Historical Accuracy of treatment of PTSD (or shell shock) during WW1

[Twitch.tv/KAEN_SG]

PTSD (known as Shell shock during WW1) depicted in this game as "Trauma" was not well understood or treated during this time period.

While I understand certain "creative liberties" are taken to gamify elements of history, it takes a lot away from the plausibiliy and historical accuracy of a game set in this time period. I scratch my head in wild bemusement when my "trauma injured patient" dies from his "wounds"... (like as if electroshock therapy would have helped him? C'mon...really?! Are we handing out loaded pistols in the trauma wards so they can shoot themselves in the head?)

Here is some Wiki included here as background material.

Shell shock is a term that originated during World War I to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized. It is a reaction to the intensity of the bombardment and fighting that produced a helplessness, which could manifest as panic, fear, flight, or an inability to reason, sleep, walk or talk.

During the war, the concept of shell shock was poorly defined. Cases of "shell shock" could be interpreted as either a physical or psychological injury.

During the early stages of World War I in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise. While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds. By December 1914, as many as 10% of British officers and 4% of enlisted men were experiencing "nervous and mental shock".

The term "shell shock" was coined during the Battle of Loos to reflect an assumed link between the symptoms and the effects of explosions from artillery shells. The term was first published in 1915 in an article in The Lancet by Charles Myers. Some 60–80% of shell shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of conversion disorder, including mutism and fugue.

The number of shell shock cases grew during 1915 and 1916 but it remained poorly understood medically and psychologically. Some physicians held the view that it was a result of hidden physical damage to the brain, with the shock waves from bursting shells creating a cerebral lesion that caused the symptoms and could potentially prove fatal. Another explanation was that shell shock resulted from poisoning by the carbon monoxide formed by explosions.


And as for the treatments of PTSD/Trauma/Shell Shock during WW1

Some men with shell shock were put on trial, and even executed, for military crimes including desertion and cowardice. While it was recognised that the stresses of war could cause men to break down, a lasting episode was likely to be seen as symptomatic of an underlying lack of character. For instance, in his testimony to the post-war Royal Commission examining shell shock, Lord Gort said that shell shock was a weakness and was not found in "good" units. The continued pressure to avoid medical recognition of shell shock meant that it was not, in itself, considered an admissible defence. Although some doctors or medics did take procedure to try to cure soldiers' shell shock, it was first done in a brutal way. Doctors would provide electric shock to soldiers in hopes that it would shock them back to their normal, heroic, pre-war self. While illustrating cases of mutism in his book Hysterical Disorders of Warfare, therapist Lewis Yealland describes a patient who had, over the course of 9 months, been subjected unsuccessfully to numerous treatments for his mutism; these included strong application of electricity to his throat, lit cigarette ends applied to the tip of his tongue, and "hot plates" placed in the back of his mouth.

Executions of soldiers in the British Army were not commonplace. While there were 240,000 Courts Martial and 3080 death sentences handed down, in only 346 cases was the sentence carried out. In total, 266 British soldiers were executed for "Desertion", 18 for "Cowardice", 7 for "Quitting a post without authority", 5 for "Disobedience to a lawful command", and 2 for "Casting away arms".

[Methlos]

A swift slap and send them back.....that's how you treat cowardice.

[Twitch.tv/KAEN_SG]

Originally posted by Methlos:

A swift slap and send them back.....that's how you treat cowardice.

Nurse: Oh so you aren't cured of trauma after 3 days in the ward? No worries take a left turn out the back door there is a firing squad awaiting your arrival!

I know... because I have to bury the bodies... :P

[Turtler]

Originally posted by Twitch.tv/KAEN_SG:

PTSD (known as Shell shock during WW1) depicted in this game as "Trauma" was not well understood or treated during this time period.

Indeed, arguably it still isn't.

Originally posted by Twitch.tv/KAEN_SG:

While I understand certain "creative liberties" are taken to gamify elements of history, it takes a lot away from the plausibiliy and historical accuracy of a game set in this time period.

Indeed.

Originally posted by Twitch.tv/KAEN_SG:

I scratch my head in wild bemusement when my "trauma injured patient" dies from his "wounds"... (like as if electroshock therapy would have helped him? C'mon...really?!

Firstly: as someone who did volunteer work as an orderly for various hospitals and who has some family in medicine, it wasn't such a bemusement for me. Suicides, self-harm, or even biological breakdowns from things like trauma or despair are a very real problem to deal with, and just because they weren't understood at the time doesn't mean they wouldn't have happened.

Electroshock therapy probably wouldn't have been TOO helpful (though it might have, surprisingly) but at a minimum it kept them constrained around medical staff and meant they were less likely to do something like unalive themselves.

Originally posted by Twitch.tv/KAEN_SG:

Are we handing out loaded pistols in the trauma wards so they can shoot themselves in the head?)

No, though if someone wants to end themselves (or even is just suffering from such a nervous condition) it is VERY likely they can find away. Reading reports about people in treatment that bashed their heads in in say Amiens is not a pleasant thing.

