I watched this short clip (contains graphic facial injuries…skip to 0:25 if you don’t want to see them) of soldiers with shell shock in World War I – the men featured have severe uncontrollable muscle spasms that leave them unable to sit still or walk properly.
I then found this fascinating book from 1919 that goes into exhaustive detail regarding all the different physical manifestations of shell shock symptoms found in WWI veterans. A brief list would include hysterical blindness and mutism, the muscular reflexes and tics seen in the film above, catatonia, stereotypies, seizures, hysterical paralysis, and so forth. (Also listed are what I think of the “usual” shell shock/PTSD symptoms, such as nightmares, anxiety, hallucinations, confusion, flashbacks, etc.)
What is so interesting to me about this is that these physiological symptoms are not features that I have seen associated with traumatized veterans of the Vietnam or Iraq wars, and I’m curious about this. Do any of you know of any academic/scientific publications that directly address this difference in PTSD symptomatology in depth? (I’m sure we can come up with our own theories, but I’m primarily interested in the opinions of experts. No offense. :))
Or maybe I should first ask, is my question even relevant? Is it even true that these extreme physiological symptoms are no longer seen so commonly in war veterans? I have a BA in psychology and wrote several papers on PTSD in Vietnam vets, so I am somewhat familiar with the literature on the subject and I don’t recall much attention being directed to patients’ physiology, but maybe I just missed reading those studies.
Oh, what the hell, now about our own theories… Part of me thinks WWI had battle conditions that were pretty extreme even for “standard” war experiences and maybe being trapped in trenches for months, being bombed to buggery, in single battles with casualty figures in the hundreds of thousands (over 700,000 at Verdun alone, for example), involving mechanized warfare that no one had before experienced and thus properly been trained for – maybe that level of trauma could be evaluated as objectively more damaging than that experienced during other wars. Like, maybe on the PTSD spectrum, the “purely mental” symptoms (flashbacks, nightmares) are on the mild end of the spectrum and it’s simply a matter of being more traumatized that pushes you into exhibiting the symptoms on the “physical” end of the spectrum.
(I know I’m getting into a brain/mind dichotomy, which may not even exist, but I don’t how else to explain what I’m thinking. :))
On the other hand, shit, war is war, right? I can’t imagine fighting guerrilla warfare in a jungle or desert city is qualitatively easier on the mind than sitting in a muddy trench in France. (Or is it? Or maybe there were relief mechanisms, like R&R rotations, that mitigated trauma and that were not implemented in WWI but were/are implemented in later wars. I don’t know these things.)
Maybe I’m too much a fan of Pat Barker’s Regeneration trilogy, but could there be something to the idea that the culture of WWI-era Europe, with the unfamiliarity with talking about one’s problems as therapy and the “stiff upper lip” mentality, led one to subconsciously “physicalize” one’s psychological trauma? E.g., because I can’t voice my objections to my superiors, I become hysterically mute; or, because the concept of actually verbally expressing the horror I’ve experienced is inconceivable to me, my brain has no other recourse but to non-verbally express* my trauma through my body.
*Nice how “express” means both “to utter” and “to emit or purge” – the Freudians would be pleased.
Thanks – I know that the name of the disorder has changed over the years, but what I’m curious about is how the disorder itself has changed in the way it manifests itself over the years. Some of the comments on the YouTube clip above suggest that it was the sustained exposure to artillery bombardment that caused the physiological symptoms, and that while certainly soldiers experienced bombardment in later wars, they didn’t do so to the extent that WWI soldiers did (where bombardment was constant, and where you stuck there in the trenches and couldn’t retreat to safer positions).
The paper I linked to says in its introduction, “In not a few instances of Shell Shock – although these are not numerous, so far as records have been obtained – actual structural lesions have been recorded even in cases in which no direct external injury of a material kind was experienced as a result of the explosion of shells” (p. xiii). It then mentions experiments done on rabbits showing hemorrhages and other injuries sustained when explosives were set off close to the animals (and they were not directly injured by the blasts). Maybe this is the answer?
