Shell shock
Based on Wikipedia: Shell shock
Lieutenant Lewis couldn't stop shaking. It was February 1918, somewhere on the Western Front, and German artillery was pounding the position with terrifying regularity. This was his first day at the front. A fellow officer tried to calm him down, but nothing worked. Then a shell landed directly on top of their dugout, blowing the roof clean off.
Lewis collapsed to the floor and began clawing at the dirt with his bare hands, trying to dig himself deeper into the earth. Then he went completely limp. His eyes stayed open, but he wouldn't speak, wouldn't respond to anything. They had to carry him out on a stretcher. He had no visible wounds.
This was shell shock.
When the Mind Breaks Before the Body
The first reports came in late 1914, just months after World War One began. British soldiers were returning from the front with symptoms that made no medical sense. They had ringing in their ears, pounding headaches, tremors that wouldn't stop. Some had lost their memories entirely. Others couldn't tolerate even the slightest noise—a door closing would send them into panic. Many simply couldn't speak at all.
Doctors were baffled. These symptoms looked exactly like what you'd expect from a serious brain injury. But here's what didn't add up: most of these soldiers had no head wounds whatsoever. By December of that first year, roughly ten percent of British officers and four percent of enlisted men were experiencing what the medical establishment awkwardly termed "nervous and mental shock."
The military needed a name for this mysterious condition, and in 1915, during the Battle of Loos, someone coined the term "shell shock." The phrase first appeared in The Lancet, one of the world's most prestigious medical journals, in an article by a physician named Charles Myers. The name seemed to make sense—perhaps the shock waves from exploding artillery shells were doing invisible damage to the brain, creating lesions too small to see. Another theory held that carbon monoxide from the explosions was poisoning soldiers' nervous systems.
But there was a problem with these tidy physical explanations.
The Inconvenient Truth
An increasing number of men with shell shock symptoms had never been anywhere near an exploding shell. They had the same tremors, the same thousand-yard stare, the same inability to function—but they'd never experienced the blast that was supposed to cause all of it.
This observation pointed toward something the military establishment desperately didn't want to acknowledge: shell shock might be psychological rather than physical. The mind, it seemed, could break just from the sustained horror of industrial warfare—the constant threat of death, the sight of friends blown apart, the endless waiting punctuated by moments of absolute terror.
The British Army tried to split the difference. In 1915, they issued instructions that cases "due to the enemy"—meaning exposure to actual explosions—should be marked with a "W" for wounded. These soldiers could wear a wound stripe and receive a pension. But if a man's breakdown couldn't be traced to a shell explosion, he got marked with an "S" for sickness. No stripe. No pension. The implication was clear: he was weak, not wounded.
In practice, this distinction proved almost impossible to maintain. Who could really say, in the chaos of trench warfare, exactly how close a man had been to any particular explosion?
Cowardice on Trial
Some shell shock victims faced something far worse than bureaucratic classification. They were court-martialed.
The charges varied: desertion, cowardice, quitting a post without authority, disobedience. The British Army conducted about 240,000 courts martial during the war and handed down more than 3,000 death sentences. Of those, 346 were actually carried out. Two hundred sixty-six men were executed for desertion, eighteen for cowardice.
Many of these men, we now understand, were almost certainly suffering from what we would today call post-traumatic stress disorder, or PTSD. Their "cowardice" was a medical condition, not a moral failing. In 2006—nearly a century too late—the British government issued posthumous pardons to all of them.
The attitude at the time was brutally unsympathetic. Lord Gort, testifying before a post-war commission, stated flatly that shell shock was a "weakness" that didn't occur in "good" units. The message was unmistakable: real soldiers didn't break down. If you did, it revealed some fundamental flaw in your character.
The Treatments Were Sometimes Worse Than the Disease
When doctors did attempt to treat shell shock, their methods often reflected the prevailing view that these men simply needed to be shocked back to normalcy. Literally.
Electric shock treatment was common. Doctors would apply current to soldiers' throats, their limbs, anywhere they thought might jolt the patient back to his "heroic, pre-war self." One therapist, Lewis Yealland, documented a patient who had been mute for nine months. The treatments this man endured over that period included strong electrical shocks to his throat, lit cigarettes pressed to the tip of his tongue, and "hot plates" held against the inside of his mouth.
The patient remained mute.
Not all treatment was so barbaric. Some physicians recognized that rest, understanding, and what we might now call talk therapy could help. A 1922 British government report recommended that mild cases should be treated near the front lines with rest and reassurance. More severe cases should go to specialized neurological centers—but crucially, nothing should be done to "fix the idea of nervous breakdown in the patient's mind." The fear was that if soldiers believed they were truly ill, they might never recover.
