The First World War, often referred to as “The Great War,” brought about unprecedented levels of violence, destruction, and human suffering. Soldiers faced new forms of mechanized warfare, including tanks, airplanes, poison gas, and heavy artillery. Alongside the physical devastation, the psychological toll of the war was immense, giving rise to a condition then known as “shell shock.” Today, this phenomenon is understood as an early recognition of what we now call Post-Traumatic Stress Disorder (PTSD).

In this article, we will explore the psychological effects of combat during World War I, focusing on the condition of shell shock. We will examine its causes, symptoms, medical understanding at the time, treatment methods, and the lasting legacy of psychological trauma in warfare.

The Brutality of World War I: A New Kind of Warfare

World War I saw a significant transformation in how wars were fought. The introduction of trench warfare, alongside rapidly advancing technology in weaponry, made this conflict particularly gruesome. Soldiers faced continuous bombardment, close-quarters combat, and prolonged periods of fear and anxiety. The trenches themselves, which stretched for miles along the Western Front, were dangerous, unsanitary, and dehumanizing environments, contributing to the mental strain of the soldiers who fought in them.

Artillery, a dominant feature of the war, caused a constant threat of death or injury. Soldiers could be killed or maimed at any moment by unseen forces. The sustained barrage of shellfire, coupled with the horrific sounds of explosions and the sight of fallen comrades, led to a psychological breaking point for many men. This relentless pressure created conditions in which soldiers developed acute psychological responses—what would come to be known as shell shock.

Defining Shell Shock

Shell shock was a term first coined in 1915 to describe the psychological collapse experienced by soldiers who had been exposed to prolonged, intense bombardments. Early on, doctors and military authorities believed the condition was caused by the physical effects of exploding shells, such as brain damage from concussive forces. However, as the war progressed, it became clear that the condition was not solely related to physical trauma but also to the intense psychological strain of combat.

Shell shock manifested in a wide range of symptoms, including:

• Physical symptoms: Tremors, tics, paralysis, or uncontrollable shaking. Some soldiers were rendered unable to speak or walk, while others developed debilitating headaches or dizziness.
• Emotional symptoms: Anxiety, depression, emotional numbness, and sudden outbursts of crying or rage.
• Behavioral symptoms: Memory loss, confusion, disorientation, and nightmares. In severe cases, soldiers could become catatonic or exhibit childlike behaviors.
• Cognitive effects: Difficulty concentrating, impaired judgment, and loss of ability to perform even simple tasks.

The condition varied greatly from one individual to another, and it became a medical mystery for doctors at the time. Soldiers affected by shell shock were often unable to return to combat, and many could not function in their daily lives without treatment.

Causes of Shell Shock: A Combination of Factors

While initial theories about shell shock focused on the physical effects of warfare—such as the impact of loud explosions and head injuries—later research pointed to a broader understanding. Psychological stress, emotional trauma, and sensory overload were recognized as major contributors to the condition.

1. Continuous Fear and Anxiety

The ever-present threat of death in the trenches led to intense, prolonged anxiety for soldiers. The anticipation of the next attack, the fear of poison gas, or the constant barrage of artillery created a state of hyper-vigilance that could erode a soldier’s mental health. Being on edge for extended periods caused psychological exhaustion, which, in turn, could trigger shell shock.

2. Horrific Visuals and Emotional Trauma

The brutality of trench warfare was not only a matter of physical danger but also emotional devastation. Soldiers often witnessed horrific scenes—friends and comrades being killed or mutilated, bodies left unburied in no man’s land, and the overall inhumanity of war. The sense of helplessness in the face of such loss and violence caused profound emotional trauma, further contributing to mental breakdowns.

3. Sensory Overload

The sights, sounds, and smells of the battlefield were overwhelming for soldiers, creating sensory overload. The constant booming of artillery, the smell of death and decay, and the visual chaos of explosions and gunfire all assaulted the senses. The human brain was not equipped to handle such intense stimuli over prolonged periods, and the result was often psychological collapse.

4. Social and Psychological Pressures

Soldiers were under immense psychological pressure to perform in battle, with the fear of being seen as cowardly or weak if they showed signs of psychological distress. This societal expectation contributed to the repression of emotions, which often led to an eventual breakdown. Additionally, many soldiers felt isolated from their homes and families, further intensifying feelings of despair and alienation.

