How do you deal with someone suffering from mental illness if you do not believe that such a condition exists? If you feel that it is possible to ‘snap out of it’, use mind over matter, and exercise the stiff upper lip?
This was the problem that confronted the British Army during the Great War, and became a particularly acute problem following the Battle of the Somme in 1916, an intense and futile battle that saw huge losses. The solutions ranged from ‘shooting at dawn’ to specialist rehabilitation in a mental hospital.
As with so many things at the time, the classification of shell shock differed according to class. The rank and file suffered from shell shock, seen as a form of hysteria. This was further subdivided. Shell Shock W (for ‘wounded’) rejected the early idea of the condition being caused by some internal injury due to proximity to an exploding shell.
Alternatively, there was Shell Shock S (for ‘sick’). If a soldier was sick, he was suffering from a complaint such as dysentery or flu, nothing that could not be cured by a spell away from the front-line.
Officers, however, suffered from neurasthenia, caused by a prolonged process of breakdown, and brought on as a result of their extra responsibilities.
So why was shell shock so prevalent? An artillery duel between the two sides, lasting for days at a time, meant that soldiers were constantly on edge. Any man at the Front had to accept that at any moment he, or the person next to him, might be blown to pieces or terribly mutilated. If a man was killed by a shell, then his body parts were likely to be scattered over a wide area.
The danger continued for days and days; then the battalion would be moved back for ten days or so; and then the whole thing would start again. Being in a trench prevented any possibility of flight or fight – one simply had to cower and endure. The lack of options created a sense of powerlessness. Medical officers noted that two occurrences were particularly likely to bring on shell shock – being buried alive, or the use of gas.
There were cases of shell shock from the beginning of the war, but the incidence escalated dramatically after the opening of the Battle of the Somme. The plan was for artillery to pound the enemy lines constantly for five days, and then the soldiers were to emerge from the trenches and walk slowly across no-man’s land and take the German trenches.
The German defences survived largely intact, however, and when the soldiers emerged from their own trenches, they were massacred by the German machine-guns. The effect of witnessing this, of taking part in what proved to be such a shambles, was too much for many.
The preferred treatment was a spell in a hospital away from the front-lines, for a few days or, at most, a few weeks, to restore the soldier to fitness, so that he could be shipped back to the trenches.
This was not always possible: sometimes the symptoms did not respond to treatment, and then the soldier might be sent back to Britain to a mental hospital. In any case, commanding officers were very alarmed at the increasing incidence of shell shock, especially as the physical casualty rate was so high.
This is a thoughtful, intelligent book about all aspects of the condition known as ‘shell shock’. We hear from witnesses and sufferers themselves, and of the attitudes towards shell shock of the Army top brass and the medical officers treating the men. Downing also looks at cases of mental trauma in more recent wars, and how attitudes have changed since the Great War.
Thoroughly researched, highly readable, and highly recommended.
This review was published in issue 70 of Military History Monthly.