Forum Eerste Wereldoorlog Forum Index Forum Eerste Wereldoorlog
Hét WO1-forum voor Nederland en Vlaanderen
 
 FAQFAQ   ZoekenZoeken   GebruikerslijstGebruikerslijst   WikiWiki   RegistreerRegistreer 
 ProfielProfiel   Log in om je privé berichten te bekijkenLog in om je privé berichten te bekijken   InloggenInloggen   Actieve TopicsActieve Topics 

Shell shock

 
Plaats nieuw bericht   Plaats Reactie    Forum Eerste Wereldoorlog Forum Index -> Medische verzorging Actieve Topics
Vorige onderwerp :: Volgende onderwerp  
Auteur Bericht
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 21 Jun 2006 7:57    Onderwerp: Shell shock Reageer met quote

Shell shock - een schotwond in de ziel

door Hans van der Ploeg


Lezing voor het Voorjaarscongres van de Nederlandse Vereniging voor Psychiatrie april 2003.

De rol van de militaire psychiater tijdens oorlog is tweezijdig. Hij staat in dienst van het leger, maar is ook dokter van de manschappen. In de praktijk komt het er op neer dat hij de psychisch gewonde militair opknapt met als doel dat deze weerdeel kan nemen aan gevechtshandelingen. De geschiedenis leert dat elk land zijn eigen behandelmethoden kent, die net zo verschillen als militaire strategieën.

”Professor, zolang de oorlog duurt kan ik niet gezond worden” zei een jonge officier die bijna verging van angst, tegen de Duitse hoogleraar psychiatrie Robert Gaupp. Dit gesprek vond plaats in 1915.

Pure oorlogsneurosen waren al voor de Eerste Wereldoorlog beschreven, dat blijkt wel uit de stukken van een Duits medisch congres in 1907. Daar kwamen de zenuwstoornissen ter sprake die Russische officieren hadden opgelopen in de oorlog tussen Rusland en Japan van 1905. Toch ontbrak het onderwerp op de agenda van de sectie militaire geneeskunde tijdens het zeventiende internationale medische congres in 1913 in Londen, aan de vooravond van de Grote oorlog.

De Eerste Wereldoorlog verliep totaal anders dan alle vorige oorlogen. Kenmerkend verschil was dat het geen oorlog van beweging was maar van stilstand. De strijd in de loopgraven bracht een nieuw ziektebeeld mee: shell shock. Uit de talloze egodocumenten die er over de Eerste Wereldoorlog zijn bewaard, blijkt dat leven in de loopgraven een verbijsterende ervaring moet zijn geweest: gevaarlijk en extreem oncomfortabel. Berucht waren de artilleriebeschietingen die geheel onverwacht konden plaatsvinden. Intensieve bombardementen konden de ineenstorting van gehele loopgraven tot gevolg hebben, waarbij de soldaten werden gedood of levend werden begraven.

Zeer gevreesd waren ook de chemische wapens die aan het westelijk front, voor het eerst in april 1915, werden gebruikt. Zelfs toen er in 1917 voldoende gasmaskers waren en de wapens als gevolg daarvan veel van hun dodelijk dreiging hadden verloren, bleef de angst ervoor bestaan. Het leven in de loopgraven was behalve gevaarlijk ook vol ongemakken: ongedierte, luizen, waardoor de mannen ondraaglijke jeuk hadden en leden onder nare infecties.

Het Britse expeditieleger dat in augustus 1914 vol enthousiasme aan de oorlog begon, werd al snel met de neus op de feiten gedrukt. De eerste slag om Ieper, die in oktober werd uitgevochten, toonde reeds aan dat de strijd tegen de Duitsers een bloedige aangelegenheid zou worden. De veldhospitalen die in België en Frankrijk in allerijl werden opgezet, stroomden vol met gewonde militairen. Onder hen bevonden zich ook soldaten die psychisch gewond waren geraakt. Zware gevallen met geheugenverlies, blindheid, verlammingsverschijnselen, en gehoor- en spraakstoornissen, en lichtere met oververmoeidheid, geïrriteerdheid en hoofdpijn. De ‘gewone’ militaire artsen, getraind in het behandelen van kapotgeschoten ledematen en het opzetten van hygiënische voorzieningen, wisten zich met deze gevallen geen raad. De in de psychologie geschoolde artsen wisten evenmin wat ze aanmoesten met deze psychisch gewonde soldaten.

Charles S. Myers, kapitein arts bij het Royal Army Medical Corps, komt de eer toe het begrip shell shock te hebben geïntroduceerd Hij deed dat in februari 1915 in een artikel in het medische tijdschrift The Lancet, waarin hij drie van deze gevallen beschreef. De mannen hadden alledrie een granaatexplosie overleefd.

Myers was weliswaar afgestudeerd als arts, maar had dit beroep nooit uitgeoefend. Voor de oorlog was hij verbonden aan de afdeling psychologie van de universiteit van Cambridge. Verder had hij antropologisch veldonderzoek verricht. Na het uitbreken van de oorlog ging hij werken in het ziekenhuis van de Franse plaats Le Touquet. Daar deed hij zijn eerste ervaringen op met shell-shock patiënten.

Aanvankelijk dacht Myers dat de gedragsstoornissen het gevolg waren van beschadigingen van zintuigen en hersenen door de granaatexplosies. Toch twijfelde Myers aan deze veronderstelling, omdat bij deze soldaten wel de smaak- reuk- en gezichtsvermogens waren aangetast en het geheugen niet meer werkte, maar het gehoor niet noemenswaard was beschadigd. Terwijl de explosies met veel lawaai gepaard waren gegaan en er alleen reukloze gassen waren vrijgekomen.

Door zijn kennismaking met de opvattingen van Franse psychiaters en neurologen ging Myers later meer aan een psychische verklaring denken voor het fenomeen shell shock. In diezelfde tijd schreef de Franse hoogleraar Gustave Roussy, geneesheer van het militaire hospitaal Val-de-Grace, in een vakblad dat het niet om een nieuw ziektebeeld ging, maar om hysterie. Deze zou het gevolg zijn van traumatische ervaringen van de patiënt of van suggestie. Door het werk en de imposante demonstratiecolleges van de Parijse hoogleraar psychiatrie Jean Martin Charcot was hysterie eind 19e eeuw een van de voornaamste ziektebeelden geworden.

Er was nog een andere aandoening waar alle continentale Europese psychiaters eind 19e eeuw over schreven: neurasthenie (letterlijk zwak zenuwstel). Deze term was bedacht door de Amerikaanse neuroloog George M. Beard, die het een typisch Amerikaanse ziekte vond. Het was een kwaal met een scala symptomen zoals vermoeidheid, hoofdpijn, misselijkheid en duizeligheid.

Met de diagnose hysterie en neurasthenie hadden de Engelse psychiaters echter niets op. Zij dachten volgens het schema gek of niet gek, waarin een grijs tussengebied ontbrak. Ze vonden Beard een charlatan en hysterie was in hun ogen toch vooral een vrouwenziekte. Pas tijdens de oorlog ontdekten de Britse psychiaters dit tussengebied, toen ze met het enorme aantal shell-shockgevallen werden geconfronteerd.

Fransen en Britten voerden een zeer verschillende beleid, als het ging om psychisch gewonde soldaten. Terwijl de Franse militair met choque traumatique voor behandeling zo dicht mogelijk bij het front bleef, moest zijn Britse collega terug naar Engeland voor opname in een militair hospitaal. Toen deze ziekenhuizen vol waren, werden grote psychiatrische ziekenhuizen van hun patiëntenbestand ontdaan en ter beschikking gesteld van het leger. In 1916 veranderen de Engelsen hun beleid. Ze moesten wel, door het enorme aantal doden, waardoor het aantal psychische gevallen tot grote hoogte steeg. De legerleiding zag nu in dat die niet allemaal terug naar Engeland konden. Pas nu kon Myers zijn kans grijpen. Hij zette dicht achter het front gelegen behandelcentra op, naar Frans model. Toch bleef het wantrouwen jegens psychologen en psychiaters groot bij het Britse legerkorps. Vanaf juni 1917 kon je als soldaat alleen nog in een behandelcentrum komen na een verklaring van de commandant dat je tijdens gevechtsacties was afgeknapt. Het aantal gevallen daalde prompt tot tien procent.

De behandeling verliep op twee manieren, hard (met elektrische stroom) en zacht (middels psychotherapie). Mede onder druk van de publieke opinie werden de Franse artsen in de loop van de oorlog milder, vooral na het geruchtmakende proces in augustus 1916 tegen Baptiste Deschamps. Deze soldaat was in oktober 1915 gewond geraakt en van het ene naar het andere ziekenhuis gesleept. In mei 1916 werd hij in een kliniek van de arts Clovis Vincent opgenomen. Deze bracht de meest extreme vormen van traitement brusque in de praktijk. Deschamps hoort van andere patiënten dat de behandeling uiterst pijnlijk was en dat er zelfs doden bij waren gevallen. Toen dokter Vincent aankondigde dat hij Deschamps wel even zou genezen en met het oog daarop elektrodes te voorschijn haalde, sloeg de soldaat de dokter tegen de grond. Het proces dat hierop volgde deed in Frankrijk veel stof opwaaien. Deschamps kon rekenen op grote publieke sympathie. De rechters volstonden met het opleggen van een voorwaardelijke gevangenisstraf.

De Engelse manschappen werden op instigatie van Myers naar Frans voorbeeld behandeld. Er was echter een groot verschil. Shell shock die gepaard gaat met huilbuien, vermoeidheid, nachtmerries en paniekaanvallen, kwam vooral bij officieren voor. De hysterische vorm met verlammingsverschijnselen, tics in het gelaat, stomheid en doofheid, werd vooral bij soldaten gezien. Patiënten met paniekaanvallen kregen de veel snellere ‘behandeling’ met elektrische stroom.

In het Queen’s Square Hospital in Londen paste de arts Lewis Yelland bij soldaten met ernstige verschijnselen van hysterie deze behandeling toe. Yelland meende dat ze een zwakke wil en een negatieve levenshouding hadden. Eerst praatte hij op hen in dat ze moesten genezen. Daarna gaf hij hen steeds pijnlijker wordende elektro- therapie, waarbij hij de verlamde lichaamsdelen met krachtige stroomstoten bewerkte. Op die manier wist hij honderden militairen binnen korte tijd te genezen.

Je kunt je afvragen welke aanpak de Britse en Amerikaanse militaire psychiaters zullen kiezen in Irak voor de mannen en vrouwen die door vrees en beven uitvallen. Hoe zou het gesteld zijn met hun vaderlandslievende ethiek? Tot nu toe hebben de militaire psychiaters zich in de pers stilgehouden. Sinds de oorlog in Vietnam valt het oorlogslijden van soldaten onder de paraplu term ‘post traumatische stress stoornis’. Het is de hoogste tijd dat vanuit de psychiatrie weer wordt nagedacht over de juiste aanpak van psychisch gewonde militairen. Kennis van de geschiedenis van de psychiatrie is daarbij van cruciale betekenis.


http://www.gezondheid.nl
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1


Laatst aangepast door Yvonne op 15 Nov 2012 17:37, in totaal 1 keer bewerkt
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 05 Okt 2006 7:11    Onderwerp: Reageer met quote

Shell-shocked

In the first world war, soldiers were traumatised by the sight of corpse-strewn trenches, writes Michèle, while official censors attempted to shield the public from the horrors of battle

Michèle Barrett
Saturday April 19, 2003
The Guardian

When cinemas across Britain showed footage of British soldiers burying German bodies on the battlefield in the official 1916 film The Battle of the Somme, the reaction from packed audiences was shock. Day after day the letters page of the Times returned to the issue of whether the film was fit for public exhibition. The king declared that the public "should see these pictures" so that they learned "what war means". The Dean of Durham objected that the film "violates the very sanctities of bereavement". Another correspondent likened the film to watching "the hangings at Newgate and the flogging of the madmen at Bedlam", "mere curiosity" serving as "a pretext for witnessing scenes of agony". The film was one of only two, both made in 1916, that showed dead bodies; by the following year public opinion had swung against the war and images of corpses were deemed bad for morale.

