We dredged him up, for killed, until he whined
“Oh sir, my eyes—I’m blind,—I’m blind, I’m blind!”
Coaxing, I held a flame against his lids
And said if he could see the least blurred light
He was not blind; in time he’d get it right.
“I can’t,” he sobbed.
… one sprang up, and stared
With piteous recognition in fixed eyes,
Lifting distressful hands, as if to bless.
And by his smile, I knew that sullen hall,—
By his dead smile I knew we stood in Hell.
Wilfred Owen
They’ll soon forget their haunted nights; their cowed
Subjection to the ghosts of friends who died,—
Their dreams that drip with murder; and they’ll be proud
Of glorious war that shatter’d all their pride…
Men who went out to battle, grim and glad;
Children, with eyes that hate you, broken and mad.
Siegfried Sassoon
On August 14, 1914, the war to end all wars began. It was destined to be, in the words of the eminent German sociologist Max Weber, a “great and wonderful war.”1 Civilization (whichever version of civilization one’s side was defending) would triumph, and the barbarians on the other side would be decisively defeated. And it would all be over by Christmas. Perhaps sooner: the Kaiser, seeing his troops off to the front in the first week of August, informed them: “You will be home before the leaves have fallen from the trees.”2
Except that they weren’t. Far from it. Instead, the conflict would drag on and on, and then drag on some more, on its Western Front chewing up the landscape of northern and eastern France, and, even more dramatically, chewing up a whole generation of young men sent off to fight for King and Country, Kaiser und Reich, Président et patrie, Donaumonarch und Kaisertum Österreich. Amidst the mud and the muck of the fields of Flanders, through the valley of the Somme, and all the way down to the Swiss border, millions of brave men would perish, and for what few afterwards could say. But alongside the corpses and those mutilated in body, a new kind of casualty of the killing fields soon began to surface, to infuriate the generals, to threaten morale and the ability to fight, and to occupy the attentions of the medical men charged with coping with battlefield casualties: the victims of what Charles Myers, a Cambridge medic and psychologist turned army doctor, famously called “shell shock.”
It was a condition that, for the careful observer, had been foreshadowed in the Boer War at the turn of the century and in the Balkan War of 1912–13, even among some of the survivors of America’s great bloodletting, the Civil War, many of whom had flocked to the neurologists’ consulting rooms in its aftermath. But psychiatric misfits materialized in 1914 and 1915 on a scale and in dramatic forms that made them impossible to ignore. And in the remaining years of the war and its immediate aftermath, shell shock became epidemic, even as the military brass forbade the use of the term. “War,” in Sir Michael Howard’s apt phrase, “was a test of manhood”3—and it was a test, under the new conditions of industrialized warfare, that many seemed destined to fail. Were such men mad, or merely malingering, sick, or slyly evading their duty?
The first months of the war brought a rapid German advance, and then stalemate and bloodshed on a massive scale, sufficient, for example, essentially to wipe out the pre-war professional British army by December 1914. But a legion of patriotic volunteers hastened to replace their ranks, and the war machine relentlessly ground on. By 1916 the British found they had to institute conscription; the French had seen near mutiny among their troops (and almost half their army would mutiny in the spring of 1917); and the Germans and the Austrians had lost any illusions about the brevity of the war but clung to a determination “to see it through.” Dug into an elaborate series of trenches protected by barbed wire, the opposing armies faced each other across no-man’s-land, periodically launching suicidal assaults that moved the front a few hundred yards east or west, and then losing the territory bought with so much blood not long afterwards. Nowhere was this cycle to be more evident than in the terrible series of battles in 1917 near Ypres, known to the British as Passchendaele. Here, where the water table lay too close to the surface to permit proper trenching, the assaults proved particularly murderous. During one battle, amidst torrential downpours, the soldiers crawled into shell holes created by the thousands of rounds of artillery launched by both sides, seeking some margin of safety. During the night, one junior officer, Edwin Vaughan, lay and listened.