Originally posted by Twitch.tv/KAEN_SG:

Here is some Wiki included here as background material.

This is where I point out there's a reason Wiki is a reference, not a source.

Originally posted by Wiki on Shell Shock:

Shell shock is a term that originated during World War I to describe the type of post-traumatic stress disorder (PTSD) that many soldiers experienced during the war, before PTSD was officially recognized. It is a reaction to the intensity of the bombardment and fighting that produced a helplessness, which could manifest as panic, fear, flight, or an inability to reason, sleep, walk or talk.

Pretty true.

Originally posted by Wiki on Shell Shock:

During the war, the concept of shell shock was poorly defined. Cases of "shell shock" could be interpreted as either a physical or psychological injury.

Also pretty true, though if it was accompanied by a physical injury that was external or at least externally visible you could usually see.

Originally posted by Wiki on Shell Shock:

During the early stages of World War I in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise. While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds. By December 1914, as many as 10% of British officers and 4% of enlisted men were experiencing "nervous and mental shock".

And of course the rates were also noteworthy among other combatants.

Originally posted by Wiki on Shell Shock:

The term "shell shock" was coined during the Battle of Loos to reflect an assumed link between the symptoms and the effects of explosions from artillery shells. The term was first published in 1915 in an article in The Lancet by Charles Myers. Some 60–80% of shell shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of conversion disorder, including mutism and fugue.

The number of shell shock cases grew during 1915 and 1916 but it remained poorly understood medically and psychologically. Some physicians held the view that it was a result of hidden physical damage to the brain, with the shock waves from bursting shells creating a cerebral lesion that caused the symptoms and could potentially prove fatal. Another explanation was that shell shock resulted from poisoning by the carbon monoxide formed by explosions. [/b]

Indeed.

Originally posted by Twitch.tv/KAEN_SG:

And as for the treatments of PTSD/Trauma/Shell Shock during WW1

Originally posted by Wiki on Shell Shock:

Some men with shell shock were put on trial, and even executed, for military crimes including desertion and cowardice.

Indeed, though not many and often for cases that were somewhat justified (such as fleeing in the face of the enemy). Executions were much worse in other armies like those of the Italian, German, Bulgarian, and Austro-Hungarian military.

Originally posted by Twitch.tv/KAEN_SG:

While it was recognised that the stresses of war could cause men to break down, a lasting episode was likely to be seen as symptomatic of an underlying lack of character. For instance, in his testimony to the post-war Royal Commission examining shell shock, Lord Gort said that shell shock was a weakness and was not found in "good" units.

Indeed, which was an issue.

Originally posted by Twitch.tv/KAEN_SG:

The continued pressure to avoid medical recognition of shell shock meant that it was not, in itself, considered an admissible defence.

Largely true.

Originally posted by Twitch.tv/KAEN_SG:

Although some doctors or medics did take procedure to try to cure soldiers' shell shock, it was first done in a brutal way.

This is what we call both over-generalization and understatement. While some of my specific WWI scholarly friends would eat me alive for how general I am going to be, initial treatments to shell shock ranged the gamut from the brutal (like electroshock) to the gentle (such as rest and trying to encourage them) to the passive or even nonexistent.

Originally posted by Twitch.tv/KAEN_SG:

Doctors would provide electric shock to soldiers in hopes that it would shock them back to their normal, heroic, pre-war self.

Indeed.

Originally posted by Twitch.tv/KAEN_SG:

While illustrating cases of mutism in his book Hysterical Disorders of Warfare, therapist Lewis Yealland describes a patient who had, over the course of 9 months, been subjected unsuccessfully to numerous treatments for his mutism; these included strong application of electricity to his throat, lit cigarette ends applied to the tip of his tongue, and "hot plates" placed in the back of his mouth.

Indeed, and this'd be worth covering, though by 1918 (which is when I understand the game is set) things had gotten better.

Originally posted by Twitch.tv/KAEN_SG:

Executions of soldiers in the British Army were not commonplace. While there were 240,000 Courts Martial and 3080 death sentences handed down, in only 346 cases was the sentence carried out. In total, 266 British soldiers were executed for "Desertion", 18 for "Cowardice", 7 for "Quitting a post without authority", 5 for "Disobedience to a lawful command", and 2 for "Casting away arms".

Indeed, and most of those were earlier in the war, especially as it became clear this problem wasn't going away and couldn't be shot away.

Originally posted by Twitch.tv/KAEN_SG:

Nurse: Oh so you aren't cured of trauma after 3 days in the ward? No worries take a left turn out the back door there is a firing squad awaiting your arrival!

Nah, you'd more likely be sending them back to their unit if/when they get stabilized and then having the military do the shooty shoot if they do something like run or freeze up or fall asleep on watch. So a scenic trip before the firing squad, though with a chance.

it's an ugly war and an ugly world.

Originally posted by Twitch.tv/KAEN_SG:

I know... because I have to bury the bodies... :P

I'll defer to your knowledge of the game there.

[The Mogician]

They need some 40K commissars, these people know how to treat shell shock the proper way.