Review of 'Mad, Bad or Extremely Dangerous? Service men in Wakefield Asylum from 1914' by Dr Dee Hoole (October 2016)

Shell shock was never really tackled in a professional way during the First World War. The medical response to the physiological and mental collapse observed was totally inadequate. The term ‘shell shock’ was first suggested by Doctor Charles Myers in 1915 in an article for ‘the Lancet’ but no precise medical explanation was forthcoming. In fact, several medical experts refused to accept the condition. Instead, unless a sufferer was invalided out of the front line or courts martial refused to see shell shock as an acceptable medical excuse from duties.

If the mental collapse was identified as a medical problem, the sufferer entered a medical chain which usually finished in separate wards and eventually, perhaps, a mental asylum. Patients with ‘mental shock’ were invariably segregated from the physically wounded as their presence on an open ward was too unsettling for the other patients. This led to confinement as facilities for nursing these patients was very limited. This was definitely a class distinction, private soldiers were considered mentally weak, often suffering from hysterical paralysis, and their treatment would be directed towards a mental asylum. Officers, on the other hand, were diagnosed as suffering from neurasthenia and as such were treated with sympathetic periods of rest and, maybe, a short stay in a special hospital like Craiglockhart run by WH Rivers. Officers were seldom committed to asylums.

The first arrival of servicemen to Wakefield Asylum was recorded in 1914 when two were admitted. The number of servicemen committed to the asylum slowly increased as the war progressed and continued after hostilities ceased, 202 had been admitted by 1920 and 409 by 1929. This pattern in asylum admissions is mirrored in other asylums across the UK. The estimated figure for the total admissions is over 200,000.

By the 1890 Lunacy Act, inmates were deemed to be dangerous usually suffering from ‘delusional insanity’. Sufferers from lunacy, epilepsy and syphilis were the usual suspects who had been identified as ‘mad’. Among the servicemen, evidence for lunacy included ‘undisciplined and never thinks of saying ‘sir’ …’

After 1918, admissions usually resulted from family consultation with doctors. A common cause was alcohol abuse, the sufferer had been self-medicating with alcohol which led to increased aggression and poor morale concerning the future. This and resentment of authority were producing ongoing problems. A common route to the asylum involved mental hospitals followed by admission to the workhouse before commitment under the 1890 Act. In family situations the inability to communicate created problems in ex-soldiers. When the sufferer became violent and abusive towards family members (wives or parents), the route to the asylum was seen as the only option. As the inmates received little treatment other than sedation, families would petition to have their young men released when guilt concerning the commitment became too much. There were several incidents of suicide in the asylum as melancholia combined with nervous breakdown and survivor guilt became too much.

The ratio of staff to inmates changed dramatically after conscription in the UK took effect. Trained attendants were called up and their replacements had little experience of handing the inmates. Eventually, by 1918, the ratio of medically trained staff to inmates reached 1 : 1250, there was no way anyone could speak to and help every inmate. Sedation was seen to be the only solution. In Craiglockhart, Rivers had been using rest, fresh air and long talks with his officers with excellent results. This was not possible in Wakefield Asylum. As mentioned above, families would petition for the release of their young men as guilt over the Asylum treatment became difficult, in these cases records finish with the statement that release had been allowed even though treatment (?) was incomplete.

In 1922 there was a report from the War Office Committee enquiring into the effects of so called shell shock. Of the 59 witnesses called to give evidence, only four can be identified as suffering from shell-shock. The committee found that nervous breakdown in the First World War was triggered in young men already having latent mental problems. The conditions of war only contributed to the breakdown if the patient had a pre-existing condition. Shell shock was a weakness which was not found in ‘good units’.

Report by Peter Palmer