This unnamed soldier was the first documented case of shell shock. In February 1915, Myers published a paper in the Lancet describing three such cases, titled “A Contribution to the Study of Shell Shock.” The term seemed to be an apt description of the phenomenon—most of Myers’s cases had “followed from the shock of an exploding shell,” leading to the soldier’s collapse. With Myers and other doctors, it almost seemed to be a case of the Victorian tendency toward scientific analogy expressing itself, a way of making concrete a decidedly abstract idea, that of post-traumatic stress. However, the fact that the term rolled off the tongue with such ease, and as a result stuck in the public imagination, was to become problematic later.
That Myers had taken notice of these odd cases was itself unusual, so strong was the desire to dismiss the soldiers as malingerers. Qualified as a physician, Myers was an example of that very British species of intellectual, the gifted dabbler. Along with W. H. R. Rivers, another notable member of Cambridge’s fledgling psychology department, Myers had taken part in a groundbreaking anthropological expedition to New Guinea, applying modern scientific techniques to the study of the tribal societies there. As an academic and a Jew, he was a double outsider within the Royal Army Medical Corps, a body noted for its attention to the needs of discipline over the needs of medicine. Nevertheless, Myers possessed a surplus of networking ability and was eager to find a role for himself in the war. While visiting Salpêtrière, the famous French neurology institute, he noticed several soldiers who had lost the power of speech or been partially paralyzed after German artillery barrages. It wasn’t long before British soldiers with similar symptoms began arriving at Le Touquet, a hospital sponsored by the Duchess of Westminster. With the publication of his Lancet piece, Myers ignited a fierce debate within British society about masculinity, honor, and the rights of the individual.
On one side of the debate were the army’s hardliners, who according to one historian possessed “a rough and ready model of human psychology, with its own clear-cut labels. Men were either sick, well, wounded or mad; anyone neither sick, wounded, nor mad but nonetheless unwilling to or incapable of fighting was necessarily a coward.” And if the force of tradition weren’t enough to persuade, the British Army, in the early years of the war, adhered to a draconian policy toward such “moral invalids.” During World War I, more than 2,200 British soldiers were condemned to death for cowardice and desertion. Though only around two hundred soldiers were actually executed, the threat of the firing squad had a powerful impact.
Regardless of the policy, shell-shocked soldiers kept appearing at casualty clearing stations. Soon their stories filled the medical press. One Oxford professor of medicine serving in the army wrote to a colleague that “I wish you could be here in this orgie of neuroses and psychoses and gaits and paralyses. I cannot imagine what has got into the central nervous system of the men . . . Hysterical dumbness, deafness, blindness, anaethesia galore. I suppose it was the shock and the strain but I wonder if it was ever thus in previous wars?” The trenches were only nine months old, but it was becoming clear that doctors were facing an epidemic. According to one estimate, at least two hundred thousand British soldiers were eventually discharged because of shell shock. By the middle of 1916, Myers had personally seen over two thousand shell-shocked soldiers.
As a phenomenon, shell shock confounded the prevailing theories of the day. Within the annals of military medicine there was simply no precedent for it. In the first reports on the subject, one detects a sense of bewilderment at the grotesque symptoms being encountered. One British military doctor wondered if the explosions of the shells weren’t damaging the entire central nervous system. A distinguished neurologist, F. W. Mott, speculated that carbon monoxide poisoning or tiny particles from the shells might be the source of the trouble. Industrialized warfare was new, and the understanding of the effect that it might have on the mind was still dominated by the stark images of exploding shells and the mysterious forces they presumably released. As a result, most of the explanations for shell shock centered on physical causes. The psychiatrists were, in a sense, trapped in the same predicament as the generals: just as the military tactics of the time had yet to catch up to the weaponry, so too had medicine yet to catch up with twentieth-century high explosives.
