Did shell shock make us serious about mental health?

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1. Bearing witness to horror

Soldiers who served in World War One endured some of the most terrible forms of warfare ever known. They faced the daily sight of death and mutilation caused by exploding shells, machine guns or silent but deadly poison gas. Many thousands began suffering strange symptoms from uncontrollable twitching to terrible nightmares.

A number of names to describe this new 'illness' were suggested but the one that stuck was shell shock.

We now know it was an understandable reaction to the horror of modern warfare, but at the time it was the cause of much confusion, distress and lack of understanding. After all, by the end of the war 80,000 men would have been diagnosed with shell shock.

2. The legacy of 'lunacy'

How was mental health understood, viewed and treated before 1914?

3. The shock of war

Shell shock emerged after the British Army's first major action of World War One, the Battle of Mons.

As artillery fire pounded down on both sides, healthy young men began suffering a range of symptoms.

A lack of understanding

Often, military commanders thought shell-shock was made-up, exaggerated or simply cowardice. It is likely that at least some of the British soldiers shot for desertion were suffering from shell-shock.

But as the cases mounted, there was a public backlash. Angry relatives of sufferers wrote to newspapers; questions were asked in parliament. Doctors and commanders began to ask whether lack of sleep, shattering noise and the sight of so much death and mutilation could be causing the symptoms.

Specialist treatment

Between April 1915 and April 1916, more than 11,000 men were sent home to British hospitals to be treated. At first, most doctors thought shell shock could be best cured by bed rest, sedatives and electric shocks. Later, doctors such as Dr W H R Rivers said this treatment focused too much on the body and not enough on the mind. Inspired by Freudian psychoanalysis, he encouraged soldiers, most famously at Craiglockhart hospital in Edinburgh, to talk about what they had been through.

After the war

By the end of the war, 80,000 officers and ordinary soldiers had suffered from “a severe mental disability which rendered the individual temporarily, at any rate, incapable of further service.” Three years later 65,000 men were still receiving disability pensions because of shell-shock.

World War One had proved that anyone could be affected by a mental health disorder, whatever their background, gender, or ‘moral character’.

4. A nation suffers

The scale of World War One meant that it touched the lives of entire populations, not just those on the front line. Click on the labels below to read about how non-combatants were also deeply affected.

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Images courtesy of Getty, Mary Evans and Topfoto

5. Treating trauma today

A century on from the First World War we now understand that ‘shell shock’ was in fact describing a range of conditions, from anxiety to post-traumatic stress disorder.

Finding the right treatment

In World War One, it was found that activities such as gardening or working with animals could help shell shocked men. Today, we understand better why they work – by empowering the patient, tackling social isolation and diverting the mind. We have also benefited from a rapid development of new medications.

Doctors also found that talking about experiences could relieve symptoms. This fueled the rise of talking therapies such as psychotherapy. Cognitive Behavioural Therapy developed as doctors came to understand that thought processes can have a powerful effect on the body.

Recognising the signs

The British military today recognises that soldiers face a real risk of developing disabling psychological illnesses. Before returning home from tours of duty, soldiers are given a period of ‘decompression’ in Cyprus to help them re-adjust.

Soldiers in each unit are trained in Trauma Risk Management (TRiM) to look out for early warning signs of post-traumatic stress disorder in their colleagues, while the Ministry of Defence works with mental health professionals to assess and treat full-time soldiers and reservists both on and after operations.

But some mental health professionals say there is still not enough support available for both veterans and the public at large, so that charities such as Combat Stress and Mind take on much of the burden.

6. How far have we come?

What progress has been made in the area of mental health since the end of World War One? Click on the four options below to find out.


In 1918 psychoactive drugs were not routinely used to treat mental health problems. How are they used today?

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Drug revolution

Scientists have found effective drug treatments for many mental health conditions. However, critics say pills are over-prescribed and only treat the symptoms.


Psychoanalysis was in its infancy in 1918. What is the picture today?

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Patchy progress

Talking therapies relieve anxiety and depression in 40% of patients. However, three-quarters of the 6.7 million with such conditions don’t receive treatment.


In 1918 there was almost no legal protection for people with mental health problems. What is it like today?

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Equality Act 2010

Today it is illegal to discriminate against people with mental health problems in public services, access to work, education, associations and transport.


In 1918 there was widespread misunderstanding and fear around mental health. How about today?

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Stereotyped views

The Time to Change campaign found 61% of people with mental health problems have experienced stigma and discrimination from friends and in their social life.