PLATTSBURGH — Several months into World War I, newspapers reported “Strange New Diseases Caused by Battle.” French army surgeons described “a peculiar mental condition,” called “hypnosis of battle.” They said this “hypnotic state” lasted at least a couple of days, during which the “victim is incapable of walking unless pushed or led by the hand,” and “cannot be awakened, but is not in a state of coma.”
There was considerable newspaper coverage during 1915 of this incapacitating phenomenon. Typical symptoms were physical, such as fatigue, tremor, confusion, loss of balance, headache, nightmares, impaired sight and hearing, loss of taste and smell, mutism and speech disorders, loss of memory and paralysis of various physical functions. What was so strange was that the condition occurred in men who had no obvious physical wound. Consequently, the British military viewed these men as cowards and malingerers, even if they had previously behaved heroically.
A review of articles in the popular press during the war reveals the puzzled search for the cause of what seemed to be a quite widespread experience. They described “Men Made Deaf, Dumb, Blind and Insane by Shell-Shock.”
The term “shell shock” was coined by British psychologist and physician Charles Myers early in the war, when it was thought that the symptoms must be caused by being close to an exploding shell, which might include being thrown in the air and/or buried in the debris. Later, Dr. Myers and others concluded that it was a misnomer and stopped using it, but its popularity in the media continued.
As no cause could be identified, the commanders’ suspicions increased. One prominent doctor suggested that “all the symptoms are easy to counterfeit,” and the men have learned they can be pulled from the front lines if they have “shell shock.” Finding no “organic” injury to the brain, shell shock was recast as a “nervous disorder” or “war neuroses.”
After the United States entered the war in April 1917, understanding this condition took on new urgency. Right away, an official visited Canada to learn the experience and methods employed in the Canadian Army. This led him to expect that about 12% of all disabled returning from overseas “would be classified as nervous or mental disease [and] that one-half of these would be war neuroses . . . .”
American military neurologists studied the problems at French and British hospitals, and extensive planning began for treatment of American soldiers. Those suffering from shell shock would be hospitalized and undergo “physical reconstruction.” This was defined as “complete . . . treatment, carried to the point where maximum functional restoration, mental, and physical, has been secured.” Much of the physical training aspect of reconstruction, including exercise, “play and recreative games as a method of treatment,” was developed and conducted by the YMCA.
Plattsburg Barracks Hospital was designated to “function in physical reconstruction” by the Surgeon General on July 31, 1918, along with 14 other Army General Hospitals. Civilian women were employed as “reconstruction aids” in occupational therapy and physiotherapy.
During the late summer and early fall of 1918, the post hospital at Plattsburg Barracks was altered, expanded and renovated, then designated as General Hospital No. 30 on Sept. 21, 1918, with maximum capacity of 1,200 beds. The Army prepared for a large number of shell shock patients, and they began arriving immediately.
“Reconstruction treatment” included hydro-therapy, “psychopathic treatments,” electric shock, and vocational training — such as classes in stenography, typing, basket-making, and carpentry. Fortunately, there was an official photographer for General Hospital No. 30, who printed 103 photos as postcards showing the personnel, buildings, scenes in mess halls and hospital wards. These are in the collection at CCHA.
Then, in November and December 1918, the declaration “Shell Shock Cured” appeared in newspapers across the country. The Surgeon General testified before a Senate Committee that 2,000 of 2,300 cases of shell shock were promptly cured when the Nov. 11 Armistice was signed.
After May 1919, no more “neuropsychiatric” cases were referred to Plattsburg, and U.S. Army General Hospital No. 30 closed on Oct. 10, 1919. The hospital was in operation for little more than a year. Most of the other planned “shell shock” hospitals never even opened.
The confusion about what they were treating seemed to continue after the war ended. Debate continued over whether shell shock was a “new nervous disease” or “emotional disorders” with “abnormal reactions to ordinary stimuli.”
In January 1920, the U.S. officially stopped using the term “ shell shock” and adopted “commotioned,” for those “nervously or mentally injured” in civilian life as well as in the military.
At a 1922 conference in Washington D.C., a neuropsychiatrist said that “shell shock” cases were a “group of acute psychoses developed under the severest of stresses of service conditions and that when these stresses were relieved, and particularly after the signing of the Armistice, these patients got well and to all intents and purposes this group as a whole ceased to exist . . . .“
At the same conference, however, a general commented that the “mental cases from the war were increasing. He asserted that in 90% of the mental cases there is “some physical cause at the bottom of the mental trouble.”
This tour through WWI era information about shell shock reveals threads of limited understanding, confusion, and searching for effective treatment. It also shows the governments’ perception that many men were faking their symptoms, or were simply weak cowards. Doctors saw their responsibility as rooting out the malingerers by trying to determine whether there was actual “organic injury” to the brain.
What is missing is a true appreciation for the reality of trench warfare, a reality that was kept hidden from the families and public during the war by extensive censorship.
We now think of “shell shock” as PTSD, although there appear to be clear differences. We no longer believe there is always a physical source, and we know that mental, emotional and psychic injuries are real, long-lasting and difficult to treat.
A longer version of this article by Clute was published online in the AMEDD Historian No. 26, Summer 2019 —Army Medical Department Center of History and Heritage, Fort Sam Houston, Texas. Sources of the quotes can be obtained from the Clinton County Historical Association.