Hysteric or neurasthenic? The role of class in the treatment of ‘shell shock’ during World War One


Managed to leave the capital twice last week, which was nice and pretty rare. One for business, one for pleasure. Below’s the talk I presented at the excellent Civilising Bodies Colloquium at the University of Exeter on Thursday 25 April. The paper itself is far longer, far more referenced, and takes in a broader swathe of the post-war experience. I’ll look to develop that and publish it somewhere. For now, here’s the abridged version delivered. As I presented this, behind me I projected footage from this film. I suggest that if you have time to read this, you arrange the display so that around half your screen displays the film. It’s intentional. The movements of the men depicted provide a commentary on this paper, and vice-versa.


Hysteric or neurasthenic? The role of class in the treatment of ‘shell shock’ during World War One
JD. Taylor, University of Roehampton.

The Great War of 1914-18 set Europe alight. Fresh-faced young men – Fathers, brothers, and children signed their lives away to death, or perhaps worse- a life of torture, haunted by their own memories, and visions of what they had seen. Male hysteria, known more commonly at the time as ‘Shell shock’, was one reaction to the new form of industrialised warfare, where enemies could not be seen, war seemed an endless prospect, and death reigned omnipotent. Although at first male hysterics were dismissed as cowards and ‘lunatics’, as war drudged on the sheer scale of the problem became apparent, and superiors as well as government were forced to confront the issue. For those who survived ‘The Great War’, these images of death and feelings of terror would forever haunt them. Caught in a No Man’s Land of male hysteria, many men serving broke down in the midst of war unable to cope, continue on, or simply function.

This paper explores the role of social class in relation to male hysterics – as well as those who observed them – through the diagnosis, symptoms and treatment of ‘shell shock’. It will do this by using the contemporary ideas of masculinity, psychology and eugenic theory as part of the context to promote further understanding of the issue. In turn it will conclude that social class had a profound affect on the expressions and livelihood of the male hysteric, and that the structure of class in Britain acted as a psychical ‘strait-jacket’. Whilst the paper is read, in the background you’ll see footage from “War Neuroses”, a 1918 film taken at Royal Victoria Hospital, Netley, and Seale-Hayne, Dartmoor, England, shows the various symptoms of 18 British soldiers suffering from ‘shell-shock’ and their treatment by Royal Army Medical Corp neurologists during World War I. There’s something far more disquieting about seeing the movements of the male hysteric body, and what this paper does is place them in a new context of how social class defined its symptoms and diagnosis, evidenced in the largely lower-ranked ‘hysterical’ soldiers represented in the film.

As the first world war grounded to a stalemate by the end of 1914, the then secretary of state Lord Kitchener faced with a manpower shortage embarked upon a extensive recruitment campaign, rather than conscription which he knew would be opposed both by the British cabinet and popular opinion. Symbolised by the famous poster “Lord Kitchener wants you”. The poster succeeded on a number of levels: it offered the everyman an opportunity to be a war hero too like the heroic British examples in the boys‘ books of G.R. Henty, the tragic heroism of Alfred Lord Tennyson’s ‘Charge of the Light Brigade’, and the male adventure stories of Rider Haggard, and in the comics working class boys might have read. At the same time, its omnipresent accusatory finger pointed at every man eligible to fight, inciting him to enlist out of loyalty to ‘King and Country’: the poster suggested that it was right and proper as a Man and a loyal subject of the Empire to join up and enlist. The men who responded were of varying ages (though generally between 18-25), backgrounds and classes. For them, not only did a war ‘all over by Christmas’ offer valuable life experience and training, but it was also seen as a romantic adventure, a citizen’s act of duty to ‘King and Country’, and promoted as an honourable thing to do, a chance for every man to be a hero.

This mix of different classes to some extent played an important part in deciding both their role and ‘fate’, as class structures in Britain were recreated in rank, with the sons of the wealthy educated elite becoming officers, and their ‘working class inferiors’ becoming privates. Immediately different expectations and responsibilities were placed on them. Officers though in a higher standing than privates, faced certain death in leading men “over the top” of trenches and into attack but further to this they also had to maintain discipline and morale, and of course, ‘keep up appearances’.His decisions meant the life or death of those under his command, not only responsible for his own life, but for those around him. This itself would have been a huge pressure, and if he survived the war, he would have then had to deal with the ramifications of these decisions within his own conscience, a “survivor’s guilt” of even greater proportions.

