The horrors of World War I, with its unprecedented scale of industrialized slaughter, gave rise to a new and widespread form of psychological collapse among soldiers. This condition, which manifested as both physical and mental breakdown, was first named “shell shock.” It represented the earliest large-scale recognition of military trauma as a genuine, incapacitating injury, forcing medical professionals to grapple with the psychological toll of modern warfare. The term itself captured the public’s imagination and became the signature mental injury of the Great War.
Defining Shell Shock
The term “shell shock” was first coined and published in 1915 by British psychologist Charles Samuel Myers, reflecting an assumed link between the symptoms and the effects of exploding artillery shells. Initial medical theories posited that the condition was a physical injury, caused by the concussive blasts of high explosives creating microscopic lesions in the brain or spinal cord. This explanation suggested that the vacuum created by a shell burst, or the resulting carbon monoxide poisoning, resulted in a physically damaged nervous system.
As the war progressed, this physical theory began to unravel because many soldiers exhibited symptoms without having been directly exposed to a shell blast. By the middle of the war, the medical community started to shift toward a psychological understanding, reclassifying the condition as a form of neurosis or war strain. This new view recognized the relentless stress of trench warfare—the constant anticipation of death and the trauma of witnessing comrades’ suffering—as the true origin.
Common Symptoms and Manifestations
Shell shock presented with a wide array of dramatic and profoundly debilitating signs that were often highly visible to observers. Physically, afflicted soldiers frequently displayed intense, uncontrollable tremors and tics that made basic functions impossible. Many suffered from functional sensory losses, including sudden deafness, mutism, or blindness, even when no physical damage to the eyes or ears was present.
Other manifestations included paralysis of limbs and movement disorders that left men unable to walk or even stand, despite being physically unwounded. Psychologically, soldiers experienced severe anxiety, marked by a constant state of hyper-arousal, insomnia, and terrifying nightmares that replayed the combat experience. They might also enter dissociative states, appearing vacant, emotionally numb, or unable to speak or reason clearly.
Treatment and Military Response
The military’s response to shell shock was often characterized by a conflict between medical understanding and the need for discipline. In the field, a principle known as “forward psychiatry” was sometimes implemented, where soldiers received immediate rest and therapeutic talks near the front lines before their condition could become entrenched. In specialized institutions like Craiglockhart War Hospital, which treated officers, more sympathetic approaches were sometimes used, including “talking cures” that drew on early Freudian concepts of repression.
For many enlisted men, the official attitude often leaned toward suspicion that the condition was a failure of moral character or outright malingering. Harsher, disciplinary methods were employed to “cure” the symptoms quickly and return soldiers to the front. These included electric shock therapy, known as faradization, where electricity was applied to mute throats or paralyzed limbs in an attempt to forcibly shock the man out of his symptoms.
The Transition to Modern Understanding
Following the war, the concept of shell shock gradually evolved as medical professionals continued to study the lasting effects of combat trauma. By the 1920s, the official term was often replaced by the broader, less specific diagnosis of “war neurosis” or “war strain.” This shift acknowledged that the symptoms were psychological, not physically caused by a shell’s blast.
The condition would be renamed again after World War II to “combat fatigue” or “operational exhaustion,” but the underlying recognition of trauma remained. This long historical progression culminated in 1980 with the inclusion of Post-Traumatic Stress Disorder (PTSD) as a formal diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Shell shock therefore represents a historically significant precedent, marking the first time a large military organization was forced to officially confront and categorize the debilitating mental injury caused by the horrors of war.