From other shell holes from the darkness on all sides came the groans and wails of wounded men; faint, long sobbing moans of agony, and despairing shrieks. It was too horribly obvious that dozens of men with serious wounds must have crawled for safety into new shell holes, and now the water was rising about them and, powerless to move, they were slowly drowning. Horrible visions came to me with those cries, [of men] lying maimed out there trusting that their pals would find them, and now dying terribly, alone amongst the dead in the inky darkness. And we could do nothing to help them … [By morning] the cries of the wounded had much diminished … and as we staggered down the road, the reason was only too apparent, for the water was right over the tops of the shell holes.4
By the end of 1917, a million French soldiers had been killed, out of a male population of perhaps twenty million, 640,000 of them in the first year and a half of the war. German casualties were even higher, because they were fighting on two fronts: a million of their troops had been killed by the end of 1916. The British lost 90, 000 men by November 1914. At the Somme offensive, which began on July 1, 1916, 20, 000 British troops were killed and 40, 000 were wounded on the first day alone, slaughtered by German machine guns and artillery as they marched futilely forward, never, in most instances, even reaching the German trenches. Many of the wounded died agonizing drawn-out deaths where they lay over the next several days, beyond the reach of rescue. By month’s end, the English and French had lost 200, 000 men, and the Germans 160, 000, and the industrialized killing had moved the front barely 3 miles. When the “offensive” was officially abandoned on November 19, stopped by the rising tide of mud, each side had suffered over 600, 000 casualties.
But it was not just the pointless sacrifice, the mass slaughter, and the sight of the maimed and frightfully wounded that wore on men’s nerves. Almost worse was the daily sense of fear and loss of control, and the tension caused by the inability to escape from an intolerable situation. All the while, of course, officers and men were meant to obey the injunction to display unnatural courage, even when a high-explosive projectile might, at any instant and without any warning, end one’s existence. Both “must remain for days, weeks, even months, in a narrow trench or stuffy dugout, exposed to constant danger of the most fearful kind; namely, bombardment with high explosive shells, which comes from some unseen source, and against which no personal agility or wit is of any avail.”5 That was the existential reality of a war of attrition, conducted with high explosives, with flesh-tearing weapons (bullets, bayonets), and ultimately even with the horrors of poison gas, by politicians and generals seemingly—and all too often actually—without conscience.
Perhaps it should occasion no surprise that, under such circumstances, many officers and enlisted men proved unequal to the task. No army was spared the epidemic of nervous disease that seemed to strike at an accelerating pace. The effects on military preparedness and military morale threatened to become overwhelming. What was one to make of soldiers who suddenly lost the power of speech or hearing; who professed to be blind; who stammered, or twisted convulsively, or walked with a peculiar and unnatural gait; who wept or screamed unceasingly, or displayed other symptoms of uncontrollable emotionality; who claimed their limbs were paralyzed; who claimed to have lost all memory; who could not sleep, or who, if sleeping, experienced the most frightful nightmares that left them bereft of rest and on the verge of collapse; who suddenly, in other words, manifested physical symptoms that rendered the notion of sending them into battle apparently absurd?
For many of the military brass, the answer was obvious: these creatures were unmanly cowards and malingerers, seeking to shirk their patriotic duty. They should be offered the choice of abandoning their “pretended” illnesses, or being shot. A relative handful did suffer the latter fate, but ordering firing squads to kill, not just a dozen or two of their comrades, but thousands and even tens of thousands of them, was perhaps too much even for the generals (and if not for them, certainly too much for the civilians behind the lines to stomach). Army medics were perforce handed a dual task: to explain what had gone wrong; and to develop remedies that would, in the shortest time possible and to the maximum extent possible, return those they treated to the military machine so that they could kill and be killed.
The term “shell shock” encapsulates one initially plausible account of the mass breakdowns. The concussive force of the high-explosive projectiles that rained down on the troops traumatized the bodies of those exposed to it. Shells that exploded were a novel form of weaponry, and many thought that the blast that accompanied their arrival inflicted invisible injuries to the bodies of those exposed to the explosion, even those who initially appeared unharmed. Their nervous systems were damaged in subtle if not directly observable ways: tears to the spinal cord, or minute hemorrhages and micropunctures of the brain. Some even speculated that winds generated by passing machine gun bullets mimicked the effects of shell blast, or that the problems were caused by the poison gases released by the explosions. It was these real, but undetectable, bodily injuries that were the cause of the soldiers’ symptoms.