Robert Graves, was one officer (later promoted to captain) who served on the Western Front, who buckled under the pressures of his duties, his experiences and the war, and continued to suffer from what he called ‘neurasthenia’ for many years after the war. Describing some of this trauma and psychological pressure in great detail, Graves documented the lifespan of the officer before succumbing to total breakdown, alcoholism and ‘uselessness’:

‘Between three weeks and four months he was at his best, unless he happened to have any particular bad shock or sequence of shocks. Then he began gradually to decline in usefulness as neurasthenia developed in him’.i

After a year or fifteen months, according to Graves, the officer was on the verge of breakdown. It was the psychological pressures of his role, the almost-impossible task to maintain discipline and morale in a situation war poets compared to the apocalypse or hell, with the added awareness that the officer’s average lifespan was considerably shorter than his men, that all contributed to the hysteric breakdowns many officers suffered. Class not only shaped the ranks that soldiers were divided into, but also dictated their conduct within those roles. Unlike the tough working class men Welsh miners Graves’ described who could indulge in a deft irony and black humour that could laugh about death and thus ease fears and anxieties, officers had to hold their “stiff upper lip” and continue to command their troops. Again Graves records the difficulty of keeping up appearances and a brave face, who recalled his feelings after an order came to launch an attack: ’Orders came that we were to attack again. Only the officers knew; the men were only to be told just beforehand. It was difficult for me to keep up appearances with the men; I felt like screaming’.ii

That is not to say that officers’ possessed the monopoly on war neurosis. Although officers were more likely to develop neurasthenia, it was working class lower-ranked men who would have formed the majority of cases of male hysteria. Although troops held less responsibility than officers, and had less of the dilemmas and guilt of decision-making, they were constantly living in close proximity to death, decomposing bodies and the fear of dying. The male hysteria of privates often displayed more ‘physical’ symptoms (as opposed to officers’ mental or ‘nervous’ symptoms), such as uncontrollable spasms, “wobbly legs” and mutism. It is the last symptom which I would like to explore here, as I believe it shows how class structures in the army affected the symptoms and perceptions of male hysteria.

Whereas officers (in the better-planned trench systems) could retire to dugouts or officers’ messes, soldiers often would live and sleep in the same places. Dealing with neurasthenic or badly-trained officers eager to assert their authority, or ordering them on a virtually suicidal attack, many soldiers would have felt angered and exasperated by their superiors. Yet to answer back to an officer spelled immediate punishment: a soldier could be sentenced by ‘Field Punishment Number One’ – a form of corporal punishment for soldiers for general acts of disobedience, drunkenness, or sleeping on duty, involving tying a soldier standing to a post or gun by his neck and feet for two hours a day, for up to 21 days. Disobedience was dangerous and humiliating, hence keeping quiet, forcibly remaining silent – mutism was a common hysterical symptom where the patient has become mute, or unable to speak. Psychologists interpreted this as a conflict between wanting to say something and yet knowing that what one wants to say is unacceptable, with potentially terrible consequences. It has been seen as evidence of self-censorship, repression, of perhaps guilt of what one might or could say, as for instance in Sigmund Freud and Josef Breuer’s pioneering 1896 Studies in Hysteria, which argued that female hysteria and mutism (in the case of Anna O.) was an unconscious reaction and revolt to the repressive gender strictures in the 19th century bourgeois society of Vienna. Yet in the context of the British Army during the first world war, it could have been seen as a silent class protest, a physical symptom of class actually inducing male hysteria.

