Many of these wartime memoirs cover the Somme and nearly all speak openly in places about war neuroses of one sort or another. Most include painful descriptions of men who have succumbed to nervous breakdowns. In many of the memoirs and novels, particularly in those written by veterans who had served on the Somme like Graves, Sassoon and Manning, battle trauma is described as pretty much a standard feature among men who had been long at the front. Soldiers are described as being ‘played out’, or ‘done in’ or of having ‘lost his head’. Graves recounts how after six months of continuous front line duty officers ‘began gradually to decline in usefulness as neurasthenia developed’ and those who had been at the front for more than fifteen months were ‘often worse than useless’ and even a danger to the rest of their company.37 Within a little more than a decade shell shock had become an accepted fact of trench life in the literature of the war.38
A fundamental shift of values had come about during the four and a half years of war. Not only had two million men willingly given up their peacetime lives and volunteered to fight for King, Empire and Country in a citizen army, but three million more had been conscripted by the state to leave home and fight. Of these, 723,000 British soldiers, sailors and airmen were killed between August 1914 and November 1918. Two million more were wounded in some way. Approximately 16 per cent of males aged between eighteen and forty-nine, or nearly 1 in 6 of the adult male population, were therefore killed or wounded in the war. And the total losses suffered by Commonwealth soldiers amounted to another 200,000 dead. The war had been called a ‘War for Civilisation’. After this, it seemed absurd that a man could volunteer and risk his life fighting to defend British values and the British political system but could not vote in an election when he returned home. The right to participate in political society was no longer seen to derive solely from the ownership of property but was more broadly seen as belonging to every civilian. The popular slogan was ‘Fit to fight; fight to vote’. At the end of the war, the Representation of the People Act in 1918 recognised this fact. Universal suffrage for all men over the age of twenty-one was introduced. Before the war seven million men had the vote. In the first General Election after the war, thirteen million men voted.
The same Act is remembered for revolutionising the electoral status of women. Before the war the suffragettes had loudly demanded ‘Votes for Women’ but many men and women were deeply opposed to this. However, during the war, two million women had done their bit by volunteering for military and medical organisations and by working in munitions factories. In addition, women took on almost every job that had previously been seen exclusively as ‘man’s work’. The 1918 Representation of the People Act therefore also gave women the vote for the first time. By this time, even those who had opposed women’s suffrage before the war now approved. Inequality still existed: only women over the age of thirty were allowed to vote. But in that first General Election after the war eight and a half million women voted for the first time and the first women were elected as MPs. In 1928 women attained the vote from the age of twenty-one. Ten years after the end of the First World War, universal adult suffrage had finally been achieved.
The post-war treatment of shell shock victims and the disabled was another aspect of this social revolution. Out of warfare had come welfare. The state had accepted a far greater responsibility than ever before for looking after those physically disabled in war while fighting for their country. The cost of pension provision for veterans was a considerable charge on the national economy. In the financial year 1913–14, the government welfare budget had amounted to £22.5 million. By 1921–2 it had risen to £179.5 million and would stay at the same or a slightly higher level for most of the inter-war period.39 Furthermore, by 1922, the majority of those unemployed (600,000 out of one million) were ex-servicemen. However, when it came to shell shock victims and the tens of thousands of personal tragedies of men unable to escape from wartime ghosts, there was a collective failure to address the issue properly. While recognising the sacrifices made by so many during the war, the state badly let down the victims of war trauma.
It’s impossible not to be critical about the wartime approach to shell shock. The army had in the main failed to see the problem as one of individuals who under the pressure of a modern war needed understanding and treatment. It imagined shell shock to be a collective threat to military morale and discipline. Just as many generals saw the regular pre-war army as well disciplined and utterly reliable, so they mistrusted a citizen army, fearing it would prove to be weak and unpredictable under fire. Senior figures often ordered a brutal and inhumane response to anything or anyone they perceived as being too sympathetic to psychiatric casualties. Moreover, many other men suffering from trauma caused by the war were not properly identified or treated during the war years. Some who should have been cared for and treated for mental distress were subject to a harsh and summary military justice system. Others suffering from shell shock were simply omitted from the lists of casualties in an attempt to massage the figures so as to claim the problem had been solved. After the war, many failed to receive the pensions they deserved. Handouts, when they were made, were miserable and insufficient. They were distributed unevenly and unpredictably and the process of handing them out considerably increased the stress of those to whom they were due. Charitable organisations helped but could never do all that was needed. It was a shameful response to those who had willingly done their bit in war and were now in distress. Ironically, it was Sir Douglas Haig, whose command had contributed to the suffering of millions in the first place, who summed up the post-war situation in his evidence to the Parliamentary Select Committee by claiming it was ‘a disgrace to a civilised state.’40 These were strong words for such an established figure to use about the pensions system. But they were entirely justified.
