Breakdown

by Taylor Downing

  Yealland took on patients suffering from hysteria whose arms or legs were paralysed, or who had lost the power of speech, and who had defied previous treatment. He often performed his treatment with some theatricality. The patient would be taken into a room; the doctor would appear and take charge, forcefully explaining that the patient must listen to his instructions while the electricity was being ‘administered’. Yealland saw this as an aspect of the discipline necessary to jolt a man into a cure from hysteria. He would begin by administering small amounts of electricity, applying more powerful charges if a patient resisted. Many of his treatments became a battle of wills, yet again, surprisingly, he had a great deal of success. Yealland described curing six cases of mutism one morning in less than half an hour by using ‘electricity mixed with persuasion and encouragement’.17

  Yealland described in detail his treatment of one young soldier who had fought at Mons, the Marne, Ypres, Neuve Chapelle and Loos. After two years’ loyal and brave service the young man had collapsed suddenly and was unable to speak. Various treatments had been tried over a period of nine months without success. As a last attempt at a cure, the patient was sent to Yealland. He was brought into a darkened room; the blinds were drawn, the door was locked and Yealland announced, ‘You will not leave this room until you are talking as well as you did.’ With the man’s mouth kept open by means of a tongue depressor, Yealland started the ‘treatment’ by applying through an electrode attached to the back of his throat a shock so severe that the jolt threw him backwards and pulled the wires from the generator. Yealland kept up the shock therapy, telling the patient, ‘A man who has gone through so many battles should have better control of himself.’

  After an hour the patient was able to say ‘Ah’. After another half-hour, he could pronounce some vowels. Stronger shocks were applied to his larynx, slowly enabling him to whisper the days of the week. At each stage, Yealland bullied the patient, with the intention of breaking his will. When he seemed almost able to speak again, his left arm began to shake, then his right arm, then both of his legs. Yealland told the poor man, ‘It is the same resistive condition only manifested in another part.’ Each tremor was stopped by the application of further pulses of electricity. After four hours of continuous treatment the man cried out, ‘Doctor, doctor, I am champion,’ to which Yealland replied, ‘You are a hero.’ At the end, the patient asked, ‘Why did they not send me to you nine months ago?’18 Today, however, it seems difficult to see the difference between treatment like this and torture.

  During the war, although he carried out no formal follow-ups on his patients, Yealland claimed total success for his electrotherapy. However, a recent analysis of the records of the 196 patients he treated at the Queen Square hospital reveals that in at least 13 per cent of cases his treatment failed and 43 per cent of cases were only listed as ‘improved’.19 Yealland’s work was denounced by some during the war and soon after, and has become controversial since.20 At the time, however, he became famous for his successes; patients were sent to him from all over the country to receive his ‘cure’.

  Dr Arthur Hurst practised another form of theatrical treatment, first at Netley Hospital and then at Seale Hayne, an old agricultural college on the edge of Dartmoor in Devon. Hurst had used both hypnosis and electric shock treatment but gave them up for an alternative, simpler technique. He believed in creating a highly charged and positive atmosphere in which hysterical patients would see recovery occurring in others around them. Dr Hurst was a great showman and made countless claims as to his ability to cure the symptoms of hysteria.

  The expectation that a patient would receive a miracle cure was drummed into him from the moment he arrived at the hospital. Preparation might take several days and the nurses would have a vital role to play in explaining to the patient beforehand how wonderful the effects of the treatment would be. On the day of the treatment, the build-up to meeting the doctor turned the encounter almost into a religious experience. When the patient finally came before Hurst, the treatment was by suggestion. Hurst forcibly commanded him to get better and applied some physiotherapy involving powerful manipulation of the arms or legs until the patient was completely relaxed and the power to perform physical movements had been restored. In this process ‘the personality of the medical officer is always of greater importance than the particular method.’21

