“Minds the Dead Have Ravished”: 1 Shell Shock,History,and the Ecology of Disease-Systems

From Wilfred Owen's poem, “Mental cases”, in The poems of Wilfred Owen, ed. by Stallworthy Jon (New York, 1986).

Rows R. G. , “Neurasthenia and war neuroses”, in History of the Great War, based on official documents: Medical services, diseases of the War, ii, ed. by MacPherson W. G. (London, 1923), 1.

“Nerves and war: The Mental Treatment Bill [lead article]”. The lancet, 1 May 1915, 919–20.

This low-end estimate of the total number of shell-shocked soldiers was provided by Rows , History (ref. 2), 7; see History, esp. pp. 4 and 15, for course of epidemic, and p. 10 for quotation.

Rosen George , “Nostalgia: A forgotten psychological disorder”, Psychological medicine, v (1975), 340–54; Ritchie Robert D. , “One history of ‘shellshock’”, unpubl. Ph.D. dissertation, University of California, San Diego, 1986, 95–107; and Leed Eric J. , No man's land: Combat and identity in World War I (New York, 1979), 163–4. For a thorough review of the American experience with war-related mental illness, see Smith John Russell , “A review of one hundred and twenty years of the psychological literature on reactions to combat from the Civil War through the Vietnam War, 1860–1980”, unpubl. Ph.D. dissertation, Duke University, 1981.

Myers Charles S. , “Contributions to the study of shell shock. Being an account of certain cases treated with hypnosis”, The lancet, 8 Jan. 1916, 65–69.

Hadfield J. A. , “Treatment by suggestion and persuasion”, in Functional nerve disease: An epitome of war experience for the practitioner, ed. by Crichton-Miller Hugh (London, 1920), 61–87, p. 73.

Also from testimony of Miss Cockrell, in (Francis J. S. H.) Southborough Chairman, Report of the War Office Committee of Enquiry into “Shell-Shock” (London, 1922), 83; and Culpin Millais , Psychoneuroses of war and peace (Cambridge, 1920), 4–5. This compiled case is typical of what, by 1918, was being called anxiety disorder.

Case compiled especially from Smith G. Elliot and Pear T. H. , Shell shock and its lessons (Manchester, 1917), 11–12; and Myers , “Contributions” (ref. 6), 65–69. This case represents what were called hysterical conditions. For another account of amnesia, see Feiling Anthony , “Loss of personality from ‘shell shock’”, The lancet, 10 July 1915, 63–66.

MacCurdy John T. , War neuroses (Utica, 1918), 27–28. MacCurdy was an American psychiatrist from the New York State Psychiatric Institute who studied shell shock at the London hospitals.

Myers , “Contributions” (ref. 6), 67; also from Rivers William H. R. , “Repression and suppression”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 88–98, esp. pp. 94–95, and Mott Frederick W. , “Neurasthenia: The disorders and disabilities of fear”, The lancet, 26 Jan. 1918, 127–9. This is a typical neurasthenic case.

For example, see Ackerknecht Erwin H. , Malaria in the Upper Mississippi Valley, 1760–1900 (Baltimore, 1945); René and Dubos Jean , The white plague: Tuberculosis, man, and society (New Brunswick, 1987); Rosenberg Charles E. , The cholera years: The United States in 1832, 1849, and 1866 (Chicago, 1962); Brandt Allan M. , No magic bullet: A social history of venereal disease in the United States since 1880 (New York, 1987); Rosenberg Charles E. and Golden Janet (eds), Framing disease: Studies in cultural history (New Brunswick, 1992).

A short list of such works must include: Rosen George , Madness in society: Chapters in the historical sociology of mental illness (New York, 1968); MacDonald Michael , Mystical bedlam: Madness, anxiety, and healing in seventeenth-century England (New York, 1981); Scull Andrew T. , Museums of madness: The social organization of insanity in nineteenth-century England (New York, 1979); Rosenberg Charles E. , The trial of the assassin Guiteau: Psychiatry and law in the Gilded Age (Chicago, 1968); Foucault Michel , Madness and civilization: A history of insanity in the Age of Reason (London, 1967); Porter Roy , Mind-forg'd manacles: A history of madness in England from the Restoration to the Regency (London, 1987); and the essays in both Madhouses, mad-doctors, and madmen: The social history of psychiatry in the Victorian Era , ed. by Scull Andrew (Philadelphia, 1981), and The anatomy of madness, ed. by Bynum W. F. Porter Roy and Shepherd Michael (3 vols, London, 1985).

