Annessa stagner. After working as a visiting associate and its assistant professor in pedagogical fellow in california, she now serves as the dean of Academic Services at lavar community college. Her research focuses on the history of psychological war trauma. Particularly the neurological effects of shellshocked during world war i. 1916will highlight how in the public began to understand of devastating complications the shellshocked tech epidemic. Later she will address how various attends were made to and oftenhe revocable invisible damage that this disorder wrought on soldiers and others involved in war. ,n this Centennial Anniversary this presentation is a talk that is both timely and irrefutably relevant to our world today. It is my pleasure to introduce dr. Annessa stagner. [applause] thank you for that introduction. As we have already heard this morning, the First World War marked for many the first modern industrial war. Indeed, as we have heard, total war. With it came new technology and instruction on a massive scale. Mines killed hundreds in single explosions. Gas, seemingly melted lungs and eyes. Machine guns signaled inevitable slaughter for those order to charge. Turn our attention for the next hour or so to the psychological and neurological effects of the First World War. Particularly in the year 1916. Medical personnel were already well aware of injuries commonly referred to as shellshocked. Yet 1916 marked the turning point in which nations and military were forced to confront the destruction the war was causing on human minds. I would like to begin by exploring how medical personnel came to understand shellshocked and how they attempted to mitigate damage from the war. Then i would like to turn our attention to the ways in which shellshocked came to have a greater meaning beyond the medical history of the war. First roach in innt the term shellshocked this february 13, 1913 article in the british journal. Argued that the impact of an exploding shell could impair the senses. Hearing, sight, smell, and taste. The symptoms doctors called buried. Eyes ranged from staring and nightmares to violent tremors and paralysis. Fact, the term became so broad that some argued that it included any malady. His firstfter article, many doctors came to understand the distinction between what we would call physical brain injury and psychological mind wounds. The cases were often difficult to distinguish and i would like to provide you with one here. Book and inblished case is a case of what he calls functional facial paralysis. Was asked to do the following in a normal expression , to close both eyes, to hold a smile and to frown. You can see that one side of his face is completely operational, the other side is not. Heres the story on this individual. December 26, his platoon hit barbed wire in an old german dugout when a shell burst and filled the dugout, all but completely covering him except to the left side of his face. Finally, he was unable to breathe. He was unconscious for three days and knew nothing of what had happened himself and the information was the result of what he had been told by a comrade who had had his arm blown off. After eight months he had been by a great number of doctors and his face had not changed. He remembers going into the dugout and sharing hearing the shell coming. He has terrifying dreams of his experience. According to the doctors that assessed this soldier, there is nothing physically wrong with the muscles in his face, yet he has been in a shell explosion and suffered concussions. And yet he is also experiencing the trauma of war. I wanted to just emphasize here blursometimes diagnoses the lines between physical and mental damage and we can see in this case how that happened. Here that myhasize look at wartime trauma is intimately connected to politics and the trauma experienced during the First World War, dealing with shellshocked differently. In todays presentation i am admittedly blurring those lines for purposes of emphasizing the year 1916. Early on many fail to recognize the significance of these war injuries. Charles wilson, who served in the Royal Army Medical Corps noted that in the early days they didnt bother with diminished mines. We did what they could for their bodies. We did not ask if a man was wearing well. Or if you would last. Of course he would last, why shouldnt he . Did reduce military courtmartialed and executed individuals that they viewed as cowards, rather than injured men. On a number of occasions the accusations of malingering caused coulters to commit suicide. At best the shellshocked soldier might be sent home to an asylum. Military officials couched their descriptions of shellshocked in language suggesting lack of courage. They described soldiers cracking up and losing their nerve. These were signs of emasculating fears. As one soldier explained i mustnt show them that im afraid. By 1916, large numbers of shellshocked soldiers have become too significant to be ignored. As was observed in the reports from france, no medical military problem of the war was more striking than those coming out of the extraordinary incidents of shellshocked. The disorders accounted for 1 7 of all discharges from the british army at the time. As attention grew, so to did debates from regarding terminology and meaning. Shellshocked was perhaps the best diagnosis that one could get. It signaled at least a physical cause and thus gave the soldier with the diagnosis sense of legitimacy. Mourn