Problems Returning Home: The British Psychological Casualties of the Great War

by Peter Leese
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Title:
Problems Returning Home: The British Psychological Casualties of the Great War
Author:
Peter Leese
Year: 
1997
Publication: 
The Historical Journal
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40
Issue: 
4
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1055
End Page: 
1067
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English
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Abstract:

PROBLEMS RETURNING HOME: THE
BRITISH PSYCHOLOGICAL
CASUALTIES OF THE GREAT WAR

PETER LEESE
Jagiellonian Cniversig, K7akdw

ABSTRACT. Although returning shellshocked soldiers constitute a specgc subgroul, their situation also illustrates the wider dzficulties oyGreat War retzlrnees. Whether disabled oryullyjt, each oeteran faced a cluster of firoblems related to the p.ychological and social readjustment to civilian socieg. Rightly or not, manq. felt that the promisesfor the postwar world were unfu4lled. TVar neurotic ex- servicemen faced two areas of dzficulty. First, like all returnees, the^ had to deal with a large and unwielb bureaucracy that paid little attention to the needs of indioiduals. Second, -Ministy of Pensions polig for war neurotic ex-servicemen, guided by Sir John Collie, tended to exacerbate the faults in the vstem. Substantial political objectives were itnfilicit in the establishment of the Ministy of Pensions, not least because of the appointment of Collie -an injuential expert on malingering as one oyits leading authorities. His allroach convenientlyjtted into the governnzent's agenda. Its objectives were to uphold and su@ort a restrictive militav vielw oy shellshock and therebj limit jnancial liability; and above all to preseroe the existing distriblltion oy wealti2 ze'hile maintaining a

visible response to fiublic concern.

Every soldier returning from combat in the Great War, and especially the injured and disabled, had to face the difficult readjustment to civilian life. Apart from any family or work related problems that returnees faced, they also met an inadequate and overburdened state bureaucracy that, at least provisionally, offered the hope of some assistance. The first problem faced by the government of the day was that it was almost impossible to process the enormous number of men involved. The work of establishing a coherent pension policy and an effective administrative framejvork for treatment was slojv and laborious. Meanwhile, there was little preparation for the postwar requirements of ex-servicemen. The introduction of the Ministry of Pensions in I 916-1 generated a new set of problems relating to the type and extent of state provision for the war disabled as well as healthy veterans.' There were large gaps both in the pensions and rehabilitation system. A'Ioreover, because the special requirements of the rapidly mounting numbers of casualties of all types were largely ignored during the first tjvo years of the Great War, there was

' See for example: P[ublic] R[ecord] O[ffice], PIN 15/421. Unrest an~ongst ex-soldiers; Administration of Labour Exchanges, etc., 1918-19.

1055

minimal provision for rehabilitation. Volunteer associations and charities attempted privately to raise funds. They also provided the majority of support for the severely disabled, such as the limbless or paralYsed.'

Several considerations prompted the establishment of the Ministry of Pensions. These included the need to keep up and encourage levels of voluntary subscription, and the desire to avoid responsibility for the enormously successful recruitment pledges. In the development of policy also, there was more than one non-welfare issue involved. Most important of these was the main requirement to sustain the existing distribution of wealth -to preserve the social system as it had functioned before the Great War.

All of this sprang from an overriding concern to limit the state's financial commitments. The view of the government was that paternalism together with charity should play an important role in assisting returnees. They persisted with this attitude after conscription even though the argument that soldiers joined the army at their risk had become an obvious nonsense. Thus through the autumn of 1918 and on into 1919 war disabled ex-servicemen and returning soldiers alike became profoundly disappointed by the inadequacy of government policy. Their grievances included the public attitudes towards war 'heroes', and dissatisfaction over the military and political handling of the Great War. Above all, it was government policy as it directly affected veterans that led to di~content.~

Healthy and disabled returnees alike were ajvare of the badly botched demobilization and the lack of adequate housing; of the low rates of pensions and gratuities; of the clumsy, insensitive and uncooperative attitude of the state welfare agencies. The inevitable result of all this was widespread discontent among ex-soldiers. This reached its height in the summer and autumn of I 91 9, jvhen throughout the country angry veterans demonstrated and marched, disrupting peace festivals and remembrance services. Some journalists and some members of parliament took up the cause, attacking the government for its apparent apathy tojvards the hardships of ex-servicemen." In October 1919 a Ministry of Pensions report brought to light the real magnitude of their discontent, as well as some of its sources. Compiled from a questionnaire sent to the regional war pensions committees at the request of the War Office, the report listed the most common grievances. The most important of these was a lack of inter-departmental co-operation, an unsympathetic and unhelpful attitude among staff, and a narrow interpretation of government guidelines on training and grants.

