Banner for Shell shock article taken from The Hydra front cover. Shows an illustration of a soldier being attacked by a mythical beast (the hydra), alludes to psychological damage.

Shell-shock

Recent estimates suggest that up to 325,000 British soldiers may have suffered from ‘shell-shock’ as a result of the First World War. Dr Tracey Loughran reflects on the encounters between Siegfried Sassoon, Wilfred Owen and W H R Rivers at Craiglockhart War Hospital, and how other doctors attempted to treat ‘shell-shock’.

You're quiet and peaceful, summering safe at home;
You'd never think there was a bloody war on! ...
O yes, you would ... why, you can hear the guns.
Hark! Thud, thud, thud, – quite soft ... they never cease –
Those whispering guns – O Christ, I want to go out
And screech at them to stop – I'm going crazy;
I'm going stark, staring mad because of the guns.

– Siegfried Sassoon, ‘Repression of War Experience’ (1918)

In July 1917, Siegfried Sassoon (1886–1967) issued a statement of protest against the continuation of the war. He hoped that this act of ‘wilful defiance of military authority’ by a decorated soldier and well-known poet would spark a public debate about the legitimacy of the war and in this way hasten its end. His hopes were not to be realised. His friend, the officer and poet Robert Graves (1895–1985) intervened to convince the military authorities that Sassoon was suffering from ‘shell-shock’. This explanation suited the military authorities: once he had been diagnosed with a mental illness, Sassoon’s declaration could be dismissed as the ramblings of an unsound mind. Instead of facing court-martial, Sassoon was sent to Craiglockhart War Hospital in Edinburgh, a specialist institution for the treatment of officers.

Siegfried Sassoon's statement of protest against the war, and related letters

Siegfried Sassoon's statement of protest against the war, and related letters

'I am making this statement as an act of wilful defiance of military authority, because I believe that the war is being deliberately prolonged by those who have the power to end it.'

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Usage terms © Published by permission from the Estate of George Sassoon. Published under a Creative Commons Non-Commercial Licence. (Some items listed in the catalogue description were not digitised for the Europeana Collections 1914–1918 project due to copyright restrictions. Permission applies to ff. 2–16, 21–24, 26, 28, 34–53).

Sassoon’s time at Craiglockhart proved a pivotal moment in his own life, and the lives of others. The editor of Craiglockhart’s patient-produced magazine The Hydra quickly recruited Sassoon as a contributor. This editor, Wilfred Owen (1893–1918), was also an aspiring poet, and Sassoon helped him hone his poetical skills. The result was one of the most powerful poems of the First World War, Owen’s ‘Anthem for Doomed Youth’.

Front cover of The Hydra, November 1917

Front cover of The Hydra, November 1917

Wilfred Owen edited and contributed poetry to the Hydra magazine while a patient at the Craiglockhart hospital.

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Usage terms This item is from The First World War Poetry Digital Archive, University of Oxford (www.oucs.ox.ac.uk/ww1lit); © English Faculty Library, The University of Oxford. Permitted Use. Anonymous artist: This material is in the Public Domain.

Poetry manuscripts of Wilfred Owen

Wilfred Owen’s first manuscript draft of ‘Anthem for Doomed Youth’ with Siegfried Sassoon’s amendments, c. 1917.

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The poet and the psychiatrist

Sassoon’s encounter with the psychiatrist W H R Rivers (1864–1922) also profoundly affected both men. Rivers immediately recognised both that Sassoon’s anti-war stance was entirely rational and that his traumatic experiences had left him teetering on the brink of psychological breakdown. Rivers was deeply troubled by his own complicity in the War Office’s attempt to neutralise Sassoon’s protest. Treating Sassoon forced him to confront the ambiguous role of the military doctor in wartime. As long as Rivers wore the military uniform, he could not interact with Sassoon as a free agent, but had to try to convince him to return to the war – a position that was difficult to square with the doctor’s first duty of care to the patient, and difficult to maintain in relation to a man he liked and respected.