Although that doesn’t explain the hysterical paralysis, blindness, and mutism that seemed to be common.
While I won’t guess how a modern soldier would do mentally after a Vedun-like experience, the military has greatly changed the mental preparedness aspect of recruit training since then. Apples and oranges both in the experiences and the training. From what I have been told, the Vietnam and Iraq War experiences have a lot to do with never knowing who is going to try to kill you, where the booby traps or IEDs are going to get the next victim, having villagers and townspeople turn into un-uniformed combatants and do bad things as soon as you turn your back.
WWI was more getting the shit bombed out of you or sitting in trenches for months at a time watching your feet rot. Different stressors.
Actually in WW1 there was no great effort at a basic training, they shipped pretty much untrained soldiers out to the trenches and dumped them into units. They were given uniforms, weapons [the sappers got them taken away again pretty much immediately] taught more or less how to march and salute, clean and use the gun and that was it. WW1 is still the era of cannon fodder enlisteds. All they needed to do was be able to obey orders to go that way and shoot anything that wasnt in our uniforms on command.
Besides these two suggestions, I would also suggest that perhaps the criteria for “shell shock” were higher than for modern day PTSD. There may be people today with PTSD with nervous ticks and so forth, but these are extreme cases of the disorder. With people like this, you can fairly definitively say that something is wrong with them. It takes more rigid testing and definitions to identify between people who are simply lazy, cowardly, or mopey and people with PTSD, and that came later.
The ways that psychiatric problems manifest themselves as symptoms is often very culture-bound. For instance, schizophrenic hallucinations amongst modern westerners are predominantly auditory, whereas in many western cultures they seem to be much more likely to be visual. (Of course, this assumes that they have essentially the same underlying disease. That is not certain, but I believe the consensus is that it is likely.) Hysterical paralysis used to be a relatively common psychiatric symptom - many of Freud’s patients suffered from it - but I understand that is now extremely rare. That does not mean that the underlying problems have become rarer, merely that they manifest in different ways. Psychiatric symptoms are the results of the mind trying to deal with a problem (whether it is trauma, or biochemical imbalance, or whatever) so they can change as people’s notions of what is normal or acceptable behavior (or indeed, of what sorts of psychological symptoms are normal or common) change.
If you are traumatized in battle, and believe that trauma often leads to paralysis (as various sexual traumas had apparently led to paralysis for Freud’s patients), then your (perfectly real) trauma is quite likely to manifest itself as paralysis. If you are traumatized in battle, and believe that trauma often leads to unpredictable and uncontrollable rages, then your (perfectly real) trauma is much more likely to manifest itself as unpredictable bouts of rage.
There is a sense in which the symptoms really are a sort of (unconscious) malingering (and thus, at some level the patient is choosing to have those particular symptoms), but it is done to try to get attention for a very real underlying problem (so choosing to no symptoms is not really an option).
Reading all your posts, it seems like there are so many variables at play it’s hard to pin down the reasons for the differences. This is fascinating to me, so I don’t think I’ll mind researching further.
That’s what I was thinking about, that maybe some of the physical symptoms are due to lesions caused by explosions close by, similar to the kind of damages this thread talks about.
Add that bombardment could, would and did go on through the night. For much of the “war in the trenches,” the purpose of bombardment wasn’t gaining ground, it was driving the enemy up a wall.
Somewhere I read it was not at all uncommon for bombardment to last 72 hours straight. And who knows how long the break was until the next period began. I can’t begin to imagine how one could live through something like that and remain sane.
That man in the clip I linked to in the OP, the one at around 0:45, has really stayed with me. The poor man looks so much like a frightened child.
I think the different manifestations you’re seeing are at least partially due to advances in diagnosing and treating PTSD over the course of the last century. I wonder how many of the soldiers in the OP’s link demonstrated symptoms earlier that, in Vietnam or even WWII, would have gotten them pulled off the front lines, but in WWI were told to suck it up and keep fighting, or chewed out for “cowardice.”