The most frequently reported criticism was that the Ministry of Pensions had delegated aspects of every individual case to the relevant government department rather than centralizing the system so that one authority was

'Morale and military pensions. Re\-olt of the towns', The Times, zo July 1916, gc; 'Disabled soldiers pensions', The Times, I Mar. 1916, gf and Ioa.

G. Rudy, ' Concerning Tommy', Contemporay Review (KO\-.I g I 8), 545-52.

PRO, PIN 1j/421, Ministry of Pensions report on 'Unrest amongst ex-soldiers', 31 iV1ar. '9'9.

I057

responsible for all aspects of any given case. The Birmingham pensions
committee president wrote on 5 October I 91 9:5

...I think the discharged men are fully justified in their complaint about lack of co-
operation between various departments. To my mind it was a disastrous policy for the
Ministry to delegate its responsibilities to other Government Departments...A
pensioner cannot be divided into so many bits. His pension, treatment, training and
employment are inseparably inter-related, and any attempt to divide up the
responsibility among various authorities was bound to lead to the present situation.

Other committees made comments on the insular and short-sighted approach
of officials at local offices, as in the following comments on the employment
exchange system :6

Men often disqualified through technical difficulty. (Portsmouth)
A tendency to 'get rid' of applicants rather than examine the case and offer all that the
Government can do. (Leicester)
KO allowance made for man's absence from training for good reason (e.g. sickness or
holiday);the date of completion of training is not accepted (as was formerly done by the
Ministry of Pensions). (Luton)

Dissatisfaction was highly vocal in the densely populated and impoverished
industrial centres of Scotland, including Glasgow, Dundee and Leith. It is also
apparent from these observations that many local officials were themselves
resentful of having to implement what they considered incompetent measures
sent down from the Ministry of Pensions :7

JVhen the training was taken over by the Ministry of Pensions the Officials did not
appear to have even an elementary knowledge of the Regulations governing training,
and consequently chaos reigned, and from what I hear things have not improved, when
a man applies for training he usually finds that the scheme is filled, and no endeavour
is made to suggest an alternative scheme. When he is fortunate enough to obtain
training he is kept entirely in the dark as to what is going on, and soon realizes that no
interest is being taken in him.

For the Ministry of Pensions, the local officials who attempted to enforce the
system -and most of all for the ex-servicemen within the system -all of this
meant long delays in the assessment and allocation of pensions and the
retraining necessary to find new work after the Great Ll'ar.

The government introduced reforms at the end of 1919. These went some way to resolving the technical and administrative difficulties that ex-servicemen faced. Statutory rights ensured a minimum entitlement to state training, employment for the disabled, and preferential treatment for ex-servicemen in finding employment. For the first time local pensions committees included veterans; pri~ate and public agencies assisted where~er possible. In spite of these efforts both employees and employers were finally at the mercy of

PRO, PIN 15/421, Birmingham war pensions committee to Ministry of Pensions, 5 Oct.

'9'9.
'PRO, PIX 15/421, Ministry of Pensions report on 'Unrest amongst ex-soldiers', 31 Mar.

'9'9.
PRO, PIN 15/421, Scottish regional HQto h.Iinistry of Pensions, I I Oct. 1919.

economic conditions. Conscripts straight from schools, as well as many others who already had skills and experience from before the Great War, found themselves out of work and without any prospects when the postwar boom ended. Many carried the burden of unemployment for the remainder of their lives. Fifty-eight per cent of all those out of work in 1929 were men who had served in the Great War.' In truth, the final War Office report of March 1920 made little practicable difference to the problems faced by veterans because their problems were beyond the control of any government. It nevertheless gave official recognition to the extent of the difficulties imposed on ex-servicemen by the state during and immediately after the Great War, difficulties that they would continue to suffer for many years to come.