A prominent exposition of the former view is Szasz Thomas S. , The myth of mental illness: Foundations of a theory of personal conduct (London, 1962). For a summary and reaction to the latter view, see Engel George L. , “The need for a new medical model: A challenge for biomedicine”, Science, cxcvi (1977), 129–36.

Eisenberg Leon , “The social construction of mental illness”, Psychological medicine, xviii (1988), 1–9.

Rosenberg Charles E. , “Framing disease: Illness, society, and history”, in Rosenberg and Golden (eds) (ref. 12), pp. xiii–xxvi. See also “Disease and social order in America: Perceptions and expectations”, Milbank quarterly, lxiv, suppl. 1 (1986), 34–55.

Kleinman Arthur , The illness narratives: Suffering, healing, and the human condition (New York, 1988); Engel , “A new model” (ref. 14).

René Dubos anticipated many of these points in his prescient book, Mirage of health: Utopias, progress, and biological change (New Brunswick, 1959).

Feiling , “Loss of personality” (ref. 9), 63.

Read C. Stanford , Military psychiatry in peace and war (London, 1920), 24. See also the testimony of nearly every witness before the War Office Committee of Enquiry, Southborough, Report (ref. 8), 12–91.

The lancet, “Nerves and war” (ref. 3), 919.

Testimony of William H. R. Rivers before the War Office Committee of Enquiry, Southborough, Report (ref. 8), 56–57.

For 1940 versions, see Kardiner Abram , The traumatic neuroses of war (New York, 1941), and Grinker Roy R. and Spiegal John P. , Men under stress (Philadelphia, 1945). Leed , No man's land (ref. 5), 167; Stone Martin , “Shellshock and the psychologists”, in Bynum (eds), Anatomy of madness, ii (ref. 13), 242–71, p. 260.

Fussell Paul , “The troglodyte world”, in his The Great War and modern memory (New York, 1975), 36–74.

Lynch Peter John , “The exploitation of courage: Psychiatric care in the British Army, 1914–1918”, unpubl. M. Phil, thesis, University College, London, 1977, 1–15. See also Keegan John , The face of battle: A study of Agincourt, Waterloo, and the Somme (New York, 1976).

Showalter Elaine , “Male hysteria: W. H. R. Rivers and the lessons of shell shock”, in her The female malady: Women, madness, and English culture, 1830–1980 (New York, 1985), 167–94; Bogacz Ted , “War neurosis and cultural change in England, 1914–22: The work of the War Office Committee of Inquiry into ‘Shell-Shock’”, Journal of contemporary history, xxiv (1989), 227–56, esp. p. 233.

Elliott T. R. , “Transient paraplegia from shell explosions”, British medical journal (hereafter BMJ), 12 Dec. 1914, 1005–6. At 36 years of age, Elliott had been elected a Fellow of the Royal Society in 1913 for the neurophysiologic research he had performed in the 1900s.

Myers Charles S. , “A contribution to the study of shell shock. Being an account of three cases of loss of memory, vision, smell, and taste, admitted into the Duchess of Westminster's War Hospital, Le Touquet”, The lancet, 13 Feb. 1915, 316–20, quotation from p. 320. An experimental psychologist, Myers documented the neurological and vision deficits with remarkable detail.

Myers Charles S. , Shell shock in France (Cambridge, 1940); Southborough , Report (ref. 8), 4–6; Rows , History (ref. 2), 49. The contemporary work of Walter B. Cannon (cited by the Official history on p. 19) had also given the term ‘shock’ a modern, scientific tone.

Bynum W. F. , “The nervous patient in eighteenth- and nineteenth-century Britain: The psychiatric origins of British neurology”, in Bynum (eds), Anatomy of madness , i (ref. 13), 89–102. See also Rosenberg Charles E. , “The place of George M. Beard in nineteenth-century psychiatry”, Bulletin of the history of medicine, xxxvi (1962), 245–59.

On Mott, see Meyer Alfred , “Frederick Mott, founder of the Maudsley laboratories”, British journal of psychiatry, cxxii (1973), 497–516. Much of the conceptual framework of my subsequent argument draws on the sociology of knowledge developed by Fleck Ludwik , Genesis and development of a scientific fact (orig. publ. 1935; English transl., Chicago, 1979); and Kuhn Thomas S. , The structure of scientific revolutions, 2nd edn (Chicago, 1970).

