Recommended: Revisiting the Mental Health Fallout from the Unprecedented Horror of the First World War

First Presented at The Literary Hub, 14 June 2023
By Charles Glass

The men and boys who straggled back to their trenches had witnessed unprecedented horror. Close friends, in some cases their own brothers, had been cut to pieces before their eyes. It was more than many could bear.

All the armies in the Great War had a word for it: the Germans called it Kriegsneurose; the French la confusion mentale de la guerre; the British “neurasthenia,” and when Dr. Charles Samuel Myers introduced the soldiers’ slang into medical discourse in 1915, “shell shock.” Twenty-five years later, it was “battle fatigue.” By the end of the 20th century, it became post-traumatic stress disorder (PTSD).

In December 1914, a mere five months into “the war to end war,” Britain’s armed forces lost 10 percent of all frontline officers and 4 percent of enlisted men, the “other ranks,” to “nervous and mental shock.” An editorial that month in the British medical journal The Lancet lamented “the frequency with which hysteria, traumatic and otherwise, is showing itself.”

A year later, the same publication noted that “nearly one-third of all admissions into medical wards [were] for neurasthenia”—21,747 officers and 490,673 enlisted personnel. Dr. Frederick Walker Mott, director of London’s Central Pathological Laboratory, told the Medical Society of London in early 1916, “The employment of high explosives combined with trench warfare has produced a new epoch in military medical science.”

This development need not have surprised Britain’s military physicians. Major E. T. F. Birrell of the Royal Army Medical Corps (RAMC) had observed nervous breakdowns in surprising numbers while supervising a Red Cross medical mission to the Balkan Wars between Turks and Bulgarians in 1912 and 1913. The new heavy weapons that Germany’s Krupp and other European industrialists sold to both sides inflicted carnage that doctors had not witnessed before.

Modern science was creating modern war. Explosive rifle cartridges penetrated flesh more deeply than balls from single-shot muskets. High-explosive artillery shells released not only the shrapnel shards of old, but ear-shattering thunder, blinding light, and a concussion so fierce that it sucked the air away. The shells demolished the strongest ramparts, leaving no refuge. Rapid-fire machine guns mowed down hundreds of men in an instant. Hospital wards received, in addition to those who had lost arms or eyes, disabled soldiers without marks on their flesh. They suffered unexplained blindness, mutism, paralysis, shaking, and nightmares. A surgeon from Belgium’s Saint Jean Hospital, Dr. Octave Laurent, documented the Balkan wounds in his book La Guerre en Bulgarie et en Turquie. Laurent removed metal shards from broken bodies, but surgeons could not cure paralysis, trembling, nightmares, blindness, stammering, and catatonia.

Laurent posited physical causes for the symptoms. This accorded with medical and military doctrine of the day that fighting men did not become hysterical. Practitioners in the new field of psychiatry shared the view of Sigmund Freud in Vienna that hysteria, a word derived from the Greek for “uterus,” was a female condition. Laurent referred to the soldiers’ malady as la commotion cérébrospinale, a variant of what American Civil War doctors had called “windage,” undetectable molecular disruption of the spinal cord from the vibration of speeding bullets and shells. Concussion had caused some, but not all, of the neuroses. Laurent’s and the RAMC doctors’ denial of the emotional causes of physical disabilities would influence the military response to mental illness when Europe’s Great War began in the summer of 1914.

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Thanks to reader Alan Kaplan for bringing this article to our attention.