Rivers did eventually persuade Sassoon to give up his protest and return to the war. But he also undoubtedly gave Sassoon greater insight into his own mental processes. Sassoon’s poem ‘Repression of War Experience’ recounts the internal monologue of a soldier ‘summering safe at home’ and trying not to ‘lose control of ugly thoughts’ that could drive him mad. The poem is named after an influential article by Rivers, published in the medical journal The Lancet in February 1918. In this article Rivers argued, against the dominant medical opinion of the day, that many soldiers broke down because they tried so hard to repress their memories of the war. The key to recovery was remembering and understanding why these memories haunted them. Sassoon’s poem is a vivid first-person account of the desperate attempt to forget; but his borrowing of Rivers’s title and brutal admission that he is ‘going stark, staring mad because of the guns’ also demonstrates his new understanding of the effects of the war on his mind. Sassoon never lost this understanding, and always referred to Rivers as his ‘saviour’.

W H R Rivers on the treatment of shell shock, from The Lancet

W H R Rivers on the treatment of shell shock, from The Lancet

W H R River's influential article, 'An Address on the Repression of War Experience'.

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Counter-Attack, and Other Poems by Siegfried Sassoon

Counter-Attack, and other poems by Siegfried Sassoon

Sassoon's poem 'Repression of War Experience'.

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Usage terms © Siegfried Sassoon by kind permission of the Estate of George Sassoon. Except as otherwise permitted by your national copyright laws this material may not be copied or distributed further.

The story of this encounter between Sassoon and Rivers is very famous. Sassoon wrote about it in his own memoirs and fictionalised autobiographies, and it formed the basis of Pat Barker’s historical novel Regeneration (1991) and the subsequent film of the same name (dir. Gillies Mackinnon, 1997). Schools still teach the powerful poetry of Wilfred Owen and Siegfried Sassoon, and their work inevitably shapes how we think about the effects of the First World War on soldiers’ minds and bodies. However, the experiences of Owen and Sassoon were in no way typical.

How did doctors treat ‘shell-shock’ during the First World War?

Recent estimates suggest that up to 325,000 British soldiers may have suffered from ‘shell-shock’ as a result of the war. The term ‘shell-shock’, which is now often perceived as synonymous with Post-Traumatic Stress Disorder (PTSD), incorporated diverse symptoms. These included headaches, nightmares, hallucinations, and distressing and intrusive memories – all symptoms we associate with war trauma today. But ‘shell-shock’ also included hysterical disorders, such as mutism and paralysis, amnesia, and even ‘personality loss’, as in the case of one man who seemed to develop an entirely new identity, including a different accent, after he had been hit by a shell. Victims of ‘shell-shock’ might have very little in common, except that they had been damaged in some way by the war.

Doctors struggled to understand what had caused ‘shell-shock’ and how best to treat it. They recognised very early on that the grief, fear and horror of war could cause men to break down. But they also wondered what effects high explosive artillery, never previously used in such quantities for prolonged periods, might have on the delicate human nervous system. Some medical men argued that the vibrations of shell explosions caused invisible, molecular damage to the brain. In more recent years, the memory loss, depression and anxiety of some troops returning from Iraq and Afghanistan has been explained in a similar way, as a result of the mild traumatic brain injury (MTBI) caused by high velocity explosions. By the end of the First World War, many doctors believed that both psychological and physical injuries could be found in many cases of ‘shell-shock’.

Images of War by Richard Aldington, with illustrations by Paul Nash

Images of War by Richard Aldington, with illustrations by Paul Nash

In 'Bombardment', poet and soldier Richard Aldington describes the physical and psychological effects of a heavy enemy assault. Unable to sleep for nights on end, men become 'Nerve-tortured, racked to exhaustion'.

