01 Dec 2014 UK Disability History Month Blogs 2014: Shell-Shock, Lunacy and Hysteria: How the First World War Changed Experiences of Mental Illness in Britain - Greta Williams Schultz
WW1 was something of a turning point for experiences of mental illness in Britain. There was a massive influx of ex-servicemen suffering from mental health problems which led to big changes for soldiers and civilians in the mental health system. Much existing historical research fails to represent lived experience, historians have found it easier or more important to study how ‘normal’ people thought of and managed the mentally ill, rather than centring the mentally ill themselves.
There was a great stigma around soldiers returning from war mentally ill, as such conditions were considered a symbol of being unpatriotic and weak, the opposite of a hero who was physically injured under honourable circumstances. Ben Shephard describes the mood of the times well; ‘it is a tall order for the state to take on the liability to support a man who becomes a lunatic because he is a coward’.
The government provided war pensions to some of the men who were disabled by the war, but only 15% of those awarded went to those with mental health related impairments. The undeserving nature of such cases was described by a psychologist reporting to the Ministry of Pensions in 1939; ‘there can be no doubt that in an overwhelming majority of cases, these patients succumbed to shock because they got something out of it’.
[Private Ross Smith (l) and Private Preston (r), two patients trated for shell-shock.]
Mental health patients who were civilians fared even worse than ex-soldiers. From the start of war, parliament spoke of sparing the fate of ‘pauper lunatics’ to soldiers and promising that soldiers suffering from shell-shock would not pass into asylums. This promise was broken, with 11,600 servicemen eventually passing into asylums, but within the institutions they enjoyed the privileges of private patients.
This distinction between mild cases of ‘shell-shock’ and serious cases of ‘lunacy’ was a false binary. As early as 1926 the term shell-shock was widely discredited in medical articles as being a vague term encompassing a ridiculous variety of symptoms. Such labels were often assigned on the basis of class, with middle and upper class men usually classified as shell-shocked and working class men usually classified as lunatics and sent to asylums.
The treatment given to different classes within the military also varied greatly, with lower classes much more likely to receive unpleasant experimental treatments. During the war new treatments were pioneered, aimed at getting men patched up and back to the front line as quickly as possible. Working class soldier Joseph S. Milne reported receiving electric shock treatment that made his entire body blue, and being subjected to repeated cold baths.
Men who succumbed to mental illness during wartime can be seen as experiencing extra suffering because they were displaying feminine behaviour in the face of war. Prior to the war the majority of mental health patients had been women, and war experiences have been described as ‘men finding themselves in a situation of being in a situation of powerlessness bearing similarity to that experienced by Victorian women in the domestic sphere’. Men who became mentally ill during the war would have extra distress added to their experiences due to being embarrassed to be suffering from a typically female condition.
[A Clinical Lesson at the Salpêtrière by Pierre Aristide André Brouillet, 1887, depicting a hysteria patient.]
There was a noteworthy pool of ex-servicemen with long term mental health problems who managed to avoid the asylum. Around 5,000 men fought hard to stay within their families, with varying levels of support from the state.This early manifestation of community care was sharply dependant on gender, it could only be accessed by ex-servicemen who could rely on an unpaid female caregiver, such as a wife.
Civilians with mental health problems must have been affected dramatically by the sudden influx of vast numbers of ex-servicemen after the war, but shockingly little historical attention has been paid to their experiences, it is an area of study I would like to work on in the future.
Before the war there was felt to be something of a moral failing in mental illness; it was often described as ‘wages of sin’. Pre-1914 medical discourse seems to portray those suffering from mental illness as not just ill, or bad, but actually unpatriotic. The Ex-Services Welfare Society, which was a charity advocating for veterans suffering from shell-shock, began by campaigning for better treatment for all mental health patients but gave this up as they felt it hurt their cause. Through this we can see that old attitudes remained into the post-war era.
Most people who became mentally-ill before the war would be taken to an asylum from which they had very little chance of ever returning. This was almost universal except for the upper classes who could afford private treatment. Just before the war, the medical superintendent of London asylum was reported as saying that only 10% of his patients had any hope of recovery. By sharp contrast, of the 11,600 ex-servicemen committed to asylums either during or just after the war, only 6,000 remained there by 1920.Some of these men had died, but many were considered to have experienced enough of a recovery to be discharged.
Civilians also became much more likely to be discharged, as the overcrowded hospitals and institutions sent them away so they could provide facilities for more soldiers.Although in many cases this meant that people were not receiving the treatment they needed due to lack of space and resources, mental illness no longer meant a life sentence in an asylum, which was a huge change from the pre-war era.
For those who stayed in asylums during the last years of the war, the conditions were dire. Around 17,000 deaths occurred, due to lack of food, lack of staff and overcrowding. The situation was a direct consequence of the war effort; male staff members were encouraged to enlist and were not replaced, and civilian patients were crammed into smaller and smaller facilities to make room for ex-servicemen.
As we have already seen, in the pre-war era mental illness was seen as a feminine affliction. One clear change in civilian mental health after the war was that the popular diagnosis of hysteria declined. Hysteria had been thought of as a condition that only affected women, but the symptoms of shell-shock, a very masculine diagnosis, were almost identical. Shell-shock has been described as ‘an epidemic of male hysteria’.Before the war many considered ‘the mental activity of women’ to be the cause of hysteria, but the fact that men experienced the same symptoms on the front line discredited this idea.
[Author Charlotte Perkins Gilman, who was treated with the 'isolation cure'.]
This helped bring about the end of the ‘isolation cure’ which had been the treatment for many women with hysteria; it involved complete bed rest with no mental stimulation of any kind. In reality the isolation cure itself could cause mental illness and many mentally ill women found war work to be an effective treatment. Clearly inactivity in itself was the cause of much female mental illness before the war, and the decline of the isolation cure was one reason that we see a lower proportion of female mental health patients in the post-war era.
In summary, World War I brought a massive influx of men suffering from mental-illness into Britain, and in many ways the experiences of these men were distinct from pre-war experiences. They were spared the fate of pauper lunatics and made up a different class within the mental health system. By contrast, the war brought a lot of suffering to civilian mental health patients as resources that they needed were taken away to be directed towards ex-servicemen.
On a more positive note, the war contributed to the decline of the hysteria diagnosis, which had brought much suffering to women with mental health problems in the pre-war era. The gap between the experiences of civilians and ex-servicemen narrowed over the years, and the post-war era saw the seeds being sown for a welfare state and community care programmes, and these things would ultimately benefit a huge number of people living with mental illness.
Greta Williams Schultz is a part time history student at University of Manchester and an activist and organiser with multiple physical disabilities and mental health problems. For a longer version, contact email@example.com.
Guest post for Disability and Industiral Society's UK Disability History Month Blogs 2014.