For mutilated and injured veterans, as well as for those with psychological injuries, the problems were even more complex. Shortly before the start of the Great War the government reformed the pension system for the disabled. Uppermost in their thinking was the necessity to avoid the embarrassment and scandal that had surrounded the issue during and after the Boer war.g In 1914 the responsibility for most pensions, specifically the other ranks of the army and their widows, rested with the Chelsea commissioners. Later that year the government appointed a select committee that recommended a number of changes. These included a new maximum disability allowance of 25s per week, gratuities for the aggravation of injury acquired before service, and payments for directly caused disability.10 This system ignored, though, the needs of war neurotic ex-servicemen, nor did it adapt to their special requirements as they became known. Even after the introduction of the special medical board in 1916-17, ministry regulations failed to recognize the distinction between assessment criteria for a physical disability -a lost limb or a debilitating injury that resulted from combat -and a mental disability. Whereas doctors had a standard calculation chart for physical injuries, the evaluation of psychological disability remained haphazard and subjective. The constant pressure to reduce expenditure by implementing a restrictive definition of shellshock added to this confusion, just as the well-known parsimony of the Chelsea commissioners had done in the early part of the Great War.''

As with all other forms of disability assessment, war neurotic ex-servicemen had to go before an examination board, and the doctors who examined on these tribunals were often former Royal Army Medical Corps or shared their viewpoint. By their whole training such professionals were sceptical towards illness. This led to the conviction that, in the interests of the war disabled as well as the economy, all non-organic symptoms (including tremors, memory loss and limb paralysis) should be ruled s~bjective.'~

Ironically it was often doctors rather than the patients who were unable to be objective. This combination of

R. C. Da\-idson, The unemployed (London, 19291,p. 94.

A. Summers, An~els and citkens \London, 19881,pp. 205-37. lo 'Pensions and allowances', The Times, 12 Kov. 1914,gd." PRO PIN I j/ 571, Entitlement to Pensions, 191 5-1 j. '"'A defence of the Chelsea system, delays due to the system', The Tzmes, 22 hug. 1916,gd;

'Payment of pensions. Official explanations of the system', The Times, 24 hug. 1916,3d.

prejudiced judgement, financial pressure and scepticism started working against psychological casualties even before the assessment process began. Often they found no sympathy. To give one example, B. IV. Downes of the 9th Battalion Cameronians wrote scathingly in his wartime memoir of his encounters with the medical board. They were, he believed, in the hands of retired doctors whose ideas were narrojv-minded and out of date, medics 'who assess what pensions, if any, would be grudgingly given to a man crippled in service to his country '.13 Dojvnes' bitterness is readily apparent but it also seems justified. Following treatment in Brighton he had no financial support from the state whatsoe~er. He described the encounter with a medical board :14

Mackenzie and his friend, the M.P. for Brighton pressed for a medical board for me and I duly appeared before one. The Chairman of the board said they had assessed my hip and leg wounds at 20 Ol0 disability but they were not giving me anything for the chest wound as in their opinion it was due to shell shock or 'war neurasthenia' 'as we call it', he observed pretentiously and would disappear after a while in civvy street.. .. when I communicated the diagnosis of the Worthing specialist to the Ministry I was given another medical board and even after more than fifty years I recognize it with its same workhouse green painted walls and the same short shrift usually accorded malefactors, with a meagre 10 added to my rounds disability pension based originally on the 1914 cost of living when whisky was 316 a bottle.

Hence, psychological injuries gave few pension benefits.''

Hojv can we describe the post-combat psychological disorders of the Great War? In relation to what social conditions did they exist? These questions are important not least because of the argument, most recently put forward by Allan Young, that traumatic experience is shaped by the moral sensibilities, political institutions and clinical practices that surround it, whether they were those of the Great War ('shell shock') or those of the Vietnam War ('post- traumatic stress disorder').16 There is only patchy evidence on the fate of British psychological casualties and war neurotic ex-servicemen. However, we can supplement this to some extent by the follow-up studies from other countries and later wars. The most useful in this context are the American studies produced mainly after the Second World \Var, which include extensive research into the process of recovery and of reintegration up to fifteen years after the end of hostilities. In particular, these investigations examine the links between domestic conditions, employment, and the continuation of mental conditions that derived from wartime experience.'' Still, there are strict limits to the usefulness of such evidence. Their pertinence depends on an ac

l3 B. M. Downes, 'Memoria technica as used in the treatment of war torn compression in the war of 1914-18', typescript, Imperial War Museum, p. 28. '"bid. pp. 29-30.

