Shell Shock and the Kloppe: war neuroses amongst British and Belgian troops during and after the First World War

Abstract

During the First World War combatants of all armies were prey to nervous disorders or psychological breakdown. These war neuroses were a response to the highly-industrialised nature of the warfare as well as to the fatigue engendered over four years of intense conflict. Yet while fear and mental breakdown were universal, national responses varied. A comparison of British and Belgian shell shock indicates that men suffered in very similar ways but that symptoms met with rather different responses: in Britain treatment and diagnostic regimes stressed the importance of class difference and shell shock was often linked to cowardice. These issues were not of overriding importance in the Belgian army. In the longer term shell shock became, and remained, a topic of political and social concern in Britain whereas in Belgium men suffering from kloppe (extreme fear) tended to be forgotten and the topic has not excited much popular interest or scholarly attention. Yet despite these differences one overarching theme remains clear, namely that despite the extensive experience of war neuroses during and after the First World War, there still remains a fierce stigma about the mental wounds of war.

Keywords:

• shell shock
• Kloppe
• war neuroses
• psychology
• psychiatry

Introduction

A soldier, half-mad, struggling in hysteric attacks, and yelling at each discharge. He screams like a terrified beast. (Deauville 1923, 57)

The shell-shocked soldier, half-mad with fear and fright, was a feature of all armies during the First World War. Men suffering from prolonged fatigue were reacting strangely to the highly mechanised violence of trench warfare, even though they had escaped life-threatening injuries. A short article in the Times in Great Britain described the typical reactions of a man who had been incapacitated by the explosion of a shell:

Consciousness is lost for a variable time, but often not so far as to prevent automatic movements, so that the man may walk in a dazed condition to a dressing station. At this stage it would appear, the mental balance is very much disturbed, nor does memory retain any record of the phase. But the man is ‘instantaneously struck blind’, and this may be associated with deafness, loss of smell and taste. The eyes are found to be watering freely and the lids tend to keep tight shut. After the lapse of a week or two, it is found, very often that the eyes are quite normal […] Eventually complete though slow recovery takes place. (‘Shell Blindness.’ Times, April 8, 1915)

Interestingly, while there is a wealth of historical literature exploring these ‘wounds of consciousness’ across Europe, it is notable that the studies of this transnational phenomenon are predominantly national in scope. Yet, as Jay Winter (2000, 11) has effectively argued, the history of shell shock is ‘the history of the war itself’ and so comparative studies of shell shock serve to highlight the way in which war experiences were shared – and the extent to which they differed – amongst combatant nations. In response, this article seeks to compare and to contrast British and Belgian experiences of shell shock as a starting point for a wider, pan-European study. We draw upon a wide variety of sources, including detailed medical studies, court-martial proceedings, personal testimony and articles in the popular press because the history of war neuroses is not exclusively a military-medical one but is also one which is political, social and cultural. Moreover, we discuss war neuroses (as opposed to neurosis) because military-mental breakdown can take a variety of different forms: there is no one specific condition which is why the umbrella term of ‘shell shock’ is, in medical terms, unhelpful.

A comparison of Britain and Belgium makes for an illuminating start in such a comparative endeavour in three key respects: firstly, because of the starkly different ways in which shell shock and war neuroses entered public discussion (or not, in the case of Belgium) in the respective countries at the time; secondly, because of the ways shell shock has been researched and remembered in ‘national’ or ‘popular’ memory of both nations since; and finally, because a comparative analysis of these distinct Allied armies provides an interesting insight into the nuances of the diagnosis, treatment, and crucially perceptions of shell shock within both the military-medical communities and the circles of the mentally wounded in this period.

In Britain, because war neuroses, popularly described as shell shock, have come to occupy a central and emblematic position in the history of the First World War there has been much historical research into the field, so it is possible to paint a detailed picture of how it affected the British Army. ‘Shell shock’ had been presenting problems since September 1914 when wounded men began to arrive back in England suffering from a range of anxiety disorders – mental tics, nightmares, confusion, fatigue, obsessive thoughts, inexplicable aches and pains – and also from functional disorders such as mutism, paralysis, hysterical blindness and hysterical deafness. By the end of the war, approximately 80,000 British soldiers had been treated for war neuroses and their complaints continued long after the war was over. A total of 65,000 men were receiving pensions for war neuroses in 1921 and by 1929, 47,669 men were receiving pensions for stabilized neurasthenia and 7800 were still receiving pensions for unstabilized neurasthenia (MacPherson 1923, 8; Mitchell and Smith 1931, 320–321). In contrast, while the comparatively smaller Belgian Army (between 75,000 and 125,000 men) also faced the widespread onset of nervous and mental disorders in its ranks, there has been much less scholarly research into shell shock in Belgium. Unlike in Great Britain, the return of shell-shocked soldiers was never a matter for public discussion and the number of soldiers treated for war neuroses is still unknown. Moreover, because there was no connection between the Front and occupied Belgium, Belgian families remained unaware of the medical conditions of their loved ones until after the war.

In Britain, because the story of shell shock is so central to understandings of the First World War, much of the historical and popular literature deals with the medical inadequacies, or even the medical crimes, associated with shell shock treatment. Both Leed and Showalter highlighted the disciplinary nature of some shell shock treatment, comparing the painful and punitive electric treatment with the apparently more progressive ‘talking cures’ (Leed 1979; Showalter 1980; Young 1995, 67–72). Moving away from the official treatment regimes, Leese has put the ordinary soldier at the centre of the shell shock narrative and Barham’s highly innovative study revealed the plight of those who were incarcerated in lunatic asylums on account of their war neuroses, some for the rest of their lives (Leese 2002; Barham 2007). Of course, the majority of shell-shocked soldiers did not spend the rest of their lives in lunatic asylums and most of them had to rebuild their lives, their families and their careers during the 1920s and 1930s (Reid 2010). Overall, historians now agree with the judgement of the Times’ medical correspondent in 1915, namely that the war had produced ‘a crisis in the handling of mental disorders’ in Britain (Times, April 24, 1915). Moreover, this crisis was replicated in other combatant nations. The French, German and Austro-Hungarian medical services were clearly unequipped to deal with the sheer number of psychologically damaged soldiers in their armies and debates about diagnosis, treatment and rehabilitation continued throughout the war and into the post-war years (Lerner 2003; Thomas 2009; Hofer, Prüll, and Eckart 2011). In Belgium, stories of soldiers suffering from war neuroses did not capture public opinion or attract the interest of politicians as it did in Britain and as a result, there are few popular or historical studies of Belgian shell shock. Benoît Amez and Bruno Benvindo briefly mention the subject but it is neglected in all of the recent works on European military-mental medicine (Amez 2003; Benvindo 2005). This might be in part due to the difficulty of obtaining sources. The Belgian military medical archives were lost when the military hospitals were closed down and the authorities decided to destroy archives which they deemed to be superfluous. Moreover, very few Belgian psychiatrists published their experiences, unlike those in France or Great Britain. (Huot and Voivenel 1918; Rivers, Lancet, XCVI, 531–533, 1918; Rivers, Sciences, April 18, 1919, 367–369; Yealland 1918; Brousseau 1920). However, there are several potential sources that can be utilised: these include the archives of the Belgian court-martial proceedings, the reports of the psychiatric experts who assessed some of the soldiers affected by nervous or mental troubles and the records of the medical registers of the civil psychiatric wards where a lot of returning soldiers were interned after the war. Considerable information can also be collected from personal military records.

