Shell Shock (was Newspaper interview request)

[James A. Landau]

In a message dated 3/25/2003 8:32:00 PM Eastern Standard Time,
fred.shapiro at YALE.EDU writes:

> OED's first use [of "shell shock"] is dated 11 Dec. 1915.  Here is a slight
> antedating:
>
> 1915 _N.Y. Times_ 30 Oct. 2  Cases of loss of speech following shell shock
> are being cured by the use of anaesthetics, according to a report in The
> Lancet, made by Dr. A. P. Procter.

Lancet, volume 189 page 977, issue of October 30, 1915, "Three Cases of
Concussion Apahasia:  Treatment by General Anaethesia" by A. P. Procter, MD,
CM.

The phrase appears exactly once in the article, in the opening paragraph:

"Loss of the power to speak has been a very common sequence of shell-shock.
A majority of the cases have been pure anarthria, with retention of the
intellectual mechanism of speech.  One may suppose the shock to have jogged
out of position the synapses of the motor conductoion tracts, the wires of
which have lost their points of contact."

Two earlier usages in Lancet:

volume 189 page 63, issue of July 10, 1915, "Loss of Personality From "Shell
Shock"" by Anthony Feiling, M.D. Cantab., MRCP Lond.

The phrase "shell-shock" is not used in the body of the article.

Volume 188 pages 317-320, issue of February 13, 1915,  "A Contribution to the
Study of Shell Shock" by Charles S. Myers, M.D., Sc.D. Camb.

from the last paragraph before the acknowledgements, page 320 column
     "Comment on these cases seems superfluous.  They appear to constitute a
definitie class among others arising from the effects of shell-shock.  The
shells in question appear to have burst with considerable noise, scattering
much dust, but this was not attended by the production of odour.  It is
therefore difficult to understand why hearing should be (practically)
unaffected, and the dissociated "complex" be confined to the senses of sight,
smell, and taste (and to memory).  THe close relation of these cases to those
of "hysteria" appears fairly certain."

The index to volume 187 (July-December 1914) has no entries for "shell
shock".

Commentary: judging by the way Myers uses the phrase "shell shock", it seems
to have been fairly well known to the Lancet readership, which is to say, to
the British medical community, by February of 1915, at which point the
British army had been in action for no more than six months.

I said in a previous letter that "shell shock" was a euphemism.  Let me
elaborate.  In 1915 most people, in and out of the military, would describe a
soldier who had a mental breakdown in combat as a "coward", and would treat
said soldier with contempt.  On the other hand, if said soldier were
considered to be suffering from the effects of a battlefield wound, then he
need not be, and probably was not, a coward but instead a wounded soldier,
deserving of sympathy.

That is, "shell shock" is not a euphemistic PHRASE but rather a term whose
use signifies a euphemistic ATTITUDE, or better a changed attitude.  To use
the term "shell shock" is to admit that this kind of mental breakdown in
combat was something that could happen to a brave soldier and therefore was
no reflection on the soldier's bravery.

(And in this case the euphemism turned out to be correct (except for the
identification with shellbursts) and the older concept of "cowardice" to be
wrong.)

Why this sudden change in attitude a few months into World War I?  Because
the syndrome got linked in the medical mind, and the public mind as well,
with artillery fire, and the kind and degree of artillery fire (massive
amounts of shells carrying high-explosive charges of the previously unknown
chemical tri-nitro-toluol) met with on the battlefields of Ypres and France
was almost unknown until 1914.

By "shell shock" did the British doctors of 1915 mean "Post-Traumatic Stress
Disorder"?  You would have to ask a psychiatrist.  The three articles cited
above discuss a total of seven cases.  In all cases the triggering event, or
so the authors believed, was a nearby shellburst.  These cases also had
symptoms, such as loss of speech, which are not usually considered symptoms
of PTSD.  This would seem to be evidence that shell shock is not the same thi
ng as PTSD.

However, with our 20/20 hindsight, we can reexamine these 1915 reports.  It
was a rare soldier who experienced heavy combat in 1914-15 who did not
experience artillery shells bursting nearby, so it was an easy
post-hoc-ergo-propter-hoc to associate the syndrome with a shellburst,
particularly since the artillery fire of World War I was of a type and
intensity never experienced before, and therefore it was easy to assume that
a new level in artillery fire would bring about new types of injuries,
including new types of mental injuries.

As for the unusual symptoms reported in these seven cased, in part they got
into Lancet because they were "good copy".  No, this is not meant as
disparagement.  By 1915 British doctors had treated tens of thousands of
battlefield casualties, including I am sure thousands of cases of PTSD.  Such
a doctor, if he chose to submit an article to Lancet on the subject, could
either write a statistical summary of dozens or hundreds of cases he had
seen, or he could write up the single unusual cases he had encountered.  It
is natural for a doctor to write up his unusual cases.  Simply because the
patient had unusual symptoms the doctor had had to put a lot of extra thought
into caring for his patient, and this extra thought in turn gave the doctor
considerably more material to use in his writeup.  Furthermore the details of
an unusual case might end up providing some other doctor with the clues to
figure out this new illness or whatever.  The same impeti were felt by the
editors of Lancet---details of an unusual case would be worth more to their
readers than would descriptions of routine treatments of routine illnesses.

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It turns out that "shell shock" was NOT the first term to be applied to
patients who had survived traumatic stress, SOME of whom we now recognize as
having PTSD.  Well before World War I some doctors had discussed what was
called "railway spine".  This was a catch-all term for mysterious ailments,
some mental, some physical, some apparently psychosomatic, suffered by
various victims of railway accidents.  In those Victorian days there were few
major wars involving English-speakers and hence only a relatively small
number of soldiers who had been overcome by battlefield stress.  During
Victoria's reign the classical source of traumatic stress was railway
accidents.

I have no proof but I suspect that the idea of "shell shock" at least
partially came from transferring the idea of "railway spine" to a World War I
battlefield setting with its unprecedented artillery fire.

             - James A. Landau

PS to Jesse: I will submit the above Lancet citations to the OED.