escaped into a different mental space, a state between sleep and wakefulness that enabled them to keep a certain distance from the outward world. This temporary withdrawal from the horrors of warfare – which modern psychiatrists would put into the diagnostic category of \u2018dissociative states\u2019 – \u00a0served to protect the individual from the intense emotional states of fear and helplessness.<\/p>\n

While some soldiers slipped in and out of dream-like states, others gradually lost all contact with the real world: they developed strange ideas, behaved in odd ways and had experiences nobody else shared. These psychotic symptoms were not an active, conscious survival or coping strategy: rather, they overwhelmed the individual and replaced reality with an alternative world. Some psychotic states could have a temporary problem-solving and wish-fulfilling function, and serve as an escape from a disturbing life situation. Karl Jaspers, the German psychiatrist and philosopher, provided the classical account of this phenomenon in his General Psychopathology<\/em>: \u2018Through delusions and hallucinations the individual\u2019s fears, needs, hopes and wishes seem to become alive and real. [\u2026] Reactive psychosis serves as a defence, a refuge, an escape as well as wish fulfilment. It derives from a conflict with reality which has become intolerable\u2019.<\/p>\n

Some of these psychotic experiences could take an epidemic course \u2013 spreading from one soldier to the next. The Angels of Mons – a cloud of angelic warriors that appeared at Mons and halted the German advance against a vastly outnumbered British force – were the most famous occurrence, but many other similar legends of supernatural warriors, magic castles and mysterious clouds developed during the World War One.<\/p>\n

The idea that traumatic experiences could trigger psychotic states was very much at odds with traditional psychiatric thinking: psychosis was believed to be a chronic disorder \u2013 inevitably leading to intellectual decline and requiring lifelong confinement to a mental institution; yet, many soldiers who developed psychotic ideas recovered within a short period of time.\u00a0 In fact, most people\u2019s concept of psychosis has remained rather monolithic until the present time: there is mental normality on one side and insanity, considered to be a chronic problem, on the other. The cases of shell shock psychosis, and their often impressive recoveries, tell another story: life events can trigger psychosis \u2013 and although the psychotic illness can, subsequently, take a chronic course, it can also be limited to a single, brief episode.<\/p>\n

This is one of the relevant medical lessons of World War One, which has been confirmed by later epidemiological work into the triggers and course of psychosis.<\/p>\n

There are other interesting lessons about the links between stress and mental illness<\/a> that the members of the Glamorgan Family History Society were particularly interested in:<\/p>\n