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Usage terms Richard Aldington: © The Estate of Richard Aldington - Selected images of 'IMAGES OF WAR by Richard Aldington - 1919 - C.100.g.4' reproduced by kind permission of the Estate of Richard Aldington c/o Rosica Colin Limited, London. Except as otherwise permitted by your national copyright laws this material may not be copied or distributed further. Paul Nash: © Crown Copyright. This material has been published under an Open Government Licence.

British Artists at the Front series

British Artists at the Front series

In this composition, war artist Paul Nash portrays a dark, nightmarish battlefield, marked with shell craters and barbed wire.

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Usage terms Paul Nash: © Crown Copyright. This material has been published under an Open Government Licence. Eric Kennington: © Family of the Artist. Published under a Creative Commons Non-Commercial Licence.

Because doctors were not sure what caused ‘shell-shock’, it was difficult to find an appropriate cure. Sassoon was extremely lucky to be sent to a doctor like Rivers, who practised psychotherapy. Few institutions offered this form of treatment. In fact, the majority of men were treated by conservative methods such as rest, diet, massage and drugs. These treatments were unlikely to have effected permanent cures, but at least they did no active harm. The same cannot be said for the electrical ‘treatment’ offered by neurologist Lewis Yealland inflicted electric shocks on his patients at Queen Square, London. Yealland believed that hysterical patients had an unconscious resistance to treatment, and that the pain caused by electrical shocks could break down this resistance The war also saw a vogue for dramatic ‘cures’ via hypnosis, as practised by Arthur Hurst at Seale Hayne in Devon. Yet while Hurst successfully removed visible hysterical symptoms, restoring movement to paralysed soldiers and speech to those who had been mute, such treatments did not tackle the root causes of these men’s disorders. We have no way of knowing how many of these men subsequently broke down again.

Nowadays, ‘shell-shock’ is part of the story of the First World War that students learn about in school, and that Remembrance Day memorialises every November. We are aware of the psychological costs of war. Between 1914 and 1918, many men painfully learnt those costs at first hand. In the aftermath of the war, they and their families struggled to cope, often with little support from governments that were keen to avoid paying out pensions for psychological damage. Indeed, the government was so keen to save money by cutting the pensions bill that in some cases, it created a very hostile environment for traumatised men who were unable to find or hold down employment, and could not pick up the threads of their pre-war lives. Some men had to repeatedly prove the extent of their disabilities, and make the case again and again that these disabilities were the result of their wartime experiences, in order to retain their pensions. Many lost this battle, and struggled to scrape by. Perhaps the best tribute to men who suffered ‘shell-shock’ in the First World War is to realise that we still do not know exactly what causes similar disorders, or how to cure them. While the suffering of soldiers like Owen and Sassoon speak to us powerfully through their writings, their lesson is not to complacently assume that people today know better. Rather, it is to confront honestly the horror and suffering that war still causes.  


Banner: This item is from The First World War Poetry Digital Archive, University of Oxford (www.oucs.ox.ac.uk/ww1lit); © English Faculty Library, The University of Oxford. Permitted Use. Anonymous artist: This material is in the Public Domain.

  • Tracey Loughran
  • Tracey Loughran is Reader in History at the University of Essex, where she specialises in the history of gender, health and subjectivity in twentieth-century Britain. Her publications include Shell Shock and Medical Culture in First World War Britain (Cambridge University Press, 2016), The Palgrave Handbook of Infertility in History: Approaches, Contexts and Perspectives (co-edited with Gayle Davis, Palgrave Macmillan, 2017), Emotion and the Researcher: Sites, Subjectivities and Relationships (co-edited with Dawn Mannay, Emerald, 2018). She is also interested in historical theory and methodology, and is the editor of A Practical Guide to Studying History: Skills and Approaches (Bloomsbury, 2017). She currently holds a Wellcome Trust Investigator Award in Humanities and Social Sciences for the project ‘Body, Self and Family: Women’s Psychological, Emotional and Bodily Health in Britain, c. 1960-1990 (2017-2020), which explores how the sweeping changes of the postwar period affected women’s experiences of bodily and emotional wellbeing.

The text in this article is available under the Creative Commons License.