Medical Understanding of Shell Shock

The medical community in the early 20th century was largely unprepared to deal with the mental health consequences of modern warfare. Initially, shell shock was misunderstood, with many doctors attributing the symptoms to physical damage caused by the concussive effects of artillery fire. This led to a focus on physical treatments such as rest, massage, and electric shock therapy, all of which were largely ineffective for treating psychological trauma.

As the war continued, it became clear that the condition was not simply a matter of physical injury but of mental and emotional strain. Psychiatrists and neurologists began to recognize the psychological nature of shell shock, though they struggled to develop effective treatments. There was also a significant stigma associated with the condition, as many military officials viewed it as a sign of weakness or cowardice, rather than a legitimate medical issue.

Treatment of Shell Shock during the War

Treatments for shell shock varied widely, depending on the medical officer and the facilities available. Some methods were compassionate and aimed at recovery, while others were harsh and punitive, reflecting the military’s focus on returning soldiers to the front as quickly as possible.

1. Rest and Recuperation

Many soldiers with shell shock were treated by being removed from the front lines and given a period of rest and recuperation. This was one of the more humane treatments, allowing soldiers to recover in a quiet environment away from the chaos of the battlefield. However, rest alone was often insufficient to address the deeper psychological wounds, and many soldiers continued to suffer from symptoms even after returning home.

2. Therapeutic Approaches

Some doctors, particularly those specializing in mental health, began experimenting with therapeutic approaches to treating shell shock. These included:

• Talk therapy: Soldiers were encouraged to discuss their experiences in an attempt to process the trauma they had faced. This early form of psychological counseling was a precursor to modern-day treatments for PTSD.
• Occupational therapy: Some soldiers were treated through engagement in productive activities, such as gardening, crafting, or light work. The idea was that keeping soldiers busy and focused on non-military tasks could help them recover from the psychological strain of combat.

3. Controversial and Punitive Treatments

Unfortunately, not all treatments for shell shock were compassionate. Some military doctors and officers viewed shell shock as a form of malingering or cowardice. Soldiers who exhibited symptoms were sometimes subjected to harsh and punitive treatments, including:

• Electric shock therapy: In some cases, doctors applied electric currents to the soldiers’ bodies in an attempt to “shock” them out of their condition. This treatment was not only painful but also largely ineffective and often caused further trauma.
• Military punishment: Some soldiers with shell shock were subjected to military discipline, including confinement, forced marches, or other physical punishments. This approach reflected the prevailing belief that shell shock was a sign of moral weakness rather than a legitimate medical condition.

The Legacy of Shell Shock: From World War I to Modern-Day PTSD

The recognition of shell shock during World War I was a pivotal moment in the understanding of psychological trauma in warfare. While treatments and attitudes were often inadequate or misguided, the sheer number of soldiers affected by shell shock forced military and medical authorities to confront the mental health impacts of war.

1. The Evolution of Psychological Diagnosis

In the years following World War I, the medical community continued to explore the psychological effects of combat. The term “shell shock” fell out of use, and by World War II, the condition was referred to as “combat fatigue” or “war neurosis.” These terms reflected a broader understanding of the psychological strain of combat, though effective treatments remained elusive for many years.

By the late 20th century, the condition now known as Post-Traumatic Stress Disorder (PTSD) became widely recognized, thanks in large part to the experiences of Vietnam War veterans and subsequent research into trauma. Today, PTSD is understood as a complex mental health condition that can result from exposure to traumatic events, including warfare, natural disasters, and personal assaults.

2. Ongoing Mental Health Support for Veterans

The recognition of PTSD has led to significant improvements in the treatment of veterans suffering from the psychological effects of combat. Modern therapies include cognitive-behavioral therapy (CBT), exposure therapy, and medication to help veterans manage their symptoms. Veterans’ mental health is now a major focus of both military and civilian healthcare systems, with dedicated programs aimed at helping those affected by combat trauma.

3. The Cultural Impact of Shell Shock

The cultural legacy of shell shock extends beyond the medical community. The condition has been explored in literature, film, and art, shaping how society views the psychological impacts of war. Works like Wilfred Owen’s war poetry, which poignantly describes the horrors of combat, have brought the emotional toll of war to the forefront of public consciousness.

The psychological effects of combat in World War I were devastating, and the condition known as shell shock marked an early recognition of the profound mental trauma that soldiers experience during warfare. While treatments at the time were often inadequate, the acknowledgment of shell shock paved the way for modern understandings of PTSD and the importance of mental health care for veterans.

As we continue to confront the mental health challenges faced by soldiers returning from conflict, the legacy of shell shock reminds us of the need for compassion, understanding, and ongoing support for those who have endured the horrors of war.