Such theories had the distinct advantage of providing the sort of somatic etiology that doctors preferred, but, given that the postulated traumatic injuries were undemonstrable, they had the equally distinct disadvantage of encouraging malingerers to simulate the behaviors that provoked the diagnosis, potentially a disaster for the military machine. Besides, accumulating evidence cast doubt on the premise: soldiers who had never been within miles of the front exhibited the signs of shell shock; the physically injured and maimed likewise seemed remarkably exempt from its ravages; prisoners of war, safe from further physical danger, were miraculously spared the symptoms. Some neurologists and army medics found ways to sustain their belief in “shock” as a genuine cause of the cases that came before them. Many more, however, saw stress and suggestibility as the root of the evil.
Even in these cases, however, ways of framing mental disease that pre-dated the war offered the intellectual resources to rescue a physical account of the disorders. The degenerationist theories that had dominated asylum medicine from the last third of the nineteenth century forwards had already been employed by Charcot to “explain” hysteria. Many were drawn to a similar account of shell shock. It had, these doctors acknowledged, a psychological component, as the cruelties and pressures of trench warfare relentlessly wore upon the men. But, in the words of one of Britain’s leading alienists, Charles Mercier, mental disorder did not occur in “people who are of sound mental constitution. It does not, like smallpox and malaria, attack indifferently the weak and the strong. It occurs chiefly in those whose mental constitution is originally defective, and whose defect is manifested in the lack of the power of self-control and of forgoing immediate indulgence.”6 Such degenerates were almost as defective physically as mentally—weak, terrified, and decrepit souls whose breakdowns were thoroughly predictable and had little to do with the exigencies of war; or else cowardly malingerers shirking their duty to comrades, king, and country—people deserving harsh treatment rather than sympathy and pensions.
Similar ideas were embraced by many French and German physicians. Charcot’s student Josef Babinski, for example (known today mostly for his eponymous reflex), had done much to discredit the work of his maître once the grand old man was safely dead. Babinski had insisted that, under Charcot, the boundaries of hysteria had been drawn far too broadly. Most patients had, in reality, been suffering from real neurological illnesses that had simply been misdiagnosed. The small subset of hysterics that remained was suffering from a condition he proposed—as we have previously seen—ought to be renamed pithiatisme, which meant “curable by persuasion.” If “persuasion” might cure such cases, it was suggestion, he argued, that had provoked them. But only the already defective would have succumbed, since “one must be abnormal to be susceptible to suggestion”7—a variant of the idea that only the degenerate were hypnotizable. Before the war, Babinski’s ideas were deeply controversial in many quarters, but the epidemic of shell shock brought a reappraisal. If the victims of this syndrome were hysterics, then their symptoms were the product of suggestion, and they might be “persuaded” to abandon them. Quite how that persuasion might be accomplished was, of course, the crucial question.
In the 1880s and 1890s, the courts in Britain, the United States, and Germany had seen a rash of claims from those victimized by accidents in the workplace or in train crashes. As well as those with obvious physical illnesses, there were others who displayed the symptoms of a traumatic neurosis, and a fierce controversy had erupted between those who claimed that “railway spine” and the like were the result of real physical trauma too subtle for existing instruments to detect, and those who saw them as “hysterical” forms of malingering, created by suggestions from complaisant physicians and the prospect of financial compensation. Such debates grew particularly fierce in Bismarck’s Germany, where the legislation of 1884 giving pensions to the victims of railway and industrial accidents had been extended in 1889 to cover mental and nervous debility. Critics had charged that the epidemic of “pension neurosis” and insurance fraud was a direct result of the financial incentives this legislation created. No pensions, no pathological and pathogenic delusions and desires, and no neuroses. If the complaints were “mere hysteria,” then work, not pension-supported idleness, beckoned—a stance that, as Paul Lerner has argued, created a “uniquely German” impetus to dislodge hysteria “from its exclusive association with women.”8
Hermann Oppenheim, who had been the most vigorous proponent of the contrary proposition—that these travails were symptomatic of real somatic trauma—remained true to his beliefs when he encountered the first psychiatric casualties of the war. But now his assertions were viewed not just as economically costly, but as dangerous to the war effort, and thus unpatriotic. German psychiatrists hastened to a meeting in Munich in September 1916, at which Oppenheim was ritually humiliated, his claims discredited, his authority as a professional stripped away. Just as his earlier doctrines were alleged to have helped to create “the heavy burden of thousands of work-shy individuals … the accident hysterics, whose epidemic appearance was made possible by the introduction of an intangible and uncontrollable concept”—traumatic neurosis—so a repetition of the error in wartime would, as one German psychiatrist put it, “artificially create an epidemic of war neurosis.”9
Henceforth, no one of any consequence on the German side of the lines dissented from the notion that “shell shock” was simply male hysteria, a flight into illness to escape hellish dangers. Karl Bonhoeffer, for instance, had treated soldiers from both sides after the battle of Verdun. It was enough to convince him that
the hysterical reactions are the result of the more or less conscious wish for self-preservation. The difference in behaviour between the Germans who came directly from the line of fire into the hospital station and the French prisoners was striking. Among the Germans the familiar forms of hysterical reactions could be found with great frequency, while among the French, who had come from the same front circumstances, no trace of hysteria was to be seen. For them, the danger had disappeared. “Ma guerre est fini,” was the common turn of phrase. There was, hence, no longer any reason for an illness to develop.
