Continuing our series about the scientific advancements that emerged from the First World War, Paul Allchin examines how shell shock led to the development of treatments for Post-Traumatic Stress Disorder (PTSD).
Confronted with the scale of shell shock during trench warfare, the British establishment and medical profession responded by gradually changing attitudes to mental illness from organic causes and punitive treatments to more sympathetic psychotherapeutic interventions.
Dr William Halse Rivers Rivers is best known for his work with shell shocked soldiers during World War One. He and his contemporaries debated long after the war the merits of the organic versus psychotherapeutic approaches to treating shell shock. One of Riversâ€™ patients at Craiglockhart War Hospital near Edinburgh was the war poet Siegfried Sassoon. In Sassoonâ€™s fictionalised autobiography, â€śThe Complete Memoirs of George Sherstonâ€ť, he described his observations of shell shock and its effects on soldiers:
â€śHow many a brief bombardment had its long-delayed after effects in the minds of these survivors, many of whom had looked at their companions and laughed while inferno did its best to destroy them. Not then was their evil hour, but now; now, in the sweating suffocation of nightmare, in paralysis of limbs, in the stammering of dislocated speech. Worst of all in the disintegration of those qualities through which they had been so gallant and selfless and uncompromising â€“ this, in the finer types of men, was the unspeakable tragedy of shell-shock â€¦â€ť
By June 1918, the government established a network of specialist hospitals to treat shell shock victims and specialist centres at Maghull and Netley for training medical field officers. However it was not until 1930 that the new Labour government changed UK legislation by removing the death penalty for desertion and cowardice in the armed forces.
In contrast to the imperialist courage and valour expressed by war poets in the Victorian era, World War One saw a sea change in the way poetry and the theatre depicted the reality of war and disillusionment of those returning from battle. Sassoon's poem â€śSurvivorsâ€ť describes the experience of some.
It could well be argued that the government and establishment were very slow in responding to the needs of shell shock victims. Military authorities believed that training, morale, and discipline could prevent shell shock, and did not maintain a psychiatric service. When the Second World War broke out, only six regular officers in the British army had psychiatric training. Equally it was not until 1930 that the Mental Treatment Act made provision for voluntary treatment at outpatient clinics, providing the mentally afflicted with an alternative to the asylum.
Even though shell shocked veterans benefitted from special clinics, many also experienced considerable difficulties in claiming pensions for psychological injury and it was many years before an adequate mental health care system was established.
World War One accelerated advances in theory, practice and research in psychiatry, psychological medicine and psychotherapy, especially the cognitive model of PTSD treatment based on prompt intervention, re-processing the trauma, conceptual meaning making and reframing, developing the therapist/client alliance and reclaiming personal control in victimâ€™s lives. These themes are echoed in the lives of all adults and children following their personal self-healing journeys whether they are male or female and whether their battles are in the military or domestic arenas. The social taboos and misunderstandings surrounding mental illness remain a challenge even today as mental health awareness programmes still need to remind us that we are human and not machines.
Our current understanding of shell-shock and PTSD is described in a chapter on trauma and stress in the American Psychiatric Associationâ€™s diagnostic manual DSM-5, Diagnostic and statistical manual of mental disorders, 5th edition, 2013 used throughout the medical profession today.
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