For psycho-analytic field-workers like Ernst Simmel, the paralysis of being unable to speak betrayed an unconscious repression, of anger, curiously, against superiors, which censored itself by preventing all use of speech. Mutism was supposedly rare amongst officers, whilst being one of the most common shell-shock symptoms amongst ordinary soldiers of the Other Ranks. W.H.R. Rivers was aware of Freud’s work, and he noted the importance of class, or rather rank, in the symptom of mutism, and connected it directly with the regimented hierarchy of rank within the army:

‘…A frequent factor in the production of war-neurosis is the necessity for the restraint of the expression of sentiments of dislike or disrespect for those of superior rank, and these restraints become particularly trying when-those who are disliked or despised are the instruments by which the many restrictions of military life are imposed or enforced’.iii

For Rivers then, mutism was an unfortunate hysterical reaction to higher ranks, and in some ways, a form of unconscious insubordination. Yet if mutism was a symptom of insubordination and class protest, I believe it stemmed from a lack of control most keenly felt in soldiers of the lower ranks. For although the officer had to deal with the added responsibility of men, he could feel at least a semblance of control over his situation: at least, his responsibility gave him control over others. For the ordinary private though, even the loosest control over his own fate was not possible. Death was as arbitrary as a stray sniper’s bullet or well-aimed shell; the enemy was stationed in an inaccessible trench across No Man’s Land and rarely if ever seen; and for working class soldiers, the war consisted of long periods of inactivity, and the occasional order to go “over the top” and invade the enemy trenches, attacks which usually resulted in large numbers of casualties . Hysterics became psychological casualties, men who had lost control of even their own bodies, victims of a war-induced madness – or as Gunner Hiram Sturdy put it, “this madness caused by pure unadulterated fear’iv. Although working class soldiers often pitied the hysteric, his willpower was still distrusted and if he was not dismissed as a coward, he would be ridiculed as a lunatic.

So far we have seen how class shaped the symptoms of male hysteria; now I would like to explore how the diagnoses of male hysteria were shaped by class. Charles S. Myers was the first not only to introduce the term ‘shell shock’, but also a dichotomy of diagnosing cases: either as ‘Hysteric’, generally regarding the uncontrolled movements, paralysis and mutism discussed earlier, or ‘Neurasthenic’, meaning a nervous exhaustion.v These two ‘conditions’ would become even more separated throughout the war, as neurasthenia increasingly became the diagnosis of male hysterics who were officers or from upper class backgrounds, and the more effeminate (and effeminising) ‘male hysteria’ reserved for the Other Ranks, made up of the working classes.For W.H.R. Rivers, male hysteria was a psychological conflict of two primal instincts, self-preservation versus fear, or as Rivers puts it: ‘a conflict between the instinct of self-preservation and certain social standards of thought mid conduct, according to which fear and its expression are regarded as reprehensible’.vi One outcome of this conflict is a retreat into ‘war neurosis’; though the exact nature of this neurosis is further shaped by the rank and social background of the male hysteric, particularly if he has received a prolonged education, and if he is an officer, and has therefore (for Rivers) had to deal with many more pressures and responsibilities, not least to keep up appearances.

As Rivers argues further,

‘…[T]here is little doubt that the average private enters upon his military training with less aversion from the expression of fear than the average officer, and that his simpler mental training makes him more easily content than the officer with the crude solution of the conflict between instinctive and acquired motives which is provided by some bodily disability…The liability of officers and men to different forms of war-neurosis is thus partly capable of explanation by differences in the conditions to which they have been exposed before the war’.vii

The social class of the male hysteric could then determine his diagnosis, whether it be the lowly, less-educated ‘hysteria’ suffered by privates, or the higher, more emotionally-refined ‘neurasthenia’ suffered by officers and ranks above. Furthermore if war neurosis was a retreat into illness out of a conflict of two different drives, then it was the male hysteric who was responsible for his malady: it was his unconscious lack of willpower, his unconscious ‘malingering’. At first, “shell shock” was seen as a fault of the individual – not of the war, or war itself – but a kind of prior weakness, a cloaked way of implying heredity of “feeble-mindedness” and degeneracy. If mental illness – or “feeble-mindedness” (a term that encompassed a lot of what would now be called learning difficulties and slower mental development) was a matter of “efficiency”, then it was simply incompatible with eugenic theory that the upper classes could be so “inefficient” to breed mental defectives. Eugenics and social Darwinism had become immensely popular before WW1 since the work of Francis Galton’s 1869 study Hereditary Genius; Before the war, the menace of “feeble-mindedness” prompted national anxiety, emblematic of a wider middle-class fear of ‘race suicide’, resulting in a number of bills for the care and provision of the ‘feeble-minded’ being brought before parliament. Neurasthenia was then a condition of the ‘nerves’, cloaked in oblique terms. Male hysteria was viewed by one eminent psychologist, F.W. Mott, as a product of prior inherited mental weakness – in 1919 he argued that 74 per cent of psycho-neurotic patients had been born in ‘neuropathic or psychopathic soil’.viii This prior mental weakness would have been associated with the degeneracy of the urban poor, thus making hysteria in some respects a working class sickness according to his perception.