euroseas, hysteria, and other terms signaled a psychogenic or what we would consider a psychological cause. Psychological causes were sometimes seen as legitimate, originating in the unconscious mind of soldiers who remained willing to fight, but unable to control the flight behavioral instinct embedded within the psyche. Other times it was considered a legitimate altogether. Perhaps the soldier was intentionally malingering. Perhaps the soldier was simply exhibiting feminine weakness. Diagnosis thee soldier received and the meaning of the diagnosis depended on the time, circumstance, Commanding Officer in dr. Treatments for shellshocked and the associated disorders took a variety of forms. Sometimes punishment. Sometimes as shown here, therapy. Others included hypnosis. But we would describe as physical therapy, talk therapy and relaxation. Obligationa sense of and reminders of cultural expectations of what masculine men should be and do. Techniques were referred to under the broad umbrella of reeducation. Validating soldiers in their conditions and convincing them of their abilities to get well. Remember, this gets at the psychological causes under shellshocked. The most controversial electricalwere sterilization. Act widely and austrohungarian units and to a lesser degree among british, french, and others, relying on electrotherapy not only as a method to be used actively but to convince a soldier to use his paralyzed limb. Andtes regarding causes methods of treatment continued throughout the war. No less than 223 american Journal Articles appeared in the war years regarding this topic. German, french, british, and other publications numbered even higher. Crucialved especially when for american doctors who had come from europe, observed treatment and developed their own eclectic approaches to treatment when the u. S. Entered the war in 1917. Mostwould develop the comprehensive plan for such disorders. This of course regarded shellshocked, and for americans it shifted towards recognizing it under its various names as a legitimate war wound and providing treatment at hospitals just as they would for the physically wounded. You can see that this is a flowchart of hospitals for americans diagnosed with shellshocked. At the very top you will see field hospitals, followed by base hospitals overseas. What i think is most important and significant about this document is you will see the arrows on the righthand side here going all of the way up and and to the field hospitals front lines. There is this notion that comprehensive american treatment looking at shellshocked is legitimate and a psycho war wound will enable American Physicians to heal the soldier. So, the United States military, directly because of 1916 and this observation that they have, take a dramatic shift in treatment. They provide a proactive medical approach. At least in policy, legitimizing the wounds of the soldier, providing specialized care and emphasizing care. Despite improvements, however, shellshocked remained a medical military problem throughout the war and would have significant consequences in terms of the pool permanently wounded in the aftermath. Statistics are difficult identify. By one count, for example, british cant cases numbered 800,000. Diagnostic criteria and potential late onset of assistance, statistics are difficult to estimate. What is clear is that the cultural significance of shellshocked extended well beyond the warriors and the numbers of actual soldiers affected. Of long contended that the shellshocked took on cultural significance in europe, becoming a symbol for the devastation of war itself and the europeans inability to recover from it. Trauma wasal expressed in public news in the years following the war and i want to give you two examples of this. One, the commission for the increase into the violations of military duty in the austrian parliament, in its investigation of the role of military thehologist revealed application of painful electrical shocks to a soldiers nichols and genitals. Physicians without any are logical or psychiatric background were put in charge of departments and feel hospitals in which nervous thomases were treated. In this case we get a sense of what punishment could mean at its very worst. Isolation cells, cold showers, straitjackets, electrical shocks, exposure with public humiliation. Continued into the postwar era. The British War Committee also held an inquiry into shellshocked. This was then released by central and british news. Such discussions did not end with the immediate end of the war. This memorial in Great Britain, titled shot at dawn, was completed in 2001 and honors the legacy of shellshocked as a symbol of war. Again, i want to emphasize the importance of 1916 to all of this discussion. The shop at dawn memorial notes specifically that 346 soldiers were executed for malingering or cowardice and we see that the wereest number of soldiers executed in 1916. This begs the question for me as a historian this is bad to do but what would have happened if the war had ended in 1916 . We see this escalation that really happens in 1916 with the treatment of shellshocked soldiers. The National Trauma also became visible in literature and art. This is a picture of a hospital from 1916. Early, as noted by the distinguished fighters, and it was shortly after in 1970 that he became disillusioned with war. Survivor, described not only the tremors and the nightmares but also the feelings of hopelessness that accompanied what