As part of the awareness campaign surrounding National PTSD Awareness Month, I am rerunning this two-part post that I first posted in 2007.
The "Great War" that raged from 1914 to 1918 added a new dimension to warfare with modern artillery fire raining down on troops as they dug into their trenches.
An estimated ten percent of all troops deployed were killed (compared to 4.5% in World War 2) with countless more being severely wounded. With the modern way of fighting wars came a new awareness of how troops were being affected. While troops of previous wars had presented symptoms of the extreme stress they were facing (eg., soldier's heart), it was in 1914 that a British medical officer named Charles Myers first coined the term "shell shock". This became a popular diagnosis for describing the impact of battle on even experienced soldiers who displayed a range of bizarre symptoms that medical doctors on both sides of the conflict were at a loss to treat. Though many of these cases were observed in soldiers who had faced the heat of battle, even soldiers who had never been deployed in the field were showing symptoms. There was a range of medical opinions offered as to the cause ranging from suggested medical explanations to accusations of cowardice. Soldiers sent to hospitals for treatment were overcome with shame over their lack of bravery with four out of five soldiers being unable to return to fighting afterward. Many of these patients, typically young men under the age of twenty, were often urged to face their trauma in a "manly way" and rarely received sympathy from commanding officers or fellow soldiers. A distinction tended to be made between the symptoms reported by common soldiers and what officers developed and they would often be sent to different hospitals.
Given the high rate casualties occurring during the war and the need for soldiers to fight, the priority was given to methods that would get soldiers back into action as quickly as possible. Different therapists advocated radically different approaches ranging from simple talking cures to "torpillage" or electroshock therapy (especially popular in the French army). Advocated by Clovis Vincent, a French neurologist, for use with cases of hysterical paralysis, the treatment involved Vincent applying a sharp current to the patient's body to provoke involuntary movement. The treatment fell out of favour after a soldier received a court-martial for punching Vincent. A similar approach was followed for the treatment of German soldiers and was known as the "Kaufman Cure" after its primary exponent, Fritz Kaufman. The treatment involved "surprise" methods including shock and physical intimidation and resulted in the deaths of an estimated twenty patients.
In 1915, a British Army directive was issued stating that "Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it were due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe". If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy', and he was to be labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension". By 1917, all British cases of shell shock were separated into "commotional cases" (due to physical causes) and "emotional" cases who were increasingly kept in their units unless the symptoms were extreme. The treatment of shell shock cases in their units by counsellors (not necessarily medical) gave rise to the PIE principles for treating shell shock cases. Treatment focssed on (P)roximity to the fighting, (I)mmediate treatment (as soon as possible), and the (E)xpectation that shell-shocked soldiers would be returned to active service following treatment. These same principles would be adopted in American and Commonwealth armies following the war (although their effectiveness in preventing PTSD has since come into question).
The shell shock diagnosis did not prove popular with the upper echelons of the British military and was abandoned in 1918. All too frequently, shell-shocked soldiers faced military tribunals and could be executed for cowardice. And they were.