  At Seale Hayne, a series of films were made to record the success of Hurst’s techniques. These short clips capture some of the sad and freakish behaviour of shell shock victims, recording tragic scenes of men who cannot walk and who roll about on the floor, who shake uncontrollably, who leap under the bed at the mere mention of the word ‘bomb’. The purpose of the films was to show victims before and after their treatment with Hurst. Certainly, the patients on film appear to be cured. After treatment they walk briskly and confidently past the camera, feed chickens or work happily on the hospital farm. However, Hurst’s many critics were not convinced that removing the symptoms of hysteria was the same as curing the source of the problem. Stories were told that by the time some patients had returned to London on the train from Devon they had already developed new symptoms and were almost as bad as before.22

  It was officers who suffered mostly (but not exclusively) from neurasthenia, the other form of shell shock. Neurasthenia was seen as a form of nervous exhaustion, often built up over a long period of time and sometimes leading to a breakdown triggered by the simplest event. For instance, one officer had spent eleven months at the front, enduring every type of physical and mental strain. He had been wounded twice, gassed twice and buried beneath a house that collapsed under shell fire. After each of these incidents he had returned to the trenches. Then he was granted five days’ leave. Having left in good health, on his return he collapsed in the train station and became unconscious. He was diagnosed as suffering a severe form of neurasthenia. It took some time to find the real cause of the man’s distress. The reason for his collapse, it turned out, was not the fear of returning to the front; in fact he was looking forward to going back. But he knew that with so many officers wounded and killed he would have to take on more responsibility and was fearful that he would not be up to the charge. It was the dread of letting his men down, rather than any fear of physical injury, that provoked his neurasthenic breakdown.23

  Today, far and away the best-known treatment centre for neurasthenia in the Great War is Craiglockhart War Hospital for Officers at Slateford, on the outskirts of Edinburgh and just a tram ride from the centre of the city. Craiglockhart was an old Victorian hydro spa, requisitioned by the War Office in 1916 as a war hospital dedicated to the treatment of neurasthenic patients. By day it was the officers’ equivalent of Maghull, humane with a friendly atmosphere; patients could play cricket, tennis, bowls, croquet or use the hydro-pool. They were encouraged to walk in the gardens, to develop their own hobbies or to take on duties such as teaching the local Boys’ Training Club. There was even a small farm where patients could grow vegetables and keep chickens. But by night, the mood changed completely. The corridors echoed to the anguished howls of the patients as they relived in their dreams the terrible experiences they had been through.

  In October 1916, Dr William Halse Rivers was commissioned a captain in the RAMC and sent from Maghull to Craiglockhart. There, he resumed his study of Freud and spent time analysing his own dreams as well as those of his patients. His persistent, conversational approach was better suited to the officers of Craiglockhart than it had been to the other ranks at Maghull, and Rivers soon acquired a reputation as something of a miracle worker in being able to talk men through their fears, making their memories tolerable and helping them recover. But as time passed Rivers grew increasingly uncomfortable about his role as a military doctor whose principal duty was to send men back to the front and to the horrors that had caused their neuroses in the first place.

  Lieutenant James Butlin arrived at Craiglockhart in May 1917. He had been on active service on the Western Front f
or more than two years. His battalion, the 6th Dorsets, was badly mauled during the battle of Arras in April 1917, with many of its officers killed. Butlin began to complain of being a ‘bit nervy’; a few weeks later he was diagnosed with neurasthenia and sent to Craiglockhart, a classic case of a slow build-up of nervous exhaustion. Butlin kept up a frank and entertaining correspondence with an old school chum named Basil who worked in the Foreign Office in London, and his letters have preserved a wonderful profile of life for an officer-patient at Craiglockhart. He described the place as ‘a magnificent hydro standing in palatial grounds fitted with all the comforts that man’s ingenuity can contrive … provided one is in by six o’clock and conforms to a few simple rules life is a complete and glorious loaf.’ His only complaint was of boredom: ‘I am sending for my tennis things as I can see I shall go mad here with nothing to do. I haven’t had a drink for a fortnight.’ Before long Butlin was seen by Rivers, and he described the encounter to his friend: ‘he is a clever man, a bit of a philosopher, an eminent nerve specialist and somewhat of a crank. He extracts from you your life history with such questions as: Is there any nervous trouble in your family? Have you been ill as a boy? Where were you at school? Do you smoke much? etc etc The great idea, as I had been previously warned, is to get you to take up a hobby.’ Butlin was determined to avoid taking on anything that seemed like extra work, but he did admit to Rivers that he liked literature. ‘The latter was rather a false step as he then asked me to join the staff of the “Hydra” a fortnightly magazine published by the officers here. However I have so far escaped fairly lightly.’

