While a highly conservative medical opinion held sway in Germany, in Britain the whole question of shell shock became a matter for heated public discussion. As early as 1915 members of Parliament, fearful that shell-shock victims returning from the front would be consigned to lunatic asylums, moved to prevent shell-shock cases from being confused with ordinary cases of insanity. Parliament’s concerns were real enough: one doctor estimated that more than 20 percent of all the shellshock victims at one of the army’s main hospitals were committed to asylums. Moreover, quite without regard to what the doctors or the army (whose medical service had forbidden use of shell shock as a diagnosis in 1917) thought, the British public readily accepted shell shock as a war-related nervous disorder that could afflict anyone at all. During the ten years immediately following the war, pension authorities examined 114,000 shellshocked veterans. On the eve of World War II, the British Ministry of Pensions was still paying two million pounds a year to shell-shocked pensioners from the 1914-18 war.


The veterans of the Great War phrased their complaints in much the same way as Vietnam veterans more than half a century later. Front-line troops often resented all but their own kind, and especially their countrymen on the home front. When soldiers returned home to find scant appreciation or understanding of their wartime trials, their resentment could easily deepen into bitterness and outright alienation. A German veteran’s lament, written in 1925, could pass for some veteran’s complaint today: “The . . . army returned home . . . after doing its duty and was shamefully received. There were no laurel wreaths; hatefilled words were hurled at the soldiers. Military decorations were torn from the soldiers’ . . . uniforms. . . .” Weimar Germany struck no medals commemorating war service as in times past. Not until six years after the armistice was there an official memorial service for the war dead.

But these were public manifestations of much more private trials. Sassoon’s Craiglockhart psychiatrist, Rivers, believed that society did no good at all by asking, “What’s it really like?” and then insisting that soldiers “banish all thoughts of war from their minds.” Torn between a conflicting desire to retrieve the past and to avoid its pain, the soldiers found their inchoate memories had become an essential part of their identities. Rivers thought that the best course of action lay somewhere between the outright repression of one’s war experiences and an unhealthy fixation upon the past.

This was more easily said than done. Veterans who recorded their postwar experiences often mentioned nightmares, vivid battle dreams that persisted for years, sometimes for decades. Certain events unexpectedly called forth memories of the war. Armistice Day celebrations meant reliving a murderous chaos in Delville Wood for one veteran—“hand-to-hand fighting with knives and bayonets, cursing and brutality on both sides, mud and stench, dysentery and unattended wounds. . . .” Unable to come to terms with a peaceful, indifferent society, another veteran escaped to the country: “I realized that this was what I needed. Silence. Isolation. Now that I could let go, I broke down, avoided strangers, cried easily and had terrible nightmares.”

Steering a course between repression and fixation proved difficult for the armies as well, for when the Second World War began, much of what had been discovered in the Great War about the stresses of combat had been repressed all too well. Valuable insights into the management of combat stress, the diagnosis and treatment of soldiers suffering from nervous disorders, and the vast professional organization required to tend such cases, not to mention a substantial body of medical and military knowledge—all were seemingly forgotten by the outbreak of World War II. The United States had suffered only a glancing blow in the Great War when compared with other nations, yet in 1942 some 58 percent of all the patients in VA hospitals were World War I shell-shock cases, now twenty-four years older. Ignoring experience, knowledge, and memory, the U.S. Army followed a now familiar cycle of mystification, suspicion, diagnostic confusion, a competition between military and medical authorities for the power to determine how such cases fitted within the business of war, a grudging reconciliation with the unavoidable facts of combat fatigue, and, by war’s end, a pragmatic approach to neuropsychiatric battle casualties.

In the period between the two world wars, medical authorities in the American army, confident that “proper psychiatric screening of the mentally unfit at induction was the basic solution for eliminating the psychiatric disorders of military service,” managed to institute psychiatric exams of soldiers when they enlisted. Of 5.2 million American men called to the recruiting stations after Pearl Harbor, 1.6 million were prevented from enlisting because of various “mental deficiencies.” But the widespread faith in psychiatric screening that one American army psychiatrist observed could only be “equated with the use of magic” was again tested by combat. In the American army alone the enlistee rejection rate for this war was more than seven and a half times that of World War I, yet before the war was over, the psychiatric discharge rate soared to 250 percent of that earlier conflict.