But these controversial scenes, which show the decent burial of intact and fresh corpses whose faces the camera avoids, were a long way from the more disturbing, old or mutilated remains the soldiers often had to deal with. Just thinking about the numbers killed during the first world war (an average of 5,600 dead soldiers every day for four years) indicates the scale of these difficulties. The defence of Verdun was an extreme case. Successive waves of men died on top of each other, defending narrow paths in the hills, and this resulted in very large quantities of unidentifiable French (and German) bones. Eventually, the bones of an estimated 130,000 men were collected and buried according to the sector of the battlefield where they had been found, in the huge "ossuary" at Douaumont.

If the battlefields were difficult for the soldiers to deal with, what could the people at home be expected to cope with? The work of the war artists was censored by Major Arthur Lee, who quickly became a personal enemy of the painter CRW Nevinson. At the end of 1917, Lee refused permission for Nevinson's painting The Paths of Glory, depicting two dead British soldiers, to be shown in public. The censor's ruling was clear, since "the War Office, on military grounds, has prohibited the appearance of dead bodies, even Germans, in any official photograph or film". The official correspondence with Nevinson adds that "photographs of this kind are now rigidly suppressed". Nevinson, confident that higher authorities would overrule the censor (as they had just done for another of his paintings) had the work hung in the Leicester Galleries in London for the opening of his Pictures of War exhibition in March 1918. When they did not relent, Nevinson simply covered the two bodies with a strip of brown paper saying "Censored", and left the painting in the show, attracting a lot of press attention and an official reprimand. To the commissioners of British war art, a German corpse was in practice more acceptable than a British one. Only two months later, in May, William Orpen was given permission to exhibit a painting of two corpses, one with a decomposing face, entitled Dead Germans in a Trench .

Sensitivity about the image of the dead British soldier continued long after the war. In 1925, Charles Sargeant Jagger's monument for the Royal Artillery, at Hyde Park Corner, set off another round of letters to the Times. Commissioned by soldiers, and executed by an artist who was a decorated war veteran, the stone Howitzer gun on top caused problems for pacifist civilians. Most controversial of all was Jagger's inclusion of a sculpture of a dead Tommy. The figures on three sides of the memorial had been long planned - there was to be a driver, an officer and of course a gunner - but the fourth side was described in terms of "a feature in bronze". At a late stage in the proceedings, thereby minimising the inevitable objections, Jagger revealed that this was to be a "recumbent figure", a dead artilleryman covered by a heavy military coat.

But none of these images really captures the shocking reality of decomposing corpses and their psychological effects on the men who had to live with them. One British painting that does point to a link between mental breakdown and the profound unease we feel when corpses are not treated properly is William Orpen's The Mad Woman of Douai, at the Imperial War Museum in London, which remains eerily green in its underpainted, unfinished state, and in which the corpse in the left foreground has received a mere mockery of a burial, one foot not even covered by the earth dumped on top of it. Orpen had been shocked when he saw the cursory attempts at burial on the Somme: "This consists of throwing some mud over the bodies as they lie, they don't even worry to cover them altogether, arms and feet showing in lots of cases." The mad woman of the title stares beyond the improperly buried corpse, her eyes neither focussed nor co-ordinated, her splayed knees an allusion to the sexual violence of war. The other figures are also clearly disturbed, as is the geography of the painting: Douai is in northern France but the nearby ruins are those of the Belgian town of Ypres. An observation balloon hovers over the scene. Balloonists, who were tethered above the front lines, proved to be the only branch of the services in which psychiatric casualties outnumbered the physically wounded. Orpen's painting shows the effect war can have on the sanity of civilians. More commonly, it was soldiers who were deranged by the corpses of their colleagues.

The war poets addressed the subject more obliquely, and Isaac Rosenberg's Dead Man's Dump is one of the few poems to refer directly to the changing physical appearance of corpses, comparing "the older dead .../ Burnt black by strange decay / Their sinister faces lie,/ The lid over each eye," with the "not long dead". AP Herbert's novel The Secret Battle contains dramatic descriptions of decomposing corpses. The ninth edition, in 1949, carries an introductory note by Winston Churchill, to the effect that the tale is "founded on fact". Herbert fictionalised, in the character of Harry Penrose, the fate of the real Edwin Dyett. He was a volunteer officer of the Royal Naval Division who had lost his nerve and was found running away from the front, court-martialled and shot for desertion.

Dyett can be seen as a man who was executed for war trauma, a psychological casualty. His case was publicised in the John Bull newspaper in 1918; he was one of only three officers executed during the war. AP Herbert had been an officer in the same RN division (the 63rd), and was "shaken to the heart's core" by what happened to Dyett. "APH" had actually taken part in the action in which Dyett's courage failed: 435 men attacked the village of Beaucourt;fewer than 20 survived.

Herbert went through the disastrous Gallipoli campaign of 1915, whereas Dyett only joined the battalion after it was evacuated in early 1916. Herbert's strategy in The Secret Battle is to use his own memories of Gallipoli - the novel was written amid "horrible and extraordinary nightmares" - to explain Penrose's mental breakdown on the western front. Rotting corpses were the worst problem. Things go wrong when Harry decides to sleep on the floor of a trench where, our narrator sees ("in a moment of nauseating insight") that there are maggots from the French and Turkish bodies not far beneath him. "Rubbish," says Harry, "they're glow worms resting."

Harry's mental decline is associated with guilt about the deaths of men under his command, and a less explicable, somewhat uncanny experience of corpses. One incident combines the two themes. A shell has hit a section of the trench parapet and Harry has moved four men out of that bay into the next one, unfortunately putting eight men straight into the path of a shell. Six of Harry's men are killed. A mere two hours later, they have unfathomably decomposed into black, reeking, fly-ridden corpses - as if they had been dead for weeks. They look like the bodies of enemy Turks, and Harry cannot identify any of his men by name. "I hope," says the soldier-colleague who is the story's narrator, "I may never again see such horror as was in Harry's face."

Harry ends up being invalided out of Gallipoli with dysentery, but before he goes, the narrator takes the opportunity to expand on the problem of dead bodies. He describes the unit being moved forward to an area that has recently seen a huge battle; there are corpses everywhere, hanging over and into the trenches. As they can only bury them at night, they have to live with them. "But there was a hideous fascination about the things ... a man came to know the bodies in his trench with a sickening intimacy, and could have told you many details about each of them." He tells us that men were constantly being sent away, stricken with nausea, by the doctor; that it was the only thing worse than the front line. Even the prospect of battle became more attractive than staying there - "anything was welcome if we could get out of that trench, away from the smell and the flies, away from those bodies ..."

Another British army officer had a quite different take on the experience. Captain Guy Nightingale's letters to his family in 1915, when the Royal Munster Fusiliers took part in the landings on Gallipoli, are unusual in addressing so directly the problem of dead and decomposing bodies. (His mother and sister got most of this, while his father got political commentary on the botched conduct of the invasion.) On April 25, the Munsters came ashore and "got most awfully badly mauled in doing so". "The heaps of dead are awful and the beach where we landed was an extraordinary sight the morning we buried them."

Writing to his mother on May 10, he described being sent on a night attack to a place where more than 2,000 unburied corpses "were still lying there highly decomposed". The stench was awful and in the dark they kept treading on them, he says. "When it was light, I found I had dug in next to the remains of an officer in the KOSBs [King's Own Scottish Borderers] [whom] I had last seen at the opera at Malta and had spent a most jolly evening with." Nightingale prided himself on his tough approach. Of one incident he says: "We mowed them down and only once did they get so close that we were able to bayonet them. We took 300 prisoners and could have taken 3,000 but we preferred shooting them. All the streams were simply running blood and the heaps of dead were a grand sight." As a professional officer, Nightingale is resentful of his over-promoted and inexperienced volunteer colleagues. He notes scornfully that "three of them have already collapsed from nerves and weak hearts, after five days on the peninsula", and complains that one new recruit got hit during dinner and inconsiderately "fell into the soup, upsetting the whole table, and bled into the tea-pot, making an awful mess of everything". The letters refer constantly to the smell of the dead and decomposing bodies lying between the trenches, and their efforts to throw lime over them. Digging for a new HQ Mess, he says brightly that they "started on four different places before we were able to procure a spot free from dead Turks".

In letters to his sister, Nightingale is full of bravado. Gallipoli is not as exciting as hunting elephants "and very little more dangerous". In fact, he is "very glad now that I used to go in for big game shooting" as it is a good education for active service. Lots of fellows are "going off their heads" but he himself "never felt better in my life ... I eat and sleep like a pig and feel most awfully cheery". Nightingale is especially withering about signs of mental weakness - even completely involuntary ones. "Geddes is a ripping commanding officer to work with, but he is frightfully worried and his hair is nearly white! I've never seen fellows get old so quickly. This morning I saw a fellow called O'Hara in the Dublins whom I hadn't seen for about a fortnight and I hardly recognised him!"

Half a century later AP Herbert tried to re-read A Secret Battle, having been rather pleased with its impact. "Mr Lloyd George, I was told, read it all night and recommended it to Mr Churchill, who was Minister of War, and gave orders that court martial arrangements should be altered in some ways." It gave, he felt, "a veracious picture of daily life in the front-line on the Gallipoli Peninsula. I saw, I heard, I smelt it all again." Of the slaughter in France, and Dyett's execution, he says, "I did not read any more."

Major Guy Nightingale survived the war but not the peace. His regiment was disbanded in 1922. In April 1935, aged only 43, exactly 20 years after the landing on Gallipoli, he shot himself. At the funeral, along with his mother and sister, were a decent muster from the local British Legion, and most of the team from his cricket club.

Captain Guy Nightingale's letters are in the Imperial War Museum. Michèle Barrett of Queen Mary, University of London, is working on a Leverhulme-funded project on shell shock.

http://books.guardian.co.uk/review/story/0,,938829,00.html
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 08 Okt 2006 9:15    Onderwerp: Reageer met quote

Shell Shock during World War One
By Professor Joanna Bourke


By the end of World War One the British Army had dealt with 80,000 cases of shell shock, including those of Siegfried Sassoon and Wilfred Owen. Joanna Bourke explores how the army tackled this extreme trauma, and how it was regarded by those back home.
Battlefield breaking points

On 7 July 1916, Arthur Hubbard painfully set pen to paper in an attempt to explain to his mother why he was no longer in France. He had been taken from the battlefields and deposited in the East Suffolk and Ipswich Hospital suffering from 'shell shock'. In his words, his breakdown was related to witnessing 'a terrible sight that I shall never forget as long as I live'. He told his mother:

'We had strict orders not to take prisoners, no matter if wounded my first job was when I had finished cutting some of their wire away, to empty my magazine on 3 Germans that came out of one of their deep dugouts. bleeding badly, and put them out of misery. They cried for mercy, but I had my orders, they had no feeling whatever for us poor chaps... it makes my head jump to think about it.' [Punctuation and syntax as originally written]

'He was buried, dug himself out, and during the subsequent retreat was almost killed by machine gun fire.'

Hubbard had 'gone over the top' at the Battle of the Somme. While he managed to fight as far as the fourth line of trenches, by 3.30pm practically his whole battalion had been wiped out by German artillery. He was buried, dug himself out, and during the subsequent retreat was almost killed by machine gun fire. Within this landscape of horror, he collapsed.

Medical symptoms


Arthur Hubbard was one of millions of men who suffered psychological trauma as a result of their war experiences. Symptoms ranged from uncontrollable diarrhoea to unrelenting anxiety. Soldiers who had bayoneted men in the face developed hysterical tics of their own facial muscles. Stomach cramps seized men who knifed their foes in the abdomen. Snipers lost their sight. Terrifying nightmares of being unable to withdraw bayonets from the enemies' bodies persisted long after the slaughter.