No wonder many German psychiatrists came to call shell shock Shreckneurose, or “terror neurosis.”10
If the French and the Germans thus converged on the notion that shell shock was a mass epidemic of male hysteria, many British doctors as well were coming to see shell shock in increasingly psychological terms. Unbearable tension, fear, disgust, grief, horror, a litany of strong emotions and frightful experiences were seen as the possible precipitants of a “flight into illness.” To employ an anachronistic term, they recognized that both officers and men were trapped in a double-bind: their powerful drives toward self-preservation could find no obvious outlet. To flee would invite being shot as a deserter, and would for many be a deeply cowardly and “unmanly” act. To stay meant more daily trauma, from which the only possible release seemed to be death. Hence the development of psychosomatic symptoms: mutism, hysterical blindness, uncontrollable shaking, paralyses, disturbances of sleep and gait, disorientation, and cardiac palpitations—so-called soldier’s heart. Now an inability to perform one’s duty had a “physical” cause.
It did not go unremarked that many of the psychological mechanisms that produced this epidemic of male hysteria could be understood in terms of the intellectual theories of hysteria and neurosis that had been developed by Freud and his followers. The role of traumatic memories, the attempts at repression, the conversion of mental conflicts into physical symptomatology, the significance of dreams, the value of abreaction and catharsis, the very notion that hysteria could be understood and explained in psychological terms: these were all elements of the Freudian corpus that were incorporated into the understanding and to some degree the therapy of shell shock. To be sure, therapeutic interventions along psychotherapeutic lines were largely (and for obvious reasons) confined to the officer class, who, incidentally, suffered from shell shock at four or five times the rate found among enlisted men. And the adoption of a modified psychoanalytic schema was made easier because of the perceived irrelevance of Freud’s claims about the etiological significance of childhood and sex to hysteria in shell-shock cases, since these two elements were always the aspect of his theories with which most Edwardian doctors were most uncomfortable. What that meant, of course, as Janet Oppenheim has trenchantly pointed out, was that “Freud’s work was, in fact, eviscerated for its first significant application in Great Britain and, no doubt, that operation made it more palatable to a suspicious public, ready to reject ‘Teutonic science’ out of hand.”11
If the larger framework that had suggested their relevance had been castrated, to employ a slightly different surgical metaphor, in its reduced state, the Freudian emphasis on dreams, trauma, and mental conflicts undoubtedly drew considerable attention from a number of physicians as the war wore on. The psychiatrist John T. MacCurdy, visiting soldiers under treatment in England in 1917, encountered a young British lieutenant who had fought bravely at the front since the early months of the war. Escalating nightmares and insomnia had led to his breakdown in March. Night after night, he dreamt that “he was back on the Somme front, and being shelled mercilessly. Shells would come closer and closer to him, finally one would land right on top of him and he would awake with a shriek of terror.” On other occasions, “when falling off to sleep he would have … hallucinations of Germans entering the room, and with these visions, too, there was great terror.” Not surprisingly, “he was in general quite convinced that he was physically and nervously a complete wreck,” afraid even to venture out into the hospital grounds.12 An officer treated in Scotland by the Cambridge physician W. H. R. Rivers had been blown up by an incoming shell and buried by the blast debris, yet somehow survived and continued to fight. Then he went in search of
a fellow-officer and found his body blown to pieces with head and limbs separated from his 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 in 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 utmost terror.13
For others, the nightmares involved no distortion of reality, merely an incessant replaying of the event that had driven them over the edge. Dreams were bad, but memories were often worse. The pre-eminent American brain surgeon Harvey Cushing, then a young army medic, later recalled an equally young “Captain B.” telling him:
The chief trouble now is dreams—not exactly dreams, either, but right in the middle of an ordinary conversation the face of a Boche that I have bayoneted comes sharply into view, or I see the man whose head one of our boys took off with a blow on the back of his neck with a bolo knife, and the blood spurted high in the air before the body fell. And the horrible smells! You know I can hardly see meat come on the table.14
Death was omnipresent. Wilhelm Reich recalled “barbed-wire fences, hung with bodies.” Battlefields were littered with corpses.