15 For a more detailed study of pensions records and pensions experience see also : Peter Leese, 'A social and cultural history of shellshock, with particular reference the experience of British soldiers during and after the Great \l:ar' iPh.D. thesis, The Open University, 1989). chs. 8 and 9.

'' A. Young, The hainiory of zlltlsions: inventinzpost-traumatic stress dzsoide~ \Princeton, 1gg5), esp. ppi743-85. K,;. aftermath \London; 1926) ; G. h.Iassoneau, 'A social analysis of a

Fenton, Shellshock and ~ts group of psychoneurotic ex-servicemen', 12.lental Hjgierze, VI (1922);H. Archibald et al., 'Gross stress reaction in combat -a 15 year follow-up', Ameitcan Jouinal of Psyciiiatry, CIX (1952-3), 46-51.

knowledgment that service and combat, medical knowledge, political attitudes to pensions and treatment, and not least public perspectives all changed sharply between, say, the Great War and the Second World War. These are limiting factors, but they do not preclude the use of such sources as a comparative yardstick, a useful point of reference.

Two American psychologists reporting on World War Two ex-combatants in 1952-3 produced one of the first systematic examinations of the return from combat.'' In their survey of postwar readjustment Karpe and Schnap linked the trauma of homecoming to several factors, especially idealization of the home situation. Returnees had a tendency to underestimate the practical difficulties involved in coming back to civilian life. On arriving home many experienced feelings of guilt over separation from, and neglect of, family and friends, and there were many other potential hazards. For instance, ill will towards the returnee might renew family feuds; the mundane realities of postcombat life could breed resentment and festering anger; or a crisis could provoke feelings of insecurity in the face of the complexities of civilian life. Additionally, changes in the composition of the household by death, birth or marriage forced veterans to adapt very rapidly to changed circumstances. Marriage, or its near prospect, could also induce intense anxiety and unusual stress; likewise, lack of a family and family support increased veterans' psychological vulnerability.

These observations indicate the range of problems that probably faced ex- servicemen, but war neurotic ex-servicemen met with further obstacles. The only significant follow-up study on psychological casualties of the Great War, at least in the English language, is Norman Fenton's Shell shock and its aftermath (1926). The author had worked at the American expeditionary force base treating American soldiers at the end of the Great War. His argument was twofold : that degree ofdisability was crucial to readjustment and reintegration; and that levels of social, economic and emotional support determined the speed and extent of recovery. With a sympathetic family and employer an ex-serviceman with a severe condition stood an excellent chance of recovery and integration. Alternatively, a mild case could linger for years, if suffered without emotional support, or other source of income or compensation, and with no other motivation.

With funds from the New York committee for mental hygiene, Fenton surveyed all the psychological casualties treated at his AEF base in France. In total 758 men answered his survey in 1919-20, and almost all responded to a second questionnaire in 1924-5. From the results of the first survey, Fenton divided his respondents into five groups. British troops did not necessarily react identically to American troops, but Fenton's groups do indicate broadly how war neurotic ex-servicemen adapted to civilian life.lg

'Psychotic' cases (1.3 per cent) had chronic and acute symptoms, such as fits, 'psychopathic personality ', 'dementia praecox', and required constant super- '' R. Karpe and I. Schnap, 'Nostopathy -a study of pathogenic hon~ecoming', American Journal of Psychiatry, CIX (I 952-3), 465 1. l8 Fenton, Shellshock, pp. 73, 91-4.

vision and institutional care. 'Disabled' cases (20.4 per cent) were subject to frequent re-hospitalization and were considered unemployable because of recurrent but not prolonged bouts of 'psychoneurosis' or 'nervous breakdown'. 'Fatigue' cases (17.3per cent) were mostly employable with support from a wife, family or sympathetic employer and under these circumstances could be reasonably independent. The remainder found work uncomfortable -mild exercise or exertion produced severe headaches and bouts of depression -and they lacked ambition and motivation. 'Neurotic' cases (22 per cent) were capable of full-time employment but saw doctors regularly or frequently for treatment. Characteristic traits in this group included problems with personal relationships, and a variety of symptoms : fine tremors and tics, speech defects, insomnia, jumpiness, inability to concentrate, memory disorders and 'spells'. War neurotic ex-servicemen with these symptoms were prone to accidents if they engaged in factory work, but agricultural labour M-as ideal therapy, especially in the prevention of moods and depression. 'Normal' cases (38.9per cent) were the largest group in this survey, and here the term refers to successful re-integration rather than full recovery. In this category less debilitating symptoms were common, as were violent outbursts and unpredictable or bizarre behaviour. The condition remained latent with a real and continued threat of relapse.

