The term “shell shock” emerged during World War I (WWI) to describe the widespread mental and physical collapse of soldiers exposed to the trauma of trench warfare. Early medical professionals initially hypothesized the condition was a physical injury, caused by the concussion of exploding artillery shells damaging the brain or nervous system. This physical explanation helped military authorities accept the condition, as it was not viewed as a psychological weakness. However, as the war progressed, it became clear that many soldiers presenting symptoms had not been exposed to a nearby blast, forcing a reevaluation of the condition’s origin and the search for effective treatments.
Early Physical and Rest Cures
The initial belief that shell shock was a physical injury, such as a concussion or “neurasthenia,” led to treatments focused on physical restoration and isolation. Soldiers were often evacuated far behind the front lines to specialized hospitals or “neurasthenic” centers for the “rest cure,” a regimen of quiet isolation, massage, and rich diet intended to rebuild their depleted nervous energy. Hydrotherapy was also common, involving treatments ranging from simple warm baths to high-pressure water jets, which doctors hoped would stimulate the nervous system back to normal function.
A highly controversial method, driven by the suspicion that soldiers were faking their symptoms, was the use of electrical stimulation, known as Faradism. This technique involved applying painful electric currents to areas of the body that exhibited symptoms like mutism or paralysis. The intent was to shock the patient back into function by associating the symptom with intense pain. For instance, a soldier unable to speak might have electrodes applied directly to his throat until he cried out.
The Shift to Psychological Therapies
As the war dragged on, some medical officers began to recognize that the condition was a psychological neurosis resulting from inescapable terror, not physical damage. This realization spurred the development of “forward psychiatry,” which advocated treating casualties near the front line to suggest a quick return to duty. The core of these new psychological approaches was the “talking cure,” a form of therapy where suggestion and a supportive environment were used to help the soldier process his experiences.
Pioneers like William Rivers at facilities such as Craiglockhart War Hospital introduced more humane and analytical methods for treating officers. A primary technique used was catharsis, where the soldier was encouraged to relive and discuss the traumatic events that caused the breakdown, often with the aid of hypnosis or suggestion. The goal was to discharge the powerful, repressed emotion attached to the memory, which was thought to be manifesting as physical symptoms like shaking or paralysis.
This therapeutic approach viewed the symptoms as the unconscious mind’s attempt to resolve an unbearable conflict between the instinct for self-preservation and the moral duty to fight. The supportive atmosphere in these hospitals aimed to validate the soldier’s suffering, contrasting sharply with the earlier punitive methods.
Military Discipline and Moral Treatment
Despite the medical advancements, the military command often viewed shell shock through a lens of discipline and morale, fearing that widespread recognition of the condition would undermine the fighting force. High-ranking officers often considered the symptoms a sign of cowardice or malingering, which dictated a harsh, non-medical form of “Moral Treatment.” This approach relied on the belief that a firm hand and a strong sense of duty could compel a soldier to recover quickly.
Soldiers who exhibited symptoms were often subjected to shaming, threats, and a constant message that they were letting their comrades down. In 1917, the British Army officially banned the term “shell shock” from medical records, replacing it with vague diagnoses like “Not Yet Diagnosed Nervous” (NYDN). The most severe outcomes were reserved for those deemed to have deserted or shown cowardice, which could lead to court-martial or execution by firing squad, driven by the necessity of maintaining order and preventing a mass breakdown of morale.