The issue of shell shock (or post-traumatic stress disorder, PTSD in today’s parlance) is a long and complex one, far beyond the capabilities of this post and its author. However, it does take up a material amount of real estate in the Seeking Courage story line (based on the historical experience of Lt Pitman), so some mention is warranted.
By the end of the First World War, the British Army had intervened with over 80,000 shell shock cases, of which four-fifths did not return to battle in spite of the generals decree to get them fixed and back onto the battlefield. From today’s perspective, it is an understatement to declare that shell shock during WW1 was seriously misunderstood.
In Bob Pitman’s case, shell shock was caused by the very real damage done to nerves and senses after being knocked down and buried alive a few times during a severe enemy bombardment. For his service record to detail that event is quite profound, and while it does not itemize the medical effects, his temporary loss of eyesight, tremors, dissociation, and nightmares were all typical of symptoms. Being assigned to Dr Frederick Mott at the Maudsley Hospital was a godsend, since convalescence was based on an ‘atmosphere of cure’, rather than more radical remedies practiced in the day.
Yet other soldiers suffered from legitimate shell shock without being present on the battlefield, afflictions which were starting to be recognized during the Great War. In this sense, psychological trauma was admitted to being a cause of shell shock. To witness such abhorrent violence created by a brutal war could equally lead to mental breakdown.
The issue of cure was as much controversial at the time. The initial purpose of treatment was to restore soldiers to their former battle ready state. For example, in the Battle of the Somme, with over 4,000 soldiers on the British/French side becoming casualties every day, every man in hospital had to be cured and sent back. The application of occupational therapy, and a strong encouragement to show masculinity, was prominent. Even though psychological instances were starting to be recognized, the men were encouraged to show their ‘manly’ side. Still, many doctors like Mott protected their patients from too much taint; although they believed in the psychological impact of war trauma, the science behind it was not well developed (and is still controversial today).
One final comment relates shell shock to courage. Suffers knew there was not a lot of sympathy in the general population, again, largely due to poor knowledge. Men were supposed to be men and fight, not hide behind some mental affliction; even today the cry out for a hurt male to ‘man up’ remains a negative curse. Yet there were indeed malingerers among the WW! troops – those who feigned shell shock truly out of cowardice. Not only did they bring their platoons lowered morale, but added to the stigma of those legitimately afflicted shell shock sufferers.
This is a deep subject, however it is now well documented for those who wish to research more.