Mott Frederick W. , “The Lettsomian Lectures on: The effects of high explosives upon the central nervous system”, The lancet, 12 and 26 Feb., and 11 Mar. 1916, 331–8, 441–9, 545–53 (quotation from p. 331).

“Nervous manifestations due to the wind of explosives”, The lancet , 14 Aug. 1915, 348–9; “Nervous injuries due to shell explosions”, The lancet, 2 Oct. 1915, 766.

“Shell shock”, BMJ , 19 Aug. 1922, 322; and also “Shell shock”, BMJ , 26 Aug. 1922, 391–2; and ‘“Shell shock’ and ‘cowardice’”, The lancet, 19 Aug. 1922, 399–400.

According to Read, Military psychiatry (ref. 20), 52, of 3000 cases seen at D-Block, Netley in 1917, nearly one-fourth had not been to the firing line; see also testimony of Gordon Holmes to the War Office Committee, Southborough, Report (ref. 8), 40. The History maintained that of the thousands of shell-shocked men examined during the war, only 2.5% showed signs of possible nervous system injury; furthermore, the two cases cited by Mott above were the only instances of apparently uninjured fatalities where subsequent autopsy revealed injury consistent with shell blast: Rows , History (ref. 2), 18–19.

“A discussion on shell shock”, The lancet, 5 Feb. 1916, 306–7 (quotation from p. 306); Southborough , Report (ref. 8), 5.

Hearnshaw L. S. , A short history of British psychology, 1840–1940 (London, 1964), 245–6; Leed , No man's land (ref. 5); Stone , “Shellshock and the psychologists” (ref. 23); Showalter , “Male hysteria” (ref. 26); Bogacz , “War neurosis and cultural change” (ref. 26); Lynch , “Exploitation” (ref. 25); and Brown Edward M. , “Between cowardice and insanity: Shell shock and the legitimation of the neuroses in Great Britain”, in Science, technology, and the military, ii, ed. by Mendelsohn Everett Smith Merritt Roe , and Weingart Peter (Boston, 1988), 323–45.

For instance, see Mercier Charles A. , “Functional nervous disease: To the Editor”, The lancet , 15 Jan. 1916, 154; and Armstrong-Jones Robert , “Functional nervous disorder: To the Editor”, ibid., 22 Jan. 1916, 210–11.

For examples of approving reviews of Freud, see Brown William , “Freud's theory of dreams”, The lancet , 19 and 26 April 1913, 1115–18, 1182–4; Glynn T. R. , “Hysteria in some of its prospects”, ibid ., 8 Nov. 1913, 1303–4; and Stoddart W. H. B. , “The Morrison Lectures on the new psychiatry: I. Fundamental psychical mechanisms, and II. Psycho-analysis”, ibid ., 20 and 27 Mar. 1915, 583–590, 639–643. See also Rapp Dean , “The reception of Freud by the British press: General interest and literary magazines, 1920–1925”, Journal of the history of the biological sciences, xxiv (1988), 191–201.

Russell J. S. Risien , “The treatment of neurasthenia”, The lancet, 22 Nov. 1913, 1453–6 (quotation from p. 1453). For the origin of neurasthenic theory, see Rosenberg , “Beard” (ref. 30).

“The definition and treatment of neurasthenia [editorial]”, The lancet, 29 Nov. 1913, 1557–8. On the acceptance of neurasthenia by U.S. doctors in the pre-war era, see Gosling F. G. , Before Freud: Neurasthenia and the American medical community, 1870–1910 (Urbana, 1987).

For a specific pre-war view of hysteria, particularly its occurrence in men, see Glynn , “Hysteria” (ref. 39). For an overview, see Veith Ilza , Hysteria: The history of a disease (Chicago, 1965).

Figlio Karl , “How does illness mediate social relations? Workmen's compensation and medico-legal practices, 1890–1940”, in The problem of medical knowledge: Examinining the social construction of medicine , ed. by Wright Peter and Treacher Andrew (Edinburgh, 1982), 174–224. See also Trimble Michael R. , Post-traumatic neurosis: From railway spine to whiplash (New York, 1981); and Schivelbusch Wolfgang , “Railroad accident, ‘Railway spine’ and traumatic neurosis”, chap. 9 in his The railway journey: The industrialization of time and space in the 19th century (Berkeley, 1986).

“Shell explosion and the special senses [lead article]”, The lancet, 27 March 1915, 663–4 (quotation from p. 663).