  After a while, Butlin’s boredom increased and he began mocking the lifestyle at the hospital. ‘Can you imagine me, my dear Basil, getting up and taking a swim before breakfast? Doing a little gardening and poultry farming after breakfast? Fretwork and photography after lunch? Viewing natural scenery after tea? Reading and writing after dinner and then to bed?’ Butlin eventually found something to interest him in the form of a beautiful, ‘blue eyed and fair haired’, twenty-year-old local girl named May whom he ardently pursued. They went on several day trips, visiting local beauty spots, and one evening Butlin brought her back to Craiglockhart. In a secluded corner of the grounds they sat down together. ‘We were, I admit, perhaps sitting closer than the warmth of the evening necessitated and in the passion of love’ when they were discovered by Rivers and the commanding officer of the hospital, Major Bryce. Furious at the breach of hospital rules, Bryce called Butlin to his office the following morning and told him the rule that he had broken was to have a visitor on the premises after visiting time was over at 5 p.m.

  Perhaps because of this incident, a week later Butlin was sent away from Craiglockhart. But his two months’ respite at the Scottish hospital had not cured him. He returned to his battalion on home duties, but in March 1918 he was classed as unfit for military service and was retired from the army on health grounds.24

  A month after Butlin left Craiglockhart, in August 1917, another officer arrived, and there started one of the most written about doctor–soldier relationships of the war. Siegfried Sassoon had been a brave soldier with the 3rd Battalion Royal Welch Fusiliers and had won an MC in 1916. He achieved notoriety in singlehandedly capturing an enemy trench on the Somme in early July, inspiring his men to nickname him ‘Mad Jack’. But his view of the war gradually changed. While recovering from wounds in London in 1917 he came under the influence of several pacifist friends and decided to issue what he called a ‘Soldier’s Declaration’ denouncing the war, making his statement ‘as an act of wilful defiance of military authority, because I believe that the War is being deliberately prolonged by those who have the power to end it.’ He went on, ‘I am a soldier … I have seen and endured the sufferings of the troops, and I can no longer be a party to prolong these sufferings for ends which I believe to be evil and unjust.’25 He refused to return to his battalion and managed to have the declaration read in the House of Commons.

  In failing to return to his unit, Sassoon could have been prosecuted for desertion. But influential friends intervened and, instead of a court martial, arranged for him to be sent to Craiglockhart, supposedly suffering from shell shock. Whether or not Sassoon really was suffering from a nervous breakdown was never clear but he certainly suffered from terrible nightmares in which he saw wounded men from his battalion crawling towards his bed.

  Rivers met Sassoon and began a long series of conversations with him. In one of their first meetings Sassoon asked Rivers if he thought he was suffering from shell shock. ‘Certainly not,’ replied the doctor. When Sassoon asked him what he was suffering from, Rivers replied, ‘An anti-war complex.’ Sassoon became fascinated by Rivers and was genuinely grateful to him for tolerating his unusual behaviour, for not lecturing him on his soldierly duties and for providing real companionship. Rivers had suppressed his homosexual tendencies, while Sassoon was becoming increasingly open about his own, and the two men soon became friends. Sassoon described Rivers as a ‘father-confessor’ figure – his own father had died when he was seven.

  Sassoon realised the unique nature of the work Rivers and his colleagues were doing at Craiglockhart. The local medical director to whom the hospital staff reported was highly suspicious of what was going on at the hospital; the consultants often seemed, in his view, to be too friendly with the patients and the place was far too lax in military discipline. At one point the medical director told Rivers that he ‘never had and never would recognise the existence of such a thing as shell shock’. Sassoon concluded that ‘in the eyes of the War Office a man was either wounded or well unless he had some officially authorised disease. Damage inflicted on the mind did not count as illness. If “war neuroses” were indiscriminately encouraged, half the expeditionary force might go sick with a touch of neurasthenia.’26

