I wondered what was happening because anything that went off, bang, over there somewhere made me jump. And I suddenly realized I’d got this thing called shell-shock, which I’d never believed in before. Simply I think because of all these shells going off quite close to one, there was a lot of concussion about it. And I realised this and I didn’t know what to do because I wasn’t going to tell anybody and I didn’t tell anybody about it.[1]

British Lieutenant Francis William Seymour Jourdain describes his involuntary startle after a bang went off, illustrating the fear associated with his symptoms and potential diagnosis—shell-shock—and explains his preconceived idea of other soldiers with the same condition. Jourdain’s description is similar to that of other British soldiers who, while fighting for their country, developed shell-shock and faced harsh treatments, accusatory stigmas, and governmental neglect. World War I was a global conflict lasting from July 28, 1914, to November 11, 1918, involving the Allied Powers of France, Great Britain, and Russia, and the Central Powers of Germany, the Ottoman Empire, and Austria-Hungary. The war was primarily fought along the Western Front of France and Belgium and the Eastern Front of Poland and Russia, where both the powers set up defensive trenches, long narrow ditches where soldiers lived and fought, to protect themselves from enemy fire. The horrific nature of trench warfare, with artillery warfare lasting hours and sometimes days, left no place to escape, while the terrible living conditions and spread of disease added to soldiers’ troubles. These circumstances contributed to the rise of shell-shock, now known as a form of Post-Traumatic Stress Disorder (PTSD), a condition of unyielding emotional and mental strain occurring as a result of a traumatic experience.[2] The term shell-shock was first used by Lieutenant Colonel Charles Myers of Britain’s Royal Army Medical Corps in a 1915 publication of the medical journal The Lancet; Myers applied the term to soldiers suffering from a large range of symptoms including tics, trembling, functional paralysis, hysterical blindness, and deafness, speech disorders ranging from stuttering to mutism, confusion, extreme anxiety, headaches, amnesia, depression, unexplained cramps, fainting, and vomiting. While the real cause–intense psychological stress and trauma–is now known, doctors treating World War I veterans believed the condition was a result of an injury to the nervous system during heavy bombing and shell attacks. The problem with that assumption is that men not directly exposed to shelling showed similar symptoms, forcing medical professionals to look for different causes.

The absence of clear-cut evidence due to shell-shock’s array of symptoms led the British government and its medical professionals to promote many different stigmas and misconceptions about the disease: that it was predisposed to weak individuals, was contagious, and would lower the morale of other men, or that it was exaggerated by soldiers who just wanted extra rest and recuperation. All of these incorrect beliefs shifted the blame from the devastating war onto the victims who were now mocked and dismissed by doctors and officers. Adding to the strain on shell-shocked men, the British government neglected sufferers by focusing more on balancing its budget and maintaining military order than on providing treatment. Soldiers were forced to contend with their condition or face the consequences, such as a court-martial; however, when they were treated, they had to endure excruciating, abusive care. The British government inhumanely treated shell-shocked victims during and after World War I, prioritizing its finances and military needs over proper treatment, dismissing the acknowledgement and diagnosis of victims' conditions, and improperly punishing and imprisoning these men, exacerbating the suffering of soldiers and their families.

Shell-shocked soldiers faced harsh stigmas regarding their condition, with officers and doctors ignoring symptoms, assuming it was a predisposed illness, and mocking and underappreciating sufferers, adding to their emotional turmoil. Because there was insufficient[3] information on mental disorders in the early twentieth century, doctors and officers had varying viewpoints on proper treatment and the true causes of shell-shock, most of which placed the blame on the soldiers. Assuming it was contagious and would make others nervous, some doctors and military officers believed the condition would undermine Britain’s army’s ability to keep fighting; Colonel J.F.C Fuller, the British Deputy Director of Staff Duties and late General Staff Officer, said, “If a crowd of men are reduced to a low nervous condition ‘shell-shock’ becomes contagious,” while others believed shell-shock was mostly malingering, cowardly soldiers looking for ways to leave the war.3 Because mental health was generally viewed as a result of a lack of discipline, officers dismissed emotionally wounded men as evading their duty to Britain. Royal Fusilier Private William Holbrook explains his opinion regarding officials reprimanding distressed soldiers:

I was reading some time ago where some general said, ‘There’s no such thing as shell-shock.’ He ought to have, he should have been there. I mean it’s ridiculous to say things like that. You get a man, even if he was a strong man, you get a terrific burst from a shell within say three or four yards of you, you know. It does, it does upset them. shell-shock, oh my god yes.[4]

R.F. Holbrook’s account highlights officers' disregard for suffering victims, emphasizing the officers’ apathy for treating their condition, but contradicts their opinion, illustrating soldiers’ contempt for their supervisors, arguing that these men needed the treatment they weren’t receiving.

A more widely accepted belief regarding the cause of shell-shock was that it was predisposed, provoking sufferers to feel cowardly and weak. The 1922 Report of the War Office Committee of Enquiry into “shell-shock” sought to investigate the causes, treatment, and management of the illness during and after World War I, describing predisposition as the primary cause of shell-shock. It highlights Dr. Lewis Bruce and Professor Graham Brown’s belief that “In the large majority of persons showing emotional ‘shellshock,’ there was present in the family history or in the personal history, evidence of weakness, instability or defect of the nervous system.”[5] The assumption of personal weakness took the liability from the war’s harrowing trenches and placed it on soldiers, making them feel as though they were responsible, and creating a culture of secrecy. Soldiers would ignore their symptoms, scared to face the judgmental opinions of officers whose callousness would further aggravate their emotional turmoil. British officer F. Jourdain describes his experience after thinking he might have shell-shock, fearing, “Am I [the] coward or what?” and explains that “People always thought it was cowardice, you see.”[6] Jourdain’s account highlights the fear and responsibility he and other victims felt, deeming him a coward based on the common assumption. Jourdain then illustrates the unwilling secrecy that stemmed from the stigma as he and others would “do [their] best to hide it. Because you’re scared thinking that you’re being a coward,” adding additional stress and pressure on their likely shell-shock and already traumatic war.[7] Soldiers suffered insult after injury because of different misconceptions, as military officers would mock, ridicule, and not appreciate victims' contributions to their country, highlighting the officers' failure in recognizing the seriousness of men’s trauma despite understanding the disturbing nature of the war. Many doctors agreed with French historian and soldier Marc Bloch’s assessment that a shell-shock victim was a “neurasthenic man of the world, not much of a warrior,” suggesting that those suffering from anxiety and emotional distress were incapable of succeeding as a soldier.[8] This mockery exemplifies the lack of appreciation these men faced, as their symptoms were mostly psychological and not physical. W.D. Esplin stresses the despair of a fellow countryman after reaching Netley Hospital in Southampton and seeing an unwelcoming crowd. He explains, “...it so happened not many of our number wore bandages: we bore few signs, outward and visible, that we had been wounded. We were not the battle-stained heroes who had been expected. There was a silence that could be felt. We hung our heads in inexplicable shame.”[9] He and others felt shame and a lack of recognition as their wounds were invisible. Doctors and military officers' unfair stigmatization of shell-shock victims blamed these already troubled soldiers, making them feel extra shame, cowardice, and responsibility, as well as leading them to keep secrets, resulting in untreated conditions.