The dreams might occur 'right in the middle of an ordinary conversation' when 'the face of a Boche that I have bayoneted, with its horrible gurgle and grimace, comes sharply into view', an infantry captain complained. An inability to eat or sleep after the slaughter was common. Nightmares did not always occur during the war. World War One soldiers like Rowland Luther did not suffer until after the armistice when (he admitted) he 'cracked up' and found himself unable to eat, deliriously re-living his experiences of combat.

'...everyone had a 'breaking point': weak or strong, courageous or cowardly - war frightened everyone witless...'

These were not exceptional cases. It was clear to everyone that large numbers of combatants could not cope with the strain of warfare. By the end of World War One, the army had dealt with 80,000 cases of 'shell shock'. As early as 1917, it was recognised that war neuroses accounted for one-seventh of all personnel discharged for disabilities from the British Army. Once wounds were excluded, emotional disorders were responsible for one-third of all discharges. Even more worrying was the fact that a higher proportion of officers were suffering in this way. According to one survey published in 1917, while the ratio of officers to men at the front was 1:30, among patients in hospitals specialising in war neuroses, the ratio of officers to men was 1lekker puh. What medical officers quickly realised was that everyone had a 'breaking point': weak or strong, courageous or cowardly - war frightened everyone witless.

Defining trauma
More difficult, however, was understanding what caused some panic-stricken men to suffer extremes of trauma. In the early years of World War One, shell shock was believed to be the result of a physical injury to the nerves. In other words, shell shock was the result of being buried alive or exposed to heavy bombardment. The term itself had been coined, in 1917, by a medical officer called Charles Myers. But Myers rapidly became unhappy with the term, recognising that many men suffered the symptoms of shell shock without having even been in the front lines. As a consequence, medical officers increasingly began emphasising psychological factors as providing sufficient cause for breakdown. As the president of the British Psycho-Analytic Association, Ernest Jones, explained: war constituted 'an official abrogation of civilised standards' in which men were not only allowed, but encouraged:

'...to indulge in behaviour of a kind that is throughout abhorrent to the civilised mind.... All sorts of previously forbidden and hidden impulses, cruel, sadistic, murderous and so on, are stirred to greater activity, and the old intrapsychical conflicts which, according to Freud, are the essential cause of all neurotic disorders, and which had been dealt with before by means of 'repression' of one side of the conflict are now reinforced, and the person is compelled to deal with them afresh under totally different circumstances.'

'...a soldier who suffered a neurosis had not lost his reason but was labouring under the weight of too much reason...'

Consequently, the 'return to the mental attitude of civilian life' could spark off severe psychological trauma. The authors of one of the standard books on shell shock went so far as to point out that a soldier who suffered a neurosis had not lost his reason but was labouring under the weight of too much reason: his senses were 'functioning with painful efficiency'.

Possible Cures
Nevertheless, how were these men to be cured of their painful afflictions? From the start, the purpose of treatment was to restore the maximum number of men to duty as quickly as possible. During World War One, four-fifths of men who had entered hospital suffering shell shock were never able to return to military duty: it was imperative that such high levels of 'permanent ineffectives' were reduced. However, the shift from regarding breakdown as 'organic' (that is, an injury to the nerves) to viewing it as psychological had inevitable consequences in terms of treatment. If breakdown was a 'paralysis of the nerves', then massage, rest, dietary regimes and electric shock treatment were invoked. If a psychological source was indicated, the 'talking cure', hypnosis, and rest would speed recovery. In all instances, occupational training and the inculcation of 'masculinity' were highly recommended. As the medical superintendent at one military hospital in York put it, although the medical officer must show sympathy, the patient 'must be induced to face his illness in a manly way'.

'...their reputations as soldiers and men had been dealt a severe blow.'

Sympathy was only rarely forthcoming. Sufferers had no choice but to acknowledge that their reputations as soldiers and men had been dealt a severe blow. After a major bombardment or particularly bloody attack, if the combatant had acquitted himself adequately, signs of emotional 'weakness' could be overlooked, but in the midst of the fray, the attitude was much less sympathetic. 'Go 'ide yerself, you bloody little coward!', cursed one Tommy at a frightened soldier. When the shell shocked men returned home, things were not much better. Men arriving at Netley Hospital (for servicemen suffering shell shock) were greeted with silence: people were described as hanging their heads in 'inexplicable shame'. No-one better described the mix of shame and anger experienced by the war-damaged than the poet, Siegfried Sassoon. In October 1917, while he was at Craiglockhart, one of the most famous hospitals for curing officers with war neuroses, he wrote a poem, simply called 'Survivors':

No doubt they'll soon get well; the shock and strain / Have caused their stammering, disconnected talk. / Of course they're 'longing to go out again', - / These boys with old, scared faces, learning to walk. / They'll soon forget their haunted nights; their cowed / Subjection to the ghosts of friends who died, - / Their dreams that drip with murder; and they'll be proud / Of glorious war that shatter'd their pride... / Men who went out to battle, grim and glad; / Children, with eyes that hate you, broken and mad.

Find out more

Books and articles

Shell Shock: A History of the Changing Attitudes to War Neuroses by Anthony Babington (Leo Cooper, 1997)

From Shell Shock to Combat Stress by JMW Binneveld (Amsterdam University Press, 1997)

War Neurosis and Cultural Change in England, 1914-22 by Ted Bogacz (Journal of Contemporary History, volume 24, 1989)

Dismembering the Male: Men's Bodies, Britain and the Great War by Joanna Bourke (Reaktion Books, 1996)

No Man's Land: Combat and Identity in World War One by Eric J Leed (Cambridge University Press, 1979)

Problems Returning Home: The British Psychological Casualties of the Great War by Peter Leese (The Historical Journal, volume 40, 1997)

Female Malady: Women, Madness and English Culture 1830-1980 by Elaine Showalter (Virago, 1987)

The Regeneration Trilogy by Pat Barker (Viking, 1996 )
Links

Archive of primary documents from World War One Established and maintained by the World War One Military History discussion group, the site focuses on 1890-1920, discussing topics from military, diplomatic, social, and economic issues to the arts.

The Great War The PBS site for 'The Great War and the Shaping of the 20th Century' series goes beyond the military and political history of World War One to explore its ongoing social, cultural and personal impact.

The Wilfred Owen Multimedia Digital Archive
About the author

Joanna Bourke is Professor of History at Birkbeck College and the author of a number of books, including An Intimate History of Killing (Granta, 1998) and The Second World War: A People's History (Oxford University Press, 2001).

http://www.bbc.co.uk/history/worldwars/wwone/shellshock_05.shtml
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 02 Nov 2006 10:22    Onderwerp: Reageer met quote

SHELLSHOCK
by Roger J. Spiller


Let’s call him Frank. “He was in the war” is how adults explained Frank’s odd behavior a generation ago. As he walked through the small town then, his gait was clumsy, his clothes disheveled, and he seemed to go nowhere in particular. One could drive through any part of town and chance to see Frank on the corner, his face at once drawn and blank, as he was waiting to cross a street where the traffic never ceased. Sometimes he carried a paper bag, clutched as though it were filled with precious things. Frank was ghostly, but in an odd way, never threatening. After all, he wasn’t quite there.

One day, in direct contravention of parental orders, a child approached Frank and asked him questions. Was he really in the war? Frank said yes. What did he do? He fought, he said, in the Pacific. Already a devotee of war movies, the child knew what that meant: jungle combat against the most fearsome of enemies, the Japanese. The child’s eyes widened, and the questions came tumbling out.

Frank answered quietly. He described crawling through the jungle, looking for signs of enemy snipers. What signs? asked the child. Rice, Frank said, at the foot of tall jungle trees. Why? Because, Frank replied, rice down below meant a sniper in the tree above.
Time after time in this troubled century, our whole society has made itself forget about the terrible, invisible battle wounds once known as shell shock, later as combat fatigue, and now PTSD—posttraumatic stress disorder

Then what did you do? asked the child. Then, Frank said almost inaudibly, then I went up and got him. And after that Frank’s eyes seem to turn inward. Sensing that he had hurt Frank, the child clumsily did his best to turn the conversation to harmless matters.

I saw Frank’s look again on television not so long ago, during one of several specials on those Vietnam veterans who suffer from what is now called PTSD, or posttraumatic stress disorder. I had been thinking a good deal lately about Frank and his kind, and then all of a sudden there was a man, roughly my own age, staring that look at me from the screen. Strangely, I remembered that I had always thought of Frank as being old.

The Veterans’ Administration hospital in my hometown had many Franks; they all seemed old, but none could have been more than thirty at the time. The VA hospitals still have their Franks. They are the old ghosts of battle. They have been with us for years, perhaps even for centuries, inextricably linked by their suffering. PTSD’s ancestors reach back at least to the American Civil War. Before this century Russian medical scholars were discussing “diseases of the soul” among their soldiery. Their American counterparts wrote at length about “neurasthenia,” but not until the First World War did they apply their knowledge to the military world. During and after that war “neurasthenia” was overtaken by “shell shock” and then by the slightly more sophisticated “war neurosis.” The “war neurosis” of World War I gave way in World War II to the even more imposing “neuropsychiatrie casualty” or the slightly more understanding “combat fatigue.” Indeed, the history of soldiering in the last century and a half can be illuminated by these terms and what they represent.
“Neurasthenia” gave way to “shell shock,” which became “combat fatigue.” Indeed, the history of soldiering in the last 150 years can be illuminated by these terms.

The man I saw on the television screen was telling the interviewer about his unsuccessful life. Not that he was unable to provide for his family; it was only that he often felt estranged, detached from everyone who cared about him. And when the dreams from the old days in Vietnam were so terrible he could not sleep for fear of having them again, he retreated to his own personal redoubt, a small, dimly lit room, filled with relics of his war, that he had cobbled together in his garage. There he spent the night with his demons. Exhausted at dawn, he would climb into his car and commute to work with the rest of us. None of his fellow workers ever knew of his torments. Had he not presented himself to a veterans’ counselor, those torments would be private still.

There were other men on the television program, new Franks all. Several of them had withdrawn altogether from society. Unable to adjust to the civil rhythms of life after their wars in Southeast Asia, they had made their homes in the mountains of the Pacific Northwest, sometimes prowling armed and camouflaged through the night forests. Nearly all were combating a past scarred by drug and alcohol abuse and brushes with the law. They commuted nowhere.

Since the end of the war in Vietnam, Americans have been engaged in a subtle and long-standing negotiation with the memory of that divisive conflict. It was perhaps the most ambiguous of our wars, and its aftermath has been no less so. “Back in the world” after their tours in Vietnam, veterans encountered indifference and sometimes outright hostility.

Even during the war, warnings were being sounded that this conflict, apparently so different in other ways, could also be different in its mental aftereffects. VA psychiatrists began to speak of PVS, a post-Vietnam syndrome, behavioral disorders that were supposed to have been created uniquely by the war. Robert Jay Lifton, a noted psychiatrist and a passionate critic of the war, told Congress in 1970 that the injustice and immorality of Vietnam were sure to stimulate rage, hate, and guilt among those who had been coerced into fighting it. No wonder veterans had difficulty adjusting, given the character of the war; in Lifton’s view, these reactions were normal and appropriate. Lifton thought PVS was so elastic and widely abused as to be useless as a diagnosis. Nevertheless, when his own study of Vietnam veterans, Home from the War, was published in 1973, he had to admit that the term was “used by almost everyone.”

What had happened was that the post-Vietnam syndrome had slipped out of its professional confines and into public usage, a transformation that mirrored American attitudes toward the conduct of the war itself. As the public definition of the syndrome evolved, the post-Vietnam syndrome became another means by which Americans tried to make sense of the war itself.

