Soldiers' Mental Health in the Deadly Trauma of Conflict

"It is my opinion that the methods now employed in the British, American, and Canadian armies will not materially lower the incidence of psychiatric casualties in a fighting force."
"There are various reasons for these opinions but two of them are fundamental. First, there is direct conflict between the needs of the service and the needs of the individual soldier as assessed by his physician."
"Secondly, the attitudes and behaviour of the successful soldier are contrary to most of his previous teaching. He must not allow death or mutilation of his comrades to prevent him from reaching his objective, and finally , he must pretend that he is glad to risk his life for that cause."
"Every soldier has his breaking point."
Col.Frederick Van Nostrand, senior neuro-psychiatrist, Canadian Army, World War I

German prisoners carry a wounded Canadian past ruined buildings in Cesena, Italy. Photographer unknown. (Photo provided by Mark Zuehlke)

 An estimated ten thousand Canadian soldiers were diagnosed with shell shock during the 'war to end all wars' from 1914 to 1918, the First World War. Military doctors termed the illness as "war neurasthenia", its symptoms including depression, insomnia, headaches irritability, fever, perspiration, difficulty in concentrating and decreased energy, among other symptoms. Doctors, although naming the condition 'shell shock', were baffled by the flood of traumatized soldiers resulting from every major battle.

There was a tendency to attribute the phenomenon to weakness of an emotional nature, or quite simply malingering soldiers and with that kind of diagnosis came distaste and contempt. Which led to a very special kind of punishment when over 300 British and Commonwealth soldiers were sentenced to be executed for the crime of desertion or cowardice throughout the war years. In our more enlightened age the diagnosis is vastly different, and named post-traumatic stress disorder (PTSD).

Once labelled shell shock, battle exhaustion, combat stress reaction, and latterly PTSD. Dr.Charles Myers identified the phenomenon of shell shock in 1915, writing of case histories of three soldiers who had been traumatized by shell explosions, and published in the medical journal The Lancet. He noted that functions such as sight, smell, taste and memory were damaged, but not their hearing. "The close relation of these cases to those of 'hysteria' appears fairly certain", he wrote. "Hysteria" was a condition generally recognized in women who typically seemed high-strung, acting out nervousness, fainting or fits.

Some in the medical community hypothesized physical brain injury resulting from repeated exposure to blast waves from exploding shells, typical of the new industrialized warfare. That was rather upset as a theory when others pointed out that some afflicted with shell shock had never been exposed to explosions; that it was "neurasthenia", triggering the stress of war. A Canadian psychiatrist, Dr.Lewis Yealland proposed a different school of thought, of shell shock as a personal failure of character.

As a clinician at the National Hospital for the Paralyzed and Epileptic in London, Dr. Yealland set about reconditioning traumatized soldiers employing powerful electric shocks, occasionally cigarette burns as well,  along with the power of suggestion as a workable therapy. During the war years, 196 patients underwent his treatment by electrotherapy, and he wrote and published the results of his treatment in 1918, his book titled Hysterical Disorders of Warfare.

Vimy Ridge and the men who drove the Germans from it at the Battle of Vimy Ridge.
Handout photo, Library and Archives Canada

The Royal Canadian Air Force had an uncompromising attitude with aircrew developing psychiatric conditions and refusing to fly, branding them as "lacking in moral fibre" (LMF), demoting or dishonurably discharging them. The senior psychiatrist in the Canadian Army, Col.Frederick Van Nostrand, insisted battle exhausted soldiers be swiftly treated close to the front lines, then dispatched back to action. Hundreds of soldiers treated weekly at field dressing stations for acute battle stress were sedated, had two days of rest, received therapeutic counselling, and were then returned to action.

"The methods that were used were no better than flipping a coin. None of it worked in terms of predicting who would break down or who would not break down under conditions of combat" (when medical officers attempted to identify recruits with emotional instability preemptively), noted Canadian military historian Terry Copp, professor at Wilfred Laurier University, who found that ground troops had represented 90 percent of battle exhaustion cases in the Canadian military in the Last Great War.

A view of 'V' Beach, Cape Helles, Gallipoli, taken from SS River Clyde.