The main point to glean from a recent historiography is that while some scholarship has focused on the acute hardships experienced by victims of shell shock – most notably from the brutality of the doctors, who ignored their suffering and who framed their responses to them in theories of cowardice and malingering – we now have more nuanced studies which, without denying the use of brutal methods, also emphasise the empathy and understanding felt by doctors (Le Naour 2011; Guillemain and Tison 2013). This is the approach we follow in the pages that follow, with the emphasis on applying a similarly nuanced reading of the treatment methods adopted by military psychiatrists in the Belgian and British armies.

Medical provisions on the front lines: the Belgian army

The Belgian Army, cut off from its rear base and exiled on the tiny piece of the country that was still free, quickly deployed its medical facilities within the immediate vicinity of the front. Little by little, as the Belgian army settled down along the Yser River, the military-medical services opened hospitals near the front and created a health network that was situated partly in Britain but mainly in France, Normandy, Brittany or the Côte d'Azur. In October 1914, after the retreat, the Belgian army hastily improvised health facilities at the port of Calais in northern France, establishing facilities in hospitals, monasteries, places of worship, schools and private homes. About 18,000 wounded Belgians found refuge and care there. Among them, nervous and psychiatric patients were taken care of at the St Pierre Boarding School.¹ Therefore, it was mainly in a foreign country, in temporary facilities (albeit under Belgian direction) that the health service supported mental and nervous cases. Arguably then, the Belgian soldiers, completely isolated from their loved ones, were suffering a double alienation, both mental and geographical.

The main military centre of neuropsychiatry was set up in November 1914 and was located at the small St Emile School in Calais. It was directed by Dr Leon Spaas (1880–1946), an alienist and a manager of a women’s asylum before the war (RMM File DO 2778). By the end of 1914, it was serving as a neuropsychiatric observation centre for military ‘delinquents’ who were being monitored for their psychiatric conditions, but by the end of 1916, it functioned more like a clinical neurology service. These centres evaluated combatants’ degrees of incapacitation, penal responsibility and aptitude for military service (Leroy 1919, 40–41). Spaas was also the head of the medical service for ‘neuropathic or insane officers’ who were being treated in various hospitals across the base of Calais (RMM File DO 2778). The small St Emile School was expanded in June 1916 with a second military neuropsychiatric centre, one that also dealt with examining soldiers who had been court-martialed. Those who had been temporarily declared unfit were also examined here by a Contre-Commission de Controle. Based in Le Havre military hospital in France, this second centre was run by the neuropsychiatrist Dr Michel-Joseph Van den Weghe (Mélis 1932, 226–229; Verhaeghen n.d., 10–35). These centres were the first step towards the recognition of the need for treatment centres for psychiatric casualties, although clearly military discipline was a central part of this system. Psychiatrists and neurologists had been recruited to the military-medical services since mobilisation and they were therefore in place to head these specialised institutions. The psychiatrists in these centres then faced a myriad of problems and challenges: the difficulty of establishing a diagnosis, whether predisposition played a part in the development of war neuroses, what kind of consideration they should give to soldiers and officers suffering from the harrowing symptoms.

At these centres, Belgian psychiatrists were much like their colleagues in other armies and favoured quick, accessible treatment, as close to the battlefield as possible, so as not to reinforce the symptoms and to maintain the soldier’s morale (Marchal 1921, 186). As with their counterparts across Europe, Belgian alienists considered both ‘soft’ and ‘harsh’ therapies and, in general, Belgian psychiatrists seemed rather more favourable to softer methods. These embraced traditional treatment for symptoms of neuroses, like rest, a good diet, relaxing baths, hypnoses (to help memories resurface), agricultural therapy and various workshops. Belgian psychiatrists also placed mentally wounded troops in ‘foster families’ or ‘host families’ to promote recovery in a safe and comfortable environment (Verhaeghen n.d., 10–35; Michel 1919). Yet other Belgian psychiatrists preferred more forceful methods, most notably the use of electrical therapy in order to stimulate wounded soldiers out of their apparent apathy. Dr René Marchal, a neurologist in charge of the electro-therapy service at the hospital of Beveren on the Yser River, encouraged a harsh therapy which consisted of persuasion along with electric treatment. From his point of view, treatment needed ‘to hurt a little in order to shake up the apathy of the patient’. If the patient was refractory, Dr Marchal believed that doctors should not hesitate to use ‘galvanic current therapy’ in a fairly intensive way, a method that had also been promoted by the French neurologist Dr Clovis Vincent (1879–1947) and which was widely known as ‘faradic treatment’ or ‘torpillage’ (Marchal 1921, 186). Yet, whether they favoured the soft or the harsh end of this spectrum, Belgian medics were all required to maintain the military framework and to promote military discipline. Treatments therefore consisted of physical exercise and military marches in order to remind patients that they were still soldiers (Marchal 1923, 513–522; Binneveld 1995, 140–156; Rousseau 1997, 13–27; Van Bergen 1998; Leese 2002, 64–84).

