Wilfred Owen, Shell-Shock, and the Effects of Ergotherapy


Over 2,000 years ago, a Roman poet named Quintus Horatius Flacces wrote that, Dulce et decorum est pro patria mori, which roughly translates to, “It is sweet and fitting to die for one’s country.”

In 1935, Ernest Hemingway wrote that in “the old days, the wrote “that it is sweet and fitting to die for one’s country. But in modern war there is nothing sweet nor fitting in your dying. You will die like a dog for no good reason.”

Another veteran of the First World War, Wilfred Owen, agreed with Hemingway’s assessment. While recuperating from shell-shock at a war hospital near Edinburgh in 1917, Owen was encouraged by his friend and fellow poet, Siegfried Sassoon, to write about his combat experiences.

His resulting poems, which were shockingly realistic testimonials of the horrors of trench warfare and gas attacks, stood in stark contrast to what the British public believed was happening in France and to the “confidently patriotic” writing of other war poets, such as Rupert Brooke.

Brooke and many others believed — and conveyed in their work — that even in death, a soldier rested easy knowing he had died for his country. Their sacrifice, in turn, endowed them with a moral weight well beyond their numbers.

In perhaps his most famous poem, “The Soldier,” Brooke begins by saying:

“If I should die, think this of me:/That there’s some corner of a foreign field/That is for ever England. There shall be/In that rich earth a richer dust concealed;/A dust whom England bore, shaped, made aware,/Gave, once, her flowers to love, her ways to roam,/A body of England’s, breathing English air,/Washed by the rivers, blest by suns of home.”

Owen, on the other hand, had actually witnessed combat during the First World War and came to believe that war was not in the least bit “sweet and fitting,” calling such a worldview “The old Lie.”

Dulce et decorum est — Wilfred Owen

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of tired, outstripped Five-Nines that dropped behind.

Gas! Gas! Quick, boys! – An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling,
And flound’ring like a man in fire or lime . . .
Dim, through the misty panes and thick green light,
As under a green sea, I saw him drowning.

In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.

If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil’s sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie; Dulce et Decorum est
Pro patria mori.

The marathon campaigns of carnage and bloodshed that made up much of the First World War produced hundreds of thousands of psychological casualties worldwide. According to author Ben Shephard, “The experience of being shelled seemed to leave men blinded, deaf, dumb, semi-paralyzed, in a state of stupor, and very often suffering from amnesia. Some could remember nothing between the moment of the explosion and coming to in hospital; others could remember nothing at all. A number of these patients also showed physical symptoms, such as extraordinary, unnatural ways of walking, that astonished the doctors who examined them.”

Initially, it was believed that these casualties were suffering from a disrupted physiology of the brain, or perhaps lesions on the brain caused by concussions — what was later termed “shell-shock.”  One doctor — Frederick Walker Mott — argued, more specifically, that large-caliber artillery fire brought about either structural or pathological changes in a soldier’s central nervous system, which resulted in blindness, deafness, paralysis, and other symptoms. He further argued that shell-shock was more likely to occur in “individuals of a neuropathic or psychopathic predisposition.”

At the same time, however, he recognized that the conditions of trench life, “combined with fearful tension and misapprehension, may so lower the vital resistance of the strongest nervous system that a shell bursting near…is sufficient to lead to a sudden loss of consciousness.”

In 1919, Mott wrote that:

“Physical shock accompanied by horrifying circumstances, causing profound emotional shock and terror, which is contemplative fear, or fear continually revived by the imagination, has a much more intense and lasting effect on the mind than simple [physical] shock has. Thus a man under my care, who was naturally of a timorous disposition and always felt faint at the sight of blood, gave the following history. He belonged to a Highland regiment. He had only been in France a short time and was one of a company who were sent to repair the barbed wire entanglements in front of their trench when a great shell burst amidst them. He was hurled into the air and fell into a hole, out of which he scrambled to find his comrades lying dead and wounded around. He knew no more, and for a fortnight lay in a hospital in Boulogne. When admitted under my care he displayed a picture of abject terror, muttering continually, ‘no send back,’ ‘dead all round,’ moving his arms as if pointing to the terrible scene he had witnessed.”

In June 1916, the first study of shell-shock in British troops was published by Harold Wiltshire, who spent a year at a base hospital in France and saw 150 cases of shell-shock. Wiltshire’s study completely negated Mott’s theory that the symptoms of shell-shock were produced by the physical effects of exploding shells.

First, Wiltshire did not find symptoms of shell-shock in men who were physically wounded, even though they had been even more exposed to the physical effects of shell fire. Second, Wiltshire could not find much physical evidence of concussion in his patients. Indeed, many of the 150 had not even been near an exploding shell prior to the development of their symptoms. The real cause of their problem, Wiltshire argued, was psychological:

“Not depend for [its] causation on the physical force (or the chemical effects) of the bursting shell. [It] may also occur when the soldier is remote from the exploding missile, provided that he be subject to an emotional disturbance or mental strain sufficiently severe…. Moreover in men already worn out or having previously suffered from the disorder, the final cause of the breakdown may be so slight, and its onset so gradual, that its origin hardly deserves the name of ‘shock.’ ‘Shell-shock,’ therefore, is a singularly ill-chosen term; and in other respects…has proved a singularly harmful one…. In the vast majority of cases the signs of ‘shell-shock’ appear traceable to psychic causes, especially, in the early cases, to the emotions of extreme and sudden horror and fright.”

