During World War I, many soldiers suffered from a condition commonly known as
“Shell Shock”. Soldiers who were suffering from shell shock were often referred
to as cowards who could not control their emotions in a very trying situation. With
limited sleep, constant shelling and poor living quarters, shell shock was quite
common. Thousands of soldiers suffered from this condition, but little was done
in the way of treatment for these individuals.
Often times the primary characteristics of “Shell Shock” were displayed through
reactions of fear and anxiety. These characteristics were also combined with
uncontrollable tremors, a pronounced startle reaction to war-related sounds, and
a profound loss of self-confidence. The secondary symptomatic characteristics
were depression with accompanying withdrawal. Soldiers suffering from these
characteristics were classified as weak and poor soldiers.
After World War I, those soldiers lucky enough to return home were often left
untreated for their condition. Little was known about the lasting impact that shell
shock could have on an individual. Soldiers were expected to carry on with their
lives as if they had not experienced the horrors of trench warfare.
Mental hospital psychiatry experienced rapid growth and development in the late
1930s. For example, insulin induced comas were common practice as treatments
for schizophrenia. Other treatments at the time were metrazol, a chemical that
would send the patient into violent convulsions, but was questionable due to
fractures of the vertebrae.
After the start of World War II, recruits were signing up in large numbers. Little
had changed with the process of signing up when compared to World War I. As
criticism grew from the army’s method of testing (strictly physical), a conference
was held in Ottawa called “ The Use of Physiological Methods in Wartime” was
held in Ottawa. The results were a new aptitude test that would determine the
mental ability of a recruit. The belief was that there was a correlation between
those struggling with “Shell Shock” and mental ability. The request was that all
soldiers be re-tested with these new tests. If a soldier came back as a failure
according to the test, they would reject their application.
In World War I alone, the Canadian Army had admitted 15 500 soldiers with
neurpsychiatric disabilities, of which 9000 were classified as “Shell Shock”. The
goal was to prevent this from happening again.
The term “Battle Exhaustion” emerged during World War II as this newly
improved understanding of soldier psychology emerged. It was recognized early
in the war that psychiatric casualties would require treatment as well as soldiers
who had been physically wounded. No. 1 Neurological Hospital was established
in September 1940 near Basingstoke in Hampshire with 200 beds. Often simply
referred to as "Basingstoke", this hospital also handled plastic surgery. In the
Mediterranean theatre, 1st Canadian Infantry Division appointed a divisional
psychiatrist, and a Base Neuropsychiatric Centre was established at No. 15
General Hospital in North Africa. Treatment included sedation, rest,
psychotherapy, and drug and electro-shock therapy. Work served as another
form of therapy, Special Employment Companies being used to load supplies of
ammunition and fuel for the battlefield among other tasks. Battle exhaustion
casualties apparently responded well to being given something meaningful to do.
As the war continued, better treatments were available for the soldiers. The work
that was being done at Basingstoke was showing promise, with survivors from
the Dieppe raid (2000), 587 were classified as wounded and the majority were
known as Battle Exhaustion cases. The British and Canadians were using this
term, while the Americans were using the term Combat Exhaustion.
Biological factors are not alone in causing battle exhaustion. Social and
psychological factors also play an important part. There is evidence that certain
people are predisposed to breaking down in a combat environment, either due to
genetic or behavioral causes. It is important to keep in mind however that battle
exhaustion can affect almost anyone at almost any time when exposed to
combat stress. The Canadian Army’s current doctrine on stress shows that, when
encountering stress, every person has a malleable breaking point. This
breakdown generally occurs either immediately following the first incidence of
Combat Stress, or after a cumulative period. As such, where the onset of this
condition is based initially on a biological defense mechanism, these changes are
ameliorated by psychological and social factors. Based on current research,
psychological factors fall into three categories. Individual factors, such as
personality and nonmilitary stresses, condition the response of the individual to
combat stress. Battlefield factors such as the type of battle, enemy action, and
uncertainty, colour the experience of the soldier, making him more or less likely
to breakdown under the strain.
