Book Review: Shell-Shock

Anthony Babington, Shell‑Shock: A History of the Changing Attitudes to War Neurosis. Leo Cooper, London, 1997, 218pp, £16.95, ISBN 0 85852 562 4.

Beginning with the description of a court martial in March 1915, Anthony Babington relates the plight of those who suffered from "war neurosis" as a result of military service, showing how medical and army authorities dealt with them and what changes were eventually brought about by political action and public opinion. The main focus is inevitably on the First World War, but the story is traced back to the Battle of Marathon (490 B.C.) and brought forward to Gulf War syndrome and post‑traumatic stress disorder (PTSD). By the end of the nineteenth century things were clearly going seriously wrong with the minds as well as the bodies of some soldiers, affecting their efficiency as fighting troops and therefore of increasing concern to those in charge. Terminology was always problematic, varying with the predominant symptoms perceived and social assumptions of the time. Soldier's heart, battle fatigue, and "nostalgia" were among the descriptions; in the American Civil War, the theory of "compression of the brain caused by shell explosions" appeared. Ideas about insanity and awareness of the unconscious mind remained a long way from furnishing either a convincing analysis or an acceptable remedy.

Whatever it was called, the phenomenon was international, and flourished as a disorder of the twentieth century, with first the Boer and Russo‑Japanese Wars bringing their quota of these cases, then, within a few months of the outbreak of the First World War, something on an unprecedented scale. The (UK) Mental Health Bill, 1915, provided for six months without being certified if the causes of mental problems were connected with the war. Treatment included rest, quiet and induced re‑creation of events under hypnosis, always with the aim of "cure" and return to the front. In spite of its growing credibility in medical circles, shell‑shock was not accepted by the army as a valid defence against charges of cowardice or desertion. Executions (of which Babington has made a special study*) without medical examination or in spite of medical findings continued until a few days before the armistice, and the highest echelons were ready both to endorse the most callous decisions and to lie about the process to the British public. Other armies did not fare much better. Sigmund Freud in a memorandum to the post‑war Austrian War Ministry enquiry observed that the prime aim of restoring fitness to service was foreign to the essence of Medicine, referring to the "insoluble conflict between the claims of humanity, which normally carry decisive weight for a physician, and the demands of a national war”. (p.66) 

After a decade of campaigning and debate, the UK in 1930 enacted the Army and Air Force Bill, removing the death penalty for cowardice, and, upon amendment, for desertion on active service. Less is heard about psychiatric casualties in the Second World War, but they still constituted a significant percentage at every stage. Post‑World War II, war neuroses among ex‑servicemen were not so obvious but could lie dormant, with commemorations as long as fifty years later sometimes triggering symptoms. Wars still happened. In Korea and Vietnam the USA developed a rotation system to limit time spent in the combat area. Frustration, helplessness and unpopularity were thought to contribute to the large proportion of Vietnam veterans showing symptoms of what was recognised in 1980 as post‑traumatic stress disorder. The Falklands campaign of 1982 found Britain with no mental health professionals serving, contemplating an estimated 2% psychiatric casualties and assuming incorrectly that none would develop PTSD. The consequences of the Gulf War and its syndrome(s) are still under investigation.

The book's Postscript notes that the efficacy of counselling or psychological debriefing is a matter of debate, and, with PTSD rates higher than ever, speculates as to whether the combatants of today may be on the one hand less selfless and resolute, or on the other, more percipient and conscious of the futility of war, than in times past. It does not plump for either explanation nor delve into the cultural changes that may have brought either about. Some further questions suggest themselves: What made some able to adjust to all the horrors? Are women subject to war neurosis to the same extent? What of PTSD among civilians and refugees? etc. Nevertheless, we have a useful basis for developing other analyses, well worth adding to anyone's collection of materials on what war does to people.

In July 1998 the British government was prepared to express regret at those 1914‑1918 executions, but not to accord a pardon to their victims. 

  L. W.

October 1998

First published in Medicine,Conflict & Survival 

* Anthony Babington, For the Sake of Example. Pen & Sword, 1993. 256pp.

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