Now all roads lead to France and heavy is the tread
Of the living; but the dead returning lightly dance.
Edward Thomas, Roads

Tuesday, March 26, 2024

They Called it Shell Shock: Combat Stress in the First World War

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By  Stefanie Linden

Helion & Company, 2017

Reviewed by Michael Robinson

Originally presented in Reviews in History, August 2017

Over 80,000 cases of shell shock were officially recognized by British Army personnel during the First World War. The diagnosis remains a culturally and historically resonant symbol of the First World War in Britain. Its significance has been influenced by the famous postwar memoirs of ex-servicemen who recounted their personal experiences of shell shock. Similarly, Pat Barker’s critically and commercially successful Regeneration trilogy only served to reinforce shell shock as an integral cultural reference point. 

Yet, this has arguably been damaging to the historiography. These works focus primarily on the officer class which has led the working-class Tommy’s torment to be comparatively obscured, despite their sizeable majority. Leading military psychiatrist researchers, Simon Wessely and Edgar Jones, went so far as to argue: "To an extent, shell shock was hijacked by the literary fraternity."  Indeed, it was only in 2002, with Peter Leese’s Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War, that the first in-depth and exclusive academic analysis of Britain’s experience of shell shock was offered. Leese’s work has been subsequently added to by a small number of additional studies into shell shock.

Stefanie Linden’s They Called it Shell Shock provides a fresh approach to the historiography of shell shock and the men who suffered from psychoneurotic reactions as a result of service in the First World War. Drawing on a host of research resources, including medical publications, institutional records, and the histories of soldier-patients who underwent treatment during the conflict, Linden’s work demonstrates the universal psychological suffering of servicemen of both the British and German armies. By doing so, this work provides the very first comparative analysis of both British and German servicemen who suffered from combat stress during the First World War. . .

They Called It Shell Shock contributes to firmly established features in the historiography of shell shock. For example, Linden makes it clear that traumatized soldiers suffered from a huge variety of subjective psychological symptoms, which could be induced by an immediate incident or the cumulative effect of service, but that some servicemen also developed psychoneurotic symptoms despite never having been exposed to active service, with many breaking down away from the front and even on home leave (pp. 32, 181). Indeed, a quantitative analysis of the Charité records demonstrates that almost a quarter of patients had not even seen action (p. 181). Linden’s analysis also provides further evidence of the differentiation in  treatment and perception of shell shock depending on whether a sufferer was a private or an officer with the treatment on offer to the latter much preferable to the former (pp. 94–8). In addition to addressing well-trodden paths in the historiography, They Called it Shell Shock provides welcome considerations into largely neglected aspects of First World War history. The study addresses suicide and desertion in separate chapters via the analysis of German and British medical literature to consider how service during the First World War could drive German and British servicemen to suicide (pp. 146–57) or desertion (pp. 158–76). Such analyses of these important subjects are welcomed, and it is no criticism of the author to suggest that much more research into these neglected topics is now required.

In addition to providing timely analyses into overlooked topics, They Called It Shell Shock is undaunted by tackling the complex relationship between shell shock and combat-induced Post-Traumatic Stress Disorder. While recognizing the intrinsic similarities in both diagnoses, Linden argues that medical diagnoses are dictated by the existing cultural and environmental context. In warfare, this includes medical progress, societal beliefs, stereotypes and stigma, and the nature and conduct of a given conflict. As Linden observes: "The physical expression of distress may also be mediated by cultural forces through popular health fears, which alert patients and doctors to particular areas of the body" (p. 235). Linden’s considered appraisal of the two diagnoses is welcome especially as debate, confusion, and disagreement regarding the relationship between PTSD and shell shock continues to feature on the floors of conferences.

The undoubted strength of The Called It Shell Shock lies within Linden’s analysis of more than 600 original medical case files of British and German soldier-patients who underwent neurological and psychiatric treatment at the National Hospital at Queen Square in London, the Charité Psychiatric Department in Berlin and the Jena Military Hospital in Jena. With regards to the former, the vast majority of patients admitted to Queen Square were private soldiers with only four shell-shocked officers being admitted between 1914 and 1918 (p. 60). Thus, this study brings timely attention to the regular private who has been overshadowed by the officer class. This original research on previously untouched medical archives allows Linden to demonstrate the universality of subjective psychoneurotic symptoms including traumatic brain injury, fits, twilight states, states of stupor, exhaustion, and paranoia and psychosis, which affected both British and German soldiers alike. . .

Ultimately, They Called It Shell Shock will be of immense interest to shell shock historians, specialists in trauma studies, those interested in the social and cultural effects of the First World War, as well as a broader audience of students interested in the impact the First World War had on servicemen and combatant nations.

Excerpted from Michael Robinson's original review.

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