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.