The commemoration of the hundred-year anniversary of the end of World War One reminded us all of the indescribable horrors that many endured in the trenches. Many young men who worked in factories and offices volunteered.They were totally unprepared for the human carnage they would face. For many their bravery and sense of duty were not enough to overcome the horrors that they witnessed. It is estimated that some 250,000 were so overwhelmed that they were unable to continue fighting.

On Monday 12^th October BBC2 broadcast a programme by Dan Snow called WW1’s Secret Shame: Shell Shock. One contributor, Sir Simon Wessely, Professor of Psychological Medicine at the Institute of Psychiatry, describes how some of these young men presented with fits, blindness, deafness, inability to speak and a range of bizarre movements. Some of these do indeed look bizarre to what we think of as our modern enlightened eyes; shaking, facial spasms, inability to walk etc. (Search Youtube for shell shock.)

At the time of WW1 in the general population more people presented with physical rather than psychological symptoms (fainting, paraesthesia [lossof sensation in limbs] pain etc]) When no physical causes could be found these somatic complaints were assumed to be due to weaknesses in the nervous system. This is a sort of physical explanation and is what many psychiatrists at the time believed was the cause of most mental health problems. In the programme Professor Wessely pointed out that culture has a big influence on how individuals present their distress. The way WW1 soldiers experienced their distress fitted with the culture at the time. Reactions to trauma have changed over time and are now regarded as Post Traumatic Stress Disorder. The presentation is now primarily explicitly psychological experiences such as flashbacks and nightmares. 

However, in line with the dominant psychiatric way of thinking, these modern psychological experiences are usually seen as symptoms of an illness. One result of this view is that the illness is seen as a direct result of the trauma and little importance is given to any intervening psychological processes. It was, perhaps, not surprising that Dan Snow unquestioningly argued for this view. He interviewed one soldier who was still suffering from PTSD and felt suicidal some 10 years after his traumatic events.The conversation with this soldier left the impression that both Dan Snow and the soldier believed that he would always suffer from PTSD. This may not be what many psychiatrists believe but it is very often the case that when someone is given a psychiatric label of whatever sort they tend to believe that they will always have the condition.

In WW1 with so many young soldiers being sent home from the front line the Army and Government were understandably concerned with what was happening. Their response was not wholly good in that they tried to suppress the notion of shell shock and blame the individual for their lack of courage. They were concerned with the idea of contagion and wanted to stop the spread of shell shock. They may also have been behind films purporting to show that shell shock could be ‘cured‘  with the right treatment in an hour or so.

Dan Snow praised the modern scientific evidence-based approachto PTSD but lamented “why we still can’t deal with it”. However, he rightly argued that more should be done to help those we train to fight for the country to deal with their experiences both at the time and when they leave theservices.

Perhaps, one thing that needs to change is the understanding of PTSD as a mental illness. Perhaps the psychological experiences of soldiers and others should not be seen as symptoms of an illness but as an active pattern of thinking that sustains and prolongs the distress. Seeing the psychological experiences only as symptoms leaves the individual searching for ‘the right treatment’ and hopingfor a ‘cure’. It robs them of a full and proper understanding of human reactions to trauma.

The latter is about quite ordinary and normal psychological processes which have nothing to do with abnormality, weakness or disorder. These processes recognise that the person is an active agent who is doing their best to make sense of their situation. Of course, such a proper psychological understanding of human reactions to trauma is only a road map. By itself it would not necessarily help soldiers recover. To do that they have to use the map to make a journey. Having witnessed the sort of horrors many of them have, they are more likely to make this journey if they have help.