On 28 June 1914, Gavrilo Princip assassinated Archduke Franz Ferdinand in Sarajevo[1]. Tensions had been brewing throughout Europe for years —especially in the troubled Balkan region of southeast Europe. Princip and other nationalists were fighting for an end Austro-Hungarian rule over Bosnia and Herzegovina. The assassination of Franz Ferdinand set off a rapidly escalating chain of events: Austria-Hungary, like many in countries around the world, blamed the Serbian government for the attack and hoped to use the incident as justification for settling the question of Serbian nationalism once and for all.
Although the assassination of Franz Ferdinand can be seen as precipitating World War One (WW1), one can also say that the political situation was primed for war. Many countries had alliances with one another, so if one country was attacked the others would get involved to defend that country[2]. Added to this, many of the key players: Great Britain, Germany, Austria-Hungary and Russia had empires. Each wanted to keep their empire strong and saw other countries taking over new territories as a threat to their own empires. As well as this there were a number of long-standing rivalries such as that between Austria-Hungary and Russia which dated back to the eighteenth century, but had been heightened by the Crimean War and the collapse of the Ottoman Empire in Europe[3]. All of this meant that when war started it quickly escalated into a global conflict.
Archduke Franz Ferdinand, the heir to the throne of Austria-Hungary, was shot while visiting Sarajevo in Bosnia. This led to Austria-Hungary declaring war on Serbia. This caused Russia to join the war, because Russia had an alliance with Serbia[4]. This in turn meant that Germany declared war on Russia[5], because Germany had an alliance with Austria-Hungary. Then when Germany invaded neutral Belgium Britain was drawn into the war because it had agreements to protect Belgium and France[6].
On 4 August 1914 German troops crossed the border into Belgium. The first battle of WW1 took place when the Germans decimated the city of Liege, using heavy cannons, before advancing on to France.
The first major battle of WW1 took place at Marne, from 6 to 9 September 1914 and both sides lost around a quarter of a million men each[7]. The French and British forces checked the German advance just 30 miles from Paris and mounted a successful counterattack, driving the Germans back to north of the Aisne River.
Both sides ‘dug in’ creating the Western Front and beginning a horrific trench war that moved no more than ten miles, lasted more than three years[8] and included:
- the Battle of Ypres (19 October to 22 November 1914) where over 230,000 died[9]
- the Battle of Champagne (20 December 1914 to 17 March 1915) where there were almost 200,000 casualties[10]
- the Second Battle of Ypres (22 April to 25 May 1915), which was the first major deployment of chemical weapons and around 100,000 died[11] (proper gas masks were not developed until early 1917 and troops faced gas with little more than bits of cloth soaked in urine[12])
- the Battle of Loos (25 to 28 September 1915) where there were 50,000 British casualties[13]
- Verdun (21 February to 18 December 1916) where roughly a million were lost[14]
- the Somme (1 July to 18 November 1916), where on the first day the British lost 58,000 and total losses were 1.1 million[15]
- Passchendaele (31 July to 10 November 1917) where the British advance was slowed by the terrible mud and there were more than half a million casualties[16]
The British army was made up of around 4 million men from England, 558,000 men from Scotland, 273,000 men from Wales and 134,000 men from Ireland. Just under 1 million British troops died.
A total of 65 million troops from around the world fought in WW1. 8.5 million troops are thought to have been killed. Twenty one million troops were wounded. An estimated two million soldiers, sailors and airmen died from disease, malnutrition and other causes. An estimated 13 million civilians were killed.
Even now the figures are almost beyond comprehension.
One of the most significant factors in WW1 was the industrialisation of warfare. This kind of warfare had never been seen before and it was shocking. The new weapons and technologies that were developed and used led to more death and destruction than any previous war.
In 1914, planes were still a very new invention. Wilbur and Orville Wright had only taken to the skies just 11 years before. When war broke out scientists and engineers were quick to develop planes that were capable of being used in battle. The Germans deployed U-boats and the British developed sonar to protect its navy. Poisonous gas was used as a weapon. Modern chemistry brought nitroglycerine and shells packed with high explosives – lyddite, cordite, melinite[17]. Artillery could be mounted on recoilless carriages that did not need resighting after each shot[18]. Sound ranging was developed for the more accurate use of artillery. Trench mortars, machine guns and hand-grenades were developed. Britain used tanks in battle for the first time on 15 September 1916 and, in total, produced around 2,600 of them throughout the war.
It wasn’t just weaponry that advanced, though, new methods of photography, sound recording and ways to communicate were developed during the war, which had a long-lasting impact.