The report explicitly rejected Freudian psychoanalysis, though it did acknowledge that "explanation, persuasion, and suggestion" could help, along with baths, massage, and gentle electrical stimulation.
The Scale of the Crisis
By 1916, shell shock had become a military emergency. At the Battle of the Somme—one of the bloodiest engagements in human history—as many as forty percent of British casualties were psychiatric rather than physical. The generals faced a nightmare scenario: an epidemic of men who couldn't fight, at a time when every soldier was desperately needed.
This crisis had several consequences. First, it pushed the military toward accepting the psychological explanation for shell shock. If these men weren't physically injured, they could theoretically be returned to combat more quickly. Second, it drove more research into treatment methods. By the Battle of Passchendaele in 1917, the British Army had developed protocols: a soldier showing early symptoms would get a few days' rest from his local medical officer. The key was to treat men quickly, before the condition set in too deeply, and to maintain the expectation that they would return to duty.
One regimental medical officer described the approach: get to know your men, so they trust you. When someone starts to crack, explain that nothing is really wrong with him, give him some rest, then go back to the front line with him. Sit with him, talk about the war, look through his periscope. Show him that you believe he can do this.
It was crude psychology by modern standards, but it often worked.
The Long Shadow
The war ended in 1918, but shell shock didn't.
By 1939, more than 120,000 British veterans were receiving pensions for psychiatric disabilities—about fifteen percent of all pensioned disabilities from the war. Another 44,000 were drawing pensions for "soldier's heart" or "Effort Syndrome," diagnoses that described the inability to handle physical or emotional exertion. And these statistics, one historian noted, represented "just the tip of a huge iceberg."
War correspondent Philip Gibbs described what came home to British families:
Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening.
This was a generation permanently marked by what it had experienced. And the official response was often to deny that the problem was real—or to blame the victims.
One British writer between the wars argued that veterans with psychological disabilities shouldn't receive compensation because it would reward "unconscious cowardice" and "unconscious dishonesty." To acknowledge their suffering, this writer claimed, would encourage "the weaker tendencies in their character."
Poetry, Memory, and Recognition
Shell shock left deep marks on British culture—marks that persist to this day. The war poets Siegfried Sassoon and Wilfred Owen, both of whom spent time at Craiglockhart War Hospital being treated for shell shock, wrote about the experience with brutal honesty. Owen would die in combat just one week before the armistice; Sassoon would survive, haunted by memories for the rest of his life.
Decades later, novelist Pat Barker would explore shell shock in her Regeneration Trilogy, drawing on the real experiences of poets and doctors to examine how the war shattered men's minds and what it cost them to piece themselves back together.
The term "shell shock" itself was banned by the British Army at the start of World War Two—the phrase had become too loaded, too associated with controversy over pensions and treatment. But the condition didn't disappear just because they stopped using the name. "Postconcussional syndrome" and "combat stress reaction" would follow, and eventually, in 1980, the American Psychiatric Association would formally recognize post-traumatic stress disorder as a diagnosis.
What We Know Now
Modern research has, in some ways, vindicated both the physical and psychological theories that doctors debated a century ago. We now know that exposure to explosions can cause real, measurable brain damage—concussions and micro-tears in brain tissue that don't show up on conventional examinations but can produce lasting symptoms. Veterans returning from Iraq and Afghanistan have shown similar patterns, and advanced imaging technology has revealed damage that doctors in 1915 could never have detected.
At the same time, we understand that psychological trauma alone, without any physical injury, can produce devastating and persistent symptoms. The debate about whether shell shock was "real" or "imaginary" was always asking the wrong question. Psychological suffering is real suffering, and it can be every bit as debilitating as a shattered limb.
There's a phrase that emerged from the trenches that captures something essential about what these men experienced: the thousand-yard stare. It describes the unfocused, vacant gaze of someone who has seen too much—who is looking at something far beyond the immediate world, something terrible that only they can see.
Lieutenant Lewis, digging at the floor of that wrecked dugout with his bare hands, eyes open but seeing nothing, had that stare. Millions of men came home from that war carrying it with them. Many never spoke about what they'd experienced. Many couldn't.
Shell shock was the first war's signature wound, the injury that announced to the world that modern industrial combat would break men in ways no previous war had managed. It forced a reluctant acknowledgment that courage has limits, that the mind can be wounded as surely as the body, and that some prices are too high for any nation to ask its citizens to pay.
The lesson took most of a century to sink in. In some ways, we're still learning it.