Wednesday, 21 May 2014

Shell Shock Revisited


by Wendy Holden

SIXTEEN YEARS ago I wrote a book about the history of shell shock - or Post Traumatic Stress Disorder as it is now more popularly known.
     The book, which accompanied a Channel 4 documentary series, was published 18 months after I had returned from Iraq - where I reported on the First Gulf War for the Daily Telegraph - and long before I realised I was suffering from a form of shell shock myself.
     The effects of my experiences in the desert have never left me. I am still plagued by nightmares of mass graves, bloody torture chambers, and rotting corpses. I often ‘sleep-run’ to escape imaginary attackers, trying to throw myself from windows or hurl myself down stairs.
     I have broken several bones and snapped my husband’s ribs twice as he tried to contain my nighttime thrashings. We now have mountaineering ropes fixed at the top of the stairs, which are clipped to metal shackles each night before we go to bed.
     When I wrote Shell Shock: The Psychological Trauma of War (recently reissued on Kindle to mark the anniversary of the First World War), I had little understanding of the effects of war on the mind.
     For months, though, I listened to the moving testimonies of WWI survivors and immersed myself in the records of the amateur psychiatrists who tried to fathom what ‘molecular commotion’ was caused in the brain by the shock of exploding shells – hence the misnomer ‘shell shock’.
     Even though the history of war-related illness goes back centuries, the flood of cases in WWI caught the medical establishment completely off guard.
    The medical enthusiasts who flocked to the fashionable ‘new science’ because of the massive numbers of mental breakdowns didn’t yet know that they weren’t caused by something physical but by human minds torn between self-preservation and duty.
     Idealistic young men wholly unsuited to homicide had marched joyously to battle with very little training or preparation. The conflict was expected to be short and sharp. “It’ll all be over by Christmas!” was a popular cry.
     But war on the western front was different from any fought before. The nerve- shattering properties of the new killing machines brought mental resistance to saturation levels. Under a never-ending bombardment of bullets and shrapnel, men were unable to sleep or even think. The trenches offered shelter but also imprisoned and immobilized, creating a powerful urge to escape.
      Men drowned in the shell holes or were sucked into the wet mud. Mules and horses were maimed and lay suffering. Human corpses littered no man’s land to be eaten by rats. The sense of helplessness was exacerbated by the terror of mutilation that pushed men to the brink of mental illness for the first time in their lives.
     There was no glorious battles to be fought with honour; just a pitiless life under siege. The prospect of being blown to pieces was a fear that flesh could not support.
     No one was immune to the horrors and none could tell who would crack. Few knew what to do with the grimacing, twitching cases who either ran from the lines or lay crying in their trenches, tormented and ashamed.
     Terms like ‘knocked silly’ or ‘got the wind up’ abounded and some 300 ‘malingerers’ were shot for cowardice, while hundreds more were dispatched to ‘loony bins’ for a brutal regime of cold baths and padded cells.
      With a serious manpower crisis and a war to be won, much of the early treatment was nothing short of brutal. There was no shortage of guinea pigs so hapless soldiers were prodded and poked, filmed and mistreated. Radical therapies were tested, including high dosage electric shock treatment that sometimes killed patients. This kind of experimentation would previously only have been possible on animals.
     Officers were generally treated differently than the rank and file and were prescribed rest, silence, occupational therapy, even a milk diet - but that didn’t make their own personal hell any easier.
     Few were able to express the horrors of the battlefield quite so well as the soldier poets such as Siegfried Sassoon and Wilfred Owen, both treated for shell shock. Sassoon wrote poignantly: “By night each man was back in his doomed sector of horror-stricken front line where the panic and stampede of some ghastly experience was re-enacted among the living faces of the dead.”
     The doctors enlisted into the Royal Army Military Corps to care for those whose minds gave way had little medical history to go on and no clear guidelines. Symptoms were confusingly diverse and might include paralysis, blindness, speech loss or impairment, hallucinations, amnesia, chronic depression, schizophrenia and suicidal thoughts.
      The top military brass continually refused to accept shellshock as genuine and feared mass panic in the ranks. Crucially, shell shock wasn’t admissible as a plea in a court martial for cowardice or desertion for which the ultimate penalty was death. From the military viewpoint men were either ‘mad or bad’ and the doctors were frequently reminded that the ‘A’ in RAMC stood for Army.
     But what to do with the thousands of gibbering wrecks sent back from the front, especially when ‘cured’ they would only be sent back for more. Psychiatry was on the fringes of acknowledged medical practice and the theories of some psychoanalysts like Freud and Jung were considered shocking, but something had to be done. And so the science of military psychology was born, designed to remove men’s moral objection to war.
     It was only thanks to the compassion of psychiatrists like Charles Myers and W.H. Rivers that a more sympathetic approach was eventually adopted. Rivers developed the ‘talking cure’ and believed ‘anxiety neurosis’ came about when men were torn between the desire to run away and the obligation to fight.
    The sight of a corpse – especially of someone familiar - was the most common trigger for mental breakdown as the image continually haunted a man’s dreams. Worn down with the mental struggle, a soldier’s body found a clever way out by exhibiting signs of serious illness to provide him with an escape route.
    The fledgling study of the relationship between war and madness came to represent a revolution in military attitudes to the fragility of men. It was later responsible for the setting up of modern systems of diagnosis and the treatment of mental illness.
      The death penalty for cowardice was abolished and terms like ‘war neurosis,’ battle exhaustion’ or ‘combat stress’ came into parlance. Those affected were given compassionate treatment instead of being forced from the army without a pension. Still, it wasn’t until 2006 that the executed ‘cowards’ of the trenches were pardoned.
    The First World War undoubtedly became a touchstone of horror by which all later conflicts would be compared. It was also a watershed in the acceptance of invisible injury. Most of the symptoms witnessed then have been seen in veterans of every war since.
    With screening and preparation coupled with the birth of forward psychiatry, soldiers, journalists and civilians are better cared for than ever when they are sent to the front line to witness things that may scar them mentally forever.
     As conflicts continue around the world, there is still much that the military and the rest of humanity needs to learn and understand about how the most extreme of human experiences can deliver a severe trauma to the moral and mental state in what will always be a battle for the mind.

·               Shell Shock: The Psychological Trauma of War by Wendy Holden is now available on Kindle, price £4.99

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