The wounds suffered by the soldiers were like nothing doctors had had to deal with before – not only in type, but in scale of numbers. The nature of the injuries forced huge leaps in reconstructive surgery. The very few British surgeons who had specialised in neurology were overwhelmed by the enormous number of head wounds requiring brain surgery[19]. The war meant that medicine had to catch up to be able to deal with these problems. Among these problems was the impact that the new forms of warfare had on the mind.
By the end of 1914 doctors were finding themselves faced by inexplicable cases: soldiers who were not injured but who had their senses deranged so that they could not see, smell or taste properly[20]. Some could not stand or walk properly, some could not speak and many suffered from the shakes[21]. Between seven and ten percent of officers and three to four per cent of all ranks were being sent home because of nervous or mental breakdown[22]. No one knew how these symptoms were created[23].
Within the British medical profession there was debate about whether this was caused by damage to the nervous system or whether it was emotional shock. Before the war the British Army Medical Corps had no specialist neurologists or psychiatrists, given this and the advances of British biological medicine before the war it was not surprising that many looked for physical explanations[24]. Some thought that ‘concussion’, ‘tiny particles’ or ‘the effects of explosive gases’ may be responsible[25]. Added to this there was great resistance from the military to psychological explanations. For the military ‘mental weakness equated with weakness and lack of self-control, something to be treated by disciplinary methods’ and not treatment[26].
A critical shift occurred in the spring of 1915. Dr Charles Myers, a distinguished psychologist from Cambridge University came to France[27]. Myers, who was a qualified doctor but had never practised, had run the small Cambridge psychology department with WHR Rivers (who was later to become famous for treating Siegfried Sassoon) and William Mc Dougall[28].
Myers had gone to France in 1914 and persuaded the Duchess of Westminster to take him on at the hospital that she was establishing at le Touquet in Paris, but was frustrated that the other doctors would not let him see any patients[29]. Because of this he took the time to visit the French neurologist Dejerine at the Salpêtrière hospital[30]. Here he saw a number of cases of soldiers who had been struck dumb or partially paralysed and was made aware of the risk of hysterical breakdown[31].
Myers returned to le Touquet where, on 5 November 1914, a 20 year-old private soldier was admitted[32]. The soldier had been moving from one front-line trench to another, when while trying to crawl under some barbed wire the German artillery ‘found’ him with two or three shells bursting near him, entangling him in the wire[33]. While he was trying to disentangle himself three more shells burst behind him and one in front of him[34]. After the shell burst in front of him his sight became blurred and it hurt him to open his eyes[35]. His escape was a miracle. He managed to get back to the trenches, where some of his comrades took him to the dressing station, crying, shaking and frightened that he was going blind[36]. He was then taken by horse ambulance to a field hospital. Four days later he was moved to le Touquet, where Charles Myers saw him[37], recorded his symptoms of sensory derangement and tried treating him with hypnosis and suggestions[38]. After ten days at le Touquet the private was evacuated to England and the Middlesex Hospital[39].
This unknown private was the first recorded case of ‘shell-shock’. At the start of the war shell-shock was not a well-known condition and Charles Myers was responsible for using the term in a Lancet article in 1915[40],[41] and bringing the term that the soldiers used into medical parlance.
This case and two others form the core of Myers article and his brief conclusion was that they constituted ‘a definite class among others arising from the effects of shell-shock’ and that the ‘close relation of these cases to those of “hysteria” appears fairly certain’[42].
His findings were not greeted with universal acceptance, particularly in the army where men were either well, sick, wounded, mad or a coward to be shot[43].
Psychoanalysis was still a very new subject and before World War 1 and the French were the world leaders. In the mid-nineteenth century Jean-Martin Charcot in Paris had established a famous neurology clinic at Salpêtrière Hospital and was one of the first doctors to take hysteria seriously[44]. His students: Joseph Babinski, Jules Dejerine, Pierre Janet and Sigmund Freud were the ones who developed the new discipline of psychoanalysis.
At the start of World War 1 the scientific status of psychoanalysis was viewed with suspicion in Britain[45]. Although Ernest Jones had established the London Psycho-Analytic Society at the end of 1913, it was founded with nine members[46] (including: Ernest Jones, William Mackenzie, Maurice Nicoll and David Eder). That only grew to fifteen in the first year and of those only four were practising analysts[47].
Following the publication of his Lancet article Myers was moved to the Boulogne where he attended various Base hospitals taking responsibility for a number of cases[48]. Myers used a simple model of the mind derived from the French neurologists Dejerine and Janet, where the mind attempts to hide experiences and emotions it cannot cope with from consciousness, causing a splitting of the mind[49]. He initially used hypnosis and suggestion to treat patients, but the method was too slow and time consuming to deal with the number of patients he faced and he rapidly lost enthusiasm[50]. Similarly, the Army had little enthusiasm for psychologists, feeling that they made winning the war more difficult[51].