What good does it do to cover them with sand and lime, or to throw a tent half over them, in order to escape their black, bloated faces? There were too many. Everywhere, shovels struck something buried. All the secrets of the grave lay open in a grotesquerie worse than the most lunatic dream. Hair fell in clumps from skulls like rotting leaves from autumn trees. Some decayed into a green fish-flesh, which gleamed at night through the torn uniforms.15
Even worse experiences awaited some poor souls. The use of poison gas by both sides—chlorine and the still more damaging phosgene in 1915, and by 1918 “mustard gas”—led to horrific deaths. Those who donned their primitive masks quickly enough were forced to watch the gruesome effects on their comrades who were not so lucky: lungs filling with liquid that caused slow suffocation; water and blood flowing from the mouths of victims as their internal organs were reduced to slime and collapsed; throats, lungs, and eyes blistered and burned, producing a slow and agonizing death, “white eyes writhing,” “blood … gargling from the froth-corrupted lungs.”16 W. H. R. Rivers, who treated shell-shocked officers sent from the front to Craiglockhart in Scotland, encouraged them to speak of their trauma, seeking to produce a catharsis. But one case, in particular, defeated his best efforts. The young man had been
flung down by the explosion of a shell so that his face struck the abdomen of a German several days dead, the impact of his fall rupturing the swollen corpse. Before he lost consciousness, the patient had clearly realized his situation and knew that the substance which filled his mouth and produced the most horrible sensations of taste and smell was derived from the decomposed entrails of an enemy.17
No wonder this patient routinely vomited when called upon to eat.
In 1918 the American artist John Singer Sargent painted the enormous canvass Gassed, after being sent to the front to portray the cooperation between British and American troops. At a casualty station near Arras, he saw an orderly leading a group of soldiers blinded by mustard gas. Beyond their devastating direct effects on the unprotected, gas attacks had a deeply traumatic effect on those who survived. Sargent’s painting, in choosing to adopt the conventions of the frieze, somewhat undercuts the horrors of such scenes, horrors that are more vividly and memorably captured in the bitter lines of Wilfred Owen’s “Dulce et Decorum Est” (1917).
18. Gassed, by the American artist John Singer Sargent, an enormous canvass (7½ ft. × 20 ft.) that hangs in the Imperial War Museum in London. (Imperial War Museum)
Gas! Gas! Quick, boys! An ecstasy of fumbling,
Fitting the clumsy helmets just in time,
But someone still was yelling out and stumbling
And floundering like a man in fire or lime.
Dim through the misty panes and thick green light,
As under a green sea, I saw him drowning.
In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.
If in some smothering dreams, you too could pace
Behind the wagon that we flung him in.
And watch the white eyes writing in his face,
His hanging face, like a devil’s sick of sin;
If you could hear at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est,
Pro patria mori.
Thomas Salmon, the American psychiatrist, was another contemporary observer who noted a close correspondence between the hysterical symptoms of patients and their particular wartime experiences: “Thus a soldier who bayonets an enemy in the face develops a hysterical tic of his facial muscles; abdominal contractions occur in men who have bayoneted enemies in the abdomen; hysterical blindness follows particularly horrible sights; hysterical deafness appears in men who find the cries of the wounded unbearable, and the men attached to burial parties develop amnesia.”18 Reality was, of course, never so neat, but for those who made such connections, the psychogenic origins of shell shock were too obvious and powerful to ignore.
