Shell shock was one of the most significant and controversial medical problems experienced by servicemen during the First World War. Doctors and military authorities struggled to understand its causes, symptoms and treatment, while large numbers of soldiers were affected by what was variously described as shell shock, war neuroses, neurasthenia and hysteria.
Shell Shock in the First World War
Shell shock was the term that came to be used during the First World War for a wide range of psychological and physical symptoms experienced by servicemen. These could include tremors, paralysis, loss of speech or hearing, nightmares, anxiety, exhaustion and an inability to continue military service.
The condition was controversial because doctors did not agree about its causes. Some believed that the symptoms resulted from the physical effects of explosions on the nervous system, while others considered them consequences of fear, emotional shock, exhaustion or prolonged exposure to the conditions of warfare.
The Origins of Shell Shock
The term “shell shock” appeared in medical writing during the First World War. In 1915, British Army doctor Charles Samuel Myers published A Contribution to the Study of Shell Shock in The Lancet, describing cases he had encountered among soldiers.
Myers initially considered whether the symptoms could result from physical damage caused by explosions. However, it became increasingly clear that similar symptoms could occur in soldiers who had not been physically close to an exploding shell.
The developing medical debate demonstrated how difficult it was to understand psychological and neurological illness during a period when contemporary medical explanations were still developing.
Symptoms of Shell Shock
The symptoms associated with shell shock varied considerably. Some soldiers experienced visible physical symptoms, including trembling, paralysis, impaired movement, blindness or loss of speech. Others experienced nightmares, anxiety, confusion, exhaustion or an inability to cope with the demands of military service.
The wide range of symptoms made the condition difficult to classify. Different doctors and institutions used different terminology, and the meaning of “shell shock” changed during the course of the war.
Shell Shock and the Experience of Warfare
The conditions of industrial warfare created circumstances in which soldiers could experience prolonged and extreme physical and psychological stress. Artillery bombardment, trench warfare, casualties, sleep deprivation and the constant threat of death all formed part of military service on the Western Front.
Shell shock therefore became an important part of the medical history of the conflict. It challenged the assumption that a soldier’s wounds were necessarily visible and demonstrated that military service could produce serious psychological and neurological symptoms even when there was no obvious physical injury.
From Shell Shock to War Neuroses
The term “shell shock” became increasingly problematic as the war continued. It suggested that the symptoms were caused by the physical effects of exploding shells, but doctors encountered many soldiers with similar symptoms who had not been close to an explosion.
During 1917 the British Army therefore restricted and then effectively removed “shell shock” from official medical terminology. In June 1917, instructions from General Headquarters restricted its use in medical documents, and cases were increasingly recorded using terms such as “war neuroses” or “Not Yet Diagnosed Nervous” (NYDN) while awaiting specialist assessment.
The change reflected an important shift in medical understanding. Shell shock was no longer treated as a single condition caused simply by the physical effects of artillery explosions. Doctors increasingly recognised a range of neurological and psychological conditions arising from the pressures of military service.
Treatment of War Neuroses
Treatment varied considerably. Some men were given rest and nursing care, while others received forms of psychotherapy, hypnosis, suggestion, occupational therapy or physical treatment.
Medical authorities also increasingly considered where treatment should take place and how quickly soldiers should be returned to their units. Some men were treated close to the front and returned to duty after a period of rest, while more severe or persistent cases could be transferred to specialist neurological or psychiatric hospitals.
Netley Hospital and the Treatment of War Neuroses
The Royal Victoria Military Hospital at Netley, near Southampton, was an important military medical institution during the First World War. It was used to treat wounded and sick servicemen, and Netley was among the locations associated with the treatment and study of war neuroses.
A contemporary film held by the Wellcome Collection, War Neuroses: Netley Hospital, 1917; Seale Hayne Military Hospital, 1918, provides particularly valuable primary-source evidence. The film shows servicemen receiving treatment and demonstrates some of the symptoms that doctors encountered.
The Royal Victoria Military Hospital was demolished in the 1960s. Today, the chapel is the principal surviving building associated with the hospital, while a small section of the former landing stage also remains. The open grounds around the chapel occupy part of the area where the hospital wards once stood.
Discipline and Shell Shock
Shell shock also created difficult questions for military authorities. Not all soldiers who developed symptoms were immediately regarded as patients. Some cases were interpreted as cowardice, malingering or a failure of discipline, particularly when symptoms appeared without an obvious physical injury.
This created a serious tension between medical explanations and military expectations. A soldier unable to fight might require medical treatment, but military authorities also had to decide whether his condition represented genuine illness or deliberate avoidance of service.
Some soldiers were subjected to harsh disciplinary treatment. The history of shell shock therefore illustrates the difficulties created when medical understanding, military discipline and contemporary ideas about courage came into conflict.
Changing Medical Understanding
Understanding of shell shock changed during the course of the war. The initial emphasis on physical damage caused by explosions was increasingly accompanied by explanations involving psychological stress and nervous exhaustion.
The change in terminology during 1917 reflected this debate. “Shell shock” was considered too broad and misleading because it encompassed a range of conditions, including cases where there had been no direct exposure to shell explosions.
The condition demonstrated the limitations of contemporary medical knowledge. Doctors were attempting to understand forms of illness that did not always fit established categories, while military organisations were confronted with large numbers of men whose symptoms affected their ability to serve.
Shell Shock and the Wider Medical History of the War
Shell shock formed part of a much wider medical challenge created by the First World War. Medical services had to deal simultaneously with physical wounds, infectious disease, gas injuries, blood loss and psychological and neurological disorders.
The experience of shell shock also contributed to changing attitudes towards the relationship between warfare, medicine and mental health. The terminology and explanations used during the First World War were those of the period, and the condition should therefore be understood within the medical and military context of 1914–18 rather than simply being given a later diagnostic label.
Primary Sources and Further Study
Charles Samuel Myers’ 1915 article, A Contribution to the Study of Shell Shock, provides a contemporary medical perspective on the condition.
The Wellcome Collection film of war neuroses at Netley Hospital provides contemporary visual evidence of treatment during the First World War.
The War Office Report on “Shell Shock”, held by The National Archives, provides evidence of the official medical debate and the decision that the term “shell-shock” should be eliminated from official nomenclature.
This article forms part of the wider Medicine in the First World War section.