In terms of numbers, the RCAMC would have some success during the Second
World War. Despite the above mentioned doctrinal deficiencies, the RCAMC still
managed to return some 36% of battle exhaustion patients to full duty in the
Italian front between 1943 and 1945. Only 7% had to be evacuated to Canada or
a psychiatric hospital. The reasons for this success rate stem from the forward
aid posts and the very serious thought given to the problem of battle exhaustion
prior to the outbreak of War. During the First World War, little to no provision had
been made for the treatment of psychiatric casualties. During the Second World
War, the war neuroses were by no means an under appreciated problem; this led
originally to the establishment of the Canadian Neuropsychiatric
Hospital at Basingstoke, and later to forward “Exhaustion Units” and roaming
psychiatrists who treated their patients at Regimental Aid Posts. With resources
like this, Canadian soldiers at least had an administrative apparatus to fall into if
they became a psychiatric casualty.
Like so many Second World War services, the RCAMC neuropsychiatric
branch was an entity bogged down by prewar doctrines and beliefs. It proved
itself intransient in those beliefs. This is probably because battle exhaustion is
such a difficult to understand condition, and early experiences in the war,
especially at Basingstoke, reaffirmed closely held beliefs on the nature of the war
neuroses. RCAMC psychiatrists did the best they could with the doctrinal tools
available, but didn’t do enough to allow themselves to be malleable in the face of
changing data that should have changed their perceptions. Despite this, they did
more good than harm, and many a soldier’s mind was saved through their efforts.
Case 1: (improved)
A.F., a 35-year old private, of average intelligence and fair stability, was
evacuated from battle because of acute anxiety symptoms. He received no
treatment except rest and was re-employed in a rear area within the sound of
gunfire. At the time of discharge from the army he was complaining of
nervousness, insomnia, battle dreams, startle reaction, palpitation and joint pains.
He was interviewed again six months after discharge. It was learned that he went
to work almost immediately in a tannery. At the same time he succeeded in
starting a small business manufacturing floor polish. He recently obtained a
divorce from his wife and has the custody of his two children. He is living with his
parents under adequate housing conditions. His appearance is improved, he has
gained weight and appears less "strained". His attitude is friendly and agreeable.
He feels his general health has improved. The battle dreams and nervousness
are diminishing but he is still easily startled. For recreation he goes to the movies,
takes his children for walks, or occasionally plays pool with his veteran friends.
Case 2: (unchanged)
R.S., was a 28-year old signalman who developed anxiety symptoms and
physical complaints after evacuation for superficial flesh wounds. He received no
treatment for the psychiatric disability. At the time of discharge he suffered from
nervousness, instability, anorexia, dizziness and palpitation. When seen six
months later he stated that he was employed in a biscuit factory but was
dissatisfied because of the dust in the shop. The subject, his wife and 7-year old
daughter were living in two rooms in the top of his mother-in-law’s house. The
remainder of the house was overcrowded and included several persons of low
mentality and doubtful morals. The subject was tired all the time but restless and
fidgety. He slept poorly and lost weight. The noise of others in the house upset
him but he would not go out except to an occasional hockey game. He would not
go to a doctor.
Case 3: (aggravated)
F.A., a 27-year old corporal, of average intelligence and good stability, was
evacuated from battle because of an acute hysterical amnesia. He was treated
immediately by narcohypnosis and improved sufficiently to return to combat duty,
but still has startle reaction and battle dreams. At the time of discharge he was
restless and depressed. He complained of stomach trouble and mild insomnia.
When interviewed six months later he was much depressed. His first job had
been with a dairy but he soon " went to pieces'" as it entailed working from 5.30
a.m. to 10.00 p.m. He left the job after one month and had a week 's rest. He has
not been able to find work since, as he has no inclination for a trade and feels
mentally incapable of working at an " indoor " job. He would like to go on a farm
but his wife refuses. He lived in a summer cottage until mid-winter and then
moved in with his mother. He has not been able to save any of his gratuity since
"all the family is living off him". His wife is pregnant and is morose and depressed.
The subject has had a recurrence of his battle dreams and startle reaction. He
cannot sleep half the time, and is unable to eat. He has had frequent attacks of
diarrhea. He is worried about his unemployment, his health and the future
generally.