1. A monstrous condition
Shell shock was a term used during WW1 to describe a condition that left soldiers with a range of symptoms, from facial tics to blindness, for which there was no obvious physical cause.
By the time the war ended 80,000 had been treated for this, but modern estimates suggest the number of sufferers could have been as high as 325,000.
To deal with the loss of so many men from the front line, specialist hospitals were set up, like Craiglockhart in Edinburgh.
2. Cures at Craiglockhart
A variety of treatments were used at Craiglockhart. William Rivers drew on ideas from psychoanalysis and helped popularise Sigmund Freud’s work with his use of the 'talking cure'. But Arthur Brock thought the key was to keep the patients active.
Images courtesy of Napier University, Society of the Sacred Heart and Getty Images.
3. More than a hospital
Craiglockhart’s small staff of doctors and nurses treated somewhere between 1,500 and 1,800 patients during the years it was operating as a shell shock hospital.
As well as their formal treatments, patients at Craiglockhart were encouraged to be as active as possible.
The Hydra outlines the range of activities that they would have taken part in – lectures, meetings, expeditions, hobbies and entertainment.
Clash of ideas
There was a degree of antagonism between the ‘doctors in uniform’ who ran Craiglockhart and the military. Some senior officers were suspicious about the existence of shell shock, believing that the patients were simply trying to avoid service at the front.
Siegfried Sassoon claimed that after the war he was told by William Rivers that, “the local Director of Medical Services nourished a deep-rooted prejudice against [Craiglockhart], and actually asserted that he “never had and never would recognize the existence of such a thing as shell-shock.”
The hospital was inspected twice during the two and a half years of operation. Following both visits, the commanding officer of the hospital was replaced.
4. Literary legacy
Craiglockhart is perhaps the best known of the shell shock hospitals because two of the best remembered poets of World War One, Siegfried Sassoon and Wilfred Owen, met here in 1917.
Their time together at Craiglockhart has featured in the play Not About Heroes and in the novel Regeneration, which was subsequently turned into a film.
In 1917 Sassoon wrote a statement condemning the war which was read out in parliament by an MP. To avoid a court martial, his friend and fellow writer Robert Graves convinced the review board that Sassoon was suffering from shell shock. He was sent to Craiglockhart to recover.
Sassoon had been a published writer before the war and he continued to write while at Craiglockhart. The poem Dreamers was first published in The Hydra.
He eventually returned to the front in France before a head wound led to him being invalided back to Britain, where he spent the rest of the war.
Owen saw fierce fighting during the war, including being trapped for days next to the dead body of a fellow officer. Such events severely traumatised him and he became a patient at Craiglockhart.
His doctor, Arthur Brock, encouraged him to write as part of his treatment and he was for a time editor of the Hydra. He was also inspired by meeting the older Sassoon, who would offer feedback on his work. Owen’s best remembered poems, such as Dulce et Decorum est and Anthem for Doomed Youth, were written at Craiglockhart.
Like Sassoon, Owen returned to the front in France after leaving Craiglockhart. He was killed on the 4th of November 1918, one week before the Armistice was declared.
5. Other pioneering hospitals
Craiglockhart was one of a number of hospitals treating shell shock in the UK.
The Maudsley, part of King’s College Medical School in London since the 1920s, was controlled by the War Office during the war under the command of Colonel Atwood Thorne.
They explored the role of heredity in nervous breakdown, and tried to understand the effects of shell explosions on the central nervous system.
Doctors at the Red Cross Military Hospital at Maghull in Merseyside focused on the psychology of the patients, in order to help them make sense of their relationships, experiences and how they see the world.
William Rivers worked here before transferring to Craiglockhart, where Siegfried Sassoon became one of his patients.
At Seale Hayne in Devon, Arthur Hurst removed hysterical symptoms using suggestion. Soldiers were then encouraged to take part in activities such as working on local farms, pursuing occupational methods similar to those used by Brock at Craiglockhart
Archive video shot during the war shows his patients undergoing a remarkable transformation.
But research suggests that some of the ‘before and after’ footage may not be genuine, with patients recreating symptoms they no longer had, or exaggerating their condition for the camera.
6. Long term support
Some specialist shell shock hospitals, like Craiglockhart, closed shortly after the war.
Special medical clinics
Support was provided for shell shocked veterans in the immediate aftermath of the war through a network of outpatient clinics set up by the Ministry of Pensions, many of which provided psychotherapeutic treatments.
These 'Special Medical Clinics' were set up, often in conjunction with an orthopaedic outpatient department, to treat veterans diagnosed with shell shock and other war neuroses. By October 1920, there were 29 in total and they operated until the mid-1920s when government funding cuts led to their closure.
In addition, the Ministry opened 10 neurological hospitals across the UK, which carried on operating well into the 1930s.
The number of patients treated declined during the 1920s, falling below 1000 patients in 1929 and declining into the 1930s.
Ex-Services’ Welfare Society
The charity Ex-Services' Welfare Society, now known as Combat Stress, was formed in 1919 to provide care and lobby the government on support for veterans.
7. Legacy of shell shock
Did shell shock lead to improvements in mental health care? Dr Tracey Loughran of Cardiff University outlines the effect that this period had on civilian and military medicine in the years following the war.
Mental Treatment Act 1930
Shell shock provided a powerful impetus for change to the mental health care system. It affected healthy young men, who were the nation’s heroes. This showed that anyone could break down, if placed under enough stress. The experience of shell shock also seemed to prove that early treatment prevented the development of more severe mental illness. But despite the strong movement for reform, it was only in 1930 that the Mental Treatment Act made provision for voluntary treatment at outpatient clinics, providing the mentally afflicted with an alternative to the asylum.
The long gap between the armistice and this Act shows that mental health was not a strong priority for the government. Shell shocked veterans benefitted from special clinics, but many also experienced considerable difficulties in claiming pensions for psychological injury. Other parts of the mental health care system lacked resources, and civilians with mental health problems were neglected.
Attitudes did not change within the military either. Military authorities believed that training, morale, and discipline could prevent shell shock, and did not maintain a psychiatric service. When the Second World War broke out, only 6 regular officers in the British army had psychiatric training.
Yet shell shock did change how doctors thought about mental illness. Doctors gained new understanding of psychological problems, and experimented with new therapies. Institutional change was slow, but individual doctors carried the lessons of shell shock into their postwar practices, affecting the lives of thousands of patients. Shell shock laid the foundations for more humane attitudes towards mental illness.