One of the most important films in the history of psychiatry, depicting treatment of ‘shell shocked’ British soldiers during World War One, has just been made freely available online by UK medical charity the Wellcome Trust who are currently releasing lots of their archive footage.
The film was made by Sir Arthur Hurst in 1917 when large numbers of soldiers with ‘shell shock’, later to be called ‘war neurosis’, were returning from the front – in this case to a make-shift military hospital in South Devon, England, which was previously an agricultural college.
Time and time again you’ll read in news articles that post-traumatic stress disorder (PTSD) is the new name for what used to be called ‘shell shock’ but this is false and you can easily see why in the film.
The most prominent symptoms of the World War One patients are ‘hysterical’ symptoms. These are symptoms that appear to be due to nervous system damage (such as paralysis, tremor or blindness, to name but a few) despite the fact that it is possible to demonstrate that the parts of the nervous system involved in the seemingly impaired ability are working perfectly fine.
A long-standing idea is that these impairment are caused by the subconscious mind ‘converting’ emotional distress into physical symptoms, but there is little good evidence to say whether this is likely or not.
These conditions are now diagnosed as ‘conversion disorder‘ or ‘dissociative disorder‘ and, while it is accepted that trauma may play a role in triggering them it is not a requirement.
This makes it quite different from PTSD, which requires the patient to have experienced a traumatic event and that includes symptoms of hyperarousal (feeling ‘on edge’), having intrusive memories of the event, and avoiding reminders of the trauma.
As we’ve discussed before on Mind Hacks, PTSD was a direct result of the Vietnam war (indeed, it was originally called ‘post-Vietnam’ syndrome) and was partly introduced as a way of allowing veterans to get treatment for their war-trauma-related psychiatric difficulties.
The 1917 film was hugely important because it unequivocally showed to a wide audience that mental stress could lead to dramatic physical difficulties, highlighting the importance of psychiatry which was often considered to be a ‘second rate’ medical speciality.
It is also an important historical document because it shows some dramatic symptoms that rarely appear in such a stark form and also outlines the treatments of the day.
The first patient seen is Pte. Meek, age 23. He has complete retrograde amnesia, hysterical paralysis, contractures, mutism and universal anaesthesia. There is a shot of him in a wheelchair with a nurse, and the intertitles explain that he is completely unaware of the efforts to overcome the rigidity of his ankles, and a man is seen trying to bend his feet. He had a sudden recovery of memory nine months later, with gradual recovery of body functions. Seven months after this we see him teaching basket-making, which was his peacetime job. Two and a half years after onset he makes a complete recovery, and there is a shot of him running up and down stairs waving his arms.
The next patient is Pte. Preston, who has amnesia, word blindness and word deafness, except to the word ‘bombs’, and his response to this is shown. When a doctor says ‘bombs’, he dives under a bed. Pte Ross Smith is also seen, who has a facial spasm. The spasm ceases under hypnosis, but return on waking. He has a lateral tremor of the head, treatment being relaxation and passive movements. There is a shot of him lying in bed having his head moved around.
You can watch the film at the Wellcome website, or they’ve uploaded it as five parts to YouTube. The first part is here and you can click through the rest.
Link to film and info from the Wellcome Trust.
Link to first part on YouTube.