At first, of course, there was an spammer of forgetfulness. “Putting the war behind us” became a common refrain in the seventies, when the nation was beset with other domestic and international problems. If remembered at all, the conflict was seen as evidence of a kind of pathological international behavior; those who had fought in it were regarded in much the same way.

But intrusions upon our forgetfulness began as early as 1973, when a group of Vietnam veterans at Southern Illinois University conducted a selfstudy that found an “emotional malaise” common to all veterans of the war. A New York Times survey the following year showed higher patterns of drug abuse among veterans than the national average. By 1978 the VA was reporting that about 20 percent of all Vietnam veterans were “having difficulty adjusting” to civilian life. Less than a year later the U.S. Department of Justice released figures showing that a majority of the fifty-eight thousand men with service records then in prison had been in Vietnam, a statistic that was sure to make headlines but that alone proved little.

The daily news did not improve the Vietnam veteran’s image. Across the country dramatic incidents were reported in which veterans of the war killed themselves, loved ones, and others, had shoot-outs with the police, took hostages, and were implicated in other criminal activities. What made these crimes different was the veterans’ trial defense: Their wartime experiences absolved them of responsibility for their actions. The courts were often sympathetic. In widely publicized cases vets were acquitted on the ground that they were suffering “com bat flashbacks” at the time of their crime, a modern military variant of “not guilty by reason of temporary insanity.”

Meanwhile, the post-Vietnam syndrome was losing ground to a more sophisticated understanding of the problem. Increasingly, veterans’ readjustment was made the subject of private and government-sponsored research. One of the earlier studies, published in 1979 by the Center for Policy Research, found that 40 percent of all Vietnam vets suffered some sort of emotional distress and that 75 percent struggled with recurrent nightmares and marital and job problems. Other terms—“delayed stress syndrome,” “posttraumatic neurosis,” and “traumatic war neurosis,” to name a few—began to supplant PVS in both professional and public literature. The inevitabledisintegration of the fragile public consensus about the war’s effects on its soldiers hinted at a new stage in America’s negotiations with its memories of the war. When Jan Scruggs launched his campaign for a Vietnam veterans’ war memorial in the nation’s capital in the spring of 1979, a good deal more was at stake than the eventual building of a monument. After six years of repressing the experiences of the Vietnam War, America began to face the public and private wounds that still cried out for healing.

In professional medical circles an accepted term of psychiatric reference for these postwar behavior disorders was established in 1980 with the publication of the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, known as DSM-III for short. Having based their work for the past decade upon outmoded diagnostic guidance within a highly charged social atmosphere, analysts, clinicians, and psychological self-help groups could now turn to DSM-III’s new definition of posttraumatic stress disorder.

In the hands of DSM-III’s authors, the shock of combat was only one of several possible causes of PTSD. Posttraumatic stress disorder was now defined as a behavioral disorder that set in after “a person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.” Significantly, the new definition avoided suggesting that PTSD victims had personalities that made them especially susceptible. DSM-III merely referred to “several studies” that assigned a more important role to “preexisting psychopathological conditions,” but it carefully emphasized that if the stress was sufficiently extreme, anyone could succumb to the disorder. Natural disasters, catastrophic accidents, victimization by criminal or state action, the death of a loved one, and, of course, combat—any of these experiences were regarded as capable of invoking PTSD in even the best-adjusted people.

Three symptomatic complexes composed the disorder: a tendency to relive the traumatic event through recollections, dreams, hallucinations, or symbols; a general feeling of disaffection in which the victim avoided any situation that threatened to recall the original events of the shock; and finally, what was called increased arousal, or a combination of sleep disturbances, irritability or anger, inability to concentrate, hyperalertness, and what laymen would call jumpiness.

Even now the number of war veterans suffering from PTSD is difficult to gauge. Posttraumatic stress disorder or a milder variant less intractable to treatment, posttraumatic stress syndrome, is estimated by veterans’ groups to have affected as many as 500,000, perhaps as many as 800,000, ex-combatants. A recent study by the Research Triangle Institute’s William Schlenger found that PTSD sufferers now make up about one-third of the 38 percent of Vietnam veterans exposed to combat action. Translated into raw numbers, Schlenger’s figures amount to about 470,000 PTSD casualties. And there are suggestions that the numbers are increasing as time goes by.

Moreover, PTSD casualties are in one sense new casualties of the war. Certain aspects of the war, such as the episodic tempo of fire base-oriented fighting, the one-year tour of duty, and the soldiers’ access to alcohol and drugs—self-medication, in essence—meant that the fighting soldier could tough it out. Of course, a serious wound enabled a soldier to escape the fighting sooner, but physical wounds and stress disorders routinely coexist, and early evacuation clearly does not protect soldiers from the threat of PTSD. Most victims of the disorder fought their war without resorting to medical treatment for any but physical wounds, went home, and were discharged, only to find that while they had left the war, the war had not left them. Official figures show that during the war, “combat stress reactions,” the term of choice at the time, amounted to only 1.2 percent of American casualties, far lower than comparable figures for World War II (23 percent) and the Korean War (12 percent). One wartime psychiatrist reported that only 5 percent of psychiatric admissions were legitimate combat fatigue, whereas 40 percent of all recorded cases were simply psychiatric disorders common to civil life. Earlier wars appear to have contained their psychiatric casualties, and anyway, the declaration of peace seemed a proper prescription for any discontent. But the most prominent feature of the Vietnam War’s psychological history seems to have been its postponement.

The more common explanations of Vietnam’s lingering psychological effect were born in our judgments on the war as it was being fought. Vietnam was conceived as somehow unique, an aberration of America’s military experience, somehow un-Amercan. Convenient as such a judgment might be, it cannot withstand scrutiny. Except insofar as any historical event is unique, our military experience in Vietnam was hardly unusual. The same is true of PTSD.
If a Civil War soldier was morose and unable to function, he became a candidate for the diagnosis of “nostalgia.” A good dose of battle was considered the best “curative.”

For most Americans the standard upon which Vietnam has been judged—and found wanting—has been the Second World War, a conflict that makes a much more compelling claim to uniqueness than Vietnam ever could. We have fought revolutionary wars, guerrilla wars, punitive wars, imperial wars, limited wars for the finer points of policy, wars marked by low and grudging social support, wars that consumed disproportionately younger men, wars whose supposed nobility was spoiled by atrocity, wars in which the rhythms of life at home were hardly interrupted, and wars in which the soldiers had only the most meager idea of why they were fighting. Indeed, the Vietnam War has been described in all these ways. By contrast, World War II’s image is so gratifying that few of these descriptions have ever been applied to that conflict. Indeed, World War II’s image is so appealing to the national memory that it has overshadowed the intervening war in Korea, a conflict that in some respects was at least as unsatisfying as Vietnam. If we are forced to remember any war fondly, World War II is always the conflict of choice.

Yet none of these traditional standards of judgment are at all likely to tell us what we need to know to understand PTSD. PTSD belongs to the soldier’s history of war, a history that until recently has been hidden from view, seldom celebrated, poorly documented, hardly remembered, almost never studied. Because the soldier’s history of war does not readily submit to the orderly requirements of history, and because, when uncovered, it often challenges the orderly traditions by which military history has shaped our understanding of warfare, the soldier’s war has been the great secret of military history. And within this special, secret history of war, the darkest corner of all has had to do with war’s essential, defining feature: combat—what it is like to have lived through it and to have lived with one’s own combat history for the rest of one’s life.

Throughout history the sustaining picture we have been given of the soldier in combat is his anonymity and his changelessness. Only a heroic act may elevate a soldier from the ranks; otherwise he never escapes from the great uniformed masses, turned this way and that, charging here, retreating there. Let a writer describe the career of an ordinary soldier at war and he will show us a man who, nervous at first, usually rises to the immediate occasion and does his duty. Purified by his baptism of fire, he attains a state of soldierly grace in which each succeeding combat experience hardens him and protects him from misfortune. If he survives his war, he disappears into manly retirement. Along the way some fail the test of combat. And because the way in which a society conducts war follows in some respects its most deeply held values, those who fail are outcasts.

Though in vogue for centuries, this simplistic view of the soldier at war was at last challenged by the Industrial Revolution. Mechanical advancements enabled combatants to fire their weapons faster, more accurately, and at greater ranges than ever before, forcing the once densely packed battle formations to disperse, to seek intermittent cover from enemy fire, and to adjust their methods of command.

What was a good deal less obvious, however, was that there had been a corresponding transformation during the nineteenth century in human relationships and sensibilities: a democratic as well as an industrial revolution had occurred. The modern ways of war sprang not only from deadly new machinery but from a new importance and appreciation of the individual man on the battlefield. If military technology now influenced the conduct of war with an unprecedented force, so, too, did the individual soldier’s performance in combat. On the eve of his own death in the Franco-Prussian War, the French officer Ardant du Picq had concluded in his classic Études sur le combat that the human cost of combat was going up. “Man is capable of but a given quality of fear. Today one must swallow in five minutes the dose that one took in an hour in Turenne’s day,” he wrote.

Du Picq was precocious. At the time only a few observers perceived the higher human burdens of modern battle. Instead, military commanders and soldiers, very like the societies from which they emerged, saw warfare in Homeric terms, as a matter of valor, courage, manliness, sacrifice, and, on occasion, the intervention of the gods. At all events, whatever a soldier did or did not do on the field of battle was believed to be the result of his absolute and conscious control over his own actions. Men chose to be heroes, and they chose to be cowards.

The persistence of the romantic view of warfare is remarkable, to say the least, when it is cast against the military history of the last century. Certainly the experience of our own Civil War should have spelled the doom of romance, but as Gerald Linderman’s recent study Embattled Courage has shown, the reality of combat was repressed by the war’s veterans. Had soldiers of the Civil War suffered mental breakdowns because of their combat experiences, either during the war or afterward? If so—and there can be little doubt that they had—the terms upon which society and soldiers alike regarded warfare ensured that their experiences would remain hidden from notice, ignored or confused with other ailments.

Society was protected from these uncomfortable questions not only by its own beliefs but by the state of medical knowledge in the mid-nineteenth century. Psychological treatises of the time belonged more to the realm of philosophy than medicine. Medical practice aimed at the alleviation of obvious physical complaints, and upon the outbreak of the war, military surgeons, overwhelmed by the massive number of soldiers torn apart by shot and shell, would not have been sympathetic toward soldiers who complained of suffering invisible wounds. In any case, neither society nor medicine provided a means by which such soldiers’ complaints could be understood.

Only two diagnoses of mental disorder were available to the field surgeon: If a soldier’s behavior was sufficiently bizarre and dramatic, he could simply be classified as one of the 2,603 cases of insanity recorded in the Federal army during the war. But if a soldier was chronically morose, lost his appetite and physical stamina, and was unable to function as well as his comrades, he became a candidate for the more opaque diagnosis of “nostalgia.” Described by surgeons as a particularly debilitating form of homesickness, nostalgia was regarded chiefly as a “camp disease,” marked by lassitude of the spirit, complicated by the boredom of long bivouacs and the rigors of marching. But neither nostalgia nor any other mental ailment was ever attributed to the rigors of combat itself. On the contrary, T. J. Calhoun, an assistant surgeon with the Army of the Potomac, advised his colleagues that if the soldier could not be “laughed out of it by his comrades” or by “appeals to his manhood,” then a good dose of battle was the best “curative.”

At only one Federal hospital could a soldier suffering from what modern clinicians would diagnose as a stress disorder expect any sort of treatment. At Turner’s Lane Hospital in Philadelphia Dr. S. Weir Mitchell investigated neurological traumas that were later recorded in his classic Gunshot Wounds and Other Injuries of Nerves. Several of Mitchell’s case narratives portray wounded soldiers, suffering from a paralysis that Mitchell and his colleagues had difficulty understanding. Although these cases arrived because of their physical wounds—one patient had fallen from a tree, while another had had part of a tree fall on him—their paralysis seems to have had little connection to their wounds. Mitchell would eventually become a novelist as well as a pioneer neurologist; in his very first attempt at fiction, a short story in the Atlantic Monthly based upon his experiences at Turner’s Lane, Mitchell wrote of a soldier, unwounded, who had been made “dumb by explosion.”

