World War I, Shellshock and Psychotherapy

Hysterical Muscular Paralysis

from War Neuroses 1918 film

19th Century: Trauma Diagnoses• Traumatic neurosis (Oppenheim)—physical

trauma causes neuroses; was compensated by the German state in 1889. Sometimes called a “pension neurosis.”

• Railway Spine (in US and Britain)—similar to traumatic neurosis

• War hysteria (Bonhoeffer and Charcot) neurosis is due to weakness of the constitution

British Bomb Throwers, 1915

The Sphere, 1915

Patient with word deafness; could only hear word “Bombs”

from War Neuroses, 1918 film

Early 20th C. War Neuroses

• Shellshock (Myers) or bomb concussion, initially thought to be due to shell explosion, and produced tiny brain lesions

• NYDN—(not yet diagnosed, nervous?) term to replace shellshock in 1917 in Britain

Hysterical soliderand after cure

from War Neuroses

(1918)

Treatments for Shell Shock• Bedrest, relaxation, baths, massage

• Occupational therapies, e.g. farm-work

• Hypnosis and Suggestion (Max Nonne)

• Electrical Shock Treatments (Lewis Yealland, Kaufmann)

• Treatment by isolation, fake injections

• Psychoanalysis (Sandor Ferenczi, W.H.R. Rivers)

• Return home or to hospital

Electroshock TherapyMaudsley Hospital, 1918

The Kaufmann Cure

Transporting the Wounded

Sandor Ferenczi and Sigmund Freud

W. H. R. Rivers (1864-1922)Instinct and the Unconscious (1920)

Craiglockhart Hospital

Siegfried Sassoon (1886-1967)

Wilfred Owen (1893-1918)

"They"The Bishop tells us: "When the boys come

backThey will not be the same; for they'll have

foughtIn a just cause: they lead the last attackOn Anti-Christ; their comrades' blood has

boughtNew right to breed an honorable race,They have challenged Death and stared him

in the face."

"Were none of us the same!" the boys reply.

"For George lost both legs; and Bill's stone blind;

Poor Jim's shot through the lungs and like to die;

And Bert's gone syphilitic: you'll not find

A chap who's served that hasn't found some change.“

And the Bishop said: "The ways of God are strange!"

(Siegfried Sassoon, 31 October 1916)

Freud’s Death Instinct (Thanatos)

“The fateful question for the human species seems to me to be whether and to what extent their cultural development will succeed in mastering the disturbance to their communal life by the human instinct of aggression and self-destruction.”

Freud, Civilization and its Discontents, 1930

American Medical Association, War Medicine 5 (1944)

Letting off Steam to shrink Resentment War Medicine (1944)

From the Cartoon Booklet, “The Story of Mack and Mike”

Mid-late 20th c. War Neuroses

• World War II —Battle Fatigue

• Vietnam— Post Traumatic Stress Disorder (PTSD, entered the Diagnostic and Statistical Manual in 1980)

• Gulf War—PTSD, Gulf War Syndrome

• Iraq--PTSD

Reports of soldiers returning from combat duty in Iraq with PTSD range from 12.9 % (panel at Institute of Medicine,2007); 19-21% (chief of psychiatry, Walter Reed Army Instituteof Research, Psychiatric Times, 2006); to as high as 30% (Army Surgeon General, Veteran’s Today, 2006).