Pioneering days for trauma care

One positive thing to come out of the first world war was that it changed the way psychological trauma was treated.

One positive thing to come out of the first world war was that it changed the way psychological trauma was treated.

Casualties at the Battle of the Somme. Picture: Alamy

The centenary of the start of the Battle of the Somme will be commemorated on July 1. On that day alone in 1916 there were 57,240 British casualties, of whom 19,240 died – the biggest loss of men in one day in the British army’s history.

By the battle’s end, on November 18, there had been 420,000 British casualties, including my own great grandfather, Private Allen Reed of the Durham Light Infantry.

Historian and writer Taylor Downing estimates that 63,200 British soldiers suffered psychological trauma at the Somme. Accounts of trauma are traceable throughout history, but the first world war stands out because of its sheer scale, the coining of the term shell shock and the pioneering of new treatments.

Reactions to those affected varied from sympathy to curiosity, cynicism to a total lack of understanding. Shell shock was sometimes seen as cowardice or malingering, which could lead to a soldier being executed for desertion.

As Fiona Reid, deputy head of humanities at the University of Glamorgan and author of Broken Men: Shell Shock, Treatment and Recovery, 1914-30 (London,Continuum), says: ‘Some lived in real fear of being sent to a pauper asylum and many spent the post-war years trying to live on scanty pensions with irregular and inadequate heath care.’

Few wartime doctors and nurses had experience of working with people with mental health problems. One, Sister Catherine Black, wrote movingly about the men she nursed in France. In civilian life she had been a general nurse at the Royal London Hospital. Now she was put in charge of a ward of shell-shocked soldiers.


She described the nights as being particularly bad. The ward became, she said, ‘a place of torment, with the occupant of every bed tossing and turning in a hell of memories let loose’. No two cases were the same and ‘it was work that demanded endless patience, for results were so slow, and you could only go one step at a time and hope for the best’, she adds.

The war changed the way psychological trauma was treated. Pioneering hospitals developed what could be loosely termed ‘talking treatments’ to supplement customary prescriptions for initial rest, nourishing diet, sleep and occupation.

There was increasing recognition that the environment could play a role in mental health problems, while before 1914, the aetiology of mental illness was generally thought heredity and degenerative. Innovations were also made in the location of treatment. As it became apparent that men repatriated to UK-based hospitals were unlikely to return to combat units, this was replaced by what became known as forward psychiatry.

Four advanced units were established, about ten miles from the trenches, admitting soldiers directly from battle. They were fed, allowed to rest, then put on a programme of graduated exercise.

The recent Invictus Games are a reminder about the damage war can cause to men and women. The work of charities, such as Combat Stress, also highlights the fact that post-traumatic stress disorder remains a real issue for the armed forces.

As the anniversary of the Somme is remembered, spare a thought for those who bore its psychological wounds, those who continue to suffer as a result of military experiences, and those who work to alleviate it, including many nurses.

About the author

Claire Chatterton chairs the RCN’s History of Nursing Society and is a tutor at the Open University in the North West.

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