Since neither society nor medicine could quite comprehend that the shock of combat caused mental as well as physical damage, soldiers took other measures to alleviate their complaints. An enormous number of them—about two hundred thousand on each side—simply deserted. During combat soldiers could always join the unofficial army of stragglers that attended active campaigning. In battle, units seemed to melt away, only to reconstitute themselves once the fighting had stopped. Hidden away among these numbers were no doubt men who in later wars would have been discovered, diagnosed, and treated for combat stress of one sort or another.

Yet the traditional conceptions of human behavior in combat were nothing if not persistent. Each war seemed to provide proof anew that how men acted in battle depended on heroic virtue. Very much in the manner that a star shines brightest before its extinction, the traditional conception of human conduct in battle took on an intense glow in the years between the Civil War and the First World War. At the very time when foundations were being laid for new psychological understanding of human behavior, there appeared within the world of military thought a set of beliefs that held that no matter what the weaponry, the spirit of the soldier, properly inspired and managed by his courageous officers, would inevitably triumph in battle.

Ironically, this crusade of self-deception was being mounted in those very nations where the greatest advances in psychology were being made. In Paris, where Jean-Martin Charcot’s studies in hysteria at the Salpêtrière attracted the young Sigmund Freud, French military savants would argue before long that élan vital—indomitable will—was the key to victory in battle. While in Germany and Britain theoretical debates over psychology routinely appeared in the medical journals, army officers often spoke of the high casualties that would necessarily be purchased by direct assaults on enemy lines and the corresponding need for men of good breeding and character to lead them.
At the start of World War I, a British journal prophesied few psychological injuries. Instead there was a “mass epidemic of mental disorders” along the fighting lines.

After the Civil War American clinicians found another diagnosis for mental disorders, one that reached a peak of social and medical popularity by the turn of the century. “Neurasthenia”—literally a loss of the finite amount of nervous energy supposed to be inherent in each person—was promoted by Dr. George Beard and found an especially receptive clientele among the upper classes of the industrial Northeast. Neurasthenia was marked by chronic physical weakness, fatigue, stomach disorders, and anxiety. In private practice after the war, Weir Mitchell himself routinely diagnosed neurasthenia in his well-born Philadelphia patients and prescribed a “rest cure” that he had first tried on Civil War soldiers. But the compartmentalization of the medical and military worlds persisted; both Mitchell and Beard had been wartime surgeons, but neither ever seemed to look to combat as a causative factor in his patients’ complaints. Nor, for that matter, did anyone else.

Only a few researchers had an inkling that psychology was an important new means of understanding combat. Before the turn of the century, articl»s in obscure medical journals in St. Petersburg and Moscow discussed what was called hysteria in soldiers on campaign. From the Sino-Japanese Naval War of 1894-95 came medical reports of “traumatic delirium” among Japanese troops who had been “wounded in the neighborhood of the places where enormous shells had exploded.” Toward the end of 1900 Morgan Finucane, a British army contract surgeon at Aldershot, treating soldiers evacuated from the Boer War, speculated in a Lancet article that artillery fire might be responsible for the mental disorientation he found in some of his patients. And an American army medical officer, Capt. R. L. Richards, observing combat during the Russo-Japanese War, reported hospital wards and evacuation trains from the front filled with troops, physically untouched, who were mentally impaired and no longer any good for soldiering. None of these reports seem to have made the least impression upon either medical or military thought. The notion that normal men could be mentally as well as physically wounded by the stresses of modern combat could not, as yet, challenge society’s long and dearly held misconceptions about what it was really like to be trapped inside a battle.

And then came August 1914. Playing the general too much, some writers have characterized the opening stages of the Great War as a period of free maneuver, and indeed, from the strategic to the tactical levels, the combatant armies did contend with one another in ways that corresponded to the fondest imaginings of any staff-college student contemplating paper victories. But this war was not the lark many anticipated. By the time the maneuvering was definitively finished in December 1914, the French Army alone had suffered more than 350,000 casualties, and on other parts of the front the numbers were sufficient to crush even the sturdiest optimism, save, of course, that of the high commands.

Apart from the vast numbers of troops engaged, the most immediately noticeable feature of this new war was the antagonists’ relentlessly industrial delivery of fire upon their enemies. And as time passed, their skill at deploying stupendous, unprecedented quantities of shell improved by quantum leaps. Less than a year after the war began, more artillery shells were fired at the Battle of Neuve-Chapelle than had been fired in all of the Boer War.

The sheer magnitude of this shellfire early on produced rumors that men died from that effect alone. The Times History of the War reports that as early as the Battle of the Marne, “dead men had been found standing in the trenches . . . [and] every normal attitude of life was imitated by these dead men” who had no signs of physical injury. Observers lucky enough to retain their wits thought it inconceivable that men could live through such experiences unaffected.

Soon enough, all the warring nations began to receive soldiers evacuated from the front who had become mentally disabled. In Germany the psychologist Karl Birnbaum drew a clinical picture from the first six months of the war in which nervous conditions arose from the fatigue and exhaustion of fighting that included “great weariness and profuse weeping, even in otherwise strong men.” One of Birnbaum’s colleagues reported soldiers who had lost their voices, who were unable to walk steadily, who were easily startled, and who had difficulty controlling their emotions.

An American psychiatrist, Clarence A. Neymann, who served with the German Red Cross in Heidelberg from the earliest days of the war, saw no cases at all until after the Battle of the Marne had halted the initial German Army offensive. Then, Neymann recognized, “Hardly a transport of sick and wounded . . . did not contain its quota of mental cases.” At first such cases were regarded as nuisances by hard-pressed surgeons and were sent farther to the rear, where after a period of “stagnation” they were returned to the front lines. One immediately noticeable class of mental case, marked by tremors, difficulty in standing, and chronic indigestion, quickly acquired the informal diagnosis of Granatfieber, or grenade fever. To these were added a growing number of casualties who had suffered “especially trying experiences” at the front. Soon, Neymann reported, his wards became so crowded that the overflow of patients had to be shunted to base hospitals for warehousing.

The British Medical Journal for December 1914 carried an article by Dr. T. R. Elliott, then a lieutenant serving with the Royal Army Medical Corps, who reported several cases of “transient paraplegia from shell explosions.” Elliott’s patients had sustained no physical wounds, but their legs were temporarily paralyzed. He did not discount entirely the possibility that shellfire had created a hysterical condition in his patients, but like a good many of his colleagues, he saw in these cases a physical origin, and shellfire provided a fertile ground in which to look. Elliott thought many cases were misdiagnosed as hysterical when, in fact, these soldiers had suffered physical injuries from being concussed, buried, blown up. He also took note of a diagnostic trend that attributed these complaints to the carbon monoxide and nitric oxide released by high explosives, but he could find no evidence for this in conversations with returning soldiers. Only a month before, in the very same journal, another doctor had forecast, “I do not think that the psychologists will get many cases.”

On the contrary, in the months and years of war that lay ahead, there was nothing short of what one scholar has called “a mass epidemic of mental disorders” along the fighting lines, disorders that inspired a huge body of literature on the psychology of combat. At the same time Elliott’s article appeared, the British army received a report from lines at Boulogne that 7 to 10 percent of all officer patients and 3 to 4 percent of patients from the other ranks were suffering nervous breakdowns. By the end of 1914 more than nineteen hundred such cases had been reported in the British army alone. The next year that number increased tenfold. By the end of the war, the British army had treated more than eighty thousand frontline men for mental disorders, variously classified.

The classification, diagnosis, and treatment of the mental wreckage of combat posed unprecedented and, indeed, unanticipated problems for the medical profession in all the countries at war. Early in 1915 C. S. Myers, writing in The Lancet, introduced a classification for these disorders that was—as it happened—all too appropriate to the epidemic then overwhelming battalion surgeons: shell shock. Ironically, Myers thought that hysteria, not concussion, was responsible for shell shock. Another British neurologist, Sir Frederick Mott, quickly entered the debate to agree with Elliott. And so began a veritable flood of articles in the professional journals and in popular literature. For better or worse, shell shock was enshrined as a term of public usage.

Shell shock had a convoluted career both during the war and after. The diagnosis was so obligingly broad that it could be applied to any number of mental ailments, and before long shell shock aroused suspicion in medical as well as—not surprisingly—military circles. By 1916 physicians only reluctantly employed the popular term, preferring to rely instead on more conventional diagnoses such as neurasthenia and war neurosis, and most of the medical elite understood that whatever lay at the bottom of shell shock, the concussions of high explosives and their gases were entirely too simplistic an explanation.

While the medical debates progressed, however, a war was on, and commanding officers interpreted shell shock in accordance with their own unambiguous professional values. In the early days of the war soldiers found wandering about behind the combat lines were simply shot for cowardice. Others who funked their duty were court-martialed. One commander flatly “refused to allow” shell-shock cases in his battalion, while in one particular infantry division anyone who evinced symptoms of shell shock was tied to the barbed-wire lines that protected the trenches.

This approach might have become more widespread but for the remarkable numbers of “all-round good sporting chaps” among the officer classes who broke down. Faced with mounting shell-shock casualties, not to mention the terrifying realities of the carnage on the Western front, the armies in time conceded that mental stresses, however classified, could easily debilitate their soldiers. One official estimate showed more than two hundred thousand British soldiers discharged during the war because of shell shock.
In 1942, 58 percent of all the patients in VA hospitals were World War I shell-shock cases, yet all the knowledge that had been gained about them had been virtually forgotten.

One of the most public cases of shell shock was that of the poet Siegfried Sassoon. As a young officer in the Royal Welsh Fusiliers from 1915 on, Sassoon was a model soldier, well liked by his men and so avid a trench raider that he was nicknamed Mad Jack. Having already won the Military Cross, Sassoon was convalescing from his latest wound when in the summer of 1917 he wrote “A Soldier’s Declaration,” which protested the conduct of the war and announced that he would no longer contribute to the massacre. And just to make sure he was heard, he sent copies of the protest to his commanding officer and the House of Commons. “A Soldier’s Declaration” was published in the Times of London at the end of July, but by then Sassoon had already met an army medical board and been packed off as a shellshock case to the Craiglockhart War Hospital near Edinburgh.

At Craiglockhart Sassoon was fortunate to be entrusted to Dr. W. H. R. Rivers, a young Freudian whose realistic understanding of shell shock was founded upon an unromantic view of the battlefield rather than on rarefied theories. Rivers soon decided that the young officer only needed rest, but he could have fallen into the clutches of other physicians who advocated a socalled disciplinary treatment for shell shock that included painful electrical shocks, isolation, and unsympathetic handling, all intended to encourage the reappearance of the soldier’s “normal” self.

Sassoon was familiar with such rough-and-ready treatment, part of which encouraged shell-shocked soldiers to repress their memories of the trenches, shake themselves out of their depression, and carry on manfully. In “Repression of War Experience,” a poem published after his experience at Craiglockhart, Sassoon made savage fun of “disciplinary treatment” and the outmoded social views that inspired it:

And it’s been proved that soldiers don’t go mad
Unless they lose control of ugly thoughts
That drive them out to jabber among the trees.

Eventually discharged by Rivers, Sassoon returned to the front, his views on the war unchanged. There he fought until July 1918, when he was wounded again and invalided home for good. But to say that Sassoon’s war was over would be a mistake. In the form of restlessness, irritability, guilt over surviving, and, above all, battle dreams, Sassoon’s war remained alive for years afterward. His memoirs recalled his time at Craiglockhart and his fellow patients there: “Shell shock. How many a brief bombardment had its long-delayed after-effect in the minds of these survivors, many of whom had looked at their companions and laughed while inferno did its best to destroy them. Not then was their evil hour; but now; now, in the sweating suffocation of nightmare, in paralysis of limbs, in the stammering of dislocated speech. . . .”