The man in a unique position to help all of these groups with their readjustment to civilian life, but whose efforts were seriously flawed, M-as Sir John Collie. The Ministry of Pensions through a series of appointments gave Collie increasing responsibility for the welfare of ex-servicemen, culminating in his appointment in January I g I 8 as director of Ministry of Pensions medical

service^.'^ He became head of the army medical services section in early 1916; president of the special medical board for neurasthenic and allied nervous disorders in April I gI 7 ; and in July of I gI 7 director of neurasthenic institution^.^^ The institutional committee of the War Office -advised by the Red Cross -disbanded at the same time. It was consequently not until the final year of the Great War that the Ministry of Pensions took over full responsibility for the treatment ofspecial classes ofdisabled men. The most important of these appointments, in that it M-as directly concerned with war neurotic ex-servicemen was Collie's post as president of the special medical board, which was responsible for the periodical re-examination of all men who had received temporary pensions after discharge and were suffering from chronic disorders. In 1918Collie estimated the number of pensioners in this group was approxi- mately 25,0oo.~~

There are obvious reasons why the army and the Ministry of Pensions chose Sir John to direct these various initiatives for injured and disabled ex

20 .*ppointment for Col. Sir John Collie', The Times, 7 July 1917, 6d; The Times, 4 Jan. 1918, 7b. PRO, PIX I 15/54, notes by Sir John Collie on the treatment of neurasthenia. 22 J. Collie, 'The management of neurasthenia and allied disorders contracted in the army', Jotlrnal of State AJedicine, VI i I gI 8), I I.

servicemen. First, his approach was close to that of the armed services generally; in other words, he was deeply sceptical towards all claims of illness. Collie wrote several volumes on malingering and medical insurance fraud before the Great War, while working as a medical examiner for the London County Council. In Fraud and the detection oj medical insurance claims (I gI 2), ~bfalingering and feigning sickness (I gI 3), and The psychology oj the)audulent mind (I g 13), he rehearses many of the arguments later deployed in his approach to shellshock treatment and pension policy. Second, unlike academic doctors and psychologists, he rejected outright any treatment that offended his ojvn 'common sense' approach. Thus, for example, he dismissed psychoanalysis as mere q~ackery.'~

Collie's scepticism had gained him a reputation in military-medical circles even before the Great War. At a British Medical Association meeting in Aberdeen on 3 I July I gI 4a discussion of malingering by Sir John brought the following response.24 'Dr. Drury (Halifax) said there was a serious danger of assuming, as specialists were apt to do, the people were suffering in the manner those specialists were usually in the habit of dealing with. For instance, just as people assumed that you had got gout ifyou went to certain spas, so ifyou went to Sir John Collie the assumption was that you had got malingering. (Laughter.)' A speech made on his appointment as director of army medical services for the Ministry of Pensions, in 1918, shows something of the man behind this formidable reputation. Thus, for example: 'Personally, I have always believed that hard work and continuous work is the only way to be really happy, and that in one form or another it is the salvation of those who are suffering from functional nervous disease. I have preached this in season and out of season for about ten or fifteen years."' This view of work as therapy as well as a professional interest in fraud and malingering have much in common with the military understanding of health and sickness. In both cases, judgements are subject to the requirements of manpower. Yet this was not the only ideological source used in the assessment of war neurotic ex-sen memen.

