Shell shock was treated through a wide and often contradictory range of methods during World War I, from talking therapy and rest cures to painful electrical currents and forced isolation. The approach a soldier received depended largely on his rank, when he broke down, and which doctor he ended up with. An estimated 40% of British battle casualties suffered from shell shock, roughly 670,000 soldiers, yet the military had no unified treatment protocol for most of the war.
What Shell Shock Looked Like
The term was first used in 1915 by Charles Myers of Britain’s Royal Army Medical Corps. The War Office adopted it as an official diagnostic classification for officers and soldiers whose battlefield experiences left them unable to function. Symptoms varied enormously: tremors, paralysis, mutism, blindness, deafness, uncontrollable shaking, nightmares, and a kind of blank, dissociated stare. The central problem for military doctors was distinguishing genuine breakdown from malingering, which led to an interim label of “not yet diagnosed nervous” (NYDN) while cases were sorted out.
By December 1914, just months into the war, one Army doctor estimated that 7% to 10% of officers and 3% to 4% of enlisted men were affected. These numbers almost certainly undercount the real toll, since many soldiers were refused treatment, misdiagnosed, or didn’t develop symptoms until after discharge.
Frontline Treatment: The PIES Approach
American psychiatrist Thomas Salmon argued that psychiatrists should be placed “as near the front as military exigency will permit.” His approach, later summarized as PIES (proximity, immediacy, expectancy, simplicity), became the foundation of forward psychiatry. The idea was straightforward: treat soldiers close to the front lines, do it quickly after symptoms appeared, keep the methods simple, and above all, convey an expectation that the soldier would recover and return to duty.
In practice, this meant military physicians used supportive conversation, persuasion, and suggestion to explain to soldiers that their reaction was normal and would pass within days. The goal was to prevent a soldier from being evacuated to a hospital far from the front, where the identity shift from “soldier” to “patient” could make symptoms harder to reverse. It was practical, optimistic, and designed as much for the army’s manpower needs as for the individual soldier’s wellbeing.
Electrical Stimulation and “Quick Cures”
At the other end of the spectrum were aggressive methods designed to eliminate symptoms fast. The most controversial figure was Lewis Yealland, a doctor at Queen Square hospital in London. His approach combined electrical stimulation of affected muscles with strong verbal suggestion that the patient was about to be cured or had already been cured.
For a soldier who had lost the ability to speak, Yealland described forcing the patient’s mouth open with a tongue depressor and applying a strong faradic current to the back of the throat. The patient reportedly jumped backward, ripping the wires from the battery. In another case, Yealland applied weak electrical stimulation to the scalp over the brain’s movement center. The patient, an officer who understood enough about brain anatomy, was told he would regain movement in his arm after stimulation. He responded immediately.
Yealland typically started with weak currents and only escalated to painful ones if a patient didn’t respond. But treatment could become extremely painful, with strong electrical currents or sustained pressure applied above the eye socket for patients with hysterical fits or blindness. He also used psychological coercion, playing on soldiers’ fear of being labeled malingerers. He told one patient outright: “If you recover quickly, then it is due to a disease. If you recover slowly, then I shall decide that your condition is due to malingering.”
In Germany, a similar electro-suggestive method developed by Fritz Kaufmann became the most widely used treatment for functional disorders during the war. The underlying logic was the same: combine physical stimulus with forceful suggestion to override the symptom.
Talking Therapy and the Rivers Method
Craiglockhart War Hospital near Edinburgh, nicknamed “Dottyville,” became the best-known setting for psychological treatment. W.H.R. Rivers, the psychiatrist most associated with the hospital, used an approach rooted in conversation and dream analysis. In the daytime, sitting in a sunny room, a man could discuss his symptoms with his doctor, who would identify phobias and internal conflicts. Patients were encouraged to write down significant dreams, and Rivers worked to remove the repressions he believed were keeping them stuck.
