In 1942, 58 percent of all the patients in VA hospitals were World War I shell-shock cases, yet all the knowledge that had been gained about them had been virtually forgotten.

One of the most public cases of shell shock was that of the poet Siegfried Sassoon. As a young officer in the Royal Welsh Fusiliers from 1915 on, Sassoon was a model soldier, well liked by his men and so avid a trench raider that he was nicknamed Mad Jack. Having already won the Military Cross, Sassoon was convalescing from his latest wound when in the summer of 1917 he wrote “A Soldier’s Declaration,” which protested the conduct of the war and announced that he would no longer contribute to the massacre. And just to make sure he was heard, he sent copies of the protest to his commanding officer and the House of Commons. “A Soldier’s Declaration” was published in the Times of London at the end of July, but by then Sassoon had already met an army medical board and been packed off as a shellshock case to the Craiglockhart War Hospital near Edinburgh.

At Craiglockhart Sassoon was fortunate to be entrusted to Dr. W. H. R. Rivers, a young Freudian whose realistic understanding of shell shock was founded upon an unromantic view of the battlefield rather than on rarefied theories. Rivers soon decided that the young officer only needed rest, but he could have fallen into the clutches of other physicians who advocated a socalled disciplinary treatment for shell shock that included painful electrical shocks, isolation, and unsympathetic handling, all intended to encourage the reappearance of the soldier’s “normal” self.

Sassoon was familiar with such rough-and-ready treatment, part of which encouraged shell-shocked soldiers to repress their memories of the trenches, shake themselves out of their depression, and carry on manfully. In “Repression of War Experience,” a poem published after his experience at Craiglockhart, Sassoon made savage fun of “disciplinary treatment” and the outmoded social views that inspired it:

And it’s been proved that soldiers don’t go mad Unless they lose control of ugly thoughts That drive them out to jabber among the trees.

Eventually discharged by Rivers, Sassoon returned to the front, his views on the war unchanged. There he fought until July 1918, when he was wounded again and invalided home for good. But to say that Sassoon’s war was over would be a mistake. In the form of restlessness, irritability, guilt over surviving, and, above all, battle dreams, Sassoon’s war remained alive for years afterward. His memoirs recalled his time at Craiglockhart and his fellow patients there: “Shell shock. How many a brief bombardment had its long-delayed after-effect in the minds of these survivors, many of whom had looked at their companions and laughed while inferno did its best to destroy them. Not then was their evil hour; but now; now, in the sweating suffocation of nightmare, in paralysis of limbs, in the stammering of dislocated speech. . . .”

Sassoon was right. The “long-delayed after-effect” of the war was to be an essential part of European postwar life. The war had blasted a great demographic hole in all the combatant nations. In Germany, where thirty-one per thousand of that nation’s population were killed during the war, another 10 percent of the population—disabled veterans, widows, and dependent families—six million in all, were victimized by it. The French lost even more: thirty-four killed for every thousand citizens. Great Britain’s war dead was less—sixteen per thousand of population—but that nation confronted the same problems of human reconstruction as the other Europeans. Ten years afterward more than two million British veterans were receiving some sort of government assistance. Sixtyfive thousand of these were still in mental hospitals, suffering from what was then classified as “chronic neurasthenia.”

The fortunes of shell-shocked veterans depended more upon social views than medical advances. Even though some German psychiatrists advanced highly sophisticated explanations for war-related nervous disorders, German society at large resisted the idea that war alone caused nervous disability. Less than 2 percent of all German casualties treated during the war had been diagnosed as nervous disorders. Either a shell-shocked veteran was insane or his suffering had to do with heredity. That being so, the war bore no responsibility for his mental state. True to this form, six years after the war’s end only 5,410 German veterans were drawing pensions on diagnoses of insanity as a result of their service.