The Effects of Shell Shock Summary

  • Last updated on November 10, 2022

This document is a physician’s account of the effects of shell shock on the soldiers who were injured in the trenches in World War I. At a time when the traumatic effects of war on the brain were not well understood, hysteria was assumed to be at the root of many injuries, if no external cause could be found. Dr. Houston goes into significant detail concerning the physical symptoms that occur with shell shock along with some of the ways they could be treated. The various and terrible injuries that soldiers fighting in the trenches faced are explained, and the relative lack of knowledge about how to treat such injuries is indicated. Dr. Houston, a distinguished neurologist, does his best to explain how to deal with these injuries, but he leaves the readers of his article without a clear idea of what treatment would be helpful or effective–such was the state of medical knowledge at the time.

Summary Overview

This document is a physician’s account of the effects of shell shock on the soldiers who were injured in the trenches in World War I. At a time when the traumatic effects of war on the brain were not well understood, hysteria was assumed to be at the root of many injuries, if no external cause could be found. Dr. Houston goes into significant detail concerning the physical symptoms that occur with shell shock along with some of the ways they could be treated. The various and terrible injuries that soldiers fighting in the trenches faced are explained, and the relative lack of knowledge about how to treat such injuries is indicated. Dr. Houston, a distinguished neurologist, does his best to explain how to deal with these injuries, but he leaves the readers of his article without a clear idea of what treatment would be helpful or effective–such was the state of medical knowledge at the time.

Defining Moment

World War I was a war unlike any that had occurred before. The day-to-day rain of mortar shells on men stuck in trenches and surrounded by mud, death, and offal created conditions that broke the spirits of many a soldier. Men who suffered from injuries, such as shell shock–also known as war neurosis–were often deemed weak or prone to failures of the nervous system and could be considered cowards because they seemed unable to cope with the pressures of battle. The explosions from shells created obvious physical injuries, but they also produced injuries that were not necessarily apparent through a physical examination. The Great War was one of the first times in history that mental trauma struck so many soldiers and to such a marked degree. This document is one that resulted from this new area of study–namely, how soldiers’ mental states played a role in their ability, or inability, to fight. Almost nothing was known about how the mind reacted to the stress of battle. Doctors tried to understand the problem, but not always with great results. Depression, anxiety, memory loss, and many other symptoms are now known to result from exhaustion and combat stress. In 1917, however, these issues were just emerging.

This article was published in the New York Times just weeks before the United States entered World War I. But even though American soldiers had not yet entered the trenches, American doctors, along with much of the country, were hungry for news and information from the front lines. Dr. W. R. Houston was interested in the new medical issues that arose from the fighting and presented his own observations on the subject. The main issue with such a document, especially since the true reasons for shell shock were not yet known, was that it spread the idea that suffering from shell shock–or what is now known as combat stress and post-traumatic stress disorder (PTSD)–was something shameful and only happened to weak men. Documents like this show how much neuroscience has advanced, due in large part to the study of soldiers in the twentieth and twenty-first centuries.

Author Biography

Very little information survives about the author of this document, Dr. W. R. Houston, other than the previously stated point about his being a doctor of neurology and a professor of clinical medicine at the University of Georgia. During World War I, Dr. Houston visited France in order to see first-hand the injured soldiers and the effects of the war traumas on their brains. It was from these experiences that he wrote the article examined below, which attempts to understand the physical reasons for the mental breakdowns experienced by so many soldiers. Dr. Houston wrote an article in The Annals of Internal Medicine in 1938 entitled “The Doctor Himself as a Therapeutic Agent.” That article examines the idea that a doctor needs to be more involved with his patient in order to create the best outcome. It is possible that this interest in healing the patient, beyond simply treating the symptoms, stemmed from his experiences with World War I injuries.

