War history: How Britain came to understand the shell-shocked soldier

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in him' - Credit: Archant

Mike Peters, Galloway’s resident military historian, continues his look at shell shock. By the summer of 1916, the numbers were staggering. During the Somme campaign they peaked at 40% of the soldiers involved.

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in him' - Credit: Archant

One hundred years ago, the army and medical science were just beginning to understand shell shock and starting to link the ferocity of massed artillery attacks to the debilitating condition affecting thousands of soldiers reporting sick.

Initially, doctors thought the condition was a physical one, caused by concussion waves created by the blast of shells exploding close by. Symptoms were disturbing. Victims of severe shell shock were easy to spot and difficult to retain in the front line. They suffered extreme fits, bouts of shaking and were often terrified of even distant artillery fire.

At first, shell shock casualties were rapidly evacuated from the front line, in part because of fear of their unpredictable behaviour. There was concern about the negative impact they may have on unit cohesion and morale.

As war progressed, Britain expanded its expeditionary force dramatically. At the same time there was an equally dramatic increase in the number and effectiveness of artillery pieces aimed at the British lines. Consequently, the number of reported cases of shell shock multiplied.

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in

'Sit down beside him and talk to him about the war and let the man see you are taking an interest in him' - Credit: Archant


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By the summer of 1916 the numbers were staggering. During the Somme campaign they peaked at 40% of the troops involved. Even at this stage, there was mounting concern about the number of what were now viewed as psychiatric cases being unable to fight and the financial burden of caring for such large numbers.

The consequence was an increasing official preference for a psychological interpretation of shell shock, and a deliberate attempt to avoid classifying victims as wounded, requiring medical treatment. This policy made it easier to return “uninjured” shell shock cases to the front line.

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However, more time was devoted to understanding and treating shell shock symptoms. Medical officers realised there were varying degrees of the condition, and, in the case of mild exposure, soldiers could be returned to the trenches after rest, food and reassurance. In these cases it was usually best to keep the soldier close to his parent unit and within reach of his mates.

By the Battle of Passchendaele in 1917, the British army had developed practical methods to reduce shell shock. The view developed that a man who began to show shell shock symptoms was best given a few days’ rest by the doctor who knew him best: his own regimental medical officer.

One such army doctor was Lieutenant Colonel Rogers, the medical officer of a Black Watch battalion in the Ypres Salient, who wrote: “You must send your emotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the men and they know you and you know them (and there is a good deal more in the man knowing you than in you knowing the man)… you are able to explain to him that there is really nothing wrong with him, give him a rest at the aid post if necessary and a day or two’s sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him.”

If the combination of rest and reassurance was not effective, shell shock cases could be moved to the rear areas and treated at casualty clearing stations.

However, for sound medical reasons these facilities were usually just a few miles behind the front line; the rumble of artillery could easily be heard and at night the flash of the guns was evident on the skyline. This made respite difficult for those diagnosed with acute shell shock; they needed to be moved beyond earshot of the battlefield.

The medical authorities established four dedicated psychiatric centres further behind the lines where specialists could investigate each case. At this point, individuals were classified as NYDN – Not Yet Diagnosed Nervous. This implied further examination was required before the soldier could be removed from duty.

This all makes for disturbing reading but, as with most of the emotive First World War myths, closer examination of the facts reveals a very different picture. The handling of shell-shocked soldiers did improve.

A combination of measures reduced the numbers significantly. This was due to increased awareness of the symptoms, the reduction of exposure to artillery by regular rotation of units out of the front line, and improved understanding of the condition among commanders and the medical services.

In 1917, during the Battle of Passchendaele, the number of reported cases was relatively few. A total of 5,346 shell shock cases reached the casualty clearing station, or roughly 1% of the British forces engaged. Of these men 3,963 (just under 75%) returned to the front line without being referred to a hospital for specialist treatment. The number of cases reduced throughout the battle, and the epidemic of illness was ended.

The treatment of chronic shell shock varied widely, according to the symptoms, the views of the doctors involved, and other factors, including the rank and class of the patient.

There were so many officers and men suffering from shell shock that 19 British military hospitals were devoted to its treatment. There was a lasting legacy: 10 years after the war, 65,000 veterans were still receiving treatment in Britain.

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