Mott , “Lettsomian Lectures” (ref. 32), 547–8. Mott expounded on his psychology theories in “Two addresses on war psycho-neurosis: II. The psychology of soldiers' dreams”, The lancet, 2 Feb. 1918, 169–72. Instead of citing Freud, Mott quoted Shakespeare's Queen Mab speech as a dream authority.

McDougall William , “Summary”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 181–98, p. 183. These views were expanded in McDougall William , Outline of abnormal psychology (New York, 1926).

Myers Charles S. , “Contributions to the study of shell shock. Being an account of certain disorders of cutaneous sensibility”, The lancet, 18 March 1916, 608–13 (quotation from p. 613).

Kuklick Henrika , The savage within: The social history of British anthropology, 1885–1945 (New York, 1991), 165–81.

Riddoch graduated from Aberdeen in 1913; Feiling from Cambridge in 1914; during the 1890s, Crichton-Miller wrote his M.D. thesis on hypnotism and had opened a nursing home for the treatment of functional nervous disorders in 1911; Brown, head of the Psychology Department at University of London, had published an article on Freudian psychology in 1913; Rows, although a noted asylum-based neuropathologist, had written in 1912 an article that advocated establishing psychiatric outpatient clinics and praised the “remarkable work of Freud and Jung, which shows us the importance of psychogenic factors in the production of neurasthenic and hysterical conditions”, and had previously translated a volume on psychiatry that addressed the psychic and social causes of mental illness, as well as discussions of hysteria and neurasthenia. “George Riddoch”, Munk's role, iv: Lives of the Fellows of the Royal College of Physicians of London, 1826–1925, compiled by Brown G. H. (London, 1955), 600; “Anthony Feiling”, Who's who, 1973–1974 (New York, 1973), 1058–9; “Hugh Crichton-Miller”, Munk's role, v: … continued to 1965, ed. by Trail Richard R. (London, 1968), 87–89; “William Brown”, ibid ., v, 56–57; Brown , “Freud's theory” (ref. 39); “Richard Gundry Rows (Obituary)”, Journal of mental science, lxxi (1925), 350–1; Rows R. G. , “The development of psychiatric science as a branch of public health”, ibid., lviii (1912), 25–39 (quotation from p. 28); and Lugaro Ernesto , Modern problems in psychiatry , transl. by Orr David and Rows R. G. (Manchester, 1909), esp. pp. 12–13.

Mott had devoted almost his entire professional life to work conducted at the L.C.C. Asylum at Claybury, and had helped to found the Maudsley Hospital; Head, after holding a junior post at the County Asylum, Rainhill, had become the leading neurologist in England, serving as editor of Brain from 1910 to 1925; Mercier was associated with Leavesden Asylum, City of London Asylum, and a private asylum in Catford; Armstrong-Jones was director of the Claybury Asylum from 1893 to 1916; and before the war Adie was a house physician at the National Hospital for the Paralysed and Epileptic in London. See entries in Munk's role, iv (ref. 49), 358–9, 421–2, 463–4, 480–1, 596–7, respectively. Yealland had graduated from medical school in 1912, but worked at the National Hospital, Queen Square, under Adrian Edgar D. , the noted neurophysiologist; see “Yealland”, Munk's role, v (ref. 49), 465; “Adrian”, Munk's role, vii: … continued to 1983, ed. by Wolstenholme Gordon (Oxford, 1984), 3–4; and Adrian E. D. and Yealland L. R. , “The treatment of some common war neuroses”, The lancet, 9 June 1917, 867–72.

McDougall , Abnormal psychology (ref. 46), 2 and 24; Myers Charles S. , Present-day applications of psychology: With special reference to industry, education, and nervous breakdown (London, 1918), 44; Crichton-Miller Hugh , “Physical aetiology”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 3–13, p. 4.

Mott , “Lettsomian Lectures” (ref. 32), 553.

Adrian and Yealland , “Treatment of war neuroses” (ref. 50), 868; Mott , “Lettsomian Lectures” (ref. 32), 172; Myers C. S. , “A final contribution to the study of shell shock. Being a consideration of unsettled points needing investigation”, The lancet , 11 Feb. 1919, 51–54 (quotation from p. 54); and Rivers William H. R. , “The repression of war experience”, ibid., 2 Feb. 1918, 173–7 (quotation p. 177).

Turner William Aldren , “Arrangements for the care of cases of nervous and mental shock coming from overseas”, ibid., 27 May 1916, 1073–5.

