During World War One thousands of soldiers suffered from ‘shell shock’ – a term coined during the war to describe a condition caused by the psychological traumas of modern warfare. This article, published in 1918 in the influential medical journal The Lancet, provides an insight into the ways in which doctors understood and treated various forms of ‘war neuroses’ in radically different ways.

The article is written by W H R Rivers, who originally delivered it as a lecture to the Royal Society of Medicine in late 1917. Famously, Rivers was one of the psychologists who treated Wilfred Owen and Siegfried Sassoon at Craiglockhart War Hospital, Edinburgh, in 1917.

How did Rivers treat shell shock and why was it significant?

Rivers was a pioneer in this field. Here, he writes about how the repression of traumatic war experiences only delays an individual’s recovery. Doctors were generally inexperienced in dealing with this new form of mental distress, and commonly believed that repression was effective ‘as a definite course of treatment’, as Rivers puts it. In Virginia Woolf’s Mrs Dalloway (1925) we are shown how the soldier Septimus Smith uses techniques of repression after he is traumatised by the death of his closest friend, Evans. Electric shock treatment was also common. Many doctors, and civilians, did not believe this was a ‘real’ illness but rather a sign of weakness or a cowardly excuse to escape combat.

Describing the effects of repression, Rivers writes:

It is as if the process of repression keeps the painful memories or thoughts under a kind of pressure during the day, accumulating such energy by night that they race through the mind with abnormal speed and violence when the patient is wakeful, or take the most vivid and painful forms when expressed by the imagery of dreams.

Most troublingly, Rivers warns that repression risks passing men who are unwell as fit for service. This ‘can have but one result when he is again faced by the realities of warfare’ – a second breakdown, or suicide.

As he practised in Edinburgh, Rivers firmly argues that soldiers can only overcome their illness by confronting, albeit in ‘moderation’, what has happened to them: ‘I advocate the facing of painful memories and deprecate the ostrich-like policy of attempting to banish them from the mind’. This has been described as the ‘talking cure’.