others saw as a failed victory. A glorious war that shattered all their pride. Men who went out to battle, grim and glad. Youdren with eyes that hate , broken and mad. Wilfred owens, enlisted in 1950, posted on the western front, january of 1917. He was diagnosed with nearest emea. Gas, gas, quick, boys, an excess of fumbling was coming home just in time, but someone is yelling out and stumbling in the floundering, like a man in fire. Mist, the pain, the thick green light under the green sea, i saw him drowning. In all my days before my helpless side, he lunges at me. Sputtering, choking, drowning. If in smothering you could pace behind the wagon that we flung him in and watch those white eyes writhing in his face, his hanging face, like a double stick of sin. If you could hear the blood come gargling from the frost crusted lungs, bitter cutting the bio, incurable sores on innocent tongues. It continues, this idea of the trauma and magnitude that soldiers are experiencing because of the war becomes very real in this literature. In fall of enlisted 1916, he also participated and earned the iron cross, november of 1917, transferred to the Eastern Front and then back in 1918. He has a series entitled intrigue. I think that this is one of the most impressionable of his pieces. Here we see those signs of in those large eyes. The face, the expressions of the and thee fingers fingers. Rising in physical pain and mental anguish of war. As was mentioned earlier this morning, the author of all quiet on the western front, transferred to the western front in 1917. Im showing a picture of the american film that was made afterwards in 1913 wherein a runs out of a bunker, screaming. His temporary insanity resulted in physical injury. He later dies of the wounds. Obviously, this is not a full accounting. And yet, this is a glimpse into some of the individuals whose work has become a part of the memory of war. And had experienced horrors horse from which they believed they would never recover. As we sit here at this centennial of 1916, i wonder what would have their works look like or would they have reduced such works had the war devastation ended in 1916. Sassoon, owen, many of them are visiting Craig Lockhart hospital in 1917 after years of fighting. Years after experiencing these kinds of trauma. It was the persistence of war the deep end both the numbers of shellshocked soldiers and narratives regarding shellshocked nations. It was not just the soldiers, but nations and landscapes that all seemed irrevocably shellshocked by war. The inability of the soldier and the nation to read cover was, as one historian pointed out, regarded in much of the literature as a mental state that mirrored a social disease and national degeneration. Intellectuals and early psychologists had long discussed industrialisms inability to overlook the senses and cause what american George Miller termed [indiscernible] dangers ofed the social the generously. Many of them are visiting Craig Lockhart hospital in 1917 after years of fighting, years of experiencing these kinds of trauma. It was the persistence of war that deepened both the numbers of shellshocked soldiers and narratives regarding shellshocked nations. It was not just children not just soldiers, but nations and landscapes that all seemed to your revocable he shellshocked all seemed irrevocably shellshocked by war. It was regarded as a mental state which mirrored a social disease and national degeneration. Intellectuals and early psychologists have long discussed industrialisms ability to overwhelm the census and cause neurasthenia. Nearest, warner assists neurasthenia, shellshocked. It signaled the breakdown of western civilization. In a wellreceived study of france and germany, it drew the conclusion of degeneracy most sharply. It reiterated that society was literally a more or less organized mental system, and beginning in roughly 1889, individual men inundated by nerve stimulation have begun losing their ability to reason. The tension found in european civilization due to advancement and industrialization had caused these men to initiate what she labeled an insane war. There was no doubt, she said, that the pace of life had affected mens minds in a disastrous way, judging by their temper. This is what is especially apparent when men were collected in clusters, and concourses, and parties, in selfconscious national groups, for these groups, these collectives were so excited that their the motions were uncontrollable. They became possessed of manias and world by anxiety and fear. The term social and national insanity, often used by writers of the war period, is no figure of speech. The regimens are exhibited in the literature and the time, and political action, and mentality and behavior of leaders and nations. In the teaching of inspirers groups. It is argued that a saner world could have avoided the war. Instead, europe had lost its Progressive Movement and became irritable and overstrained, and to euro cynical to think logically about the consequences of war. Public debates through war inquiries, popular culture, and intellectual discussion contributed to your revocable damage to bodies and nations. It is worth noting, as i did earlier, that the United States stood distinct, both in treatment and in national understandings. The United States, at least for some, and for a short period of time, believed that they had done it right. They fused progressive psychological practices to field soldiers, and with the help of