Myers, who was familiar with French thinking on hysteria, treated the first case with hypnosis and sent the man back to England after ten days of treatment. In his Lancet article, he argued that “the close relation of these cases to hysteria appears fairly certain.” Hysteria, derived from the Greek word for uterus, was until the late nineteenth century thought of as basically a female disorder. The idea that men could be reduced to weeping, spasming shadows of their former selves was practically unheard of. Freud’s ideas on hysteria, which could have been of great service, were not widely accepted at the time, being largely confined to a group of disciples clustered around Vienna. Twenty years before the war, Freud had argued that hysteria was caused by unpleasant memories and experiences. These repressed memories were “flung” into the unconscious in an attempt to avoid mental conflict. In extreme cases, repressed memories were “converted” into physical symptoms, which bore some resemblance to shell shock. Later, Freud would theorize that war neuroses were caused by an internal conflict between self-preservation and the need to maintain one’s sense of honor and duty to comrades.
Some contemporary trauma workers, such as Bill Nash, a retired U.S. Navy psychiatrist, have suggested that these sorts of “conversion disorders” were related to the stigma associated with not doing one’s duty and not being “manly,” a powerful motif in British society at the time. (This was, after all, an era that saw women handing out symbolic white feathers of cowardice to men not in uniform.) The fact that hysterical blindness and mutism, common during World War I, are almost nonexistent today seems to confirm Nash’s thesis, as “stigma reduction” with respect to PTSD has become a part of the medical culture within the military. This issue of stigma is, in fact, one of the great points of divergence between the Great War era and our own.
By late 1915, the British Army, realizing that something had to be done, broke with its old policy and officially admitted to the existence of a gray area between cowardice and madness. This new policy, enacted by the Army Council in London, established what amounted to a two-tier system: shell shock caused by enemy action and shell shock resulting from a simple breakdown. In official reports, this distinction was to be recorded as either “Shell-shock W” or “Shell-shock S.” In the minds of many, including Myers, this system was ripe for abuse. One medical officer complained to him, “We have seen too many dirty sneaks go down the line under the term shell-shock to feel any great sympathy with the condition.” Six months later, Myers proposed that the term shell shock be abandoned and replaced with two new categories, “concussion” and “nervous shock,” but popular opinion both inside and outside the army was fixed. In part because of its power as a metaphor, shell shock was here to stay.
Confusion about how to treat war neuroses was reflected in this confusion about what to call it. The nineteenth century had seen the development of a number of psychological theories, and when the war came, these theories were put to the test. More than a few doctors saw the war as an opportunity to experiment. Military doctors on both sides unleashed an arsenal of therapies on the shell-shocked soldiers, including hypnosis, drugs, talk therapy, milk diets, bed rest, physical exercise, “military discipline” (which frequently meant shouting insults at shell-shocked soldiers), and a crude form of electroshock therapy.
Unsurprisingly, the use of electricity on soldiers was controversial. One French soldier, Baptiste Deschamps, punched a physician when he tried to apply electrodes to his body. Because he had struck an officer, Deschamps was court-martialed. Eventually, the French press, which had been growing increasingly skeptical of the war, seized on the story, and Deschamps’s case became a cause célèbre. He was given a light sentence in the form of a suspe
nded six-month prison sentence. The doctor who had attempted to electrocute him, Clovis Vincent, whose center at Tours was infamous for its electrocution technique, known as torpillage (literally, “torpedoing”), voluntarily stepped down and asked to be reassigned to the Western Front. While a few other doctors continued to experiment with it, by 1918 torpillage had been discontinued and its leading proponents excoriated in the press.
One doctor who championed a more liberal approach was Myers’s old mentor at Cambridge, W. H. R. Rivers. A doctor who seemed ill at ease in uniform, Rivers was a member of the same New Guinea expedition as Myers, a trip that epitomized both his wide-ranging intellectual interests and his deep human sympathies. His medical knowledge, while not as technically polished as many of his peers’, ran deep. If later generations would come to idolize him, converting him into a sort of iconic doctor-hero, as novelist Pat Barker did in her award-winning Regeneration trilogy, it was not without reason. With his myopic, reserved demeanor and humanistic sensibility, he seemed the embodiment of the modern physician as Renaissance man.
