Shellshock

“The groundwork had been laid for the acceptance of psychological paradigms before shell-shock burst onto the psychiatric scene. . . . In the first 18 months of the war, the interplay of two factors shaped British medical responses to shell-shock: the framework of explanation inherited from pre-war psychological medicine [e.g., railway spine], and attempts to comprehend the particular influence of industrial warfare in producing neuroses. Both militated against the ascription of a purely physical aetiology . . . doctors did not uniformly insist on a physical origin for shell-shock in the early months of the war. Physical explanations were barely put forward at all. When they were, it was in the context of widespread acceptance of the functional nature of most cases. . . . physical theories were seen as an alternative and under-explored possibility” (Loughran II, 83). Only in 1916 were separate physical (Frederick Mott) and psychological theories of shell shock put forward: “These developments were in fact two sides of the same coin: Psychological explanations could not be defined in opposition to physical theories until the latter had been formulated in detail. The mid-point of the war did not witness the triumphal march of psychology so much as the emergence of distinct groups from the welter of medical opinion” (86).. . . After 1917, the bulk of the British medical literature focused on the emotional and psychological origins of the war neuroses [though] the assertion that symptoms sometimes resulted from invisible injury to the central nervous system continued to be made until the end of the war and beyond, although most believed that physical shell shock accounted for only a minority of cases” (87).