Unlike in the British Army, where, as we will see in due course, both the terms to describe war neuroses and the nature of the diagnosis were distinguished by class and rank, in the Belgian medical services, the various descriptor terms for war neuroses – nervous breakdown, neurasthenia, melancholy, chronic bronchitis, neurotic disorder, mental distress, pathological emotions, cachexia (‘wasting syndrome’) – as well as the symptoms (delusions, hallucinations of persecution, dementia, epileptic seizures, hysteria, maniacal behaviour and mental confusion) were all applied indiscriminately to the affected soldiers and officers.² In a similar vein, while it is harder to track down sources on officers, the evidence seen thus far also indicates that in Belgian cases, officers and soldiers were treated in the same facilities, once again, in a marked contrast to their British counterparts. This is made clear in a report written by the Belgian Senator Jules Dufrane-Friart (1848–1935) who had been appointed to inspect army hospitals. In his report on the asylum of St John Baptist in Zelzate (near Ghent, East-Flanders), he noted that:

two sick officers occupied beds in the infirmary, among the soldiers; that is to say that, contrary to the habits in our military hospitals, these officers do not have the benefit of a separate bedroom. (RMM, Moscow Archives 1079)

Another important contrast to make is that unlike the British, who for the most part were transferred for psychiatric treatment in their home country, Belgian soldiers suffering from war neuroses did not have the luxury of going home. It was almost impossible to send discharged Belgian soldiers back to civilian life, as this would have meant exile in foreign parts rather than a return to home and family. Being discharged from the army would only leave them impoverished and isolated in a country where they were unlikely to have either family or friends. As a result, soldiers had to be kept within the military community in order to recuperate and so men categorised as unfit for military service were sent to armament factories controlled by the Belgian army behind the battlefield or to auxiliary services in the rear lines (bakeries, laundries, transport services, etc.). Others were sent to work in hospitals but all of them remained on duty, under the control and discipline of the Belgian army. Unfortunately, those declared to be incurable had to leave the military treatment and recovery facilities and were sent to French asylums where they were cut off from their compatriots and all that was familiar to them such as eating habits, shared culture and sometimes even their language because the majority of Belgian soldiers were Flemish and did not speak or understand French.

Medical provisions on the front lines: the British army

How did British responses to shell shock in wartime compare to the Belgian experiences and practices? As stated earlier, in Britain, there was a much wider popular discussion of shell shock and it remains a politically potent issue today so it is possible to gauge how it was discussed both in the military community and in the wider public. Ordinary soldiers were referring to shell shock at the very beginning of the First World War but Charles Myers (1873–1946), consulting psychologist to the British Expeditionary Force, was the first formally to use the term when describing men who were displaying hysterical symptoms, namely functional disorders and memory loss, after being exposed to shell blasts (Myers 1915, 316–320). Shell shock was not a medically precise term, as Myers quickly recognized, and he later commented that ‘a shell, then, may play no part whatever in the causation of “shell shock”: excessive emotion, e.g. sudden horror or fear indeed any “psychical trauma” or “inadjustable experience” is sufficient’ (Myers 1940, 26). So shell shock was a misnomer, but it remained popular and was widely used by medics, the military, politicians and the general public. The deficiencies of the label were clear, but it made sense to combatants because it conveyed the drama of the modern, mechanised battlefield, while it also reflected the old soldier’s belief that a man could lose his nerve as a result of the ‘wind of a shell’ (‘Shell Explosions.’ Lancet, March 27, 1915a, 663; ‘Nervous Injury.’ Lancet, October 2, 1915c, 766).

Much of the medical and the historical literature focuses on the way in which shell-shocked men were categorized as suffering from either hysteria or neurasthenia. Unlike in Belgium, these medical diagnoses were closely tied to the British class system because ordinary soldiers were routinely described as hysterical and as displaying gross physical symptoms such as mutism or paralysis, whereas officers were seen as suffering from the more refined and socially acceptable neurasthenia. Lieutenant Colonel Frederick Mott (1853–1926), pathologist to the London County Council and one of the most prolific commentators on wartime shell shock, summarized his own experience of this pattern:

Among the large number of officers I have seen sent back on account of neurasthenia, a considerable number associated with shell shock, I have not observed a single case of functional paralysis or mutism. (Mott 1916, 448)

Yet, medical practice was often more nuanced than this simple binary opposition indicated. Myers, influenced by practices in the French army, persuaded the Director General of the Army Medical Services to establish forward treatment centres close to the fighting lines. This reduced the relapse rate and it is the basis for the current approach to psychological casualties in war zones (Myers 1940, 88). Moreover, while there were complaints about the lack of formal medical classification in 1915 when soldiers were ‘sent in batches to this or that hospital without discrimination’, a more effective system was in place by the following year. (Times, March 19, 1915) By 1916, mentally wounded men were being divided into three main groups:

1. Those whose symptoms were due to the bursting of high explosive shells or the secondary impact of shells, for example, those affected by noxious gases or men who had been buried alive.

2. Cases of general neurasthenia, described as exhaustion of the nervous system due to physical or nervous strain.

3. Cases of obvious mental breakdown including mental confusion, mania, melancholia, delusion and hallucinatory psychoses (Turner 1916).

Once back in the UK, these men were sent first to clearing hospitals and then to one of a range of specialist institutions, the most prominent being the Red Cross Military Hospital at Maghull, for borderline cases requiring close supervision; Springfield War Hospital for severe and protracted cases; and Napsbury War Hospital for cases of acute mental disorder. Neurological sections were also developed in general hospitals throughout the country and at all times, men and officers were treated separately. This state system was also overlaid by private and charitable institutions, the first of which was Lord Knutsford’s ‘Special Hospital’ for officers at Palace Green, Kensington, funded by public donations.

Official concern for shell-shocked men reflected and reinforced popular concerns. Widespread mental breakdown amongst the fighting forces was clearly unprecedented but civilians had long been accustomed to the problems of weak nerves or nervous collapse. This popular or lay interest in nervous disorders ensured that much public opinion was prepared to engage with, and to understand, the problems of mentally wounded soldiers during the war. From 1914, the Times regularly included articles which attempted to explain ‘battle shock’ and to rouse sympathy for ‘many a poor fellow [who] is little better than a wreck’. The somewhat populist Daily Mail produced more sensationalistic articles but nevertheless was keen to stress that the results of shell shock ‘are very serious’. Shell shock was clearly taken seriously by the general public, as advertisements for remedies, tonics and medicines attest. Both the Daily Mail and the Times promoted ‘phosferine’, generally alongside attestations from Medical Officers claiming its powers to cure ‘shell shock’ and ‘nerve fatigue’. Phosferine was a pre-war branded nerve tonic containing quinine, diluted sulphuric acid, diluted phosphoric acid, alcohol and water. It was sold alongside Iron Jelloids, Sanaphos Nerve Food, Dr Cassell’s tablets, the Turvey Treatment and Wincarnis Remedy, a hearty tonic made from red wine and beef. All of these remedies were explicitly directed at soldiers and soldiers’ families and it was possible to forward some remedies, such as the Turvey Treatment, directly to the trenches. The effectiveness of these products is highly dubious, but their widespread availability indicates a public acceptance of the validity of mental wounds and a belief that it is possible to treat them.