The son of a Kent clergyman, Rivers possessed a sort of puremindedness and omnivorous curiosity about the human psyche that has fallen out of fashion today. This curiosity took him through a variety of investigatory incarnations, including that of international anthropologist, general practitioner, ship’s surgeon, and house physician to two famous neurologists in Queen Square, London, all prior to heading to Cambridge as a lecturer in psychology in 1893. One colleague was later to say of him, “Perhaps no man ever approached the investigation of the human mind by so many routes.”
After the war, Rivers would conduct a study of war neurosis published in the War Office’s inquiry into shell shock. His conclusions were fifty years ahead of their time. Examining the incidence of neurosis in the air corps, he found that neurotic symptoms were best correlated not to the intensity of the action seen nor the amount of time spent in combat but to the relative physical immobility of the victim. In the air corps, as in the infantry, neurosis was a function of having control over one’s surroundings. Examining medical records, Rivers found that, among other things, the pilots, who enjoyed a degree of control over their fate, suffered far fewer cases of neurosis than artillery observers in the balloon service, where men were tethered to the ground, essentially sitting ducks. Incredibly, he found that in the balloon service, the psychiatric casualties actually outnumbered those who were physically wounded. In short, the more helpless the patient felt, the more likely he was to be traumatized, a finding that remains essentially unchanged to this day.
Rivers was fifty-one and serving as an army physician at Craiglockhart Hospital in Scotland when he treated his most famous patient. In July 1917, a few weeks before arriving at Craiglockhart, Siegfried Sassoon, a decorated infantry officer and celebrated poet, had published a statement in a newspaper denouncing the war, and it had been read aloud in the House of Commons. The declaration ended by saying that “on behalf of those who are suffering now I make this protest against the deception which is being practised on them; also I believe that I may help to destroy the callous complacence with which the majority of those at home regard the continuance of agonies which they do not share, and which they have not sufficient imagination to realize.” That Sassoon was speaking (and continued to speak) for many soldiers went without saying; from the point of view of the army, he was dangerous, and after some deliberation, they declared him shell shocked and had him sent to Craiglockhart, where he was soon under Rivers’s care.
It was a meeting of the minds that became the stuff of legend: two noted intellects clashing over the question of their time. Whether or not Sassoon was technically suffering from shell shock is open to doubt (he suffered from nightmares, and at one point left the front claiming to suffer from “trench fever”), but in the long run such a technical question is almost irrelevant. What the Sassoon–Rivers dyad came to address was nothing less than the central questions of trauma, questions that continue to echo today: How does one reconcile the self with the often inhumane demands of society? How does one communicate to society the conditions that constitute the underworld of trauma? How does one face death with dignity and authenticity?
At first, it seemed far from an ideal match. Sassoon, aware of how the army was attempting to marginalize him with the shell-shock label, was indignant, even truculent, toward Rivers. Sassoon had a tendency toward snobbishness, and he scorned the other patients at Craiglockhart, referring to the place in his letters to friends as “Dottyville.” Rivers met Sassoon’s rebellion with an avuncular tone that he had probably perfected in dealing with Cambridge undergraduates. Rivers’s method, such as it was, seemed to be a sort of medically guided social conversation. They spoke as peers. As Sassoon would later write in his heavily autobiographical novel, Sherston’s Progress:
One evening I asked whether he thought I was suffering from shell shock.
“Certainly not,” he replied.
“What have I got, then?”
“Well, you appear to be suffering from an anti-war complex.” We both of us laughed at that. Rivers never seemed elderly; though there were more than twenty years between us, he talked as if I were his mental equal, which was very far from being the case.