Edward Stainbrook detailed the established history of electrical therapy in “The uses of electricity in psychiatric treatment during the nineteenth century”, Bulletin of the history of medicine, xxii (1948), 156–77. Brown , “Between cowardice and insanity” (ref. 37), 337, notes that similar techniques had been used on female hysterics in the 1890s. For examples of anaesthetization, see Proctor A. P. , “Three cases of concussion aphasia: Treatment by general anaesthesia”, The lancet , 30 Oct. 1915, 977; and de H. Dawson G. , “A case of shell concussion: Treatment by general anaesthesia”, The lancet, 26 Feb. 1916, 463–4. With very different purposes in mind, some doctors used low doses of ether to produce psychological disinhibition and subsequent cathartic “abreaction” in patients.

Testimony of Adie Major William J. , in Southborough, Report (ref. 8), 17–18. Adrian and Yealland (ref. 50), “Treatment of war neuroses”, described similar techniques, noting that they were quick and relied on the power of suggestion over these male hysterics. Other, less punitive-minded physicians, however, turned to electricity as a time-honoured neural “tonic”, employing a course of milder therapy that took months to complete; see Wilfred Garton, “Shell shock and its treatment by cerebrospinal galvanism”, BMJ, 28 Oct. 1916, 584–6.

Rivers recalled for the War Office Committee that this repression was “habitually” recommended for disturbed soldiers at the beginning of the war: Southborough, Report (ref. 8), 58.

Culpin , Psychoneuroses (ref. 8), 3–4. See also Myers , Applications of psychology (ref. 51), 40.

Myers , Applications of psychology (ref. 51), 40. See also Hadfield , “Treatment” (ref. 7), 73–74.

Hadfield , “Treatment” (ref. 7), 81.

Brown , “Between cowardice and insanity” (ref. 37), 339; Ritchie , One history of “shell-shock” (ref. 5), 248–50.

The official statistics compiled after the war indicated that for the shell-shocked soldiers treated from August to October 1917 at field hospitals in France, 55% returned to active duty after brief therapy, 29% returned after one month on agricultural detail, and 16% required evacuation to a base hospital; furthermore, only 10% of the cases seen were recurrences, suggesting that the treatments not only returned men to battle, but also kept them there: Rows, History (ref. 2), 41 and 43. William Brown, “The treatment of cases of shell shock in an advanced neurological centre”, The lancet, 17 Aug. 1918, 197–200, reported that these centres returned 70% of the patients to the front within a fortnight. Read , Military psychiatry (ref. 20), 50–52, analysed 3000 consecutive cases admitted to D Block, Royal Victoria Hospital in 1917, categorizing their outcome after 12 months: 50% “Recovered”, 13% “Improved”, 24% “No Change”, 13% “Congenital Defects”. Regarding final disposition: 60% discharged, 7% returned to duty, 20% sent to asylums, 9% repatriated.

Scull , Museums (ref. 13); and McCandless Peter , “Liberty and lunacy: The Victorians and wrongful confinement”, in Scull , Madhouses (ref. 13).

Quotation from The lancet, “Nerves and the war” (ref. 3), 919. For contemporary accounts of the military mental hospital system, see Turner , “Arrangements” (ref. 54); and Salmon Thomas W. , The care and treatment of mental disease and war neurosis (“shell shock”) in the British army (New York, 1917). These fears persisted well after the war: See “Homes for shell-shock cases” and “War neurosis and shell-shock”, The lancet , 23 July, 6 Aug. 1921, 208, 310; and Robinson William , “The future of service patients in mental hospitals”, Journal of mental science, lxvii (1921), 40–48.

Scull , Museums, and Scull (ed.), Madhouses (ref. 13).

Rows , History (ref. 2), 47–49 and 7; Turner , “Arrangements” (ref. 54), 1073–5; and Salmon , Care and treatment (ref. 64), esp. pp. 81–98. See also Mott's description of Maudsley Hospital, equipped for recreation and “special attention”, in “Lettsomian Lectures” (ref. 32), 553; Siegfried Sassoon's depiction of Craiglockhart in “Rivers”, Sherston's progress (New York, 1936); “Special hospitals for officers”, The lancet , 20 Nov. 1915, 1155–7; and “Lord Knutsford's Special Hospital for Officers”, ibid., 27 Nov. 1915, 1201–2.