woodrow wilson, avoided the euroseas of war in 1914. If we were to compare some of the literature and art i have shown you about europe from art and literature at the time in the United States in a period of 1918 and 1919, we would see a very stark difference. Often times in american literature, the shell shocked individual is the heroine. All it takes is a crackle of the head with a frying pan or holding their infant child for the first time. The soldiers are instantly cured, and they come out to be the great heroes of the story. It is a very optimistic tone compared to some of the works we have discussed. The United States had this progressive mindset. They appeared optimistic and in control of both american medicine and of politics. The central question of the post war world would become, who could repair the irreparable damage that had been brought by years of war . Who could restore europe from its shell shocked state . Today, as we gather here for the 1916 centennial event at the museum and memorial, i challenge us to remember the legacy of war in its medical and cultural effects. Shell shock has become an important part of the museum. The horrors of war are pictured in the individual experiences of soldiers and the descriptions of wartime medicine. Let us also remember the extensive debates regarding the definition of shell shock and how it would be treated. Let us remember how the initial assumption that strong would survive war without blemish proved false. For us, never forget the common saying we often linked to world war i, should also remind us of our past attempts to treat wars mental trauma, and the great, i would argue inevitable, mental toll war takes on individuals. Thank you. [applause] ladies and gentlemen, i would invite you to either microphone for our time of q a. Thank you for that great talk. I assume youre familiar with todd barkers trilogy about the war. A twopart question. One, obviously it is a novel and not supposed to be accurate, thats not the point of writing fiction, but it is based on real events, and a psychiatrist treats them and so forth. Do you want to reflect on their treatment . Also, both of them obviously go back to the front after they are treated, and i wondered how common that was. Ms. Stagner regeneration has done so well, and i think so many people have read it. I think it is a wonderful work of literature. I think sassoon and a wins experience was quite unique when compared to other individuals. William rivers was at Craig Lockhart for a particular moment in time when it did have a very sympathetic and understanding approach to shell shock. I think we see that in rivers relationship with sassoon. Sassoon is an officer. He is a decorated officer at the time he goes there. The story does a good job of capturing that, but not necessarily of what it might have been like to have shell shock if you were someone other than sassoon. Yeah. I hope that sort of answers that part of the question. For them to go back to the front, i find sassoon is a very interesting case. He does not really have shell shock, but he suddenly, in early 1917, but comes so upset becomes so upset by the length of the war and what he begins to perceive as political bodies that are pressing this war onwards when individuals are dying. I think he had a real sort of moral conscience in terms of the men under his leadership. I think what happens at Craig Lockhart is key is essentially convinced to go back, and the patriotism is worth fighting for. What exactly that experience was like for him, i cant really stay to a lot of details, but i can say that a lot of his writings occurred while after the war. Well after the war. Later in life, he was writing about the horrors of war and shell shock and returning, just being dissatisfied with this social network he was returning to. I think that gives us a glimpse into the fact that i dont think his mentality about more changes. I think he still holds on to that throughout his life. Last part, are there statistics about how many people returned to the front aftertreatment . Ms. Stagner there are not a lot of statistics about those who return. Great britain, for the majority of the war, has their Treatment Facility in england. They dont do the front line clinics. Most people, i would argue this is a bad way to say it a more distinctive shell shock, like the pictures i had shown, do not return. They stay in Great Britain. In the american case, i think many were sent back. I think they did a lot of single day treatments in the field right behind lines, and they sent them back out. The goal was to send various send very few back to the United States, and i think they accomplished that fairly well. Thank you. Im curious if you have any information about what people felt like at home, both during and after the war, about soldiers that were affected by shell shock, whether they were treated properly or not. And kind of the background to my question is, i think of pattons famous incident, and the fact that, i believe, in the raf during the second world war, there was a lack of moral fiber category. It seems like the lesson did not stick, at least in some corridors. Ms. Stagner at home and what people thought, i think really varied depending on the nation. Great britain at the beginning of the war, there is not a lot of sensitivity for these guys. You are not physically wondered, why cant you find . That is our duty, you need to be there. I think thats pervasive. I think that public understanding