An academic like Myers had trouble winning allies, even among his colleagues in the Royal Army Medical Corps, who were alarmed by his use of hypnosis[52]. Although Myers had identified shell shock and other doctors were able to support his analysis he had trouble getting the Army to accept it as a category and it was only late in 1915 that the Army recognised its existence[53]. However, even then it created two categories: shell-shock-W (wounded), and shell-shock-S (sickness)[54]. The difference was only the wounded were eligible for a pension, even in 1915 the Army was seeking to defray costs. As well as this how care at hospitals was administered was hugely variable.
There was a great difference between how officers and the rank and file were treated. Officers and men ‘went to different hospitals and got different levels of treatment’[55]. Soldiers were ‘either sick, well, wounded or mad’[56]. Most soldiers would be ‘given a brisk laxative’ and sent back to the front[57]. A man who was ‘unwilling to or incapable of fighting was necessarily a coward, to be shot if necessary’[58] (during World War 1 the British handed out 3,080 death sentences[59]).
JR Rees, one of the founder members of the Tavistock Clinic and its second Medical Director, described the mud in the trenches, the unsteady duckboards, the corpses, rats and lice as mere ‘travelers’ tales’[60]. What affected him was ‘seeing young soldiers, who had been broken by anxiety and run from their duty, being shot at dawn’[61], a proceeding in which he, as a Medical Officer, had to take part.
Myers continued to do good work. In May 1916 he began to press for shell-shock to be treated earlier, arguing that it should be treated at specialist hospitals near the front[62]. In this, he had already identified the principle of ‘proximity’ on which all modern military psychiatry is based[63]. Unfortunately, by this stage he was so marginalised that his advice was largely ignored.
Most cases of shell-shock were evacuated back to England[64]. Many were left to moulder unattended. Some were shipped to county asylums, where by treating traumatised soldiers as if they were mad pushed many into genuine insanity[65].
By the Somme shell-shock had become a serious drain on manpower, escalating to possibly almost 100,000 cases in that battle alone[66]. As well as being treated at the front many were shipped back to the UK. The use of electric shock treatments was common. Certainly, some of the treatments developed for shell-shock had an element of ‘punishment’ about them and ‘some have described these methods as sadism’[67].
For the rank and file the army established Maghull near Liverpool, under the command of Ronald Rows, who had been a pathologist[68]. It drew together a specialist team of 67 medical officers[69], (including Oxbridge heavyweights: William Brown, William MacDougall and William Rivers[70]) to try out ‘the psychological ideas of Dejerine, Janet and Freud’[71].
At Maghull, Rivers found that the patients confirmed Freud’s theories that ‘dreams have the fulfilment of a wish as their motive’[72], but he also found that ‘the dreams of uneducated persons are exceedingly simple’[73]. Because of this in October 1916[74] River’s moved on to Craiglockhart Hospital near Edinburgh, where the officers were sent and where he treated Siegfried Sassoon, which made him ‘the most interesting of the shell-shock doctors’[75].
The experience of treating shell-shock led Rivers to recognise the value and wide application of Freud’s theory of the unconscious, but to categorically disagree with the notion that all neurosis was produced by sexual factors, stating ‘the results of warfare provide little evidence in favour of the production of functional nervous disorders by the activity of suppressed sexual complexes’, but that they relate ‘directly, to the strains and shocks of warfare’[76]. By the end of the war Freud too revised his theories to encompass a model of what happens in trauma, where dreams can be seen as ‘helping carry out another task’, which is to ‘master the stimulus retrospectively’[77].
At the outbreak of war in 1914 Hugh Crichton-Miller volunteered for the Royal Army Medical Corps[78] and was posted to the 21st General Hospital, Alexandria in Egypt[79],[80],[81] as Medical Officer in charge Functional Cases[82], with the rank of lieutenant-colonel[83]. At that time Hugh Crichton-Miller was already familiar with the ideas of Freud[84], Jung and the French Schools[85]. However his growing psychoanalytic orientation was influenced by his work with an Army in Alexandria, where he came into direct contact with cases of shell shock.
At the 21st General Hospital Hugh Crichton-Miller saw many examples of shell-shock, particularly after the Gallipoli[86] campaign of 1915, which made Alexandria an important hospital centre. His experiences at the 21st General Hospital enabled him to see ‘more clearly than before the relations between mind and body’[87], arguing that an emotion like fear ‘may produce a direct effect on mental stability, but it may also produce an effect on the endocrine system… which in its turn, would react finally on mental stability’[88].