The officer in charge of one converted asylum detailed the substantial addition of extra staff for the military mental hospital: Hotchkis R. D. , “Renfrew district asylum as a war hospital for mental invalids: Some contrasts in administration”, Journal of mental science, lxiii (1917), 238–49. Another attendant recounted the improvements made to convert his asylum into a hospital for sick and wounded soldiers, and how “the Director General of the Army Medical Service, Sir Alfred Keogh, at the War Office … [instructed] that the asylum tradition, and character of the institution, was to be as completely transformed for the time as possible, and that everything in the way of the highest medical and nursing skill, and of appliances was to be provided”. Thomson D. G. , “A descriptive record of the conversion of a county asylum into a war hospital for sick and wounded soldiers in 1915”, Journal of mental science, lxii (1916), 109–35.

Riddoch George , “Differential diagnosis”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 14–27, p. 17.

Rows R. G. , “Mental conditions following strain and nerve shock”, BMJ, 25 March 1916, 441–3 (quotation from p. 443).

Bryce W. H. , “The management of the neurotic: Institutional”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 155–66 (quotation from p. 158).

McDougall , in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 188.

Smith and Pear , Lessons (ref. 9), 19 and 21.

Rows , History (ref. 2), 49; Stone , “Shellshock” (ref. 23).

Fraser Derek , The evolution of the British welfare state, 2nd edn (London, 1984), 177 and 150–1.

Read Donald , England: 1868–1914: The age of urban democracy (New York, 1979), 494–513.

Stevenson John , British society 1914–45 (New York, 1984), 64.

This observation has also been made by historians. Brown, for example, has proposed that modern nations that fight patriotic wars with conscript armies are “likely to experience considerable pressure to create some flexible middle ground between cowardice and insanity”. Brown , “Between cowardice and insanity” (ref. 37), 334.

“Neurasthenia and shell shock [lead article]”, The lancet, 18 March 1916, 627–8 (quotation from p. 627).

Smith and Pear , Lessons (ref. 9), 98 and 72.

Testimony of Gordon Holmes to the War Office Committee, Southborough, Report (ref. 8), 40.

Culpin , Psychoneuroses (ref. 8), 17; see also Read , Military psychiatry (ref. 20), 38.

McDougall , Abnormal psychology (ref. 46), 49–50. This scheme was similar to the social psychology developed by Trotter Wilfred , Instincts of the herd in peace and war (London, 1916).

Freud Sigmund , “Introduction to Psycho-analysis and the war neuroses” (1919), in The standard edition of the complete psychological works of Sigmund Freud , xvii, ed. by Strachey James (London, 1955), 207–10; Hearnshaw , Short history (ref. 37), 246; and McDougall, in Crichton-Miller (ed.), Functional nerve disease (ref. 7). For exceptions, see Eder M. D. , “The psycho-pathology of the war neuroses”, The lancet , 12 Aug. 1916, 264–8; Read , Military psychiatry (ref. 20), 39; and Crichton-Miller Hugh , “The mother complex”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 115–28, p. 120.

Read , Military psychiatry (ref. 20), 36.

A similar idea, on the social roles of diseases as ‘actors’, has been expressed by Charles Rosenberg E. ; see his “Framing disease” (ref. 16).

Ellenberger Henri F. , The discovery of the unconscious (New York, 1970).

Southborough , Report (ref. 8), 6.

Testimony of Lord Gort, in Southborough, Report (ref. 8), 50.

Brown , “Between cowardice and insanity” (ref. 37).

Babington Anthony , For the sake of example: Capital courts-martial 1914–1920 (New York, 1983).

Rows , History (ref. 2), 10.

Lynch , “Exploitation” (ref. 25), 226.

Lynch , “Exploitation” (ref. 25), 225–37; Brown , “Between cowardice and insanity” (ref. 37), 332, mentions that Myers also saw the conflict between military and medical values.

Leed , No man's land (ref. 5), 168, makes a similar point.

Mott Frederick W. , “Two addresses on war psycho-neurosis. (I.) Neurasthenia: The disorders and disabilities of fear”, The lancet, 26 Jan. 1918, 127–9 (quotation from p. 127).

Read , Military psychiatry (ref. 20), 145.

McDougall , Abnormal psychology (ref. 46), 10–11; and Culpin , Psychoneuroses (ref. 8), 12–13.

Myers , Applications of psychology (ref. 51), 32.

Southborough , Report (ref. 8), 124, quoting from a memorandum that Myers had written in 1916.