Sassoon was right. The “long-delayed after-effect” of the war was to be an essential part of European postwar life. The war had blasted a great demographic hole in all the combatant nations. In Germany, where thirty-one per thousand of that nation’s population were killed during the war, another 10 percent of the population—disabled veterans, widows, and dependent families—six million in all, were victimized by it. The French lost even more: thirty-four killed for every thousand citizens. Great Britain’s war dead was less—sixteen per thousand of population—but that nation confronted the same problems of human reconstruction as the other Europeans. Ten years afterward more than two million British veterans were receiving some sort of government assistance. Sixtyfive thousand of these were still in mental hospitals, suffering from what was then classified as “chronic neurasthenia.”

The fortunes of shell-shocked veterans depended more upon social views than medical advances. Even though some German psychiatrists advanced highly sophisticated explanations for war-related nervous disorders, German society at large resisted the idea that war alone caused nervous disability. Less than 2 percent of all German casualties treated during the war had been diagnosed as nervous disorders. Either a shell-shocked veteran was insane or his suffering had to do with heredity. That being so, the war bore no responsibility for his mental state. True to this form, six years after the war’s end only 5,410 German veterans were drawing pensions on diagnoses of insanity as a result of their service.

While a highly conservative medical opinion held sway in Germany, in Britain the whole question of shell shock became a matter for heated public discussion. As early as 1915 members of Parliament, fearful that shell-shock victims returning from the front would be consigned to lunatic asylums, moved to prevent shell-shock cases from being confused with ordinary cases of insanity. Parliament’s concerns were real enough: one doctor estimated that more than 20 percent of all the shellshock victims at one of the army’s main hospitals were committed to asylums. Moreover, quite without regard to what the doctors or the army (whose medical service had forbidden use of shell shock as a diagnosis in 1917) thought, the British public readily accepted shell shock as a war-related nervous disorder that could afflict anyone at all. During the ten years immediately following the war, pension authorities examined 114,000 shellshocked veterans. On the eve of World War II, the British Ministry of Pensions was still paying two million pounds a year to shell-shocked pensioners from the 1914-18 war.

The veterans of the Great War phrased their complaints in much the same way as Vietnam veterans more than half a century later. Front-line troops often resented all but their own kind, and especially their countrymen on the home front. When soldiers returned home to find scant appreciation or understanding of their wartime trials, their resentment could easily deepen into bitterness and outright alienation. A German veteran’s lament, written in 1925, could pass for some veteran’s complaint today: “The . . . army returned home . . . after doing its duty and was shamefully received. There were no laurel wreaths; hatefilled words were hurled at the soldiers. Military decorations were torn from the soldiers’ . . . uniforms. . . .” Weimar Germany struck no medals commemorating war service as in times past. Not until six years after the armistice was there an official memorial service for the war dead.

But these were public manifestations of much more private trials. Sassoon’s Craiglockhart psychiatrist, Rivers, believed that society did no good at all by asking, “What’s it really like?” and then insisting that soldiers “banish all thoughts of war from their minds.” Torn between a conflicting desire to retrieve the past and to avoid its pain, the soldiers found their inchoate memories had become an essential part of their identities. Rivers thought that the best course of action lay somewhere between the outright repression of one’s war experiences and an unhealthy fixation upon the past.

This was more easily said than done. Veterans who recorded their postwar experiences often mentioned nightmares, vivid battle dreams that persisted for years, sometimes for decades. Certain events unexpectedly called forth memories of the war. Armistice Day celebrations meant reliving a murderous chaos in Delville Wood for one veteran—“hand-to-hand fighting with knives and bayonets, cursing and brutality on both sides, mud and stench, dysentery and unattended wounds. . . .” Unable to come to terms with a peaceful, indifferent society, another veteran escaped to the country: “I realized that this was what I needed. Silence. Isolation. Now that I could let go, I broke down, avoided strangers, cried easily and had terrible nightmares.”

Steering a course between repression and fixation proved difficult for the armies as well, for when the Second World War began, much of what had been discovered in the Great War about the stresses of combat had been repressed all too well. Valuable insights into the management of combat stress, the diagnosis and treatment of soldiers suffering from nervous disorders, and the vast professional organization required to tend such cases, not to mention a substantial body of medical and military knowledge—all were seemingly forgotten by the outbreak of World War II. The United States had suffered only a glancing blow in the Great War when compared with other nations, yet in 1942 some 58 percent of all the patients in VA hospitals were World War I shell-shock cases, now twenty-four years older. Ignoring experience, knowledge, and memory, the U.S. Army followed a now familiar cycle of mystification, suspicion, diagnostic confusion, a competition between military and medical authorities for the power to determine how such cases fitted within the business of war, a grudging reconciliation with the unavoidable facts of combat fatigue, and, by war’s end, a pragmatic approach to neuropsychiatric battle casualties.

In the period between the two world wars, medical authorities in the American army, confident that “proper psychiatric screening of the mentally unfit at induction was the basic solution for eliminating the psychiatric disorders of military service,” managed to institute psychiatric exams of soldiers when they enlisted. Of 5.2 million American men called to the recruiting stations after Pearl Harbor, 1.6 million were prevented from enlisting because of various “mental deficiencies.” But the widespread faith in psychiatric screening that one American army psychiatrist observed could only be “equated with the use of magic” was again tested by combat. In the American army alone the enlistee rejection rate for this war was more than seven and a half times that of World War I, yet before the war was over, the psychiatric discharge rate soared to 250 percent of that earlier conflict.

Since U.S. Army medical authorities were slow to recognize the problem that awaited them—the Surgeon General’s Office of the U.S. Army did not even appoint a psychiatric consultant until well after the war began—the troops were in effect defenseless against combat stress in the first years of the war. Field commanders once again adopted the rough-and-ready approach so prevalent in the Great War, and which Gen. George Patton’s celebrated slapping incident showed was still in vogue in some fighting units. On the besieged island of Malta in 1942, when air attacks were at their most intense, antiaircraft artillery crews were officially advised that “anxiety neurosis was the term employed by the medical profession to commercialize fear, that if a soldier was a man he would not permit his self-respect to admit an anxiety neurosis or to show fear.”
Wartime psychiatry’s objective was the prompt return to duty of wounded soldiers. A cure was hardly the point: perfectly welladjusted men were not required for combat.

Knowing very well that most physicians had little training in or understanding of psychiatric disorders in civil life, much less the special permutations that combat stress could produce, psychiatrists were anxious to find their way to the front lines, a journey whose difficulties were compounded by a less than warm reception from military authorities. One board-certified psychiatrist who was to accompany the Americans’ Western Task Force as it invaded North Africa in the summer of 1942 was assigned to latrine inspection duties before shipping out. After he landed in North Africa, he was given guard duty on medical-supply convoys.

The U.S. Army had its baptism of fire in North Africa at Kasserine and Paid passes in February 1943. Up to 34 percent of all casualties were “mental.” Worse yet, only 3 percent of these soldiers were ever returned to frontline duty. Despite the experience of World War I, when it was discovered that shell shock intensified if the patient was evacuated from the combat zones, neuropsychiatrie casualties were shuffled through an evacuation system that took them hundreds of miles to the rear. One American psychiatrist, working in the rear areas, reported that most of these cases presented a “bizarre clinical picture, which included dramatic syndromes of terror states with mutism, dissociative behavior, marked tremulousness and startle reaction, partial or complete amnesia, severe battle dreams, and even hallucinatory phenomena.” Unable to return to combat or even to noncombat duty, these soldiers could only be sent home. At one point the number of soldiers evacuated from North Africa as neuropsychiatrie casualties equaled the number of replacements arriving in that theater of operations.

The experiences of North Africa were repeated elsewhere, and during the entire war. Fighting in the South Pacific at New Georgia, the American 43d Infantry Division virtually disintegrated under fire. More than 40 percent of the 4,400 battle losses sustained by the soldiers of this division were diagnosed as psychiatric cases. During one forty-four-day period of fighting along the Gothic Line in Italy, the 1st Armored Division’s psychiatric casualties amounted to a startling 54 percent of all losses. Even toward the end of the war, the 6th Marine Division on Okinawa suffered 2,662 wounded in a ten-day period—as well as 1,289 psychiatric casualties. Nearly a half-million American soldiers were battle casualties during the fighting in Europe; by 1945 another 111,000 neuropsychiatrie cases—then usually called combat fatigue—had been treated. Worse yet, these statistics must be regarded as the minimum credible figures. Still more cases were no doubt masked by an imperfect medical accounting system, command resistance, actual wounds, susceptibility to disease, selfinflicted wounds, desertions, and even frostbite cases.

During the course of the war, frontline soldiers and medics alike had come to agree that everyone in combat had his breaking point if he fought long enough. As early as 1943 consulting psychiatrists in the Army’s II Corps had persuaded their commanding general, Omar Bradley, to order that all breakdowns in combat be initially diagnosed simply as exhaustion, putting to rest the notion that only the mentally weak were susceptible to the stresses of combat. Eventually a vast network of psychiatric care was constructed in the Army; each fighting division had its own psychiatrist, and some younger practitioners even found their way to the fighting battalions. Whether the enlightened view of combat fatigue and its real causes ever triumphed is a good deal more problematical.

The Second World War produced an unprecedented body of knowledge about human behavior in combat, knowledge that has for the most part been little studied outside professional medical circles. One compendium of medical literature, published in 1954, shows 1,166 articles on the subject of combat fatigue. There was, of course, a great diversity of interpretations regarding the cause, character, and treatment of the disorder, but in one respect all agreed that combat fatigue was “transient.” They may well have been wrong.

Wartime psychiatry, no less than wartime medicine in general, had as its official objective the prompt treatment and return to duty of the wounded soldier. Psychiatrists in uniform took pride in turning in the highest “return to duty” rates they could manage, and indeed, wounded soldiers were often anxious to get back to their buddies on the fighting lines. Combat fatigue was meant to be transient; when a soldier’s condition intensified, military psychiatry had failed its primary purpose of maintaining the fighting strength of the army in the field. A cure was hardly the point. Perfectly well-adjusted soldiers were not required for combat. The adjustments, if they occurred, were postponed until after the victory parades.

The best known of all World War II’s heroes and the quintessential infantryman, Audie Murphy, had a celebrated homecoming. But he was also lucky. When Murphy was invited to Hollywood by the actor James Cagney, his fatigued appearance so alarmed Cagney that he gave the young soldier the use of his pool house for a year. Despite his advantages, Murphy never really got over his war. Twenty-two years after his last combat experiences, Murphy slept with the lights on and loaded .45 by his bed.

As the American memory commemorated the image of the Second World War, other veterans picked up their lives again and took on the comfortable identity that so characterizes them today: children of the Depression generation who went off to wage a victorious defense of freedom and humanity—tough, uncomplaining, irrepressible in their pursuit of the American Dream. If there were those, like my childhood friend Frank, who did not quite fit the image, they never seemed to interrupt the public consciousness. They lived on with their torments or in the clinical quite of VA hospitals.

In 1951 two psychiatrists working at the Los Angeles VA Hospital’s mental-hygiene clinic published a disturbing report in the American Journal of Psychiatry. For the preceding five years Samuel Futterman and Eugene Pumpian-Mindlin had been treating two hundred veterans who exhibited persistent symptoms of intense anxiety, battle dreams, tension, depression, guilt, and aggressive reactions and who were easily startled by minor noises. The psychiatrists’ general impression of their patients was of a “well-adjusted individual who broke down in [the] face of an overwhelming trauma.” More disturbing still, Futterman and Pumpian-Mindlin wrote, “even at this late date we still encounter fresh cases that have never sought treatment until the present time.” And although some veterans responded to treatment, they added, for others “it is as if they lived in the ever present repetition of the traumatic experience that so overwhelmed them.”