'

The \\'orkmen's Compensation Acts, implemented in the early years of the century, led to a parallel civilian interest in the detection of malingering. Academic psychologists felt little of the impact of these acts, but Collie was the most widely recognized authority on the implementation of these acts, with long experience as a medical referee for the Home Office, and for various public bodies and private corporations. Of his standard reference work, hfalinge~ingand

feignzng sickness, one reviewer complained that it made the world seem 'full of cunning and unscrupulous impostors against whom the doctor has to be always on his guard."6 Many other doctors also gained a knowledge of medical fraud and of its detection when the acts came into force and they used the same

'Battle shock. The wounded mind and its cure. .4 special hospital'; The Tirnes, 2j Ma)- 1915,

I IC. J. Collie, 'The management of neurasthenia', pp. 2-26. %4 rcc How to be ill." Doctors on psychology and malingering', The Times, I Aug. 1914, jc. " J. Collie, 'The management of neurasthenia', p. I I; 'Obsession and fraud. Studies in

diseased personality. Sir John Collie's lecture', The Times, 27 Jan. 1915, ja, 26 'Malingering', Times Literav Su@lernent, 6 Mar. 1913, IOOC.

approach in shellshock treatment and the assessment of pensions. For example,

A. Bassett Jones and Llewellyn J. Llewellyn both treated cases of wartime neurasthenia and hysteria and wrote about them in their textbook Malingering or the simulation of disease (I 9I 7)." For these doctors malingering resulted from moral corruption, and so it was most common among the badly educated, less intelligent, and less evolved members ofsociety. By a neat sleight ofhand, many doctors defined 'shellshock' as physical shell concussion, and excluded it from this category. However, the possibility of malingering was clearly in the minds ofmany doctors when they examined psychological casualties, perhaps more so than either a military vision of bravery or an academic specialist's view of hysteria.

None the less, these dual military and civil perspectives on shellshock solidified into a series of practices and attitudes under the weight of the many thousands of cases that resulted from the Great il'ar. This pressure also helped Sir John to the conclusion that willpower and motivation were the key to effective cure based on military discipline and a regular work pattern. In his favour, even these treatments were preferable to the numerous counterfeit cures that proliferated in I 918-1 9." One of Collie's earliest statements relating to neurasthenia was in January 19 15 when he gave a speech in his capacity as the then medical examiner for the London County Council and vice president of the hledico-Legal Society. His description of civilian neurasthenia is very close to his understanding of the psychological disorders of the Great War:'"

There is often an inability to make up the mind as to any particular course of action, patients being unable to force themselves to do even what they wished to do, and responsibility forced upon them produced mental confusion. Almost invariably symptoms were inability to fix attention for any length of time and incapacity for mental work, Most suffered from sleeplessness, all were obsessed with the idea that they would never be themselves again. They lived on perpetual mental anxiety and morbid introspection ... and nine-tenths of the subjective symptoms were the result of auto- suggestion.

These comments describe Collie's early views on the problem; reported nationally, they also indicate the importance of shellshock to the wider public. Politicians, the public and the military continued to discuss the issue throughout the Great il'ar and after. These debates reached a peak in 19I 7and early I 91 8, when there was concern over the use of asylums, over the misuse of military punishments and over the most effective forms of treatment. Collie continued to make his views known to the wider public because he knew the subject had an intense appeal, but at the same time he came under increasing attack.

In May 1917 the Pall Mall Gazette published an anonymous letter that alleged negligence of shellshock cases by the Ministry of Pensions. The author

" -4.Bassett Jones and L. J.Llewellyn, .blalingerirzg or the sinitilatior~ of disense :Londo11, 1917'1, p, ix.

" 8Vi~co~~~t

Knutsford, 'Neurasthenia and shellshock', The Times, 16 Apr. 1919,'Fa.
"J. Collie, 'Obsession and fraud'.

stated there were curable soldiers held in asylums, and that the Ministry of Pensions claimed credit for the work of the voluntary agencies for shellshocked ex-servicemen. Collie's draft reply could promise only to treat such cases in 'a broad and sympathetic way'.30 Throughout the Great Ft'ar the Red Cross played a vital role in the organization of specialist treatment centres, as did a number of smaller charities including the 'recuperative hostels for soldiers and sailors invalided from H.M. Services with nerve strain'.31 In early 1917 this charity approached the ministry asking it to reconsider a number of their policies; in particular they wanted to emphasize the need to organize large scale facilities. The state was unable to provide effective treatment, so many ex- servicemen were turning to such charities, but the numbers involved in turn overwhelmed these organizations. The response from the Ministry of Pensions to these suggestions was unhelpful, and it was in part this dismissive attitude that led to so much criticism of both them and Collie in particular. Charities, they stated, should restrict their activities to raising funds; the ministry would deil with treatment as it saw fit. Thus, based on itsiestricted definitionofwhat shellshock was and how it should be treated, the ministry tried to fulfil its three major requirements: to uphold and support the restrictive military view of shellshock; to limit financial liability; and to maintain a visible government response to public concern.32 These objectives remained essentially unchanged during and after the Great War. Meanwhile, disagreements in public over treatment, and concern among the civilian population over the well-being of war neurotic ex-servicemen grew in intensity in the final two years of the Great War.