and concern for the way soldiers were treated increases with public dissatisfaction with the war, and sort of reaches its climax in the postwar period, and i think there is a correlation there with how they perceive the individual soldiers. In the United States, its a little bit different because they really are honored as he rose. If someone is shellshocked, it is kind of cool, its like, almost better than a physical wound, because it shows true bravery in which you have put yourself in a condition where there is all kinds of trauma, and you have pushed through and on this for your country. There is a kind of on or with it honor with it in the u. S. That does not exist in europe. The world war ii and patton, that is a really fascinating story. In my work, i argue that what happens, it is very specific to the u. S. Context. Shell shock is used in the u. S. Context as a diagnosis, a term, a valid war injury. You can be diagnosed with shell shock, you are taken to a hospital, you are treated by a certain series of steps. It is the most comprehensive system that the u. S. Military will use for psychological treatments until well into the vietnam war. The reason i think there was this moment in world war ii is because the u. S. Military invested so heavily in world war i treatment. They had the best doctors in the United States on the western front. These are guys from harvard, johns hopkins, columbia, better treating these soldiers, and there had been money poured into these field hospitals, and they are doing everything they can, and yet after the war there is still a very Large Population of individuals who return who claim to be shellshocked and become permanently disabled. I think for the u. S. Military, theres almost a feeling that, well, we tried treatment and it did not work, therefore shell shock must be caused by something else. If we tried treatment and our treatment does not work, it must be because it is hereditary, and it is within the soldier and something no medical technology could fix or heal. By the time we get to world war ii, they did not include psychologist or psychiatrists in the military units, and instead they invest heavily in screening. The idea is we have already screened out all those people who would suffer from shell shock. If you suffer in the field, it must be because you are just being a pansy, right, and you need a good slap, because shell shock is hereditary and those people are not here. It is a much less empathetic approach than world war i. Hi. Is there any distinction between the medical literature between what you would call an acute incident versus accumulative . You see these going up by a time where these guys have been in the western front for a year or two, which is very different than somebody involved in one attack. Not to say that might not be terribly traumatic. Did that result in any management in terms of rotating units to try to reduce the cumulative stress . Ms. Stagner i think doctors definitely tried to find that association. What is the magic combination of events and pressures that caused someone to snap, as they might say . Is it that they have been without food for two weeks and they are malnourished and tired because they have not slept, and they have been under bombardment and the this dramatic thing happens . In the literature, they are careful to document everything that has happened to that soldier before the onset of symptoms, and i think thats why. I think that doctors are at a loss as to what that combination is. Its certainly time on the western front makes, i would argue, tremendous difference in how they are treated. And you asked a second part to your question that i have forgotten. Did it involve any sort of rotation of units . Ms. Stagner right. In the american force, which i am most familiar with, there are psychologists or psychiatrists placed with each unit, and they are responsible for pulling men out when they begin to see signs. They will pull those men out, they will take them back to a field hospital, or maybe somewhere quiet, let them rest for a few weeks, and then send them back to the front. There does become sort of a preventative strategy, if you will come up for trying to recognize that early and not letting the convention not letting her condition worsened. Fair condition worsened i am running about a vietnam veteran who discovered he had ptsd sometime after the war. He went to the Veterans Hospital in topeka, and they told him to write his trauma. That sounds a little bit like what happened with Siegfried Sassoon and the other gentleman. Im wondering if that was something they prescribed, or if that was just something that mr. Sassoon did on his own. I dont think that happened after world war i before modern diagnoses of ptsd. First off, did sassoon do that on his own, or was that something the doctors talked about and prescribed . Ms. Stagner i think for Siegfried Sassoon, it was both. I think that for that writing trauma was definitely used during the First World War. Its interesting to me the variety of techniques that American Physicians tried. They have soldiers painting, they had soldiers doing occupational therapy, things with their hands, crafts. They put them in farms to help them try to heal. They are doing talk therapy. There is a lot of attempt to remember the event fully in order to be able to process it, if that makes sense. It sounds like modern ptsd treatments are in some ways a trip back to the future. Ms. Stagner yeah, its interesting. Once