Nearly fifteen years after the Los Angeles psychiatrists’ report another article appeared in the Archives of General Psychiatry. Working in a VA outpatient mental-health clinic near San Francisco, Herbert Archibald and Read Tuddenham had been “struck with the persistence and severity of the combat syndrome” in their patients. A systematic study of these cases revealed “a clear-cut picture . . . of the combat veteran’s chronic stress syndrome” consisting of precisely the same complaints as those identified in 1951. Nor, in the authors’ judgment, were these mild cases; most were ”severely disabling. . . chronic, highly persistent over long intervals and resistant to modification.” As in the earlier investigation, some of the men who saw Archibald and Tuddenham had never before sought treatment. The article concluded on a forbidding note: ”Perhaps the most disturbing in the latest reports is the suggestion that the incidence of the syndrome is increasing, as aging makes manifest the symptoms of traumatic stress which have been latent since the war.”

Just two months before this report was published, President Lyndon Johnson ordered the U.S. Marines to South Vietnam. The cycle of war experience, and the repression of it, was about to begin anew. Maybe this is what Frank saw, so far away.

Roger J. Spiller is a professor of military history at the U.S. Army Command and General Staff College, Fort Leavenworth, Kansas.

TO FIND OUT MORE

There is no overview of this problem, so far as I know, but the following touch on various aspects: John Keegan, The Face of Battle (Penguin, 1983); Gerald Linderman, Embattled Courage (Free Press, 1987); Denis Winter, Death’s Men: Soldiers in the Great War (Penguin, 1985); Cols. William S. Mullins and Albert J. Glass, Neuropsychiatry in World War II (Government Printing Office, 1973); Peter Bourne, Men, Stress and Vietnam (Little, Brown, and Co.,1970). The last two are medical works, and the Bourne is mercifully short.

—R.J.S
http://www.americanheritage.com/articles/magazine/ah/1990/4/1990_4_74.shtml
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
Percy Toplis



Geregistreerd op: 9-5-2009
Berichten: 13473
Woonplaats: Suindrecht

BerichtGeplaatst: 31 Dec 2009 17:20    Onderwerp: Reageer met quote

WWI mental casualties were 'hidden'

Of the 330,770 young Australians who served abroad during World War I, 61,919 never came home and 137,013 were wounded in action.

But there's another group of hidden casualties - the psychologically scarred who may have suffered no physical harm but whose wounds in many cases endured to the end of their life.

Historian Michael Tyquin said the full story of this group, their suffering and treatment during and after the Great War, had been kept quiet for generations.

"It's an area that has been hushed up, either through family embarrassment but more importantly because it doesn't match up with the Anzac myth according to (official historian) Charles Bean," said Dr Tyquin, a retired army officer.

"Since that time we have continued to disenfranchise the psychologically scarred soldiers from our Anzac Day memory and our Anzac Day celebrations."

Launching Dr Tyquin's new book "Madness and the Military: Australia's Experience of the Great War", army chief Lieutenant General Peter Leahy said it showed what happened in the past and what could be done about it in the future.

He said the story resonated in continuing discussion of post-traumatic stress disorder in troops who served in Vietnam and more in recent wars in the Middle East and Afghanistan.

"We know that many physical wounds are capable of healing quickly and they leave only a scar - even a lost limb can be replaced by an artificial one," he said.

"But the mind is different, scars on the mind are internal and frightening and their healing can be a long and difficult process.

"Shellshock did not accord with figure of the digger carefully composed by the official historian C.W Bean and others.

General Leahy said in those days, a physical wound was regarded as a badge of honour acquired in service of the nation.

"Shellshock was blamed on the weakness of the individual rather than the nature of war. That was a view that long persisted," he said.

Dr Tyquin said there had been little previous research into Australia's psychological casualties of World War I.

He found material in letters, soldier's diaries, medical officer's field diaries and patient case notes from mental asylums.

Dr Tyquin said British doctors first applied the catch-all term shellshock to soldiers returning from France with curious symptoms.

"The rationale behind this was that they had been blown up by an artillery shell, they had been physically concussed, the brain had somehow been affected and this was causing their withdrawal symptoms, their stammering, twitching and seizures," he said.

"Only later with increasing numbers of men coming back who had never been exposed to a shell blast and who had no physical injury did they start to ask questions.

"In the first war the science of psychology was very much in its infancy and they were still looking for answers."

Dr Tyquin said in all armies in that conflict there was a strongly held view at the top levels that many soldiers exhibiting such symptoms were malingering or somehow morally lacking.

"Even amongst the medical profession there was always a doubt at the back of their minds as to whether this guy was trying to get away," he said.

Dr Tyquin said just how many suffered psychologically wasn't known but the best estimate was about one per cent of all who served.

On return to Australia, some committed suicide, some ended up in mental hospitals while others drank to excess, took drugs and turned to criminal behaviour. In a few sad cases, wives killed abusive veteran husbands.

"This is the untold story of what families suffered and suffered in private," he said.

Some only manifested symptoms years later, aggravated by the Great Depression.

"Between the wars often the only way these fellows could make sense of their own experiences was at the RSL clubs at boozy, smokey pub nights," he said.

"They couldn't sit down with their wife or mother and say this is how it really was."

Bron: http://www.smh.com.au/news/National/WWI-mental-casualties-were-hidden/2006/04/25/1145861339437.html
_________________

"Omdat ik alles beter weet is het mijn plicht om betweters te minachten."
Marcel Wauters, Vlaams schrijver en kunstenaar 1921-2005
Naar boven
Bekijk gebruikers profiel Stuur privé bericht
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 14 Sep 2010 9:31    Onderwerp: Reageer met quote

Reevaluating Society's Perception of Shell Shock:

A Comparative Study Between Great Britain and the United States


By Annessa Cathleen Stagner
West Texas State University


The combination of traditional fighting techniques and new technology in World War I forced both soldiers and officers to face devastating situations that tested not only their courage, but also their mental strength as well. While society had taught men to be tough and brave at all times, many broke upon enduring the horrifying environment of the trenches. It is obvious that men's ability to hold on to such an extreme ideal of manhood was unrealistic; however, many men tried. Jessica Meyers quoted Private Miles, who explained his emotional conflict saying, "I was frightened out of my life at nighttime. I was jellified, but I was more afraid of people knowing that I was afraid-- just a sort of bravado-- I mustn't show them I was afraid." [1] Like private Miles, many men tried to suppress their emotions, stay in control, and live up society's standard of masculinity. The devastating impact of war on soldiers, however, quickly forced society to confront the inability of soldiers to maintain society's idealistic courage. Some returning soldiers suffered through nightmares, while others suffered physically, exhibiting nervous twitches, blindness, or limb dysfunction. [2] In 1915, physician C. S. Myers unknowingly acknowledged the result of soldier's mental conflict between idealistic courage and survival leading to a form of nervous disorder, which he termed shell shock. [3]

The large number of soldiers affected by shell shock continues to engage World War I historians even today. "The heightened code of masculinity that dominated in wartime was intolerable to surprisingly large numbers of men." [4] Nearly 80,000 men in Britain were diagnosed with shell shock during the War, and the number of cases continued to rise after the War ended. Some estimates, including undiagnosed soldiers, claim 800,000 British cases and 15,000 American cases. [5] Shell shock was not just a disease of the common soldier either. Myra Schock acknowledged "historians have generally taken it for granted that officers experienced shell shock in far greater numbers than soldiers of other ranks." [6] Inevitably numerous soldiers from all ranks were diagnosed with shell shock, thus having a tremendous impact on all of society.

Shell-shocked soldiers made an impression on society not only because of their sheer numbers, but also because they called into question masculine ideals of the era. Governments suddenly found themselves confronted with sizable numbers of men who claimed to be unable to fight, but showed no visible signs of wounds. After the war ended, society had to face those same men who remained in a strange mental state. To adequately interpret and judge both societies' reactions to shell shock, it is important to examine how the governments dealt with it, and how opinion makers, through writers and especially the media, reacted to their actions. By examining the Times as well as the New York Times one is able to gain an understanding of what the views influencing the public were, not only during the war, as some historians describe, but also after. It is only then British and American societies' reactions to shell shock compared to those of their governments can be exposed.

During World War I, the British government's primary focus was to keep as many men available for service and in the field as possible. Shell-shocked soldiers directly hindered the army's ability to successfully wage war because their inability to fight decreased the army's number of active troops. Myra Schock pointed out the conflict doctors experienced when trying to balance their governmental obligations with their own sympathy for the mentally strained soldiers. The doctors knew firsthand what shell shock felt like and realized it as a genuine sickness among the troops. However, the British government viewed shell shock as a form of malingering, deserving court martial, and many soldiers "were shot for cowardice, even when doctors argued that the accused was suffering from a medical condition caused by trauma and/ or shell shock." [7] Schock stated British "doctors attempted to draw firm distinctions between their service as doctors and their role as members of the armed services at war." [8] The British government clearly put pressure on doctors and officials to treat shell shock harshly, not as a disease, but as a form of malingering.

Other historians have argued the government became more sympathetic when it became evident that those affected were experienced soldiers and officers. Joanna Bourke stated, "society as a whole acknowledged that of those affected, some had war medals for valiant behavior under fire." [9] They were not cowards, but some of the best fighting men Britain had. Instead of acknowledging the disease's legitimacy among the troops, however, the government still discredited many of its victims. Attempts were made to "protect" officers of high status by classifying them as victims of "anxiety neurosis" or "neurasthenia," while common soldiers were classified as victims of "hysteria neurosis," a purely feminine disease. [10] The differing titles reflected the British government's willingness to make a clear distinction between the legitimate illness of its officers and the unfounded appeals of its psychologically weak common soldiers.

While the government did not intend to allow shell shock to hold any legitimacy among its troops, experienced soldiers' and officers' traumatic experiences convinced to advocate for proper treatment of the shell-shocked soldiers. Virtually ignoring the existence of shell shock within common soldiers initially, Peter Leese suggested the government proceeded to improve treatment only as a result of strong public opinion.

On the Home Front, the army could not completely ignore the journalists, politicians and soldiers who discussed shell shock, so here too it became necessary to limit the conditions definition and rework its meanings, especially by promoting a limited, empirically defined view of the disorder in educational talks and semiofficial public appeals. By promoting the cure of officers in 'special' hospitals, it never the less became possible to incorporate the condition into public notions of 'honorable' suffering. [11]

According to Leese, the public's initial interest in shell shock persuaded the British government to give the soldiers proper treatment. After realizing the potential anti war threat shell-shocked soldiers produced, the government took action to ensure shell shock would become a subject that would rally the people in favor of the war effort rather than against it. Agreeing with Leese, Jessica Meyer noted in her dissertation that "by controlling of diagnosis and treatment the [British] government was at liberty to recognize whichever theory of causation and treatment suited it." [12] The government initially did little to protect the shell shocked; however, they later became eager to utilize the soldiers' condition in their own efforts to curtail pubic opinion.

While holding the same ultimate goal of the British government, that of maintaining troops, the United States government dealt with shell shock differently. The government strove to prevent the public outcry and large losses of combat ready men shell shock had produced in Great Britain. "At training camps, the aim was to weed out as many potential shell-shock cases as possible through rapid psychiatric interviews and intelligence tests, used for the first time on a mass scale." [13] Robert Zieger stated that "American psychiatrists and other medical officers largely avoided the 'treatments' that some British counterparts continued to inflict." [14] The United States government decided to accept the treatment of shell shock as a sickness, rather than punish those soldiers for malingering. [15]

The governments' views of shell shock due to their actions in denying it legitimacy or helping to prevent and treat it can be fairly simply defined. The general public's perception of shell shock, however, is somewhat more difficult. Both governments strove to deal with shell shock in light of their own war efforts. The British denied its legitimacy in order to discourage what they considered malingering, while the United States hoped to keep up home-front morale through preventative screening.