  Although still anguished by the war, Sassoon slowly came around to thinking that his real place was back in the trenches with his battalion rather than in this unusual hospital, ‘surrounded by the wreckage and defeat of those who had once been brave’. After three months of ‘treatment’ from Rivers, he decided that it was his ‘mission’ to return to the battlefield. He was sent at first to Palestine but eventually returned to France, where he was finally invalided out of the army after being wounded again in July 1918. Both Sassoon and Rivers wrote about their relationship, which became the core of Pat Barker’s award-winning 1990s Regeneration trilogy of novels, the first of which was later turned into a film.27

  It is possible that in their relationship, Sassoon had a greater effect on Rivers than the doctor had on the patient. But in any event, soon after Sassoon’s departure, Rivers decided to leave Craiglockhart and instead became a psychologist at the Royal Flying Corps hospital at Hampstead in London. The incidence of ‘Aviators’ Neurasthenia’ was high in the RFC, where in the later stages of the war it affected 50 per cent of all pilot officers, although roughly half were successfully treated and returned to full flying duties.28

  Sassoon had already acquired a reputation as a soldier-poet by the time he was sent to Craiglockhart, but another poet who arrived at the Scottish spa that autumn was more obviously suffering from shell shock. Wilfred Owen, a sensitive young officer in the 5th Battalion Manchester Regiment, had gone through some horrific experiences at the front. Soon after the Battle of the Somme he had been sent with his platoon to a tiny flooded dugout in No Man’s Land where he spent more than two days under continuous shelling. Later he fell into a cellar and was trapped there for three days. On another occasion he was blown into the air by the blast of a trench mortar shell and covered with earth and debris. Later still he spent some time lying in No Man’s Land alongside the dead body of a fellow officer. Noticing how shaky he had become, the other officers in the battalion sent him to the regimental MO, who diagnosed him with neurasthenia. He was bad enough to be sent back to Britain and to Craiglockhart, suffering from terrible nightmares, what he called his ‘barrag’d nights’, in which he repeatedly
saw the accusing faces of the men he had witnessed being blinded or gassed in front of his eyes.

  Depressed, anxious, with a strong sense of guilt and sleeping badly, Owen became the patient at Craiglockhart not of Rivers but of another doctor. Captain Arthur Brock believed that every patient had it in him to cure himself, all he needed to do was to work at it. So he set Owen tasks, like lecturing to the Craiglockhart Field Club, editing the house magazine, The Hydra, and most importantly, trying to work through his intense feelings by expressing them in poetry.

  Owen was already writing some poetry but had not yet found a style he was happy with. He introduced himself to Sassoon, whose work he greatly admired. Already famous, Sassoon became a source of inspiration to Owen and helped him find his voice in his poems. Sassoon later wrote that he did very little for Owen apart from loan him a couple of books, but the combination of Brock’s treatment and Sassoon’s friendship changed Owen completely. Instead of having nightmares about the faces of his scarred and mutilated men, he began to confront his dreadful experiences in poetry. He left Craiglockhart towards the end of 1917 a different man, more secure in himself and more confident in his writing.

  For several months Owen wrote some of the finest anti-war poems in the English language. These included ‘Dulce et Decorum Est’, in which he was haunted by the face of a man who failed to put on his gas mask in time, ‘Anthem for Doomed Youth’, ‘Futility’ and ‘Strange Meeting’. In a draft preface to his poems, he concluded ‘My subject is War, and the pity of War’, by which he meant that he was not writing about glory, honour or courage, but wanted to be ‘truthful’ about the utter waste and futility of the war. But Owen was no pacifist. His sense of duty was strong, so he returned to the front in September 1918 and won an MC for bravery. On the early morning of 4 November 1918, in one of the final advances of the war, he was leading his men across the Sambre-Oise canal when he was shot and killed. He was twenty-five years old and his parents received the news of his death one week later as the church bells rang out to proclaim the Armistice. Hardly any of Owen’s poems had been published at the time of his death and he remained something of a minor figure for many decades. It was not until his work was republished in the 1960s that his life and poetry came to epitomise the story of the innocent generation that had been sacrificed in the Great War.29 But it was the treatment for shell shock at Craiglockhart that had helped to transform Wilfred Owen from a shattered and nervous soldier into a great war poet.