THERE have always been problems establishing the parity of mental health and physical health.
Even today there is a stigma over admitting to any kind of depression or emotional instability.
This is more extreme in military circles for reasons which are comprehensible if not admirable. Soldiers are trained to function in dangerous circumstances.
Solders must stand together and work for their pals as well as ‘king and country’. They can’t be whining that they are frightened. Or staring into space, eyes bulging from sockets.
Clearly, if someone’s leg is blown off they must be returned home. No one could pretend that their leg has gone. However, if a mind is frazzled — ah, well — it could be pretence, it could be cowardice.
Military commanders at all levels are tasked to maintain morale. Personnel with twitches, with muteness, with blank eyes are not helpful. Various approaches to addressing these behaviours were taken.
Some officers tried shouting very loudly. Some medical men tried shocking frontal lobes with electricity.
Max Kaufman, in Mannheim, tried shocking and shouting both at once. Others merely shot victims as cowards. Shellshock can be a terrible worry during times of war.
Taylor Downing’s book takes as its starting point the Somme. He compares incidences of ‘shellshock’ in the British Army before and during the prolonged engagement which lasted from July to November 1916.
Using materials from military and medical archives Downing attempts to link the particularly bloody and extended battle with a peak in mental breakdowns.
His task is nearly impossible due to the fact that the syndrome he is studying is not cut and dried in the way that, for example, facial burn injuries can be documented.
The prologue offers some startling accounts of shellshock in the thick of combat in Delville Wood during the third week of July 1916.
Downing quotes at length from a report written by Brigadier Reginald John Kentish on August 3. Kentish’s prose is fragmented and ‘convoluted’ almost as if it had been affected by the chaos.
So Downing summarises, stating that “prolonged exposure to intense fire was a major contributory factor … and although it affected individuals one by one, it was also contagious and could spread among an entire unit”.
The idea of shellshock being infectious terrified military leaders. How could they stop the ‘wastage’?
Medical officers were reporting all sorts of symptoms: Most were suffering from peculiar forms of paralysis. Many were described as having ‘the shakes’. Some could not stand up or walk normally. A few did not appear able to speak coherently and were stammering badly.
Others had been struck completely dumb and could not speak at all. Most appeared to be in a state of stupor and a few had completely lost their memory. Others seemed to find it difficult to see clearly. Many had lost their sense of taste or smell. Some vomited repeatedly.
The epidemic of shellshock was a new phenomenon. Quite quickly it was realised that it was partly to do with the passivity of immobile warfare.
The noise of gunfire was incessant; sometimes the shells would land in the trenches. Soldiers could do nothing to protect themselves, could take no action. They just had to hope that they would not be hit.
Meanwhile, friends and comrades were hit and sometimes turned to red mist, or a decapitated head or a legless torso. It is unsurprising that many had breakdowns.
The trickle of traumatised men returning from the lines became a tumult. If it were to continue to increase it would be impossible to fight the war. However, it was hard to diagnose and no easy treatments were available.
Opinion was divided between those who wanted to shout at the victims and force them back to their regiments and those who
felt that some rest and therapy might help them recover. Additionally who could distinguish between genuine sufferers and malingerers?
Even before the Battle of the Somme commenced on July 1, 1916 the army had identified two types of shellshock. ‘W’ stood for wounded and ‘S’ stood for sick.
If a soldier’s brain suffered ‘commotional’ damage due to being close to an exploding shell he was ‘W’ but if, after a period of time under constant pressure, he collapsed then he was ‘S’.
There was only a small percentage of ‘Ws’ compared with ‘Ss’. There was also a category used mainly for officers: ‘N’ for neurasthenia.
Downing notes that official records show ‘that there were 16,138 battle casualties in France from shellshock in the months July to December 1916, over four times more than in the previous six months; and more than 10 times greater than in the six months from July to December in 1915’.
These figures only included the ‘Ws’ and Downing thinks that the total figure is more likely to be around 53,000 to 63,000.
Medical opinion was veering towards the idea that shellshocked soldiers should not return to England. It was thought better that they be treated in field hospitals as near to the battlefields as possible, although out of hearing of the barrages.
The men were to be kept under military discipline. The idea was that after as short a period of rest as possible the recovered patient could, having been given a stern telling off, be sent back to the front.
Downing gives details of men whose nervous state prevented them from conducting themselves well under fire. Some had already been treated for shellshock and then sent back to the trenches.
They were sometimes court martialled and shot as cowards. There would be no pensions for their widows.
The records were held secret for 75 years. In 2001 a memorial showing a blindfolded soldier facing a firing squad was erected in Staffordshire, England, and in 2006 a posthumous pardon was given for all 306 executed soldiers. It is not clear how many of those shot were shellshock survivors.
In an appendix Downing attempts to give some numerical assessment of the problem. He thinks about 17% of ‘injuries’ were mental stress rather than wounds and that about 4% of all soldiers suffered from non-physical trauma.
Readers of Downing’s book may be familiar with the ‘pity’ of war from poets such as Sassoon and Owen; they may also be aware of the ‘treatment’ of ‘shellshock’ from Pat Barker’s 1990s Regeneration trilogy but here Downing offers an analysis which, by chronicling the military and medical responses to post traumatic stress disorder, reinforces the idea that mental illness is as injurious as physical wounds.
Downing obviously found some of what he discovered debilitating and in his acknowledgments he thanks his wife Anne for cheering him up. The book is an essential addition to the history of the First World War.
What is depressing, however, is that for similar reasons, military institutions still find it difficult to care for those who mental illness is caused, to a great extent, by battlefield action.