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.
Siegfried Sassoon, October 1917
Sassoon wrote this poem while a patient at Craiglockhart hospital. Craiglockhart was set up to deal with the epidemic of psychological casualties created in the trenches of the First World War and, in particular, with the huge increase of casualties following the battle of the Somme in 1916. Two of the finest poets of a war over-flowing with poetic voices were treated there, Wilfred Owen and Siegfried Sassoon. It was Sassoon who nicknamed the place ‘Dottyville’ in a letter of 1917.
During the First World War, the experiences of men in the trenches left not only physical damage, but psychological wounds which could not be cured in the same way as an amputation or a bullet wound. Many men found themselves unable to eat, sleep or speak, reliving the moments in which artillery fire crashed down around them, or the experience of close encounters with the enemy. Every case was different and severity ranged from mild to extremely debilitating. Recovery was slow, and treatment was often harsh and insensitive by today’s standards.
‘Shell Shock’, now more commonly known as Combat Stress or Post Traumatic Stress Disorder, was the manifestation of a psychological break caused by the strain and pressures of active combat. During the war, and in the years after the armistice, more than 80,000 cases were diagnosed.
Shell shock was initially considered to be a physical injury, a form of head trauma caused by close proximity to falling shells. Accordingly, it was treated as a sudden damage to the nerves, the treatment for which was rest followed by a return to the front lines. Over time, it became clear that shell shock was not exclusive to those who had been under fire, which led some doctors to conclude that the disease was a psychological one.
Since not every soldier was afflicted with shell shock, it was for a long time suggested that the condition only affected the weak-willed. This called into question the bravery and temperament of sufferers. In biological terms, many believed that a ‘degenerate’ nervous system could lead to shell shock. Frequently, it was decided that the illness was an excuse for displays of cowardice, and, since much had been done to prevent shell shock from becoming an official medical complaint, when soldiers suffering from shell shock were court-martialled for desertion, little could be done to prevent their sentencing. Thus, many men with shell shock were shot dead for desertion.
Throughout the war, however, rapid advances were made in the understanding and treatment of the condition. At the beginning of the war, then shell shock was mostly believed to be an organic, physical disease, treatment ranged from ‘shocking’ a man back to his senses by causing physical pain, often through violent and painful means such as electric shocks or, in some cases, cigarette burns. In 1918, a Canadian psychiatrist, Dr Lewis Yealland, published a book, ‘Hysterical Disorders of Warfare’, in which he details a case in which he attempts to condition a suffering soldier into speaking. He explained:
“Placing the pad electrode on the lumbar spines and attaching the long pharyngeal electrode, I said to him, ‘You will not leave this room until you are talking as well as you ever did; no, not before’. The mouth was kept open by means of a tongue depressor; a strong faradic current was applied to the posterior wall of the pharynx, and with this stimulus he jumped backwards, detaching the wires from the battery. ‘Remember, you must behave as becomes the hero I expect you to be,’ I said. ‘A man who has gone through so many battles should have better control of himself.’ Then I placed him in a position from which he could not release himself, and repeated, ‘You must talk before you leave me”.
There was, however, a better and more successful way.
Across the country, those who treated shell shock as a psychological disease found that occupational therapy and psychotherapy meant that men could begin to recover their former attitudes and temperaments. Treatments ranged from the ‘Talking Cure’, as advocated by Freud, to knitting, gardening, and even, in some cases, shooting, if the patient felt comfortable with the activity.