Still, even these modified psychoanalytic accounts of this epidemic of male hysteria always remained a minority taste, just as only a comparative handful of shell-shock victims were treated with sympathetic attention, talk therapy, and hypnosis. But, because the men in question were officers, and, in a number of instances, major war poets, whose images of the trenches haunt even the contemporary imagination—men such as Wilfred Owen and Siegfried Sassoon—disproportionate attention has been lavished on them and those who treated them, W. H. R. Rivers, A. J. Brock, and others. They have even materialized in fictional and filmic form—for example, in Pat Barker’s Resurrection trilogy, and the film derived from the books, Regeneration (released in the United States as Behind the Lines).
Because the treatment of an Owen or a Sassoon was relatively humane (though ultimately still designed to return them to the killing fields, where Owen would die, ironically after the war’s official end), and because of the stark contrast that exists in the treatment of many of the “other ranks,” it would be easy to construct a link between the recognition of shell shock’s psychogenic origins and a more understanding, “kinder” therapy. Easy, but wrong. Whichever side of the mortal combat one examines, the more common link is between an assimilation of shell shock to the pre-war conceptions of hysteria, and the infliction of painful, almost sadistic, remedies.
Perhaps that should occasion little surprise. After all, however much one insisted that the symptoms were the product of the unconscious, the idea that hysteria was “all in the mind” conjured up uncomfortable echoes of the generals’ conviction that it was all fakery and weakness of the will. The line between shell shock and cowardice seemed blurred at best, and many of the doctors who treated hysterical soldiers were only a little less inclined than their military superiors to conflate the two. So far as they could tell, “hysterical” paralyses and the faked paralysis of the malingerer were equally unanchored in any real neurological disorder, and both reflected an enfeeblement of the will. With immense pressures on the medics to return as many patients as possible to the front lines, and little official concern with the long-term psychological state of the cannon fodder, the temptation to resort to autocratic, sometimes brutal, forms of treatment was great.
There were some experiments with hypnotism, notably by the charismatic Max Nonne, who treated some of the German troops, but few could replicate the dramatic results he claimed to obtain. Instead, direct attempts to strengthen the will and to induce the soldier to relinquish his symptoms were far more prevalent. Independently, the French, the Germans, the Austrians, and the British all responded to the catastrophic threat to military manpower by employing a mixture of “conscious suggestion” reinforced by electrotherapy. There were remarkable overlaps in the different approaches. In Germany, a Fritz Kaufmann invented what was quickly dubbed the “Kaufmann cure,”19 the use of a combination of electricity and forced military drill, to the accompaniment of loudly shouted orders. Intense and painful electrical stimulation was applied to apparently paralyzed limbs for several minutes on a repeated basis, for hours at a time, till the patient gave way and the hysterical paralysis resolved itself. Among the Austrian troops, under the supervision of Julius von Wagner-Jauregg, the Professor of Psychiatry at the University of Vienna, a Dr Kozlowski applied powerful electrical shocks to men’s mouths and their testicles, forcing other shell-shocked soldiers to observe the “treatment” they were about to undergo.
The British might (and did) denounce these activities as further evidence of the depravity of the Huns, but only by mobilizing a not-atypical hypocrisy. For they and their French allies employed almost precisely the same weapons on their own men. Babinski, who had insisted from the start that shell shock was simply the product of hysterical suggestion, advocated, in Marc Roudebush’s words, “a direct and systematic assault on the psychological defenses of hysterical patients.”20 Other French neurologists hastened to give substance to his recommendations. Along the banks of the Loire, Clovis Vincent set up his reeducation camp. Here, torpillage, the use of electrodes designed to deliver a fearsomely sharp galvanic current to the patient’s body to “encourage” the paralyzed to move, was accompanied by other techniques deliberately designed to frighten the patient. Vincent added the force of his own personality, and an absolutely implacable demeanor to the occasion, insisting that the single treatment would continue as long as necessary to overcome the “debility of self-control and of the will.” In the words of André Gilles, an enthusiastic disciple, “these pseudoimpotents of the voice, of the arms or legs, are really only impotents of the will; it is the doctor’s job to will on their behalf.”21 Treatment must be swift and merciless.