The British government severely mistreated shell-shocked soldiers during and after World War I, physically and emotionally abusing injured men during therapy and wrongly court-martialing and executing sufferers, leading to intensified hardship and humiliation of soldiers and their families. The extreme maltreatment of patients was caused by the lack of proper mental health training, the overwhelming number of cases, and governmental and patient neglect. Captain Frederick St John Steadman, a doctor who ran a field ambulance unit in the Somme, highlighted his inexperience in a letter to his wife, saying, “I have become fairly expert in diagnosing the degree of shell-shock a man has, as I have seen so many cases now.”[10] Steadman’s description of his newfound ability to diagnose shell-shock exemplifies the lack of training doctors had, contextualized by the fact that the Royal Army Medical Corps-trained psychiatrists to treat war trauma as of 1914, while also illustrating the increasing number of patients doctors were overwhelmed with.[11]

British Medical Officers saw their patients as weak and used torture as a method to cure their weakness, adding more strain to soldiers’ already traumatized minds. Lewis Yealland, Resident Medical Officer at the National Hospital for the Paralyzed and Epileptic in London, describes a patient, a twenty-four-year-old suffering from mutism, who endured physical abuse before receiving treatment from him in his Hysterical Disorders of Warfare. He explains how this victim had been strapped down and a “strong electricity was applied to his neck and throat; lighted cigarette ends had been applied to the tip of his tongue and ‘hot plates’ had been placed at the back of his mouth.”[12] Instead of stopping these painful and ineffective treatments as they “proved to be unsuccessful in restoring his voice,” Yealland doubled down and continued to wound his patient by “placing the pad electrode on the lumbar spine and attaching the long pharyngeal electrode” and later administering “strong shocks to the outside of [his] neck.”[13] Yealland acknowledged his cruelty when, after his treatments were not working, he told the man, “I do not want to hurt you, but, if necessary, I must,” illustrating the emotional abuse the victim faced, and Yealland’s conscious decision to injure him.[14] Yealland's violent therapies represent the broader mistreatment of soldiers, psychologically and physically traumatizing them in an attempt to cure their distress.

Instead of receiving gruesome and inhumane treatments, some servicemen were tried and executed for cowardice. The extent of Britain’s scapegoating of soldiers, men who were suffering and instead of receiving treatment took the blame for weakness, was considerably greater than in other countries, executing a total of 306 men compared to a less significant 25 in Germany.[15] Private Harry Farr, a member of the 1st Battalion West Yorkshire Regiment, was killed on October 16, 1916, for cowardice. On September 17, 1916, Farr was part of a ration party moving towards the front lines of the Battle of the Somme. When he was unable to continue, Farr asked to see a medical officer but was told by his superior, Regimental Sergeant Major Haking, “You are a fucking coward and you will go to the trenches. I give fuck all for my life and I give fuck all for yours and I’ll get you fucking well shot.”[16] Farr was escorted to the front lines, but when a fight broke out, he fled; he was arrested for showing cowardice in the face of the enemy the following day. The Field General Court Martial found Farr guilty and sentenced him to death, despite his medical records, which included three hospital stays between 1915 and 1916 for the treatment of shell-shock.[17] Farr was not the only one who suffered as a result of his execution; his family also endured significant hardship and humiliation as a result of his cowardice. Gertrude Harris, Farr’s daughter, explained how she and her mother were left penniless without an army pension, how they went homeless as a result, and how she was so embarrassed that only she “knew the truth about what happened to [her] father when [she] was 40. [Her] mother never, ever spoke about it.”[18] While he was posthumously pardoned in 2006, as Mr. Browne, Minister of Defense, stated, “I believe it is better to acknowledge injustice were clearly done in some cases,” admitting Britain’s wrongdoing, the damage was already done, as Farr faced neglect, verbal abuse, and death while his family lived in shame and poverty.[19] The British government’s mistreatment of shell-shocked soldiers, characterized by torture, neglect, and execution, profoundly harmed both soldiers and their loved ones, who endured shame and hardship as a result.

