On this day in history: 'Shell Shock' report is presented in 1917

The psychiatric field of Posttraumatic stress disorder (PTSD) is a relatively new one. The term dates as far back as 1980s, and its predecessor, “gross stress reaction,” was coined in 1952. However, the term “shell shock” is an older one, and made its mark in the minds of the public during the first world war.

On December 4, 1917, a psychiatrist by the name of W. H. R. Rivers published “The Repression of War Experience.” It does not actually use the words shell shock, but it was a ground breaking report in regards to the psychological toll that intense war could have on a person, and how that can in turn affect a person physically.

Rivers had a heart for soldiers—he had tried to enlist as a young man and was devastated when he couldn’t due to a history of typhoid. It is difficult to imagine the difficulties of seeing this quite apparent in so many soldiers throughout WWI, and then suffer through ridicule and skepticism when presenting that evidence. The British were particularly conflicted in their acceptance of shell shock as a diagnosis, and some were even tried for cowardice if it affected their military work. The Viscount Gort, a ranking, highly decorated officer in the British Army, said that you wouldn’t find shell shock in “good” units, and that it was a sign of weakness. Despite this friction with the powers that be, Rivers continued to press the issue and gave conclusive evidence in his report, where he outlines the varying examples of shell shock and how it can manifest in different ways.

Here is an excerpt from the report:

Another Case of Improvement after Cessation of Repression.The next case is that of an officer, whose burial as the result of a shell explosion had been followed by symptoms pointing to some degree of cerebral concussion. In spite of severe headache, vomiting, and disorder of micturition, he remained on duty for more than two months. He then collapsed altogether after a very trying experience, in which he had gone out to seek a fellow officer and had found his body blown into pieces, with head and limbs lying separated from the trunk.
From that time he had been haunted at night by the vision of his dead and mutilated friend. When he slept he had nightmares in which his friend appeared, sometimes as he had seen him mangled on the field, sometimes in the still more terrifying aspect of one whose limbs and features had been eaten away by leprosy. The mutilated or leprous officer of the dream would come nearer and nearer until the patient suddenly awoke pouring with sweat and in a state of the utmost terror. He dreaded to go to sleep, and spent each day looking forward in painful anticipation of the night. He had been advised to keep all thoughts of war from his mind, but the experience which recurred so often at night was so insistent that he could not keep it wholly from his thoughts, much as he tried to do so. Nevertheless, there is no question but that he was striving by day to dispel memories only to bring them upon him with redoubled force and horror when he slept.
The problem before me in this case was to find some aspect of the painful experience which would allow the patient to dwell upon it in such a way as to relieve it horrible and terrifying character. The aspect to which I drew his attention was that the mangled state of the body of his friend was conclusive evidence that he had been killed outright and had been spared the long and lingering illness and suffering which is too often the fate of those who sustain mortal wounds. He brightened at once and said that this aspect of the case had never occurred to him, nor had it been suggested by any of those to whom he had previously related his story. He saw at once that this was an aspect of his experience upon which he could allow his thoughts to dwell. He said he would no longer attempt to banish thoughts and memories of his friend from his mind, but would think of the pain and suffering he had been spared.
For several nights he had no dreams at all, and then came a night in which he dreamt that he went out into No Man’s Land to seek his friend and saw his mangled body just as in other dreams, but without the horror which had always previously been present. He knelt beside his friend to save for the relatives any objects of value which were upon the body, a pious task he had fulfilled in the actual scene, and as he was taking off the Sam Browne belt he woke with none of the horror and terror of the past, but weeping gently, feeling only grief for the loss of a friend.
Some nights later he had another dream in which he met his friend, still mangled, but no longer terrifying. They talked together and the patient told the history of his illness and how he was now able to speak to him in comfort and without horror or undue distress. Once only during his stay in hospital did he again experience horror in connexion with any dream of his friend. During the few days following his discharge from hospital the dream recurred once or twice with some degree of its former terrifying quality, but in his last report to me he had only one unpleasant dream with a different content, and was regaining his normal health and strength.”

Featured image courtesy of Wikimedia Commons

Here is an excerpt from the report:

Another Case of Improvement after Cessation of Repression.The next case is that of an officer, whose burial as the result of a shell explosion had been followed by symptoms pointing to some degree of cerebral concussion. In spite of severe headache, vomiting, and disorder of micturition, he remained on duty for more than two months. He then collapsed altogether after a very trying experience, in which he had gone out to seek a fellow officer and had found his body blown into pieces, with head and limbs lying separated from the trunk.
From that time he had been haunted at night by the vision of his dead and mutilated friend. When he slept he had nightmares in which his friend appeared, sometimes as he had seen him mangled on the field, sometimes in the still more terrifying aspect of one whose limbs and features had been eaten away by leprosy. The mutilated or leprous officer of the dream would come nearer and nearer until the patient suddenly awoke pouring with sweat and in a state of the utmost terror. He dreaded to go to sleep, and spent each day looking forward in painful anticipation of the night. He had been advised to keep all thoughts of war from his mind, but the experience which recurred so often at night was so insistent that he could not keep it wholly from his thoughts, much as he tried to do so. Nevertheless, there is no question but that he was striving by day to dispel memories only to bring them upon him with redoubled force and horror when he slept.
The problem before me in this case was to find some aspect of the painful experience which would allow the patient to dwell upon it in such a way as to relieve it horrible and terrifying character. The aspect to which I drew his attention was that the mangled state of the body of his friend was conclusive evidence that he had been killed outright and had been spared the long and lingering illness and suffering which is too often the fate of those who sustain mortal wounds. He brightened at once and said that this aspect of the case had never occurred to him, nor had it been suggested by any of those to whom he had previously related his story. He saw at once that this was an aspect of his experience upon which he could allow his thoughts to dwell. He said he would no longer attempt to banish thoughts and memories of his friend from his mind, but would think of the pain and suffering he had been spared.
For several nights he had no dreams at all, and then came a night in which he dreamt that he went out into No Man’s Land to seek his friend and saw his mangled body just as in other dreams, but without the horror which had always previously been present. He knelt beside his friend to save for the relatives any objects of value which were upon the body, a pious task he had fulfilled in the actual scene, and as he was taking off the Sam Browne belt he woke with none of the horror and terror of the past, but weeping gently, feeling only grief for the loss of a friend.
Some nights later he had another dream in which he met his friend, still mangled, but no longer terrifying. They talked together and the patient told the history of his illness and how he was now able to speak to him in comfort and without horror or undue distress. Once only during his stay in hospital did he again experience horror in connexion with any dream of his friend. During the few days following his discharge from hospital the dream recurred once or twice with some degree of its former terrifying quality, but in his last report to me he had only one unpleasant dream with a different content, and was regaining his normal health and strength.”

Featured image courtesy of Wikimedia Commons