The flat rate for a weekly disabled war pension was 27s 6d, a sum increased to 33s in November 1918 (27s 6d is roughly equivalent to £75 in 2016 value; 33s is roughly equivalent to £90. So the payments were by no means generous.5). But the calculation of payments involved a complicated structure that depended upon the scale of a man’s disability. The loss of two or more limbs entitled a man to a 100 per cent pension. On the other hand, the percentage payable for the amputation of a leg depended upon whether it was above the knee (60 per cent) or below (50 per cent). Payment for the loss of a thumb or four fingers depended on whether they were from the right hand (40 per cent) or the left (30 per cent). Moreover, payment was increased proportionately as a consequence of the claimant’s final rank and number of dependents.
The Ministry of Pensions and the four other new ministries created by Lloyd George have been described as the beginnings of a form of ‘war socialism’.6 But it can rarely have felt like that at the time. The government did accept that mental or nervous disability could be included in the list of injuries that merited a pension, but the details were always going to be more difficult to determine than with the loss of limbs. A doctor had to examine every ex-serviceman to decide whether his shell shock was wholly the consequence of his military service (in which case it was classed as ‘attributed’) or whether it derived from an existing condition made worse by wartime service (in which case it was called ‘aggravated’). Attributed pensions could be paid for life; aggravated pensions were usually paid only for a short period until it was decided that the shell shock had passed.7
From the start the Treasury was horrified by the thought of the funds that it might need to spend on disabled ex-servicemen. As a consequence the state bureaucracy was slow, inefficient and overwhelmingly mean in its allocation of pensions. The processing and calculation of pension requests took time. Complex medical opinions had to be sought. And those administering the payouts seemed to show neither a sense of haste nor much sympathy to those making claims. Many victims of war neuroses were made to feel that they were somehow failed soldiers. No doubt officials were fearful that unless they minimised the number of payments due, the floodgates would open and post-war governments would be crippled by vast legacies of payments that would have to be made for decades to come.
Even at the front, while the war was raging, some people grew suspicious that changes were being introduced into the diagnosis of shell shock victims with a view to minimising post-war costs. Lieutenant Gameson was a young doctor who served as a MO with the 45th Field Ambulance during the Battle of the Somme, treating wounded men as they were taken from the front-line aid posts to the greater care available in the CCSs. He was very critical of the distinction that was drawn between Shell Shock ‘W’ and ‘S’. A man diagnosed with Shell Shock ‘W’ had suffered as a consequence of enemy action and would potentially be due a pension. A man diagnosed ‘S’ was suffering a temporary condition from which he was supposed to recover. Gameson wrote in his diary, ‘We all knew that shell-shock was highly debatable.’ But he was suspicious about what lay behind the distinction. ‘There can be no reasonable doubt that the motive concerned the subsequent status of a man. It concerned the distant questions of the employers’ liabilities: PENSIONS [Gameson’s capitals].’
In Gameson’s view, the distinction between the two forms of shell shock did not stem from a concern to provide men with the best treatment, but was a long-term plan to avoid the payment of war pensions to those who might already have been suffering from a nervous malady before joining the army and to keep down the numbers who would qualify for care having suffered war neuroses. He wrote: ‘All this “W” versus “S” stuff seemed a shade tendentious, and it did not only apply to the admittedly difficult Shell Shock cases. Once a man had officially been labelled “W” – and here is the point – he was in a much better bargaining position [in obtaining a war pension] than one marked “S”.’8 Gameson’s fears were certainly realised when it came to calculating pension rights after the war.
Most of those who suffered from some form of shell shock and were deemed suitable for a pension were officially classed as having had ‘neurasthenia’. Having been applied largely to officers during the war, afterwards this became the standard word to describe the condition of all soldiers who had suffered from war trauma. But other categories were also added, including ‘anxiety neurosis’ (a term preferred by William Rivers), ‘debility’ and ‘nervous debility’.9 This indicates yet again the continuing confusion over the diagnosis of shell shock.
