A century of war trauma: shell shock and its lessons for today

Psychological reactions to traumatic experiences of combat in World War 1 reached an epidemic scale that surpassed anything known from previous armed conflicts. This "shell shock" epidemic deeply affected soldiers' lives in and behind the trenches and morale on both sides of the frontline. This article is based on patient records from London and Berlin. It analyses the clinical phenomenology of the cases that were subsumed under labels such as "shell shock" or "war neurosis". The documentation of clinical presentations reveals a broad range of symptoms and syndromes. Moreover it unveils some distinct differences between the two countries, for example the predominance of non-epileptic seizures in Germany. I furthermore discuss the models - past and present - that have been adduced to explain such traumatic reactions. I argue that then as today the pendulum swung back and forth between organic and psychological explanations. Finally, I describe the main therapeutic approaches of military psychiatry and neurology during World War 1. Both the quest for explanatory models and the search for the most appropriate therapy for functional neurological disorders are still of considerable clinical relevance