The British government disregarded soldiers’ symptoms and prioritized its finances and military discipline, attempting to lower bills by removing pensions, ignoring medical therapy in favor of military treatment, and encouraging doctors to be skeptical about soldiers' trauma, all of which left victims without proper care. Pensions, which were typically awarded as a percentage of the thirteen-shilling flat rate based on the severity of soldiers' injuries, were often contested for shell-shock victims, as their injuries were psychological rather than physical.[20] Claimants were forced to go to a medical board which would determine if their trauma was ‘attributed’, solely a result of the war, or ‘aggravated’, derived from an underlying condition that was worsened by soldiers’ military service.[21] By 1931, the British Ministry of Pensions, focusing on lowering their bills, warned medical officers to look out for pension neurosis, shell-shocked men who exaggerated or maintained their improving symptoms to receive a higher pension.[22] John Collie, a leading specialist in shell-shock, explained how “gross exaggeration” was “often met,” highlighting the dismissive attitude of the government, trying to downplay soldiers’ trauma to lower its bills.[23]

Robert Dent, a private who suffered from shell-shock after the Battle of the Somme, started showing symptoms of emotional distress in the summer of 1924. Dent’s wife, Hannah, attested that he was “strong and healthy before enlistment” but came back from the war as a “total wreck.”[24] He was sent to the Morpeth Mental Hospital, and doctors put in a pension claim for a recurrence of shell-shock. The Ministry of Pensions refused to give Dent any money, asserting that there was “no evidence to connect the shell-shock to his present disability.”[25] While he was reluctantly given his pension after his vicar contested the decision, Dent’s story is an example of the British government's failure to acknowledge the war’s impact on soldiers, prioritizing its finances over the well-being of soldiers and their families.

The British government treated shell-shocked patients based on common sense and military experience, while other nations based their therapies on medical knowledge. By 1915, France’s military services, using medical expertise to determine treatment, started to concentrate on casualties with neurological disorders. The French Service de Santé, responsible for providing medical and sanitary support to the French Armed Forces, established 12 neurology centers around Paris, with more than 200 beds per center, and set up other institutions throughout the country.[26] Neurological patients would be treated in neurological-focused facilities to deal with cases before they became overwhelmed, exemplifying a comprehensive treatment plan for injured soldiers. Britain, however, used a less coordinated approach. In the 1922 Report of the War Office Committee of Enquiry into ‘shell-shock’, Major Adie, physician at the Great Northern Central Hospital in London and special reserve of the Royal Army Medical Corps, described his approach to treating shell-shock:

“He should get to know the soldier and to live with him. He need not know much medicine – a smattering of neurology would be useful. He should not be a peacetime psychologist, this would be a great disadvantage.” Major Adie emphasizes how medicine and medical training are generally unneeded, as understanding patients' trauma is enough to properly treat them, and that military experience is more essential than medical training, since peacetime psychologists aren’t suited to deal with military traumas.[27] The contrast between each nation’s approach highlights how Britain undermined the treatment of its soldiers by focusing on a martial approach to medicine, while France had a more calculated system that emphasized rapid medical treatment. The British government prioritized finances and military treatment, as well as promoted suspicion between doctors and patients, leaving them without pensions, subjected to worse treatment, and with extreme distrust in physicians.

The British government’s lack of support and concern for shell-shock victims is exemplified by its ineffective attempts to properly diagnose and treat sufferers' conditions. The creation of harsh stigmas, reinforced by medical and military officers who would mock and dismiss symptoms, placed the blame back onto soldiers, while the government’s emphasis on finances and martial discipline left victims without proper care. As a result, these already afflicted men faced further distress, having to endure emotionally and physically excruciating therapies, which doctors recognized as painful. If they were unable to follow orders because of their trauma, they faced court-martial and execution for cowardice, leaving them dead and their families humiliated without needed pensions. While soldiers put their lives on the line for their country, those suffering from shell-shock were never recognized for their contributions but were seen as deceivers, either looking for money or trying to avoid combat. The World War I term shell-shock eventually became known as combat stress reaction (CSR) in World War II, where military psychiatrists were more sympathetic to victims, because of their previous experiences, and warned the public about the dangers of stress, reducing the stigma soldiers faced.[28] The British government’s dismissal and mistreatment of shell-shocked soldiers highlights the limited understanding of psychological trauma at the time, but serves as an example of the need to recognize mental illness.