Hugh Crichton-Miller argued that most cases of shell-shock had ‘broken down, either from the emotional strain associated with trench life or from the… chronic apprehension of danger’[89]. However, he also found a significant pattern of ‘developmental flaw’[90] relating to the experience of violent and abusive behaviour during childhood, normally associated with having an alcoholic father[91]. Nowadays it is recognised that ‘many traumatised children are in threat-induced hyperaroused sympathetic nervous system states’[92] and that ‘whether we bounce back or go under after a knock is “overdetermined” by factors such as… early history’[93].
This idea that the mind could influence the health of the body and that physical health influenced the state of the mind became Hugh Crichton-Miller’s key insight from his work on shell-shock and a major influence on his work after the war. It was an approach which he termed ‘binocular’[94],[95], and which his colleagues good-humouredly called the ‘double-barrelled approach’[96].
Hugh Crichton-Miller’s work on shell-shock was of sufficient significance for William McDougall to list him as being one of the school that he called British or ‘integral’, which also included: WHR Rivers, TW Mitchell (editor of the British Journal of Medical Psychology), W Brown, JA Hadfield (another key figure at the Tavistock Clinic) and M Culpin[97]. This school, while accepting Freud’s basic propositions around the unconscious, resistance and conflict took rather individual and pragmatic approaches[98].
Later in the war Hugh Crichton-Miller returned to London and between 1915 and 1917[99] was appointed as a Consultant on Shell-shock to the 4th London General Hospital[100]. The 4th London General was a military hospital that had taken over the then unnamed buildings that were later to become the Maudsley Hospital [101], where he spent most of his day on his war work for the Special Medical Board of the Ministry of Pensions[102].
At the end of the war Hugh Crichton-Miller’s standing among the pre-eminent British shell-shock doctors was such that he could front Functional Nerve Disease, a book which included contributions from JA Hadfield, WHR Rivers and W McDougall.
As well as an understanding of neurosis, another area of work to understand the mind that developed considerably during World War 1 was intelligence testing[103]. Again the key developments initially came from French research.
During the nineteenth century, with the introduction of universal education in France an early problem that was encountered was children who were not capable of learning[104]. Administrators sought a scientific and rational method for identifying such children. Although nowadays educational testing is so normal as to seem obvious, at the time it was not. Initially doctors sought to identify the ‘feeble minded’ through physical examination[105]. However they quickly found that disproportioned limbs, deformed palates, cranial shapes and degenerate ears were unreliable as indicators of intelligence[106].
Somehow the internal workings of the mind had to be made visible and in 1904 the French analyst Alfred Binet had developed a test for identifying the ‘feeble minded’[107].
This was initially to identify children for admission to special schools, but then between 1908 and 1911 Alfred Binet revised his work transforming it from a technique for diagnosing the pathological into a scale for mapping the normal and thus intelligence testing was born[108]. The two keys to this were the use of the statistical concept of ‘normal distribution’[109] and the use of age as a way of ranking individuals, which only became possible with the advent of large schools with large numbers of children of similar ages[110].
Like psychoanalysis, intelligence testing provided another tool for understanding the mind and also of charting the mind’s development.
In Britain this work was adapted by Cyril Burt to meet the administrative requirements of the education authorities[111]. It would later give rise to psychometric testing through which the previously ungraspable domain of mental capacities was opened up into numbers, quotients and scores that could be turned into profiles that made the individual knowable[112].
The first uses of intelligence testing was to screen military recruits[113]. From the outset it was believed that such tests could perform three crucial tasks for the military: eliminating the mentally incompetent, classifying men according to ability and selecting competent recruits for responsible positions[114].
In March of 1918 the Germans launched a massive offensive on the Western Front, but the allies held their line and then in September with the help of the newly arrived American allies a counter-attack finally pierced the previously impregnable Hindenburg Line[115]. The retreating German Army realising they could no longer win sued for peace.
World War 1 ended on 11 November 1918. Its costs were huge and resulted in the reshaping of the political map of Europe. Under the Treaty of Versailles Germany lost about a tenth of its land. Further treaties saw Bulgaria, Austria and Hungary lose territory too.
World War 1 spelled the end of the Ottoman Turkish empire and contributed to the Russian revolution, which marked the beginning of communism.
World War 1 brought about massive social upheaval, as millions of women entered the workforce to support men who went to war, and to replace those who never came back. The first global war also helped to spread one of the world’s deadliest global pandemics, the Spanish flu epidemic of 1918, which killed an estimated 20 to 50 million people.
Author: Glenn Gossling 2019
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