War neuroses, degeneracy and cowardice

While we know much less about the responses of the general public in Belgium to cases of war neuroses, we do know that Belgian psychiatrists displayed varied responses as to whether war neuroses denoted a ‘real’ pathological condition or whether they were ‘simulated’ and thus signified weakness of character. We also know that they were divided over the extent to which it was the horror of war that caused cases of shell shock, or whether factors of predestination and heredity played a key role. In congruence with their British counterparts, the majority of Belgian alienists recognised and understood the concept of war neuroses long before the outbreak of the war, and drew upon their pre-war experience of cases involving traumatic neuroses as the result of railway accidents. Attuned to the idea that a traumatic event could trigger symptoms of neuroses, they were therefore disposed to the view that conditions of war could cause nervous breakdowns. Spaas, for instance, was for the most part sympathetic to the soldiers suffering from neuroses. Through his medical reports, he comes across as an attentive and understanding man, who was acutely mindful of the circumstances through which his patients had lived before arriving at the centre. In a report of March 1916, Dr Spaas squarely placed the responsibility for mental and neurological disorders on the war itself:

War, with its external and internal emotions, especially the effects of heavy artillery projectiles, has contributed to a large extent – for many military men – to the outbreak of nervous and mental diseases or particularly upsurges in latent lesions. Heredity and personal history were sought after in each particular case. Among mental illnesses, the one that was found most frequently was mental confusion. The extension of the duration of the campaign has seen an ever growing increase in the number of soldiers suffering from mental disorders, neurasthenia, nervous breakdowns, etc.³

Spaas and his colleagues were not the only ones to be thoroughly aware of the pathological impact of the war on the mental and nervous equilibrium of the soldiers and officers concerned. As early as July 1915, the physician of the 1st Infantry Regiment of the 5th Army Corps made the same observation (RMM, Box 5465: file 185-14-7027). Furthermore, when the Archives Médicales Belges resumed publication in January 1917, an article entitled ‘After Two Years of War’ also emphasised the destructive effects of artillery on the human nervous system. The article suggested that because artillery was becoming more and more powerful and inflicting ‘unprecedented’ suffering to the nervous system, it was causing serious injury which, while not external (although it sometimes caused internal or brain bleeding), was internally causing damage from which originated psychical and neuro-psychical disorders (‘Après deux ans de guerre’, Archives médicales belges, January, 1917, 8–9).

Yet, other alienists were not so convinced and placed greater emphasis on the importance of predisposition and heredity. In August 1918, the regimental doctor, Evrard, made explicit reference to the work of a colleague who had diagnosed a recidivist deserter from the 18th Infantry Regiment:

Reports of physicians on injured persons, published since the war, often point out the persistence of some psychiatric disorders characterized by hyper emotional sensitivity, anxiety, anxious paroxysmal attacks, thus constituting real mental injury and morbid emotionalism.⁴

To these medics, the war often only revealed latent disorders.⁵ Similarly, Dr Henri Hoven, who had been an assistant physician at the Colonie d’aliénés de Lierneux before the war, was also convinced that predisposition explained the cases of traumatic psychoses (Leroy 1919, 40–61; Hoven 1920, 972–974). While he was aware that the great fatigue and intense emotional shocks of war induced a decline of the mental faculties, he emphasised the importance of predisposing factors in the development of mental and nervous disorders (Hoven 1917, 402). This approach reflected the widespread importance of the pre-war fear of degeneracy, a fear which was marked in all of the modern or modernising European nations, and one which had preoccupied the army before the outbreak of war. The Belgian military had introduced compulsory military service in two stages, first in 1909 for one son per family, then in 1913 for all men fit to carry arms. This had arguably generated a change in the institution’s purpose: the military now strove to become a forger of robust character, a training school for duty and bravery, an institution which cemented patriotism (Hoegaerts 2010). The army’s mandate was to educate and fashion soldiers, both physically and morally, and to produce citizens who were conscious of their duties (Ribaucourt 1911). Military doctors were therefore mobilized to fight against alcoholism and venereal diseases, which were thought to engender mental diseases and degeneracy (Nys 2003, 79–118). Yet even if psychiatrists did favour theories based on predisposition and did attribute psychiatric ailments to hereditary tendencies, the discourse on degeneracy was never applied specifically to soldiers suffering from war neuroses and psychiatrists did not label mentally wounded men as ‘degenerate’. The same can be said of the language of cowardice. In none of the psychiatrists’ reports, nor in any of the (admittedly few) articles that they penned on this subject, was the question of cowardice mentioned. Belgian psychiatrists acknowledged fear and were aware of bad examples, namely men who baulked at fear, but they did not label them as cowards.

Overall, the actions and reactions of Belgian psychiatrists were meant to be preventive and curative, rather than punitive. While the military high command expected all military members to do their duty without flinching and without fear, psychiatrists did not hesitate, throughout the war, to exempt those they deemed ‘unable’ from frontline duty. There are also several examples of psychiatrists who thoroughly deplored the absence of robust psychological selection processes at the recruitment stage, as they argued that men inherently unfit for service (because of weak minds or a negative predisposition) were nonetheless being enrolled (Wilmaers 1925, 228–229). Some were also angry at their colleagues for treating men with disdain on the grounds that they lacked willpower. Dr Modeste Molhant, a physician in the reserve battalion, had lived on the front with soldiers and recognised their value and heroism. He roundly castigated those who readily dismissed shell-shocked soldiers as simulators:

This was the time when the neurological centres at the rear of all the allied armies were crowded with what later would be called people with ‘reflex disorders of the nervous system’. They were considered recalcitrant hysterical persons or simulators. Repressive psychotherapy was predominant. Convinced – for having seen it with my own eyes – about the obstinate and heroic tenacity of our men, it never entered my mind that a jass (a soldier), wounded or injured on the battlefield, would voluntarily create or even carry on ‘preserving’ a mental trouble with the only purpose of escaping from duty. So I started to observe more closely, and soon I had the distinct and accurate conviction of their sincerity. (Molhant 1919)

Questions of degeneracy and of cowardice were more explicit, and possibly more potent, in the British army. As we have already seen, unlike in Belgium, ‘shell shock’ was a concept recognized by medics, the military, politicians and the general public. Yet a formal recognition of war neuroses – and the development of sophisticated diagnostic and treatment regimes – did not mean that shell shock was an unproblematic category or that all mentally wounded men were treated sympathetically. British medics were divided over the extent to which war neuroses were real or simulated, or whether the roots of military-mental breakdown lay in pathologies caused by war or a predisposition to mental weakness. In addition, attitudes towards shell shock were framed in moral and judgemental terms with the poor shell-shocked boy serving as a foil for the rascal or the coward who would not or could not do his duty: the shadow history of British shell shock is the history of the ‘shell-shy’.

I am always suspicious of the soldier who, when asked what he is suffering from, glibly informs you ‘shell shock, sir’. I am apt to believe he is ‘shell shy.’ (Mott 1917)

Just as the discourse of nineteenth and early twentieth century poverty made a clear distinction between the deserving and the undeserving poor, the discourse of wartime nerves distinguished between the shell-shocked and the shell shy. This categorization blurred the boundary between the medical and the moral and reflected elite fears about a feckless working class as well as a military culture in which there was a widespread suspicion of scrimshanking and malingering (Bourke 1996). These suspicions were so well established that when Captain James Dible, a young doctor recruited into the RAMC for the duration of the war, received his first posting, he was immediately informed that ‘most supposedly sick soldiers are “scrimshankers”’ (Dible’s Personal account 1914). The belief that shell-shocked men were routinely dismissed as shell-shy scrimshankers dominates retrospective political analyses of shell shock in Britain, and this sentiment finds clear expression in the most popular of the war poetry.

We sent him down at last, out of the way.

Unwounded; – stout lad, too, before that strafe.

Malingering? Stretcher-bearers winked, ‘Not half!’

Next day I heard the Doc's well-whiskied laugh:

‘That scum you sent last night soon died. Hooray!’

Wilfred Owen, ‘The Dead Beat’. (1917)

Wilfred Owen (1893–1918) suffered from shell shock himself and was treated at Craiglockhart, an officers’ hospital near Edinburgh. Yet in ‘The Dead-Beat’, the ordinary soldier who loses his nerve receives risible treatment from stretcher-bearers and the doctor, and his subsequent death is not mourned but scorned. This was not Owen’s experience, but it was clearly a genuine fear and men did their best to protect each other from the fate of ‘The Dead-Beat’ by trying to look after their own shell-shocked comrades. However, the soldiers’ reluctance to pass their mates on to the medical authorities was, in part, because they too had accepted the notion of the shell shy. Charles McMoran Wilson, later Baron Moran (1882–1977), made the following comments about a group of men who had attempted to protect a shell-shocked friend:

It was a long time before we doctors understood what had happened. But from the first the men made up their minds that their mate was not frightened, he was hurt. They could not bear to think that he might be bundled back to the base with men who were afraid of their own shadow, when a few minutes back he had been one of themselves. (Moran 1945, 22)

Officers shared this fear of being seen as shell shy by association, and similarly wanted to avoid the opprobrium of being part of ‘a shell shock hospital with a rabble of misshapen creatures from the towns’ (Moran 1945, 22). Dunn, commenting on Siegfried Sassoon’s now famous anti-war statement, noted ruefully that ‘Sassoon’s quixotic outburst has been quenched in a “shell-shock” retreat. He will be among degenerates, drinkers, malingerers, and common mental cases, as well as the overstrained’ (Dunn 1938, 372). Sassoon seemed to share this assessment of his fellow patients, writing that during his stay at Craiglockhart: ‘I think I began to feel a sense of humiliation […] it was as though there were a tacit understanding that we were all failures’ (Sassoon 1937, 523).

Soldiers and officers in the Belgian context experienced similar fears. On one level, of course, brothers-in-arms understood that experiencing fear and discouragement was normal in a war situation, and some were not afraid to admit to a temporary lapse in strength or to a bout of the kloppe (fear in trench slang). They displayed sympathy rather than reprobation towards those who lost courage temporarily as all men suffered from homesickness and the loss of everything familiar (Deauville 1923, 121–122; De Bruyne 2007, 68; RMM, 20/620, Lefèvre 28/5/1916). However, the key point here is that displays of ‘weakness’ had to be temporary. By contrast, lasting fear and discouragement were deemed shameful and there was considerable fear of being regarded as one of the ‘shakers’, who were despised (Smeyers 1933, 59, 66; RMM, Fund Leconte 64/41). This fear of being labelled a ‘shaker’ made it even more challenging for soldiers to seek medical help for the symptoms of war neuroses, most notably because of the lack of privacy during medical visits, where consultations would take place in the presence of other soldiers, and where private issues were exposed to all (RMM, ex-CDH, Fund 22, vol 3, 3/4/1918). In cases where soldiers were questioned by doctors (or state police in cases of criminal offence) in this way, some soldiers openly admitted to pure and simple fear, while others said that they could no longer bear to endure the paralyzing sound of the guns. Others found that they were incapable of naming their ailments or expressing themselves clearly, and complained of a multitude of problems, such as headaches, vertigo, heart dysrhythmia or permanent fatigue. ⁶ Officers were also afraid of being seen as ‘shakers’. The role of the officer is to set an example, to be courageous and level-headed, and to demonstrate his worth he has to make quick and accurate decisions under pressure. The reality was quite different, especially as the Belgian army suffered from a shortage of professional or career officers and were forced to call upon auxiliaries.

