After every major conflict the military brushed psychiatric trauma under the carpet, leaving veterans without support and inflicting a huge cost on society as a whole. And, as an incredibly moving and shocking new BBC documentary shows, far from consigned to warfare of the past, this battle is leaving growing numbers of casualties across Britain today.
In World War 1’s Secret Shame: Shell Shock, Dan Snow traces the history of what we now know as PTSD as experienced by successive generations of the armed forces. WW1 was the first truly industrial war with wholesale death and horrific injury on a scale never before witnessed: 23 million troops were killed, making it one of the most deadly conflicts in history. The physical effects of mental trauma could not be ignored and by 1916 hospitals were filling up with soldiers suffering from what doctors named shellshock.
“It was a new kind of war,” explains Snow. “Hand-to-hand combat is traumatic, but in the trenches or behind the lines you have no idea when a shell or bomb can kill you. You are living under that constant threat, your enemy is close, you know you’re in danger. Your whole group of mates got destroyed, you didn’t know what was going on, the air was full of supersonic steel, poison gas, razor-sharp bits of shrapnel, fragments of boiling hot shell casings flying through the air.”
Some people were treated in a progressive way, others were treated like criminals.
Many soldiers were shot for cowardice in order to prevent shellshock ‘spreading’. But this was not universal practice. “It depends on the doctor, the unit, the place and the hospital. Some people were treated in a progressive way, others were treated like criminals. Even in the same war and the same army there were radically different responses. Some doctors were very advanced and would say let’s help these people with talking therapy, others would say we are going to clamp down and shoot them.”
Spiralling numbers of soldiers suffered shellshock’s disabling impacts. “Psychiatric wounds threatened to overwhelm certain units,” Snow continues. “Officers and generals thought it was a threat that could destroy the army. In the same way that drugs in the Vietnam war almost destroyed the US army, psychiatric illness came close to destroying the British army.” By 1922 the word ‘shellshock’ had been banned from use, the concept discredited as an infectious form of ‘disgrace’ to soldiers.
As a result all lessons about war’s devastating psychological consequences were completely forgotten by 1939: at the advent of World War 2 the British Army had only six psychiatrists. This increased to 200, and by the D-Day landings psychiatric hospitals were overwhelmed with shellshock victims.
“It’s very sad, that lack of memory,” says Snow. “If you don’t do things for a while you get out of the habit – you forget how to treat major gunshot wounds and the same is true of mental trauma, what they learned was forgotten between World War 1 and the Second World War.”
History repeated in 1982 when Britain embarked on the Falklands War; the army refused to recognise shellshock as a condition, assigning just one psychiatrist for 30,000 troops. At this time the US army was researching combat trauma and PTSD was first identified. By 1986 the British Navy finally recognised it, ahead of the army, which persisted in describing it as LMF or “lack of moral fibre”.
Falklands veterans are still dealing with the fallout. In the 1990s military hospitals were closing, PTSD programmes shut, and today growing numbers of veterans of Britain’s wars in Afghanistan and Iraq are struggling to cope with sometimes extreme psychiatric trauma and no support network. One military doctor describes it as “really an NHS problem”.
“We are starting to feel the consequences of this,” points out Snow. “These things might not present until years after traumatising events. They are going to be coming in to hospital in 10 to 15 years’ time when the conflict is forgotten.”
Snow’s film shines a light on this very human, often hidden, cost in heartbreaking, deeply personal detail. The wider impact on society is all around us: relationship breakdown, unemployment, violence, prison and homelessness are not infrequent consequences. The Big Issue has over the years been sold by many ex-servicemen and women. And, devastatingly for loved ones, in some cases veterans turn to suicide.
Wounds to the mind are as deep as physical trauma,
When does Snow think research and support for mental health impacts of warfare was at its best in the last 100 years? “Oddly, probably parts of the First World War. It went from nothing to quite good stuff. The Second World War seemed a bad time.” While understanding of mental health and specifically PTSD has improved radically in recent decades, much still needs to be done. “Wounds to the mind are as deep as physical trauma,” he points out.
But military funding is a political football and successive cuts have locked out those who need help down the line. “We have got to invest in it, we’ve got to create systems and work it out. That’s true of all society, not just soldiers of course. There’s people with trauma all around – bereavement or accidents are traumatic. Our prisons are full of traumatised people. We’ve got a long way to go.”
And, he adds, especially around Remembrance Day we must recognise that ex-armed services personnel who are struggling are the responsibility of all society. “This is on all of us. We are a democracy and therefore it’s on us. We let those people down.”
World War 1’s Secret Shame: Shell Shock is on BBC Two on November 12 at 9pm. Dan Snow is an ambassador for charity Soldier On
Image: Effects of shell shock (Reeve 016246), National Museum of Health and Medicine