However, out of nearly 556,000 war pensions awarded to officers and men invalided out of the army and navy during the war, a total of 34,471 (about 6 per cent) had been given for a disability arising from ‘nervous diseases’.10 By February 1921, the figure had grown considerably; 65,000 men were drawing pensions for disability due to neurasthenia and allied conditions. Of these, an extraordinary 14,771 were still in hospital or attending a clinic. One reason why the overall number had risen so much was that nervous disability was the one form of injury that could emerge after the war was over. Of the men still in hospital two and a half years after the war ended, 1,367 had developed symptoms after their discharge from the army. These included many soldiers who had been rewarded for their bravery in the war and had returned to employment, but who had suffered a nervous breakdown after apparently settling back into civilian life. The vast majority had suffered the onset of their disease within six months of leaving the army. Very probably many soldiers had been hesitant about presenting with a nervous disease when still in the army and had only come forward after returning to civilian life.
Reflecting on these figures, the Official Medical History noted, ‘it is remarkable that after three years of peace so great a number should remain disabled. It is to be feared that a large proportion of them will never recover their full mental capacity.’ After a clinical analysis of the figures, the authors concluded that the numbers still suffering so long after the war ‘alone would be sufficient evidence, if any were required, that this disease is a real and very serious consequence of war, and further that it is one of the most prolonged and difficult to cure’.11 These figures also raise the question as to when the war really came to an end. The guns fell silent on 11 November 1918 but the suffering went on. For some, it had barely begun.
However, the number actually receiving pensions after the war was without doubt only the tip of the iceberg. Thousands suffering from shell shock had been refused pensions or denied further treatment and care. There was still a suspicion among officials of malingering, that men were trying to obtain a state pension when they were not eligible for one. In 1919, the provision of military pensions had become a bureaucratic muddle involving three different departments: the War Office, Lloyd George’s wartime Pensions Ministry and the Ministry of Labour. It was brought together in that year under the Labour Ministry in order to allow the distribution of pensions through local Labour Exchanges. However, this totally overwhelmed the system. There were long queues outside the exchanges as ex-servicemen waited in line in the hope of finding new jobs and registering for pension payments. Those suffering from mental conditions had to join the queues and wait their turn, and doubtless this added to their distress. But unsympathetic bureaucrats trying to save the state money were not exclusively responsible for such distress. Everyone drawing a pension for an aggravated nervous condition had to attend a medical board at regular intervals to maintain their entitlement. It was often the doctors on these boards who decided whether the pension was payable or not.
As in the war, medical boards could be notoriously unpredictable. Some were filled with ex-RAMC doctors who had considerable sympathy for men suffering from the consequences of shell shock. Others could be made up of doctors who had little or no experience of shell shock and whose instinct was to assume that it was all a case of swinging the lead and trying it on. There was a widespread belief that physical wounds, the loss of a limb, were a sign of bravery and a badge of
courage. A man who had lost an arm or a leg had clearly been in combat and had faced up to his duty. Mental conditions were more ambiguous.
Moreover, the medical questions were themselves difficult to answer fairly. How was it possible to tell for sure if a man had picked up his mental illness entirely as a consequence of the war, or if he had a pre-existing nervous condition that had been aggravated by the war? According to the dominant medical opinion, many men who suffered from shell shock had some family background of nervous or neurotic conditions. In which case, to what extent was a prevailing condition responsible for the mental strains brought on by the war? The boards had a difficult task on their hands and although there was a right of appeal against their decisions, it was a time-consuming and complex process.
A few clinics around the country provided treatment for the psychological casualties, but they always had to struggle against financial cutbacks. For instance, in November 1920, the government shut the Maudsley Hospital, which still had a waiting list of ex-servicemen queuing for treatment. Men suffering from shell shock or neurasthenia had to attend medical boards every three months, and as their pensions could be taken away from them as a consequence of the judgement of these boards, the whole process must also have added considerably to the anxiety of those drawing pensions.