Moreover, back in Britain some clearly thought that the shell shy was consciously avoiding duty and there is evidence of doctors using hypnotism as a treatment to deter and detect malingerers (Mott 1917). Yet the majority of the military and medical elite were more discriminating, with Sir John Collie (1860–1935), a pre-war expert on malingering and feigned sickness, arguing that

Most men of his [i.e. soldier’s] class have little capacity for stating their disabilities clearly, and being naturally anxious to make sure that their complaints will receive adequate attention, they are apt to exaggerate them. Allowances should be made also for their incapacity to express themselves clearly owing to defective education and their diffidence before their superior officers. (Collie 1916, 525)

Collie’s analysis clearly reflected the rigid class boundaries of early twentieth-century Britain and it provided real insight into the complexities of the doctor–patient relationship in the First World War armies. Alongside the question of class – and inextricably bound up with it – was that of character or will. Moran was quite sure that men of sound character could temporarily lose the will to fight on account of emotional shock, yet such men would recover rapidly and only those of ‘bad stock’ would be permanently incapacitated. This belief in the intrinsically robust mental health of those from ‘good stock’ may well have afforded some officers a degree of laxity. Captain William Hewitt, in a letter home, confided to his friend, Miss Daubey, that ‘my general has gone on leave, as he is considered to be war-worn. I am feeling very slack today and have given the trenches a miss’ (Imperial War Museum, London, 96/37/1). Yet the essential and moral implications of Moran’s position – men of ‘good stock’ do not break down irreparably – may also have bolstered the disinclination of many officers to recognize their own nervous problems, and Major Adie, reporting to the post-war government commission of enquiry into shell shock, acknowledged that ‘many of us were suffering more or less from “shell-shock”, which made us not so efficient, and yet we stayed in the line’ as quoted in Southborough (1922). Manning similarly stressed the importance of staying in the line and refusing to give into fear: the shell shy were not men who broke down but men who refused to try (Manning 1929, 82).

The unofficial category of ‘shell shy’ was designed to differentiate between respectable and non-respectable breakdown, and so to accord those genuinely nerve-shattered men an element of dignity. Yet, the distinction did not operate in such a straightforward manner. In practice, an hysterical man had to be removed from the trenches whether he was deemed to be shell-shocked or shell shy because leaving him in place was both disruptive and dangerous. Furthermore, this distinction between ‘genuine’ and ‘non-genuine’ shell shock ensured that mentally broken men were vulnerable to accusations of cowardice, weak will and degeneracy. The essentially moral – as opposed to scientific – nature of this categorization ensured that there was a consistent level of doubt and suspicion surrounding men with nervous complaints. Edwin Blomfield, a New Zealander who volunteered to fight in the British army, was hospitalized with shell shock in 1916 but later reflections on his war experiences provoked this somewhat ambiguous response:

The numbers will never be known but the fact remains that there are still numbers of poor men, who might almost say that they had been wounded by their own folk. The fact also remains that there must be a good few no doubt prosperous ex-soldiers who can chuckle with how they got out of the army with shell shock. (Blomfield NAM 2006-11-38)

It was not simply the military and medical elites who dismissed shell-shocked men as fraudulent scrimshankers. Fighting men – both officers and those from the other ranks – had internalized the concept of the shell shy and used it to police their own and the behaviour of others.

While we have seen from the Belgian case that the language of degeneracy – and implicitly madness – was not linked to shell shock by psychiatrists, this was not the case in Britain. While those perceived as shell shy – men who were overly fearful or consciously malingering – were derided and sometimes punished, the situation was in many ways worse for those perceived as mad.

Private Albert Osbaldeston, of the 6th Cheshire Territorials, writes home to Marple saying he is at Boulogne guarding British soldiers who have gone mad from the noise of the guns on the battlefields. (Labour Leader, June 10, 1915)

The Labour Leader printed Osbaldeston’s comments to elicit sympathy for the soldiers and to condemn the British government for becoming involved in such an inhuman war but accusations of lunacy or madness were generally highly pejorative and provoked deep shame. It was a longstanding belief that insanity was a hereditary complaint that signalled degeneracy and throughout the nineteenth century, respectable families often went out of their way to conceal mental illness so as to protect their family dignity. The extent of the prejudice was such that the British government was determined to protect serving soldiers from the stigma of lunacy and in July 1915, the War Office announced that the ‘unfortunate men’ suffering from shell shock would not be treated like ‘ordinary lunatics’ (‘Treatment.’ Lancet, July 31, 1915b). Those with financial resources were able to access private doctors and nursing homes, but ‘ordinary lunatics’ had to be certified as insane and incarcerated in a local asylum before receiving any medical treatment. There was deep popular and political hostility to the certification of serving soldiers during wartime, in part because of the stigma associated with lunacy, in part because many people associated the local pauper asylum with the detested workhouse: admittance to the local asylum implied both madness and penury. In addition, the material conditions inside asylums worsened as the demands of the war meant that there were fewer doctors and fewer orderlies, and asylums struggled to provide care in the face of the rising cost of drugs and surgical dressings (Lomax 1921, 18). As a result, the government was committed to treatment without certification for serving soldiers and to ensuring that treatment ‘will be afforded in nursing homes or other institutions which are not associated with the administrative care of lunacy’ (Times, April 24, 1915).

Despite these formal commitments, shell-shocked men were continually described as mad and treated accordingly. Sassoon referred to Craiglockhart – one of the most prestigious and progressive of shell shock treatment centres – as ‘Dottyville’, a clearly derogatory reference to the insane. Similarly, in a casualty clearing station on the western front, Henry Waynard Kaye, a temporary captain in the Royal Army Medical Corps (RAMC), consistently referred to ‘mental cases’ and men who were ‘dotty’ (Kaye 1916). Ward Muir, a thoughtful and considerate orderly throughout the war, was dismissive of the ‘sham lunatics’ he sometimes encountered and many doctors remained firmly of the belief that shell-shocked men were simply the ‘neurotic element’ that should not have been allowed into the army in the first place (Muir 1917, 47), as quoted in Southborough (1922).

Military justice and war neuroses

So, if the military-medical professionals, the soldiers, officers and (British) public displayed ambiguities as to whether war neuroses were triggered by war, predisposition, ‘bad’ stock, scrimshanking or madness, what was the response from those who administered military justice? In Belgium, the attitude of military authorities varied. Some were sympathetic and tried to spare the afflicted soldiers, others were much harsher and strove to keep what they saw as deplorable examples away from the regiment. Also, the attitudes of those meting out military justice evolved during the war. In the first few months of the war (August–October 1914), the army needed to impose discipline on inexperienced men and justice was therefore often hard. The military authorities clearly did execute men who were suffering from psychological complaints, often poor frightened men, unaware of the rigours of military discipline. It was not possible for men to appeal their verdicts until 1916, but later, as the war progressed, Belgian military justice became more lenient and if men with war neuroses incurred prison sentences, they were often able to leave prison relatively quickly and return to the front (Horvat 2009). During the war, there were no scandals about shell shock treatment, but there were clear tensions between military authorities and what were then known as alienists on how to manage cases of shell shock: the military authorities accused doctors of too rapidly discharging soldiers on medical grounds, and alienists often did not hesitate to exempt the most fragile patients from combat duty and to place them in rear-line services (for example, ammunition factories). However, these conflicts were not severe and the military authorities did not condemn men out of hand for suffering from war neuroses.