Epilogue
In May 1980, the members of the American Psychiatric Association gathered for their annual meeting in San Francisco. That year’s was a special meeting, at which the members were to review their Diagnostic and Statistical Manual of Mental Disorders. The Association is the principal organisation representing professional psychiatrists in the United States, and has worldwide influence. Its manual is highly respected and is used internationally to define mental disorders, a sort of global psychiatrists’ bible.
When they gathered in San Francisco in 1980, the members of the association had many issues to review, but one stood out. During the Vietnam War, from 1961 to 1975, the levels of combat trauma had been particularly low. Psychiatric casualties were reported as being ten times lower than in the Second World War and three times lower than in the Korean War.1 However, in the years following the end of the war veterans had reported what was called an ‘epidemic’ of delayed mental problems. It was described as a ‘time bomb’ for the future.
There appeared to be several reasons for this. The war had been immensely controversial and deeply unpopular among the American people. Society in much of the western world during the 1960s and 70s had gone through major changes and had become broadly hostile to military culture and values. Vietnam veterans appeared to suffer from a lack of respect, feeling they had been rejected by society and even blamed for the war, and consequently many experienced difficulties in readjusting to civilian life. The use of drugs and alcohol had become widespread. The stereotype of the Vietnam ‘vet’ was the sinister, troubled, often violent outsider, epitomised by the psychotic Travis Bickle, an ex-Marine, portrayed by Robert de Niro in Martin Scorsese’s Taxi Driver (1976). Observers and journalists summed up the phenomenon by speaking of a ‘post-Vietnam syndrome’.
A set of activists had formed working groups to study the syndrome in the years preceding the review of the Diagnostic and Statistical Manual. Many of them had been strongly opposed to the Vietnam War, and they lobbied hard at the association’s meeting to include a new definition of the delayed effects of trauma. What followed in 1980 was formal recognition of a new mental disorder that was given the nam
e post traumatic stress disorder (PTSD). This was something quite different from the condition categorised as ‘shell shock’ sixty years before. There were none of the immediate physical symptoms that came from hysteria – the shakes, the deafness and blindness, the paralysis that had plagued the poor victims of shell shock. PTSD was a disorder that came on after the sufferer had experienced a traumatic event, sometimes within six months, sometimes later. A key feature was the re-experiencing of the trauma, either through flashbacks or dreams of the event, or through a feeling that it was recurring. The condition was not limited to ex-servicemen. It was clear that anyone who had been through an exceptional form of trauma, and this could include being in a road traffic accident or observing some horrific occurrence, or having been raped or endured child abuse, could experience it.2
Large-scale analyses followed the classification of PTSD, including the federally funded National Vietnam Veterans Readjustment Study. This massive survey demonstrated that while the majority of veterans had settled successfully back into civilian life, an extraordinary minority of 30.6 per cent of male Vietnam veterans (over 960,000 men) and 26.9 per cent of female veterans (1,900 women) had experienced some form of PTSD.3 In defining PTSD and including it in its new manual, the American Psychiatric Association had effectively created a new mental disease and given it a form of legitimacy. US federal resources were now allocated to the counselling of veterans suffering from PTSD. And it has since become the most common term used to describe combat stress.
The British army was, of course, not involved in the Vietnam War (although the Australian army was, and its veterans also suffered from high levels of PTSD and difficulties in settling back into society). The next conflict involving British troops was the Falklands War of 1982. The Falklands campaign was short, lasting only twenty-five days from the landings at San Carlos Water to the recapture of Port Stanley, and the troops who took part were considered to be in the elite battalions of the British army, with a high state of morale. There were very few reported cases of ‘battle shock’ during the war. But despite the flag waving and the patriotic revival prompted by the war, in the years that followed more and more cases of PTSD among veterans were diagnosed, attracting considerable media attention. This had the effect of putting the Ministry of Defence itself on the defensive, arguing that such media interest would undermine the fighting spirit of the armed forces and that a man’s mental state after he returned to civilian life was his own business and a private matter. The MoD was fearful that the obsession with legal rights which became apparent in the 1980s would open the floodgates to endless claims for compensation.
The short Gulf War of February 1991 created its own ‘Gulf War syndrome’. At first this was thought to be linked to the handling of depleted uranium shells by the Allied forces, along with the cocktail of vaccines given to servicemen in advance of the campaign to protect them from the possible use of chemical and biological weapons by Saddam Hussein’s forces. In the years following the war, many veterans reported they were suffering from headaches, feelings of listlessness and an inability to concentrate. Some suffered from chronic pain, while there was a higher than usual proportion of birth defects among their children. In Britain the King’s Centre for Military Health Research was established at King’s College, London to investigate the syndrome and explore whether it was the consequence of the toxins in use during the war or another manifestation of PTSD. Once again, as in 1919, officials feared that ex-servicemen would pretend to have the syndrome in order to obtain benefits, although there was no hard evidence that this was happening.