Rows , History (ref. 2), 10 and 40–41 (quotation from p. 40). The actual number of shell-shocked soldiers who faced possible court-martial is difficult to estimate, but for at least one N.Y.D.N. centre over a sixteen-month period, less than one percent of its patients were under observation for this purpose: Rows , History (ref. 2), 40.

Rows , History (ref. 2), 10; Stone , “Shellshock” (ref. 23), 250 and 256; and Southborough , Report (ref. 8), 43–44 (quotation is from a synopsis of Brown's testimony).

Stone , “Shellshock” (ref. 23), 252.

Rows , History (ref. 2), 9. Cited by Stone, “Shellshock” (ref. 23), 254. The History actually berated this “misguided public opinion”.

Southborough , Report (ref. 8), 6.

Smith G. Elliot , “Shock and the soldier”, The lancet, 15 and 22 April 1916, 813–17, 853–7 (quotation from p. 817).

Nicoll Maurice , “Regression”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 99–111 (quotation from p. 106).

Paul Fussell eloquently traces the literary legacy of the war in Great War (ref. 24); Showalter examines specifically the literature of shell shock in “Male hysteria” (ref. 26), 191–4.

For a similar analysis of psychological theory and practice, see Sicherman Barbara , “The uses of a diagnosis: Doctors, patients, and neurasthenia”, Journal of the history of medicine and allied sciences, xxxii (1977), 33–54.

Brown , “Between cowardice and insanity” (ref. 37), 328.

Hearnshaw , Short history (ref. 37), 247; Kuklick , Savage within (ref. 48), 174–9.

Read , Military psychiatry (ref. 20), 5; see also MacCurdy , War neuroses (ref. 10), 16.

MacCurdy , War neuroses (ref. 10), 16–17; this use of “normal” is clearly used normatively, not statistically: Read , Military psychiatry (ref. 20), 8.

Both quotations from Culpin , Psychoneuroses (ref. 8), 23.

Smith and Pear , Lessons (ref. 9), 1–2.

See Hadfield , in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 86–87.

Bryce, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 158.

MacCurdy , War neuroses (ref. 10), 70.

Bryce, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 161.

Culpin Millais , “The management of the neurotic — individual”, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 167–78 (quotations from pp. 177–8).

Both quotations from Bryce, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 161 and 162–3.

“Special hospitals” and “Lord Knutsford's” (ref. 66); Salmon , Care and treatment (ref. 64), 93–98.

McDougall , Abnormal psychology (ref. 46), 471.

ibid., 472–3.

Both quotations from Crichton-Miller, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 116 and 128.

Fussell , Great War (ref. 24).

Showalter , “Male hysteria” (ref. 26), 171.

Testimony of Anonymous Witness, Southborough, Report (ref. 8), 88–91. In both language and narrative structure, this account conforms with harrowing fidelity to Fussell's analysis, Great War (ref. 24), of ironic memory.

Read , Military psychiatry (ref. 20), 9.

Smith and Pear , Lessons (ref. 9), 41.

Hadfield, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 79.

Clark Michael , “The rejection of psychological approaches to mental disorder in late nineteenth-century British psychiatry”, in Scull , Madhouses (ref. 13), 271–312.

Adrian and Yealland , “Treatment of war neurosis” (ref. 50), 868. The phrase “disciplinary treatment”, drawn from the wartime literature, is used in apposition to “analytic treatment” by Leed, No man's land (ref. 5).

Myers , Applications of psychology (ref. 51), 34.

ibid., 43.

Rivers, in Crichton-Miller (ed.), Functional nerve disease (ref. 7); Rivers , “Repression” (ref. 53); Sassoon , Sherston's progress (ref. 66); and Brown William , “War neurosis: A comparison of early cases seen in the field with those seen at the base,” The lancet, 17 May 1919, 833–6.

McDougall, in Crichton-Miller (ed.), Functional nerve disease (ref. 7), 196.

MacCurdy , War neuroses (ref. 10), 29.

Paraphrase of Edmund Blunden, cited in Fussell , Great War (ref. 24), 13. Quoted lines from Owen , “Mental cases” (ref. 1); the poem was not completed until the summer of 1918.

See especially the testimony provided in Southborough , Report (ref. 8). Eisenberg , “Social construction” (ref. 15), has commented on the ability of psychological theories to shape human behaviour.

Fenton Norman , Shell shock and its aftermath (St Louis, 1926), esp. pp. 97 and 130.