This method was closer to what we would recognize today as psychotherapy. It treated soldiers as thinking people whose symptoms carried meaning, not just malfunctions to be overridden with electricity. Rivers’ most famous patients were the war poets Siegfried Sassoon and Wilfred Owen, whose literary output at Craiglockhart gave the hospital an outsized place in cultural memory. But this kind of individualized psychological care was largely reserved for officers. Enlisted men were far more likely to receive quicker, less personal interventions.
Rest, Baths, and Work Therapy
Many treatment programs combined physical and psychological rest with hands-on activity. This holistic approach had roots in a pre-war method developed by American neurologist Silas Weir Mitchell for treating neurasthenic women: a regimen of rest, special diet, massage, and hydrotherapy adapted for military patients.
At hospital facilities in Germany, doctors used cold wet packs, hot and cold baths, and whole-body massage alongside structured work therapy. At the Jena Military Hospital, partly recovered soldiers were sent daily to workshops, gardens, and a farm about an hour’s walk from the hospital. The work included joinery and boot-making. A characteristic note in one doctor’s records reads: “The best therapy is productive labour, through which the patient will regain his self-confidence.” Doctors consolidated treatment progress with rewards like baths, massages, and garden walks.
Sedatives and anaesthetics also played a role, though a smaller one during WWI itself. Some British doctors experimented with ether and chloroform as treatments. It was not until World War II that drug-assisted therapy became more systematic, with barbiturate-based sedation used at the Maudsley Hospital in London for quick relief from severe anxiety and hysteria.
Isolation and Deprivation
Otto Binswanger, a German psychiatrist working in Jena, applied a deprivation therapy in which patients were isolated and cut off from human contact and distraction. The idea was that removing all stimulation and comfort would motivate the soldier to recover, while also providing a kind of enforced rest. Binswanger applied this method to a large number of servicemen. It was harsh by modern standards, but it existed on a continuum with other treatments that mixed care with coercion, reflecting the military’s constant tension between treating soldiers as patients and needing them back in the fight.
Specialist Hospitals and the Referral System
As the war dragged on, a more organized system developed for routing shell shock cases. From 1916 onward, neuropsychiatric casualties evacuated from France were sent to two main clearing hospitals: D Block at the Royal Victoria Hospital in Netley and the Maudsley wing of the Fourth London General Hospital at Denmark Hill. These facilities assessed each case before referring soldiers for specific treatment, sorting patients whose symptoms were primarily psychological from those with possible physical brain injuries.
Despite this structure, a post-war government inquiry found that only about 80,000 men, or 1.6% of soldiers, were officially receiving medical treatment for shell shock. Specialists who treated these men after the war estimated that one-seventh of officers and one-third of enlisted men who were medically discharged had been suffering from shell shock, suggesting the official count captured only a fraction of the problem.
Punishment Instead of Treatment
Not every soldier who broke down received medical care. Some were court-martialed. During WWI, 346 British soldiers were executed for offenses on active service, including 266 for desertion, 18 for cowardice, and 7 for quitting their post. An unknown number of these men were suffering from shell shock that was never properly diagnosed. The case of Private Harry Farr, shot for cowardice in 1916, became a symbol of this failure. There was no compelling medical evidence presented at his trial that he was shell-shocked when his nerves gave way. His daughter Gertrude, who was 93 years old when a blanket pardon was finally issued in 2006, said: “I am so relieved that this ordeal is over and that I can be content knowing that my father’s memory is intact.”
The Aftermath and the Ban on the Term
In 1922, the War Office Committee of Enquiry into “Shell-Shock” recommended limiting the term to cases where a clear causal connection existed between an explosion’s physical force and the resulting nervous symptoms. The disorder had been so disruptive to military operations and so poorly understood that when World War II began, British authorities banned the term entirely and introduced strict policies to prevent another epidemic. The hope was that future research would clarify the boundary between physical brain injury and psychological breakdown. That clear-cut distinction has never fully materialized, in part because physical and psychological injury so often coexist in the same person.