In the US many surveys were conducted, including, in 2001, a study of 15,000 US Gulf War veterans and 15,000 control veterans. Some of these surveys have been accepted as valid and some challenged in that their sampling did not meet epidemiological models. The general conclusion reached in 2006 by the US Institute of Medicine was that because veterans exhibited such a range of different symptoms there was nothing that could uniquely be described as a ‘Gulf War syndrome’. This has been broadly accepted in Britain, but the Kings Centre still insists that service in the Gulf War ‘did adversely affect the health of some personnel’. The subject remains one of dispute and controversy.4
Since then, the British military has been involved in several full-scale engagements, including the conflicts in Bosnia in the late 1990s, in Iraq from 2003 to 2011 and in Afghanistan from 2001 to 2015. These have involved some of the most intense bouts of combat since the Second World War. In fierce fire-fights in Iraq and Afghanistan, British troops have fired off the same number of rounds per unit as their fathers did in the bitterest battles in the Western Desert or in Normandy. At times the army came near to running out of ammunition. The potential for combat-related trauma was high.
Although society today regards itself as far more understanding and tolerant of mental health issues than one hundred years ago, the problems facing ex-servicemen as they return from a period of wartime service can be as troubling today as they were for some of those returning home in 1919. In July 2012, a report revealed that one in ten prisoners serving time in prisons in England and Wales were ex-servicemen, many imprisoned on charges of violence. This was three times higher than the number claimed by the government.5 It has often been said that the military devotes a lot of time and money to training men and women to become killers, but none to de-training them and helping them to settle back into civilian life. Just as in 1919, limbless ex-soldiers today are treated with great sympathy by a generally supportive public. They are given therapy and some of the best treatment in the world at rehabilitation centres like Headley Court in Surrey and the Queen Elizabeth Hospital in Birmingham. That is clearly a very good thing. But those whose minds have been damaged or who find it difficult to cope with ‘civvy street’ are once again often left to struggle on and face their own demons.
In February 2014 Lord Ashcroft, appointed by the Prime Minister to act as his Special Representative on Veterans’ Transition, published a review of the situation. In this he recognised that in the second decade of the twenty-first century, 91 per cent of the British public believed that ‘it was common for those leaving the Forces to have been physically, mentally or emotionally damaged by their Service career.’6 While this view was less disastrous than the stereotype of the angry, moody, drugged-up Vietnam ‘vet’ was in the United States, it clearly created an image of the British ex-squaddie that harmed the prospects of many ex-servicemen and women in finding work. The stigma surrounding the ‘service leaver’ made employers wary. The Ministry of Defence claims that 85 per cent of those leaving the forces find employment within six months and re-assimilate into civilian life without difficulty. But it is hard to believe that the situation is quite so rosy. Ashcroft called for new industry initiatives to help men and women trained with specific skills to find work in a marketplace that was often calling out for people with exactly those skill-sets. He wanted service leavers with only four years’ service (and this would include many of those who fought in Iraq and Afghanistan) to have the same support as those with longer service records who were given more help in the past. All service leavers who had completed basic training, he argued, should receive a full resettlement package.
But the problems have not gone away. Christopher Grayling, the Justice Secretary, reiterated in December 2014 that the state owed a ‘duty of care’ towards anyone who had served in the military: ‘These are people who served our country, in many difficult and stressful situations. The least we can do is try and ensure that we look after them and make sure that we help them get their lives back together again.’7 This could have been said by a government minister one hundred years ago. But the reality is still far removed from the assertions of official concern.
Combat Stress is the leading veterans’ mental health charity in the UK. In 2015, it helped more than 5,900 veterans suffering from anxiety, depression or PTSD to ‘get their lives back’.8 Its foundation in 1919 as the Ex-Services Welfare Society provides
a direct link from today to the troubles of those suffering from shell shock after the First World War. Emphasising this continuity between the present and the past, Dr Walter Bussitil, the Medical Director of Combat Stress, who runs a 34-bed residential treatment centre in Leatherhead, Surrey, sees himself as running ‘today’s version of Craighlockhart’.9 But there are no veterans to be seen quietly convalescing in bath chairs in a modern Combat Stress treatment centre. In a manner that fits the twenty-first century, the help offered today includes the teaching of basic domestic skills such as how to cook and how to use a washing machine, skills which men who have been in the institutionalised world of the military for up to twenty years may have entirely missed out on.
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