In the final months of 1914, medical officers on the Western Front began seeing a new kind of casualty. Soldiers who had no physical injury were displaying a wide range of alarming symptoms. Some appeared to be completely dazed or were shaking uncontrollably, others had lost their sense of taste or smell, or were suffering from blindness, mutism and various kinds of paralysis. It was not until February 1915 that the term ‘shell shock’ first appeared in print, in the Lancet. It was originally intended to describe a physical condition in which the brain had been damaged by the percussive effects of high explosives, but was subsequently adopted to describe many different forms of battle trauma.

Unsurprisingly, the incidence of shell shock rose dramatically during the battle of the Somme. According to the Official History of the Medical Services, 16,138 battle casualties suffered in France between July and December 1916 were ascribed to shell shock. Taylor Downing suggests that this was a serious underestimate of the true figures, but even so it was over four times the number of similar casualties in the previous six months and ten times more than those in the same months in 1915. Military commanders feared that shell shock had become an ‘epidemic’, and were very suspicious of a condition that in their opinion was difficult to differentiate from sheer funk.

One way in which the army dealt with shell shock was to re-categorise it. Victims who had suffered from the explosive shock of a nearby shell were classed as ‘Shell Shock W’, which meant that they were a ‘real’ casualty, ‘wounded as a result of enemy action’; those deemed to be experiencing ‘some kind of hysterical response, a temporary breakdown of the nerves’, were classed as ‘Shell Shock S’ (for ‘Sick’), which meant that they did not figure in the casualty lists. A third category, ‘neurasthenia’, was largely reserved for officers and defined as ‘a prolonged process of breakdown’ resulting from ‘the extra responsibility they had to bear’.

In reality, although mild cases of shell shock could sometimes be effectively treated by taking men out of the line and giving them proper bed rest, there was often little to differentiate between either the causes or symptoms in these bureaucratic and face-saving categories. Wilfred Owen, for example, suffering from the shakes, confused memory and violent nightmares, was diagnosed with neurasthenia, but this was caused less by his responsibilities as an officer than by a succession of traumas — enduring days of uninterrupted shelling, being blown into the air and covered with earth by an exploding shell, and lying out in no man’s land beside the body of another soldier — that were among the most
commonly reported causes of shell shock in the ranks.

Many writers will be producing their Somme books for this year’s centenary, and although Downing has hit upon a new approach to a very familiar subject he is too much the military historian to pass up the opportunity of providing his own account of the planning, strategy, fighting and consequences of the famous battle. He does this well enough, but for long stretches of the book shell shock is mentioned only in passing. By far the best chapters are those dealing not with tactical decisions and their consequences but with the high command’s fear that shell shock would cause the entire army to fall apart.

This fear led to some disgraceful incidents, most notably the treatment of the 250 members of the (volunteer) Lonsdale Battalion who had survived ‘one of the worst massacres in the history of the British Army’ during the first day on the Somme. A week later some of these men, clearly suffering from battle trauma and diagnosed as ‘unfit’ by their highly respected medical officer, were nevertheless ordered to take part in a chaotic and ineffective bombing raid, during which several of them refused to go over the top. General Gough not only wanted the MO dismissed from the Royal Army Medical Corps for showing the men ‘undue sympathy’, but arranged for the Lonsdales to be publicly reprimanded and humiliated in front of all the other units in the brigade.

Similarly, although General Haig assured Parliament in 1918 that the death sentence was never carried out on men convicted of cowardice or desertion if they had been diagnosed with shell shock, he had personally overruled recommendations for clemency in at least two such cases on the grounds that ‘to commute the sentence would be to legitimise the condition’.

The suspicion and bureaucratic categorising of shell shock persisted after the war. Unlike the physically disabled, every soldier with shell shock had to be examined to determine whether this had been caused by the war or merely ‘aggravated’ by it, with pensions awarded accordingly. All in all, this is a sorry tale, from which only the victims of shell shock and those who tried to understand and treat it emerge with any credit.