Most likely, the general public knew little about how shell-shocked soldiers hindered military efforts. However, they quickly became aware of the disease's social implications. The soldier had not only failed at being a courageous hero, but had fallen subject to hysteria, a purely feminine disease. Some doctors even called it hysteria, which emphasized the soldiers' inability to maintain their masculinity. Female Malady stated, "signs of physical fear were judged as weakness and alternatives to combat- pacifism, conscientious objection, desertion, even suicide-were viewed as unmanly." [16] Upon realization that soldiers' self-control over their emotions was unachievable, shell shock destroyed society's ideal masculinity.

One of the most obvious ways to identify society's conflict between shell-shocked soldiers and masculinity can be seen through the work of popular World War I writers such as Rebecca West and Siegfried Sassoon. Rebecca West's novel The Return of the Soldier generated sympathy for Chris, a shell-shocked man who returned home without any memory of his former life. In her novel the shell-shocked soldier was welcomed home, and the reader was made to feel much compassion for him as he and his family struggled to return to normal life. The welcoming family, although restless at times, still remained patient and dedicated to Chris's recovery.

West's novel spoke of excellent relations between shell shock victims and society, yet not all works of literature portrayed that same positive ending. Sassoon's famous poem "Survivor," by contrast, portrays a vividly negative image of how society viewed the shell-shocked soldier.

...the shock and strain / Have caused their stammering, disconnected talk. / Of course they're 'longing to go out again,'-/ These boys with old, scared faces, learning to walk./ They'll soon forget their haunted nights; their cowed / Subjection to the ghosts of friends who died-/ Their dreams that drip with murder; and they'll be proud / Of glorious war that shattere'd all their pride.../ Men who went out to battle, grim and glad; / Children, with eyes that hate you, broken and mad. [17]


:ees verder op:
(c) http://www.wfa-usa.org/new/shellshock.htm
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
Cobra4



Geregistreerd op: 11-8-2009
Berichten: 48

BerichtGeplaatst: 20 Sep 2010 10:33    Onderwerp: Reageer met quote

Wat filmpjes over Shell Shock in WO1. Gezien de zichtbare verwondingen in sommige films niet voor mensen met een zwakke maag.

http://www.youtube.com/watch?v=RRv56gsqkzs

http://www.youtube.com/watch?v=SS1dO0JC2EE&feature=related

http://www.youtube.com/watch?v=AL5noVCpVKw (Deel 1 van 5, verder selecteren via Youtube)
Naar boven
Bekijk gebruikers profiel Stuur privé bericht
Percy Toplis



Geregistreerd op: 9-5-2009
Berichten: 13473
Woonplaats: Suindrecht

BerichtGeplaatst: 25 Nov 2010 0:20    Onderwerp: Reageer met quote

Shell Shock and Mild Traumatic Brain Injury: A Historical Review
Edgar Jones, Ph.D., D.Phil.
Nicola T. Fear, D.Phil.
Simon Wessely, M.D.


Mild traumatic brain injury is now
claimed to be the signature injury of the
Iraq and Afghanistan conflicts. During
World War I, shell shock came to occupy a
similar position of prominence, and postconcussional
syndrome assumed some
importance in World War II. In this article,
the nature of shell shock, its clinical presentation,
the military context, hypotheses
of causation, and issues of management
are explored to discover whether
there are contemporary relevancies to
the current issue of mild traumatic brain
injury. When shell shock was first postulated,
it was assumed to be the product of
a head injury or toxic exposure. However,
subsequent clinical studies suggested that
this view was too simplistic, and explanations
soon oscillated between the strictly
organic and the psychological as well as
the behavioral. Despite a vigorous debate,
physicians failed to identify or confirm
characteristic distinctions. The experiences
of the armed forces of both the
United States and the United Kingdom
during World Wars I and II led to two conclusions:
that there were dangers in labeling
anything as a unique “signature” injury
and that disorders that cross any
divide between physical and psychological
require a nuanced view of their interpretation
and treatment. These findings
suggest that the hard-won lessons of shell
shock continue to have relevance today.

http://ajp.psychiatryonline.org/cgi/reprint/164/11/1641.pdf
_________________

"Omdat ik alles beter weet is het mijn plicht om betweters te minachten."
Marcel Wauters, Vlaams schrijver en kunstenaar 1921-2005
Naar boven
Bekijk gebruikers profiel Stuur privé bericht
Percy Toplis



Geregistreerd op: 9-5-2009
Berichten: 13473
Woonplaats: Suindrecht

BerichtGeplaatst: 24 Dec 2010 13:44    Onderwerp: Reageer met quote

WALTER B. CANNON AND THE MYSTERY OF SHOCK: A STUDY OF ANGLO-AMERICAN CO-OPERATION IN WORLD WAR I
by SAUL BENISON, A. CLIFFORD BARGER, and ELIN L. WOLFE

The autumn of 1914 marked the beginning of an extraordinary transformation of
the plains of northern France and Flanders. Fields where farmers had for centuries
ploughed with horses, laid down seed, and set out livestock to graze in an effort to
sustain life, in a relatively brief period of time became a maiming and killing ground for
British, French and German armies. At first, combatants on both sides believed the
conflict would be a short one, crowned by a quick victory. Within months, that illusion
was shattered by an unplanned strategy of positional warfare which featured miles of
trenches protected by barbed wire and the massed firepower of rifles, mortars, machine
guns, and artillery.' Such warfare not only prolonged the duration of the fighting, it
also exacted a frightful toll of casualties. No one was prepared for this situation, least
of all the military surgeons, who often had to deal with burgeoning problems far
beyond their understanding and skill. In 1915, British surgeons in Flanders became
aware that in addition to the alarming number of severely lacerated and contaminated
wounds they saw day after day, more and more of the soldiers who came to them for
care mysteriously died of shock. It was not an unknown condition.

Lees verder op Medical History, 1991, 35: 217-249, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1036337/pdf/medhist00051-0075.pdf
_________________

"Omdat ik alles beter weet is het mijn plicht om betweters te minachten."
Marcel Wauters, Vlaams schrijver en kunstenaar 1921-2005
Naar boven
Bekijk gebruikers profiel Stuur privé bericht
Percy Toplis



Geregistreerd op: 9-5-2009
Berichten: 13473
Woonplaats: Suindrecht

BerichtGeplaatst: 23 Jan 2011 18:33    Onderwerp: Reageer met quote

PUNCH, OR THE LONDON CHARIVARI, Vol. 152, January 24th, 1917.



"ELLO, WOT'S THE MATTER WITH 'IM?"

"SHELL SHOCK, I RECKON."


http://www.gutenberg.org/files/14093/14093-h/14093-h.htm
_________________

"Omdat ik alles beter weet is het mijn plicht om betweters te minachten."
Marcel Wauters, Vlaams schrijver en kunstenaar 1921-2005
Naar boven
Bekijk gebruikers profiel Stuur privé bericht
Yvonne
Admin


Geregistreerd op: 2-2-2005
Berichten: 45457

BerichtGeplaatst: 17 Nov 2012 19:41    Onderwerp: Reageer met quote

Disturbing footage reveals devastating effects of shell shock on WW1 soldiers as they were treated in Devon hospital

Filmed during World War One, these remarkable films show traumatised soldiers displaying symptoms from strange tics to uncontrollable shaking
Usually victims had solitary confinement or electric shock therapy treatment
But at Newton Abbott's Seale Hayne in Devon, the approach was very different due to the revolutionary approach of a doctor called Arthur Hurst


Read more: http://www.dailymail.co.uk/news/article-2229655/Disturbing-Pathe-footage-World-War-One-reveals-devastating-effects-shell-shock-soldiers-treated-pioneering-Devon-hospital.html#ixzz2CVTDPyjx
Follow us: @MailOnline on Twitter | DailyMail on Facebook

Pas op, verontrustende beelden.
_________________
Met hart en ziel
De enige echte

https://twitter.com/ForumWO1
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Verstuur mail Bekijk de homepage
shabu
Cheffin


Geregistreerd op: 7-2-2006
Berichten: 3032
Woonplaats: Hoek van Holland

BerichtGeplaatst: 24 Jul 2016 10:00    Onderwerp: Reageer met quote

WORLD WAR I: 100 YEARS LATER
The Shock of War

World War I troops were the first to be diagnosed with shell shock, an injury – by any name – still wreaking havoc


In September 1914, at the very outset of the great war, a dreadful rumor arose. It was said that at the Battle of the Marne, east of Paris, soldiers on the front line had been discovered standing at their posts in all the dutiful military postures—but not alive. “Every normal attitude of life was imitated by these dead men,” according to the patriotic serial The Times History of the War, published in 1916. “The illusion was so complete that often the living would speak to the dead before they realized the true state of affairs.” “Asphyxia,” caused by the powerful new high-explosive shells, was the cause for the phenomenon—or so it was claimed. That such an outlandish story could gain credence was not surprising: notwithstanding the massive cannon fire of previous ages, and even automatic weaponry unveiled in the American Civil War, nothing like this thunderous new artillery firepower had been seen before. A battery of mobile 75mm field guns, the pride of the French Army, could, for example, sweep ten acres of terrain, 435 yards deep, in less than 50 seconds; 432,000 shells had been fired in a five-day period of the September engagement on the Marne. The rumor emanating from there reflected the instinctive dread aroused by such monstrous innovation. Surely—it only made sense—such a machine must cause dark, invisible forces to pass through the air and destroy men’s brains.

Shrapnel from mortars, grenades and, above all, artillery projectile bombs, or shells, would account for an estimated 60 percent of the 9.7 million military fatalities of World War I. And, eerily mirroring the mythic premonition of the Marne, it was soon observed that many soldiers arriving at the casualty clearing stations who had been exposed to exploding shells, although clearly damaged, bore no visible wounds. Rather, they appeared to be suffering from a remarkable state of shock caused by blast force. This new type of injury, a British medical report concluded, appeared to be “the result of the actual explosion itself, and not merely of the missiles set in motion by it.” In other words, it appeared that some dark, invisible force had in fact passed through the air and was inflicting novel and peculiar damage to men’s brains.

“Shell shock,” the term that would come to define the phenomenon, first appeared in the British medical journal The Lancet in February 1915, only six months after the commencement of the war. In a landmark article, Capt. Charles Myers of the Royal Army Medical Corps noted “the remarkably close similarity” of symptoms in three soldiers who had each been exposed to exploding shells: Case 1 had endured six or seven shells exploding around him; Case 2 had been buried under earth for 18 hours after a shell collapsed his trench; Case 3 had been blown off a pile of bricks 15 feet high. All three men exhibited symptoms of “reduced visual fields,” loss of smell and taste, and some loss of memory. “Comment on these cases seems superfluous,” Myers concluded, after documenting in detail the symptoms of each. “They appear to constitute a definite class among others arising from the effects of shell-shock.”


Read more: http://www.smithsonianmag.com/history/the-shock-of-war-55376701/#5pb2voL0ZDtEU1bb.99
_________________
If any question why we died
Tell them, because our fathers lied
-Rudyard Kipling-

http://ww1relics.com/
Naar boven
Bekijk gebruikers profiel Stuur privé bericht Bekijk de homepage
Berichten van afgelopen:   
Plaats nieuw bericht   Plaats Reactie    Forum Eerste Wereldoorlog Forum Index -> Medische verzorging Tijden zijn in GMT + 1 uur
Pagina 1 van 1

 
Ga naar:  
Je mag geen nieuwe onderwerpen plaatsen
Je mag geen reacties plaatsen
Je mag je berichten niet bewerken
Je mag je berichten niet verwijderen
Ja mag niet stemmen in polls


Powered by phpBB © 2001, 2002 phpBB Group