‘You love us when we’re heroes home on leave,’ wrote the First World War poet Siegfried Sassoon, ’or wounded in a mentionable place.’
For a majority of soldiers, then as now, the least ‘mentionable place’ was not on the body but in the brain.
While an injury to an arm or leg was considered honourable, when the there was no physical cause of their disability it was dismissed as either malingering, cowardice or both.
There was little understanding of or sympathy for mental breakdown, from which hundreds of thousands of soldiers suffered – as they still do today – under combat conditions.
‘Honourable Wounds’ in WW1 caused by shot and shell
Lack of Moral Fibre
The British tended to diagnose ‘other ranks’ with mental breakdown, having Lacking Moral Fibre (LMF) and shot over 300 of them. Officers, like Siegfried Sassoon, were sent to special “mental hospitals” when they received talking therapy and drugs.
In this blog I want to talk a little about the nature of mental breakdown during the First War, and how it was viewed by doctors.
This is relevant to modern history since, as I argue in my new book Triumph of the Will? Based on US Intelligence documents it seems more than likely that the blindness from which Adolf Hitler suffered in October 1918, was due to mental breakdown not physical injury.
And it was the treatment he received to cure his blindness which, I contend, transformed him from a purposeless drifter into a ruthless and single-minded dictator.
Mental Breakdown Takes Doctors by Surprise
For the first few months of the war, mental breakdown among troops on all sides was so insignificant that doctors attached to the 1st Bavarian Army Corps were able to report:
‘The percentage of mental disorders in the field army is extraordinarily small and cannot be compared to the numbers observed in other wars and even in other armies.’
It seemed the optimistic belief that warfare would benefit mental health by reversing the ‘damaging influences of civilisation’ (Kulturschädlichkeiten) would be borne out by events.
One German psychiatrist recounted how, in the year leading up to the outbreak of war, he had treated: ‘A whole series of weak-nerved youths . . . anxious, cowardly, irresolute, weak-willed little creatures, whose consciousness and feelings were determined only by their own egos, and who amounted to nothing more than whiners, complaining of physical and mental pain. Then came the war. The illnesses fell away in an instant. They reported to their divisions and – what seems even more remarkable to me – every single one of them, with only one exception, has held up to this day. . . Thus, even among those with sickly dispositions the great purifier war has done its work.’
War regarded by doctors as a ‘great purifier’ in 1914
The War Turns to Stalemate
By 1915, the swift and decisive victory all sides had confidently predicted in 1914, had proved illusionary. With the German advance brought to a halt, and troops bogged down in the mud of the Western Front, it was becoming increasingly apparent to German, French and British doctors alike that mechanised warfare breaks not only bodies but minds.
Soldiers, first in their hundreds, then by the thousand, and then in hundreds of thousands, were being crippled without a drop of their blood being spilled.
By the winter of 1917 war neuroses had risen to the point of parity with physical injuries, up from 14 per cent of all injuries in 1914 to 45 per cent three years later.
‘Their number has grown and grown,’ one doctor reported in 1917. ‘Scarcely is one nerve hospital opened than it fills up and space must be found somewhere else. We’ve now got to the point where nervous illness represents the most important medical category and in our province the nerve hospitals are practically the only ones that are always full.’
Some patients were partially paralysed, others lacked all co-ordination or were plagued by constant tics and tremors. There were soldiers whose limbs were contorted by violent seizures, those perpetually bent at an acute angle, others who were blind, deaf or mute, many whose speech was made incomprehensible through stutters and stammers.
‘Wounded in an ‘unmentionable place’ – WW1 soldier showing
the physical signs of mental breakdown.
The Search for a Cause
At first, the German medical profession responded as if the soldiers had been the victims of some ‘colossal industrial accident’ by attributing their disabilities to what was quaintly termed ‘Railway Brain’.
This diagnosis had first been made in the 1880s by Germany’s most eminent neurologist, Hermann Oppenheim, while he treated the survivors of railway accidents.
Dr Hermann Oppenheim
Although apparently uninjured, some of the victims displayed tremors, tics, stutters and partial paralyses similar to those now being found among the soldiers. Oppenheim concluded the force of impact between two speeding trains had caused tiny lesions in the brain or nervous system. He argued that, despite being undetectable, even using a microscope, these were sufficient to account for the disabilities.
Collision between two speeding trains in 1880. Victims often suffered injuries for which doctors could find no physical cause.
Once the war had started, Oppenheim extended his theory to account for the effects of relentless artillery bombardments, and the explosion of bombs, mines and grenades. These too, he suggested, produced undetectable lesions in the brains and nervous systems of soldiers.
WW1 doctors believed explosions produced microscopic lesions in the brain.
This explanation was eagerly adopted by the medical and military authorities, who were reluctant to accept that their courageous lads could ever suffer a mental breakdown. The phrase used by the British to describe these invisible injuries was ‘shell shock’, implying that the impact of the exploding ordnance had physically injured the sufferer.
German neurologists even began distinguishing between simple Granaterschutterung (shell explosion), Granatexplosionslahmung (shell paralysis) and Granatfernwirkung (the indirect effects of an explosion).
Although the lack of any physical evidence had caused doctors on both sides of the conflict to feel uneasy about Oppenheim’s theory from the start, it was not until the summer of 1916 that the ‘microscopic lesions’ theory met its first serious challenge.
It came in the form of a study by Dr Harold Wiltshire, a captain in the Royal Army Medical Corps, who had been treating British troops in a French hospital.
Early in the war, Wiltshire, an experienced London physician, had been among the many doctors who viewed the hardships and hazards of trench life as beneficial to the soldier’s health.
After twenty months treating mental breakdowns, and following consultations with other front-line doctors, he published an authoritative report stating that his patients were mentally rather than physically injured.
The wide variety of signs and symptoms lumped together under the label ‘shell shock’ was, he argued, caused by their ‘psychological resistance being gradually exhausted under the stress of war: ‘
First Accepted Then Rejected – First Rejected Then Accepted
Although initially rejected by the military authorities, Wiltshire’s conclusions received considerable support from other front-line psychologists, psychiatrists and neurologists.
Oppenheim’s ‘Railway Brain’ theory was finally laid to rest during a heated debate at a session of the German Association for Psychiatry in Munich in September 1916.
Psychiatrists, argued that not only must Oppenheim’s theory be rejected but that psychiatrists must come to terms with the idea that functional disorders of the type they were now treating in vast numbers represented not a medical but a purely psychological problem.
With ‘Railway Brain’ consigned to psychiatric history, doctors were left with two possibilities – neurasthenia and hysteria.
What these terms meant and how they were treated will be the subject of my next blog.