Rivers had been influenced by Freud, but he was no Freudian. He saw little use for Freud’s theories on infantile sexuality in treating war neuroses. Nevertheless, he looked at dream analysis as an important part of understanding the workings of the mind. Whatever his theoretical leanings, he took an individualized approach with Sassoon. They saw each other every day at first, and then Rivers cut it down to three times a week. It wasn’t long before Rivers was trying to convince his patient to return to the front as a means of strengthening his argument about the war’s injustice.
The director of Craiglockhart believed in the therapeutic value of sport, and daytime saw the officer-patients playing tennis, croquet, and cricket, a curriculum that lent the place a buoyant atmosphere. The ever-aloof Sassoon took to the links, brooding his way over the Scottish countryside. The nights were a different story. As Sassoon saw it, the place was divided into two spheres, the enforced bonhomie of the day followed by the dismal night, a division no doubt familiar to many veterans today. “By day the doctors dealt successfully with these disadvantages and [Craiglockhart] so to speak, ‘made cheerful conversation.’ But by night they lost control and the hospital became sepulchral and oppressive with saturations of war experience. One lay awake and listened to feet padding along passages which smelt of stale cigarette smoke . . . One became conscious that the place was full of men whose slumbers were morbid and terrifying—men muttering uneasily or suddenly crying out in their sleep. Around me was that underworld of dreams haunted by submerged memories of warfare and its intolerable shocks and self-lacerating failures to achieve the impossible.” In time, Rivers began to win Sassoon over.
Also at Craiglockhart was another troubled infantry officer and poet, Wilfred Owen. He had fought with the Manchester regiment and been blown up by an artillery shell near Fayet. Dazed and unresponsive, he was eventually sent back to England. Seven years younger, Owen was as yet unpublished, and after hearing that Sassoon was at Craiglockhart, he went to his room and sought his writing advice. Stammering out his admiration for the older officer, Owen asked him to autograph a book of his poetry. Over the course of their residence at Craiglockhart, Sassoon mentored Owen, helping to polish the work that would become the defining poetry of the war. Many of Owen’s greatest poems were written during this period, including “Anthem for Doomed Youth” and “Dulce et Decorum Est.” The two agreed about a number of things, including the “apparent indifference of the public and press” toward the war.
If Sassoon was expecting a kind of martyrdom at Craiglockhart, he was to be disappointed. Over the course of their time together, Sassoon went from sparring ineffectively against Rivers to seeing him as a kindred spirit, despite Rivers’s lack of combat exposure. Years later, he would descr
ibe him as a “dream friend.” Ashamed by the comforts of the hospital, by the end of the summer Sassoon seemed to accept his fate, saying, “Reality is on the other side of the Channel, surely.” In an extraordinary act of sublimation, Sassoon came to believe that offering up his life to the pacifist cause in the trenches was the proper course. In November, Sassoon appeared before an army medical board and was declared fit for general service.
It was never entirely clear how Rivers was able to alter the trajectory of Sassoon’s life, apart from simply talking thoughtfully with him about his predicament. On a certain level, there seemed to be something curative about the respect Rivers accorded him, an act of creative compassion that seems almost magical, considering the pressure both men were under. Sassoon later wrote, “Shutting the door of his room for the last time, I left behind me someone who had helped and understood me more than anyone I had ever known. Much as he disliked speeding me back to the trenches, he realized that it was my only way out. And the longer I live the more right I know him to have been.”
By May, Sassoon was back in France. Returning to friendly lines after an incredibly risky two-man reconnaissance of a machinegun position, he was shot in the head by a British soldier who mistook him for a German. Despite his protests, he was evacuated back to England. After the war, he lived as a lettered country gentleman and continued to write poetry, though his style was much changed. The war was never far from his mind, and decades later he would continue to dream of returning to the front, echoing the experience of other veterans, such as Ivor Gurney, a Great War poet and composer who died in a mental hospital in 1937 convinced that the war was still going on.
Owen’s luck was of a different sort. He was killed in action a week before peace was declared. Word of his death reached his parents as church bells announced the Armistice on November 11, 1918.
The Evil Hours Page 12