In Britain, for many men, the possibility that shell shock could be interpreted as simple ‘shell shy’ was a real threat. A sense of honour, whether based on male pride, family responsibility or group loyalty, was combined with a genuine fear of the mental health system and ensured that many were reluctant to acknowledge nervous complaints, despite some concerns that shell shock had given fear ‘a respectable name’ (Moran 1945, 186). In addition, there was always the possibility that men seen as shell shy could be categorized as cowards or deserters, a clear military offence which was punishable by execution. John Whitehouse (1873–1955), the Liberal MP for mid-Lanarkshire, was so concerned that shell-shocked men had been executed for cowardice that he requested the War Office to issue a regulation under which ‘it would be impossible for any soldier to be sentenced to death who has previously been invalided home suffering from shell-shock.’ (Hansard, February 19, 1918). Several months later, the Independent Labour Party went a step further and requested that the death penalty in the army should be abolished, an apparently radical request that was eventually implemented in 1930 (Labour Leader, April 4, 1918).

For British servicemen, there were two primary concerns about military executions during the war: courts martial may have been hastily or improperly conducted and the military justice system may well have been skewed to favour officers. Looking back at his First World War career, Moran described a colleague’s role in a military court martial:

He [the medical officer] stopped presently outside a casualty clearing station.

‘There’s a fellow here who ran away from the trenches’, he said, ‘they are going to shoot him and they want me to say if he is responsible. I shan’t be long’, and with that he disappeared among the huts.

It was very peaceful in the sunshine, but my mind was no longer at rest. These rough decisions worried me because they were not decisions at all but only guesses with a bullet behind one of them. Was that poor devil crouching in that hut, who was to lose his life because he had sought to save it really responsible? Could any man who knew little of war and less of him decide by looking at him? (Moran 1945, 189–191)

One also has to consider the extent to which medical officers were properly qualified to comment on psychological complaints. Dr Alastair Robinson Grant, in peacetime the House Surgeon at Aberdeen Royal Infirmary, was called to give evidence at a court martial in 1918 and noted with some surprise: ‘I see by the document I am described as a “specialist in mental disease”’ (NAM 2000-09-62). Military authorities were largely confident about the expertise of medical witnesses but were more concerned about different treatment being meted out to officers and to men. In September 1916, Medical officers on the western front received the following letter from the Headquarters of the Reserve Army:

It has come to notice that there have been a certain number of cases of officers who have failed to do their duty in the face of the enemy, and in reporting these cases, Officers Commanding Units have asked or recommended that the officers may be sent home on medical grounds as suffering from nervous breakdown […] Under such conditions any failure to control their nerves amounts to cowardice, pure and simple. […] In some cases officers have been sent home on medical ground who, if they had been privates, would most probably have suffered the death penalty. Such a state of things cannot be allowed to continue, and is most detrimental to discipline and to the standards of leadership and honour among officers. (IWM 6988 97/37/1)

Here, the concern was not that shell-shocked men had been improperly executed but that shell-shy officers were being treated with undue leniency.

After the war

After the war, the return of soldiers to their home countries posed great challenges for all combatant nations. In the case of Belgium, the post-war population had suffered a wide diversity of war experiences. Some returned home after four years’ of fighting, many returned from exile and those who had stayed in Belgium had endured four years of occupation: there was no homogenous war experience. Many found that they could not share their experiences and could not understand one another’s suffering. While ‘officially’, the interwar commemorations strove to convey a sense of shared wartime experiences of soldiers and civilians, in the privacy of the familial reunion, it was often a different story. So for instance, a woman who had suffered four years of starvation and extreme poverty may not have always been sympathetic to a husband traumatized by war.

As the sick and wounded soldiers were repatriated to hospitals in Belgium, those with mental and nervous complaints were grouped in the new military neuropsychiatric centre that had moved to the civil psychiatric ward in Zelzate, in the north of Ghent, in March 1919. This military centre was hosted by the congregation of the Brothers of Charity who headed the majority of psychiatric wards in Belgium. Between October and December 1919, the soldiers were demobilised and sent to psychiatric institutions all over Belgium to live among the other patients who included criminals, those in poverty and those deemed incurable (Warner 1972–1973, 19–20; Tallon 1984, 43–45). The ex-servicemen were thus not housed in special military psychiatric wards and were not allocated specific treatment. However, both at international conferences and in press articles, some did argue the case for gathering all soldiers suffering from mental and nervous illnesses in one single institution so that ex-servicemen could receive specific treatments and be among their comrades. This never occurred though, as the aim of the treatment was the rehabilitation and reintegration of patients into their families and into society, as soon as possible (Invalide belge, May 1, 1923; February 1, 1928; February 2, 1933; Borgers-Sergent 1937).

As time went on, neuroses became a subject matter for war pension committees and lawyers in Belgium. Yet strikingly, hardly any mention was made, not even in specialised publications nor in registers of psychiatric wards, of the war and its consequences on the mental state of the Belgian population. It was as if the war had only been a parenthesis with specific circumstances, and that once the war and its devastations were over, the troubles would probably vanish as well. Overall, Belgian psychiatrists did not believe that the war had created new conditions. They thought traumatic neuroses – already present in peacetime – only reappeared in wartime, and while cases certainly intensified, that they were basically identical to previous cases of neuroses in their symptoms. They therefore did not see the need to innovate new ways of managing these conditions.