Lewis Yealland, a young Canadian doctor practicing at the Queen Square Neurological Hospital in London, and his colleague Edgar Adrian (later to win a Nobel Prize) agreed completely. Shell shock developed “as a result of autosuggestion acting on a mind enfeebled by fear and emotional tension and this autosuggestion becomes so strong that the patient resists all attempts to undermine his fixed belief.” In treatment, “he is not asked whether he can raise his paralysed arm or not; he is ordered to raise it and told that he can do it perfectly if he tries. Rapidity and an authoritative manner are the chief factors in the re-education process.” Once again, in case an authoritative command did not suffice, another weapon was held in reserve. A mute soldier is brought into a darkened room, fastened to a chair, and told he must speak. Silence. Mouth propped open with a tongue depressor. A strong electrical current applied to the pharynx. The pain is so excruciating that the soldier arcs back in his chair, tearing the electrodes loose from the battery. Again, they are applied to his throat and he is ordered to speak. After an hour, a muffled “ah.” Yealland informs the man that he can and will talk, and will not leave until he does. Hours pass. The man begins to stammer and cry. Not enough. More “strong faradic shocks are applied.” The soldier at length talks. Only when he says “thank you” for his cure is he allowed to leave.22
For some feminist theorists, the passivity, the impotence, the close confinement of the troops in both the physical and the social sense, their absolute lack of autonomy, their role imprisonment within the confines of the ideology of masculinity and the cult of manliness, and the supposed connections of these constraints to the conversion of their distress into physical symptoms were analogous to the role imprisonment suffered by upper-middle-class Victorian ladies, and the soldiers’ hysteria thus directly comparable to theirs. Elaine Showalter has even suggested a further analogy between the brutality of the “therapies” visited upon the shell-shocked, and the sadistic responses of a Brudenell Carter, a Baker Brown, or a Robert Battey to their female hysterical patients. The parallels are interesting on some levels, if easy to overdraw. One wonders, for instance, about how valid it is to compare the wretchedness and brutality of the trenches, the immediate and unceasing threat to the integrity of one’s body, indeed one’s very existence, to the gilded cage within which a class of privileged women lived—however existentially empty and male-dominated much of their existence proved to be. More seriously, however, such analogies rest on the notion that hysteria was the peculiar province of the female upper classes, a claim that would have astonished Charcot’s legions of working-class hysterics, male and female alike, to say nothing of the great man himself. Still, if anyone had doubted the existence of hysteria in the male, the sight of the returning victims of shell shock rudely disposed of that prejudice.
Not that these particular war veterans generally received a warm welcome. The victorious British reneged as often as possible on promises to provide pensions, let alone efforts at treatment, for those who remained battered in mind. In the chaos of a defeated and dismembered Austria–Hungary, as in the struggling post-war Germany, such pathetic figures were a reminder of a bitter defeat, and an impossible drain on a faltering public treasury. The French, as Marc Roudebush has shown, dismissed shell-shocked soldiers as an embarrassment or, worse, a threat to the health and virility of the nation: no pensions or official recognition of their service for them. Only in the United States, perhaps because it had entered the war so late, and so had fewer casualties, or perhaps because of the lobbying efforts of the American Legion, were the shell-shocked veterans eventually accepted as battle-scarred heroes, worthy of acknowledgment and thanks. But then, from its Civil War onwards, the United States has routinely treated its military veterans as the only group worthy of the protections of a welfare state: medical care at public expense; pensions for disabilities; public support for getting an education; and so forth.
As for their doctors, as is customary, those on the winning side escaped all censure. Briefly, it appeared that those on the losing end might be called to account. Their techniques were bitterly resented by the troops and their families, and, in the short revolutionary fever that seized Germany after the Armistice, neurologists were chased from their offices, and there was dark talk of revenge. But the re-establishment of order under the Weimar Republic soon brought such mutterings to naught, and the old hierarchies re-established themselves. In dismembered Austria–Hungary, Wagner-Jauregg found himself on trial for war crimes, the details of his tortures put on public display, only for professional solidarity to trump evidence once more, and for an acquittal to be rendered on all charges. (Wagner-Jauregg would win a Nobel Prize in 1927 for introducing malaria therapy for the treatment of General Paralysis of the Insane, aka tertiary syphilis.) And, with shell shock retreating from public view, the doctors who had sought to treat it largely lost interest, and returned to their peacetime pursuits. The epidemic of male hysteria was no more.