Kardiner Abram , The traumatic neuroses of war (New York, 1941). After the Second World War, this book appeared in a second edition, yet Kardiner avowed that his wartime experience had not necessitated a revision of the “psychopathology” or the “basic principles” of therapy: Kardiner and Herbert Spiegel, War stress and neurotic illness , 2nd edn (New York, 1947), p. v.

The Ministry of Pensions reported that at the beginning of 1921 there were 65,000 men drawing disability pensions secondary to shell shock; see Rows , History (ref. 2), 7–8. Leed , No man's land (ref. 5), 186–92, and Stone , “Shellshock” (ref. 23), 242–8, describe this delayed-onset epidemic.

Salmon , Care and treatment (ref. 64), 90. See also Hotchkis , “Renfrew” (ref. 67), and Thomson , “Conversion” (ref. 67).

Stone , “Shellshock” (ref. 23), offers the most thorough examination of these sequela; see also Southborough , Report (ref. 8), esp. pp. 138–44, where they discuss cowardice, malingering, court-martial, and expert medical opinion; and Culpin Millais , “The problem of the neurasthenic pensioner”, British journal of psychology, medical section, i (1921), 316–26.

Brown Tom , “Shell shock in the Canadian Expeditionary Force, 1914–1918: Canadian psychiatry in the Great War”, in Health, disease, and medicine: Essays in Canadian history, ed. by Roland Charles G. (Waterloo, Ont., 1984), 308–32 (quotation from p. 323).

Salmon , Care and Treatment (ref. 64), 47.

See Schier A. R. , “Detection of the feebleminded applicant for enlistment — Value of the Binet-Simon Scale as a diagnostic aid”, U.S. naval medical bulletin, vii (1913), 345–60; and for the history of intelligence testing, Gould Stephen Jay , The mismeasure of man (New York, 1981), and Kevles Daniel J. , In the name of eugenics: Genetics and the uses of human heredity (Berkeley, 1985).

Due to restricted sources, this review has focused on the macro-ecology of shell shock and only alluded to individual micro-ecologies of particular patients, families, and doctors. Ritchie, One history (ref. 5), uses the allied concept of “micro-” and “macro-negotiation” of shell shock, while Kleinman , Narratives (ref. 17), 230–6, speaks of “mini-ethnographies”.

Bailey Pearce , “War neuroses, shell shock, and nervousness”, Journal of the American Medical Association, lxxi (1918), 2148–53.

Leed , No man's land (ref. 5), 173.

On Kaufmann , see “Notes from German and Austrian medical journals: Disciplinary treatment of shell shock”, BMJ , 23 Dec. 1916, 882; for widely divergent views of Wagner-Jauregg, see Szasz Thomas , The myth of psychotherapy: Mental healing as religion, rhetoric, and repression (Garden City, N.Y., 1978), 86–91, and Eissler Kurt R. , Freud as an expert witness: The discussion of war neuroses between Freud and Wagner-Jauregg, transl. by Trollope Christine (Madison, Conn., 1986); Bailey , “War neuroses” (ref. 149).

For the progression of war-related mental illnesses' labels and theories, see Smith , “A review” (ref. 5); and Glass Albert J. , “Introduction”, in The psychology and physiology of stress, with reference to special studies of the Viet Nam War, ed. by Bourne Peter G. (New York, 1969), pp. xiii–xxx.

Compare the profile of signs and symptoms given by Rows , History (ref. 2), 19–34, especially the 10% of patients who manifested hysterical symptoms of mutism, deafness, and motor dysfunction, with the current phenomenological profile of PTSD, as provided by the American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 3rd edn, rev. (Washington, 1987), 247–51. See also Glass , “Introduction” (ref. 152); and Richard A. Kulka and others, Trauma and the Vietnam War generation: Report of the findings from the National Vietnam Veterans Readjustment Study (New York, 1990).

David Ingleby considers the broad ramifications of psychiatric thinking in “The social construction of mental illness”, in Problem of medical knowledge (ref. 43), 123–43.

Dubos and Dubos , White plague (ref. 12); Ackerknecht , Malaria (ref. 12); McNeill William H. , Plagues and peoples (New York, 1977); Ethridge Elizabeth , The butterfly caste: A social history of pellagra in the South (Westport, 1972); Rosner David and Markowitz Gerald , Deadly dust: Silicosis and the politics of occupational disease in twentieth-century America (Princeton, 1991).