The prevailing wisdom was still that lunacy was hereditary. In an attempt to ascertain whether a man’s condition was pre-existing or inherited, or had come about because of military service, the War Office wrote to the families of those who had been diagnosed with some form of nervous disease asking if there was a history of mental troubles in the family, ‘including uncles and aunts’. Most people seem to have been honest in their replies. Mrs Bertram, in Cheshire, wrote back that concerning her husband, a clerk in the army in France who was hospitalised with shell shock, ‘there is no “nervous” or “mental” trouble in any way connected with his family and he has never been like it before and never had fits or touched spirits and very seldom beer and was very moderate and clean in his morals.’ However, when she was told that he was in the Lord Derby War Hospital at Warrington, Mrs Bertram knew that he might well be in a seriously disturbed state. Reflecting on the problem of his homecoming, she wrote, ‘I could not have him home unless he was well and could go to work as I am not strong enough myself to work and keep him. He was earning good money before joining the Army.’ It seems that this wife’s love of her husband was somewhat conditional.12
Lieutenant James Butlin was one of tens of thousands who felt hard done by. Six months after leaving Craiglockhart, he had a nervous breakdown. As he recovered, Butlin described how he felt in a letter to his pal Basil. ‘I still am rather feeble, can’t walk far and liable to “come over queer” at the slightest exertion.’ In March 1918 he went before a special army board consisting of a major and two colonels who declared that he was ‘permanently unfit for military service’. He was now twenty-one years old and had given up university at Oxford to spend three years in the army. Butlin complained to his chum, ‘the Army have taken all the best out of me and now wish to turn me out with an inadequate pension … I am just as likely to break down in civil life where I shall have to work harder than I do now.’ Four weeks later he went before a medical board of civilian doctors who assessed him for his pension. Clearly the sum they settled on was not enough for a young man like Butlin, who was without independent means. Again Butlin wrote to his friend that he had been discharged and was ‘of course out of uniform. Now what the hell am I to do for a living? Can you tell me the answer to that question? Seriously though, I must get work soon or I shall be broke.’13 Butlin became another statistic as the war neared its end and thousands of men with shattered minds tried to return to a civilian existence.
Robert Dent, a tough Northumberland miner before the war, had fought on the Somme where he had been hospitalised with shell shock. The neurosis appeared to be mild and after five days he returned to duty. He finally left the army suffering from trench foot and returned to work as a hewer at the local pit. In the summer of 1924 he began to show signs of intense emotional disturbance. His wife, Hannah, testified that he had been ‘strong and healthy before enlistment’ but was now ‘a total wreck’. Dent was taken into Morpeth Mental Hospital, where the doctors put in a claim that he was suffering from a recurrence of the shell shock he had suffered eight years previously. But the Ministry of Pensions refused to countenance this, arguing that there was ‘no evidence to connect the shell shock with his present disability, which is of purely constitutional origin and unconnected with war service’. Dent’s local vicar, Rev. Fogg, an ex-serviceman who tried to help war veterans, took up the case, writing to the Ministry, ‘I am convinced we have a MOST CLEAR CASE [capitals in original]. By Dent’s conduct and ravings we have sufficient evidence that he is suffering from shell shock.’ Rev. Fogg appealed to the Ministry ‘on behalf of people who are suffering acutely as the direct result of the War’. The good vicar’s appeal finally carried the day and the Ministry relented, granting Dent a pension.14 The story reveals not only how difficult it was to crowbar a pension out of the Ministry but also the difficulty of assessing cases of emotional trauma that manifested nearly a decade after the original occurrence.