If male hysteria in privates did not indicate prior weakness, then it was considered as a form malingering or cowardice. Rivers’ theory of difference between officers and other ranks in terms of male hysteria suited political and social requirements. In the year ending 30 April 1917, whilst the ratio of wounded officers to wounded men was 1:24, the ration of neurasthenic officers to men was 1:6.ix The phenomena of officers with hysteria – the noble manly sons of wealthy aristocratic elites, true citizens of the British Empire could cause a potential political crisis. The stigma of male hysteria was so damning that the solution inadvertently became to change the name of the condition, from “neurasthenia”, taking on nerves, or “anxiety neurosis”, a term that allowed for all the symptoms of hysteria without calling it something so demeaning, so shameful, so effeminising as hysteria.

In 1929 a the first of a number of war memoirs were published, documenting the experiences and travails of a small but considerable number of educated shell-shocked officers like Edmund Blunden and Robert Graves. Officers were often better able to describe their experiences of male hysteria, drawing on an extensive canon of religious and romantic motifs in English poetry to describe their ‘nerves’ and ‘neurasthenia’, without the effeminate overtones of hysteria. But the officers’ accounts also disrupted assumptions that hysteria was a symptom of working class hereditary degeneracy, with the (anti)war-poets like Wilfred Owen, Siegfried Sassoon and Robert Graves making ‘nerves’ almost noble in their poetic language, shaping “shell shock” into a cultural memory of war. But the active male hysteria of the working class private who never recovered his mind after the war, who was ineligible for specialist state support and unable, due to unemployment, to afford the expensive private fees of the psychological clinic, became increasingly alien and impossible to understand – why was he still afraid of shells when war was over? Hence “Shell shock” – the officers’ experience of war neurosis, a usage of nerves reserved only to the upper classes – thus became the post-war perception of male hysteria that we retain in popular memory today.


i Robert Graves, Good-bye To All That: An Autobiography, ed. Richard Perceval Graves (Providence, Rhode Island: Berghahn, 1995), 157.
ii See Graves, Good-bye To All That, 150.
iii W.H.R. Rivers, “War-Neurosis and Military Training”, Instinct and the Unconscious: a contribution to a biological theory of the psycho-neuroses (Cambridge: Cambridge University Press, 1920), 214.
iv Gunner Hiram Sturdy of the Royal Artillery Regiment, cit. in Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War (Houndmills: Palgrave Macmillan, 2002), 37.
vSee C.S. Myers, “A Contribution to the Study of Shell Shock: (1), Being an Account of 3 Cases of Memory, Vision, Smell and Taste, Admitted to the Duchess of Westminster War Hospital, Le Tocquet”, The Lancet, I (13 Feb., 1915), 317-20.
vi Rivers, “War-Neurosis and Military Training”, Instinct and the Unconscious, 208.
vii Rivers, “War-Neurosis and Military Training”, Instinct and the Unconscious, 210.
viii F.W. Mott, cit. in Joanna Bourke, Dismembering the Male: Mens Bodies, Britain and the Great War (London: Reaktion, 1999), 119.
ix See Bourke, Dismembering the Male, 112.


One response to “Hysteric or neurasthenic? The role of class in the treatment of ‘shell shock’ during World War One”

  1. […] still recovering from dysentery and the psychological damage of war that he called “neurasthenia“, Harry’s ambition is palpable in his own […]

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