Document Analysis

The aim of this document is to address and explain some of the reports and rumors that were coming across the Atlantic Ocean concerning the war and its effects on soldiers. Dr. Houston, although he went to France in order to gain experience with these new forms of injury, also wants to enlighten the public about the conditions from which the soldiers were suffering. The article was written about two years after the term “shell shock” was first coined, and the condition’s nature was still largely unknown. About all that was known was that it was a stigmatized sort of injury and one that was said mainly to affect the cowardly and the weak.

Dr. Houston, in fact, opens his account with a theory of the type of men that are affected by shell shock. This theory has now been shown to be invalid, as most anyone can become deeply troubled by the horrors of war and develop physiological reactions or symptoms. At the time, however, shell shock was mostly associated with “the nervously frail, the men of unstable equilibrium.” Houston, in his opening paragraphs, does mention that there were many types of neurological conditions that have resulted from the war and its associated injuries. He seems to associate these types of injuries with the “air concussion” produced by exploding shells, as with internal injuries that sometimes left soldiers dead, yet seemingly uninjured to the eye. The link between the ideas that the internal organs can be injured to the point of death and that the brain can be injured to the point of breakdown, seems to be operative in Houston’s account, although perhaps not explicitly so.

As the author continues in the article, he describes the terrible wounds and ailments that left soldiers bed-bound and unable to fight or even care for themselves. His understanding of the physical nature of these injuries–even those that cause hemorrhages in the brain–is confident. What he seems unable to get at are other physical traces of damage to the brain and what such damage can lead to, such as partial paralysis or the inability to speak. Because shell shock was not fully understood, Houston does not fully differentiate between the mental inability to cope with war and the physical damage done to the brain that produced bodily symptoms. The instances in which Houston mentions such problems as loss of memory, “convulsive attacks…similar to…epilepsy,” and uncontrollable tremors show that, as is now known, the brain was likely damaged in such a way as to be mostly invisible to the naked eye. Traumatic brain injury and post-traumatic stress can be extremely harmful conditions, with lasting effects on one’s physical and mental health. It may hinder a soldier’s ability to move on in postwar life.

Essential Themes

The identification of shell shock and the evolution of understanding and treating it began with early physicians, such as Dr. Houston, venturing to the army hospitals and reporting what they saw. These doctors were experts in various fields, but this new type of trauma lay outside their empirical knowledge. Shell shock was seen as evidence of cowardice or internal weakness. In the military, cowardice is and was punishable, even by death–though, often, soldiers were simply hospitalized and sent back to the trenches. In the case of Houston and his article, the aim is to provide a medical description for lay persons in an attempt to address rumors and perhaps lighten American fears. He provides some answers as to why soldiers have died in the trenches without a wound on them and lays out the basics regarding shell shock.

Reports like Houston’s ultimately created a basis for the expansion of neurological and psychiatric understanding of concussive impact and emotional trauma and their effects on the body and the brain. Even today, although traumatic brain injury is generally accepted as a medical condition, there remains some stigma attached to post-traumatic stress disorder. Fortunately, this is beginning to change and more people now recognize mental conditions as legitimate–and treatable–medical conditions. This change is thanks, in part, to neurological specialists like Dr. Houston.

Bibliography and Additional Reading
  • Babington, Anthony. Shell Shock: A History of the Changing Attitude to War Neurosis. Wiltshire: Redwood Books, 1990. Print.
  • Hipp, Daniel. The Poetry of Shell Shock: Wartime Trauma and Healing in Wilfred Owen, Ivor Gurney, and Siegfried Sassoon. Jefferson, NC: McFarland, 2005. Print.
  • Houston, Dr. W. R. “The Doctor Himself as a Therapeutic Agent.” The Annals of Internal Medicine 11 (1938): 1416–1425.
  • Jones, Edgar, and Simon Wessely. Shell Shock to PTSD: Military Psychiatry from 1900 to the Gulf War. East Sussex: Psychology Press, 2005. Print.
  • “Shell Shock and War Neuroses.” British Medical Journal 2 (1918): 260.
Categories: History Content