i talked about this period in world war ii where they talked about, we dont need treatment, lets get rid of it. All that was brought back during the vietnam war, and they refer back to Thomas Salmon and his writings. He was the one who designed the treatments and processes for world war i. There is a direct correlation between what happens in vietnam and what happened in world war one. Thank you for this very dramatic presentation, because it is interesting to see how people, with their unsophisticated knowledge of neurology, grappled with this subject. I have been curious to know whether some scientists have done the definitive clinical 3d explanation for exactly what happened to these individuals that suffer from shell shock. Thats the first part of the question. I would love to know why it happened to some and not others. My grandfather was buried by shells. And also gassed and didnt suffer it. He was a quiet farmer from pennsylvania. I would also like to know whether the germans sustained as many cases as english, the french, and the americans. Did one country present with more cases of shell shock . In other words, ultimately, why did it happen to some and not to others . I would like to know if there is a modern explanation for this. Ms. Stagner i will answer the second part first, about german cases. Paul lerner has done an excellent study on german cases on shell shock. In part, when he argues is that interpretations of cure become very different based on the National Context in which the soldiers are placed. After the First World War, there are many shell shock cases in germany, what they referred to as male hysteria. They are deemed cured when they can again work. The definition of cure is your ability to be a sufficient work er and participate in the state. Many of those soldiers never returned to their families. They developed group homes, barracks for them to live in. Those soldiers are cured because of their ability to work. What constitutes cure, how many are diagnosed definitely has that national component, but there are definitely large numbers of german cases. As far as the clinical definitions of shell shock and a definitive study, there are definitely some cases that have tried to look at shell shock in a lot of detail and really play out what individual cases and what happened. Anthony babington is one that looked at the british case. I always caution about studies that use presentist ideas and medical terms placed on another time period, because the concept of what shell shock was was so culturally embedded, it is hard to make those comparisons. Although certainly people do. Historians have done great work doing that. Yeah, there are some individuals who argue, well, if we looked at achilles, there are signs of shell shock. And we look at civil war and world war i, and there is certainly, to what i believe, there is trauma through every war. The way in which the body exhibits trauma i think is very culturally based. If we were to look at films of soldiers under shell shock treatment, the stills i took from the hospital are from a film, and those soldiers exhibit trauma very differently than soldiers today with ptsd. It is an interesting comparison, trying to figure out what actually was going on. Our last question come from this gentleman. It sounds like you are quite familiar with current ptsd, the gulf war in iraq and all that. The soldiers are volunteers. Has anybody looked at the difference between that and conscription as in vietnam and world or to, world war i, and the civil war . I particularly emphasize the civil war. We need to remember also that posttraumatic stress disorder and shell shock are are wastebasket terms, medically speaking. What about brain chemicals in response to stress . Those things manifest themselves differently in different people. Has anybody looked at some of those issues . You sort of alluded to them. Ms. Stagner thank you for that question. I think it is a good one to it a good want to end on, bringing what happened in world war i to the present day. I think it is understanding that there is a real psychological component going on. I think even in present wars, we are still dealing with this distinction between posttraumatic stress disorder, ptsd, and ptbi, post traumatic brain injuries, and when did they overlap . What is the brain doing under stress . What does the brain due under the impact of an explosion . I think that there has been a lot of work done on brain chemicals, as you suggested, and i think that work really is continuing now. I saw a recent article that talked about doing an mri of a soldiers brain and seeing how being in an explosion had affected the brain and might even affect behavior or emotions and stuff like that. I think that the interesting thing for me, the volunteer versus conscription, i dont think that theres necessarily a difference in the number or type of individual affected. I think it is based on time, circumstance, the number of traumas that soldier has experienced. Its just you are at the wrong moment at the wrong time. What is interesting is that i for ptsd our sympathy be as great as it was in Great Britain and germany after the wars because they are volunteers. Something i find interesting to think about. , what doeseering that do to our understanding of what a soldier should experience or what the consequence of that volunteering is. Thanking join me in the doctor. [applause] are watching American History tv. All weekend, every beacon, on cspan 3