There was a very blurred distinction between shell shock or neurasthenia, and madness. Some soldiers had been classed as insane during the war and had been passed into the asylum system. This was clearly inappropriate for those who had suffered from shell shock. Montagu Lomax, a retired GP too old to enlist in the military, went into the asylum service to do his bit after war was declared. He was appalled at what he found. He described a twenty-year-old inmate who had suffered from shell shock. The young man was ‘intensely confused and had the greatest difficulty in getting the words out that he wanted to say. He was besides thoroughly frightened and in consequence “resistive”. He seemed to imagine that everyone around him was a German and an enemy … and probably took the place for a German prison.’ The man sometimes refused to eat, dress properly or obey orders, so he was often kept in solitary confinement in a darkened cell where it was thought he could do no harm.
Lomax reflected, ‘Had he been an officer he would have been sent to one of the many luxurious mental homes instituted for the treatment of such cases. Being only a private, he had, like hundreds of others, been simply drafted into a pauper lunatic asylum, where he may become hopelessly insane.’ However, the young lad was often visited by his two devoted sisters, whose presence seemed to cheer him up. As Lomax wrote, ‘The boy wanted mothering; not dragooning into obedience’ by the impersonal, degrading and regimented life of an asylum. Lomax concluded, ‘In a country as wealthy as England is, even after all her war losses, it is scandalous that those who have given their all in her defence should be so scurvily treated.’15
After the war, the numbers of ex-soldiers in asylums grew from 2,500 at the beginning of 1919 to more than 6,400 by October 1921.16 With public opinion generally sympathetic to the victims of war neuroses, most people felt that it was inappropriate for ex-servicemen to be assigned to asylums as ‘pauper lunatics’. So the Ministry of Pensions gave each ex-serviceman a suit of civilian clothes and 2s 6d per week to assist him. It is doubtful that this did much to ease the men’s lot. Some of those sent to asylums were suffering from what was categorised as ‘general paralysis of the insane’. This rare condition was a consequence of syphilis, which had been widespread among soldiers during the war years.17
But many other ex-soldiers also ended up in asylums, either because as single men there appeared to be nowhere else to send them, or in some cases because their families had found them so difficult to live with after the war that they had certified them. Rifleman Albert Styles had been a personal valet in a gentleman’s club in Piccadilly before the war; smart, lively and totally reliable. Having joined up in September 1914 he spent three years in the 13th Battalion Rifle Brigade before losing his arm and suffering from shell shock. In September 1917 he returned to his parents�
�� home at Tooting Bec in south London. He had been granted a pension of 27s 6d for nine weeks which was then to be reduced by one-half. But he was depressed and morose. He sat around vacantly for hours; he had spells imagining everyone around him was a German; finally he barricaded himself in his bedroom and refused to come out or take food. His father called in the medical authorities, who bundled him off to Long Grove Asylum in Epsom. Having survived three years in the trenches he lasted, tragically, only fifteen months in the asylum, dying there of dysentery in January 1919.18
The asylum system had been badly run down during the war years. Several institutions had been closed to civilian patients and reopened as military hospitals. Staff had departed in large numbers to join up. Conditions were wretched and the newspapers were full of stories of officers and men who had fought for their country mouldering in cold, insanitary asylum dormitories, akin to the old Victorian workhouses.19 A charity was established in London in 1919 with the principal aim of keeping ex-servicemen out of the lunatic asylum system. Called the Ex-Services Welfare Society (ESWS), it was founded by a group of well-meaning upper-middle-class women, although its management soon became more professional and was dominated by ex-servicemen. The only charity exclusively dedicated to helping those wounded psychologically after the war, the ESWS set up its own ‘recuperative home’ at Chartfield on Putney Hill in 1921, opening another at Eden Manor in Beckenham in 1924. But for private charities to work effectively they needed to be hand-in-glove with government departments. In the early 1920s the ESWS fell out with the Ministry of Pensions, who thought it was too political, and it lost its royal patronage and support from the British Legion. Nevertheless, it continued to assist shell shock victims and their families by supplementing the official welfare programme.20
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