In Britain, the post-war history of shell shock is highly paradoxical. On one level, politicians and members of the public were gravely concerned that the association between shell shock and madness continued. In 1921, Dr Christopher Addison (1869–1951), the Minister for Health, insisted that ‘It was vital that this class of men should escape the stigma and disabilities of being classed as lunatics’ (Addison 1921, 136). His words so closely echo the War Office commitment of 1915 that it is tempting to conclude that there had been little progress in this area. The Ex-Services’ Welfare Society (ESWS), the primary charity charged with the care of mentally-wounded veterans and their families, argued throughout the 1920s that the government was holding veterans in ‘pauper asylums’ and that they all deserved better, non-institutional and properly therapeutic care. These are ‘the loneliest men in the world’, argued Sir Frederick Milner, the ESWS President and long-time champion of mentally wounded soldiers (ESWS Annual Report 1930). For its part, the Ministry of Pensions consistently denied these claims and insisted that the government could be trusted to treat mentally wounded veterans properly.

Yet, while the ESWS and the government argued over the morality and the practicalities of treating veterans in asylums, there were popular fears of a post-war crime wave and widespread concerns that shell shock was being used as ‘an excuse for criminal acts’ (Times, October 15, 1920). While there had been genuine popular outrage at the thought of young men being unjustly executed for shell shock, age-old fears of lunacy remained intact and there was little popular sympathy for ex-soldiers – grown men – who could not act rationally. As a result, there were lurid tales detailing the crimes of shell-shocked men: one robbed a widow then, like a highwayman, held up a car on a lonely road; one notorious ‘street lounger’ used shell shock as an ‘excuse’ for his perjury; another shell shock sufferer allegedly attacked a new bride in Brixton (Daily Mail, February 24, 1920; October 8, 1921; September 28, 1922). In these stories, the shell-shocked man is no longer ‘unfortunate’ and he is certainly not a ‘poor fellow’. On the contrary, these shell-shocked men were a danger in the public space and also a danger in private: they could not conduct themselves properly in the streets or in the law courts and they were brutal towards women. These prejudices surrounding mental breakdown and public behaviour endured. In 1944, the ESWS Annual report described psychologically wounded men as living ‘in the shadow of destitution and prone to fall foul of the law’. A recent research has indicated that combat troops are still reluctant to admit to psychological complaints because of the stigma attached to them and there is much evidence of the ordinary soldier’s disdain for both psychologists and psychology (Aguirre et al. 2014).

Conclusion

This brief study of Belgian and British shell shock indicates the extent to which the condition raised similar issues amongst the military-medical elites in both countries: concerns about simulation, degeneracy, cowardice, discipline and madness. The questions were of greater import in Britain, but this is a matter of degree rather than of substance. The key difference is of course that shell shock became, and remained, so politically and culturally important in Britain, whereas the topic has held no political or popular significance in Belgium. This is not because of a lack of information in Belgium, as the current study attests, but is to do with the way that war neuroses were conceptualised and framed during the war and in the immediate post-war years. Britain and Belgium were industrial nations before the war and so doctors had grown accustomed to the concept of traumatic neuroses as a response to industrial accident. Responses to wartime shell shock were largely based on responses to pre-war industrial shock, but in Britain, the question of class seems far more significant. Notions of class affected both diagnostic and treatment regimes in the British army but did not have the same impact in the Belgian army, despite an obvious class structure within the Belgian society. This is possibly due to the fact that Belgium is suffering from the effects of invasion and occupation; the British state remained intact throughout the war, so underlying social and political structures remained similarly intact.

After the war, the Belgian shell-shocked patient simply became part of the wider neurotic or mentally unstable population and so he was swiftly forgotten. In Britain, by contrast, the wartime determination to separate the mentally wounded man from the ‘ordinary lunatic’ ensured that he became a suitable cypher for all that was seen as shocking, mad and traumatic about the war and the post-war world. At an official and a popular level, there was always tremendous sympathy for shell-shocked men, but there was also widespread condemnation of cowards and a longstanding prejudice towards the mentally ill. All of these issues have remained relevant throughout the century. First, there is still a tendency to ‘forget’ mentally wounded veterans, especially those with long-term complaints; this is even the case in Britain where the shell shock story has remained important in the popular discourse of the First World War. Second, although the diagnosis of post-traumatic stress disorder (PTSD) has officially exonerated mentally wounded soldiers by acknowledging that the stresses of war, rather than the weaknesses of men, are responsible for wartime mental breakdown, the stigma of it remains (Reid 2011). The histories of the British and Belgian shell shock sufferers indicate that military-mental breakdown can be expressed and managed in a variety of different ways, but what has remained constant is a widespread inability to accept and understand it fully.

Notes on contributors

Fiona Reid is a historian and an associate head of Humanities and Social Sciences at the University of South Wales. She has written extensively on the history of shell shock and PTSD and her publications include Broken Men: Shell Shock, Treatment and Recovery in Britain 1914–30 (Hambeldon Continuum: 2010) and Outcast Europe, 1936–1948: Refugee Experiences in an Era of Total War (Hambledon Continuum, 2011) (co-authored with Sharif Gemie). She is currently working on a medical history of the First World War.

Christine Van Everbroeck has PhD in History from the Université libre in Brussels. Her research focuses on Flemish nationalism during the inter-war period and on psychiatric pathologies in the Belgian armed forces in 1914–1918. Recruited by the Royal Museum of the Armed Forces and of Military History (Brussels) in order to set up and head the educational service, she has become the museum's joint director ad interim since April 1, 2014.

Notes

1. Royal Military Museum (RMM): superior commander of the base at Calais, file 6, Report on the organisation of sanitary services at Calais. 9/3/1916.

2. RMM: various military files on soldiers and (non) commissioned officers; Medical Service Archives: five hospital registers (King Albert Hospital nbr. 1, Bonsecours, Mortain, St Méan, unnamed register); medical registers of the psychiatric institution at Grimbergen 1919–1939; State Archives: archives of the Conseils de guerre de l’armée en campagne 1914–1918.

3. RMM: superior commander of the base at Calais (CSBC), file 6, Report on the organisation of sanitary services at Calais. Report by Dr Spaas, 1/3/1916.

4. State archives: archives of the Conseils de guerre de l'armée en campagne 1914–1918, 4 DA, nbr. 6487 (box 338), August 18: medical report by regimental surgeon Evrard.

5. State archives: archives of the Conseils de guerre de l’armée en campagne 1914–1918: Numerous expert reports drawn up by Spaas.

6. State archives: archives of the Conseils de guerre de l'armée en campagne 1914–1918, 5DA, nbr. 2991 (box 403), Report by Spaas, 20/12/1916.