The Ministry of Pensions appointed Sir John Collie head of the army medical services section in early I 91 6.33 Some members of staff and some of the medics at the ministry were unhappy with this decision. They felt he was entirely unsuitable for a senior post because of his high-handed management methods, spiteful manner and personal ambition.34 These reservations among staff echoed significant public disapproval of Collie and his methods. One case will suffice as an example. In the summer of 1918, after his first Ministry of Pensions examination, John Johnson received no pension award for psycho- logical disorder.35 Despite symptoms including partial paralysis and nervous tics the special medical board regarded Johnson as a malingerer; his symptoms were not trustworthy evidence of real disability, they argued, because they were entirely functional. Unhappy with this decision, in the summer of 1918

30 PRO, PIN I j/ 54, 'Sanitas', 'Homes for the nerve strained soldiers', Pall .Z4all Gazette, 2 May 1917; draft rep1)- by Sir John Collie. See also J. Collie, '\l:ar shaken men. The treatment of the neurasthenic', The Times, 28 Dec. 1916, 3c. See also: 'Soldiers in as)-lums. Nelv arrangements b)-the Ministry of Pensions', The Tirnes, 12 Oct. 1917, 3c; and 'Xews in brief', The Times, 28 Feb. 1917,3f (last para.)

'Recent developments and editorial notes', Recalled to L@, 3 Xpr. 1918,p. 322.

32 PRO PIN 15/53, Recuperative hostels for soldiers and sailors to Ministry of Pensions, 3 Jan. 191 7; Ministr). of Pensions to adviser of the Lord Major, 12 Jan. 191 7. 33 The Times, 4 Jan. 1918, 7b. 3"ee early correspondence: PRO, PIX 1514,Medical boards, 1917-22, 35 PRO, PIN I 511431,Examinations of cases or suspected cases of malingering, 191 7-18.

Johnson went to a Harley Street specialist who duly stated it would be impossible to fake such symptoms. Report in hand, and by now with a personal grudge against Collie, Johnson set out to reopen the case. He went to his M.P. and wrote to the press in an attempt to gain recompense. Among the journals that picked up the story was John Bull, edited by the rabble-rousing, self- appointed ' tribune of the people', Horatio B~ttomley.~~

Fl'ith a scurrilous and populist reputation John Bull took a campaigning approach towards veterans and their rights, as in the following attack on Collie on 29 June 1918:~'

A PAINFUL CASE. BASELESS CHARGES AGAINST DISABLED SOLDIER. Physicians of a high standing -we except Sir John Collie, Medical Officer to L.C.C., who is less a specialist that a monomaniac -are agreed that 'shell shock' in its various forms is a painf~ll and debilitating affliction. Unfortunately, Dr. Collie has a 'pull' at the Ministry ofPensions; and in the case of John Johnson, of Brixton, recently noted in these columns, his influence has been exerted to rob a discharged man of a pension to which he was clearly entitled as if he had lost an eye or limb. Despite the publicity given to the matter, no satisfactory steps have yet been taken towards meeting the man's indubitable claim; yet the Ministry are in possession of medical evidence which ought to outweigh the opinion of Sir John Collie, whose handling of the case and many others of the same character, has been grossly unsympathetic.. .

Despite its inaccuracies fJohnson was a sailor), such articles illustrate the increasingly critical attitude taken towards the ministry generally, and Collie in particular. The case remained closed.

The strength of feeling stirred up by the Johnson case, among others, resulted from the inability of Collie and other senior medics like him to adapt to the new conditions of the Great Fl'ar. Throughout he remained remarkably inflexible, ignoring the rapidly developing theories of aetiology and advances in treatment. As Collie was also the key figure in the formation of pension policy his failure had wider implications. A lecture at the Royal Institute of Public Health in the autumn of 1917 is illustrati~e.~' Strong willpower and a good hereditary background, he argued, were central in the process of postcombat re-integration, but those unwilling or unable to cure themselves were responsible for their condition. Like non-war neurasthenia, wartime cases of psychological disturbance lingered because of weak will or a tendency to morbid introspection. Such conditions were largely self-sustaining. To break this cycle of reinforcement it was necessary to correct the allegedly perverted mental outlook of sufferers. So, re-education was the means to bring about effective cure through military discipline and regular work routines. One centre that used these methods was the First Home of Recovery, Golders Green. Before the Great Ft'ar ended, there were eleven similar centres throughout the

36 .4. J. P. Taylor, English Histov 1914-4j (Harmonds\vorth, 1982),p. 48. 3' PRO PIX I j/1431,Press cuttings: '.4 painful case. Baseless charges against disabled soldier', John Bull, 29 June 1918.

38 J. Collie, 'The management of neurasthenia and allied disorders contracted in the army', Recalled to LiSe, 2 Sept. 1917, pp. 234-53; (reprinted) State Journal of .lledicine i1g18), xxvr, 2-17,

United Kingdom set up by the Ministry of pension^.^' Collie described their aims as follows :40

The class of cases we lay ourselves out for are men suffering certain classes of paralysis, tremors, stammering etc., \t'e are hopeful that by the rapid cure of a few of the earlier and simpler cases we shall create in the institutions an atmosphere of confidence and cheerfulness which will unconsciously influence the trend of thought of these unfortunate men. Our idea is that cheerf~~lness

shall be the prevailing atmosphere of these homes.

il'hatever assistance these initiatives gave, the inadequacies built into the system at the beginning of the Great MTar and equally incorporated into the Ministry of Pensions still affected the lives of many war neurotic ex-servicemen long after that conflict was ended.41

By the summer of I 918 the number of shellshock cases returning to Britain had completely swamped the available facilities. The pensions survey board was examining on average 495 cases per week; the branch dealing with complaints, appeals and exceptional cases handled 300 per day; the number of cases as a whole was still rising in August I 918." All of this was at least in part a result of Collie's uninformed and simplistic policies. It was his lack of sophistication and mismanagement, which caused continued distress and disability to many soldiers when alternative and effective forms of treatment were available.43

Although returning shellshocked soldiers constituted a specific subgroup, they are also a sample group illustrating the wider problems of all Great il'ar returnees. They faced the same problems as any other veterans when they came home. Commonly, they felt alienated from non-combatant society, frustrated at personal failure, and resentful of inadequate government policies and petty- minded officials. Above all, there was a powerful sense of hopelessness, especially among the chronic cases. A sense, rightly or not, that the promises of the postwar world were unfulfilled. However, war neurotic ex-servicemen also suffered for other specific reasons. First, there was a lack of knowledge and experience among the medical service. This would have been very hard to avoid given the difficulties of wartime as well as postwar conditions and the fledgling status of psychological medicine. Second, the work and thinking of Sir John Collie at the Ministry of Pensions, particularly in the formation of policy, exacerbated the failures within the system. Still, it would be wrong to blame one man for all of these problems. Collie's approach was apparent from the outset. His appointment, even though he was a known expert on malingering,

39 J. Collie, 'Restorative treatment', Reueille, I .4ug. 1918. pp. 42-4.

"J. Collie, 'The management of neurasthenia', p. 15.

" See, for example: FV. Draper, 'Village centres for cure and training', Recalled to L@, 3 iXpr.

1918), 342-jj. i\lso: Leese, 'Shellshock', ch. 9.

"J. Collie, 'Restorative treatment', pp. jn-3.

" See, for example: .4. F. Hurst, 'Cinematographic demonstration ofwar neuroses', Proceedings of the Ryal Sociep of Medicirze, .~Veurologicnl Section, XI i I gI 7-1 8), 39-42 ; 'Observations on the etiology and treatment of war neuroses', British Aledical Jot~rnal i2g Sept. 191 j), 409-14; 'Nerves and the men', Reueille, 2 Nov. 1918, pp 260-8; The j.ycholog). oj the special senses and their functional disorder (Oxford, I 920).

only reinforces the impression that the wider objectives that were implicit in the establishment of the Ministry of Pensions took priority. The government failed many of its veterans whether injured or not. His approach conveniently fitted the wider government agenda of financial constraint and a limited military view of shellshock.

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