In other words, Wiltshire believed that the prolonged strain of trench warfare wore down the soldiers’ resistance until “these men were in a position of psychic tension in which they could have been knocked down by the proverbial feather and the effect of the blows was psychic rather than physical.”

Wilshire wasn’t the only one who began questioning the term shell-shock. In 1918, Grafton Elliot Smith and Tom Hatherley Pear published a book, Shell Shock and Its Lessons, in which they argued that a preferable term might be “war strain” because they believed the latter to be “a popular but inadequate title for all those mental effects of war experience which are sufficient to incapacitate a man from the performance of military duties.” These scholars also argued against the common misconception of the time that the condition resulted in “shock,” described as lack of reason or lack of senses. Rather:

“Whatever may be the state of mind of the patient immediately after the mine explosion, the burial in the dug-out, the sight and sound of his lacerated comrades, or other appalling experiences which finally incapacitate him for service in the firing line, it is true to say that by the time of his arrival in a hospital in England, his reason and his senses are usually not lost but functioning with painful efficiency. His reason tells him quite correctly, and far too often for his personal comfort, that he had not given, or failed to carry out, a particular order, certain disastrous and memory-haunting results might not have happened. It tells him, quite convincingly, that in his present state he is not as other men are. Again, the patient reasons, quite logically, but often from false premises, that since he is showing certain symptoms which he has always been taught to associated with ‘madmen,’ he is mad too, or on the way to insanity. If nobody is available to receive this man’s confidence, to knock away the false foundations of his belief, to bring the whole structure of his nightmare clattering about his ears, and finally, to help him rebuild for himself (not merely to reconstruct for him) a new and enlightened outlook on his future — in short, if he is left alone, told to ‘cheer up’ or unwisely isolated, it may be his reason, rather than the lack of it, which will prove to be his enemy…In a word, it is not in the intellectual but in the emotional sphere that we must look for terms to describe these conditions. These disturbances are characterized by instability and exaggeration of emotion rather than by ineffective or impaired reason.”

Smith and Pear also believed that the trigger for war strain was intense emotional arousal and the subsequent suppression of sympathy for others. Couple that with fear, and the resulting symptoms were believed to include:

“loss of memory, insomnia, terrifying dreams, pains, emotional instability, diminution of self-confidence and self-control, attacks of unconsciousness or of changed consciousness sometimes accompanied by convulsive movements resembling those characteristic of epileptic fits, incapacity to understand any but the simplest matters, obsessive thoughts, usually of the gloomiest and most painful kind, even in some cases hallucinations and incipient delusions…[These symptoms] make life for some of their victims a veritable hell.”

Before the war actually ended, most medical officers tried to distinguish between two kinds of shell-shock — that which resulted from understandable circumstances and that which had a purely psychological basis. Only those suffering from the former, it was decided, were seen as deserving of therapeutic treatment. Those suffering from the latter, on the other hand, were more often than not treated as a “disciplinary” matter.

Treatment for such “malingerers” varied from hypnosis to torture.

With regard to torture, Lewis Yealland is perhaps the most infamous of all of the British practitioners of disciplinary “therapies.” One of his patients, a 24-year-old private, totally mute for nine months, had witnessed some of the most incredible battles of World War I: the retreat from Mons, the Battle of Marne, Aisne, and the First and Second Battles of Ypres. Sent to Salonica to take part in the Gallipoli expedition, he collapsed and woke up mute.

His initial treatment included being strapped down in a chair while strong electricity was applied to his neck and throat. He also had his tongue burned by lit cigarettes, and hot plates were placed at the back of his mouth, though Yealland argued that these techniques failed because they had not been thoroughly applied.

To rectify the situation, Yealland took the private into the darkened room and locked the doors. It was there that he applied electricity to the private’s throat for one hour, at the end of which the private could say “Ah.” After two hours, the private tried to leave the room. Yealland stopped him, assuring him that, “When the time comes for more electricity, you will be given it whether you want it or not!”

He then raised the voltage and continued for a half hour until the spasms in the private’s neck had disappeared and he could speak in a whisper with no spasms or stammer.

“Such bestial disciplinary treatment,” writes Myra MachPherson, “was reserved for those arbitrarily judged to have character defect because they cracked. Those deemed sufficiently brave (and willing to return to the front) were mostly subjected to analysis. Elaborate tests were set up to detect the true malingerer, the partial, and the quasimalingerer. However, such distinctions defied observers. Concluded one authority, the ‘signs of genuine [war] neuroses and simulation [malingering] are identical.'”


“From the earliest days of the war,” writes Ben Shephard, “doctors in the United States had heard stories of ‘strange new diseases apparently having their origin in the stress and special horrors of modern warfare,’ which seemed to present problems in treatment and prevention to the medical organization of the British Army. The first published reports were eagerly read by American neurologists and psychiatrists who realized, even then, that the time might very soon come when they would be dealing with the same problems.”

After spending two months in England, one American doctor — Dr. Thomas W. Salmon — wrote a report on the British experience with shell-shock. In it, Salmon recognized that there were undoubtedly physical elements in the war neuroses the British were dealing with. For example, many soldiers’ endocrine systems were disturbed, some suffered injuries of the spinal cord, and many more had irregular heartbeats. He also determined that the treatment methods the British were employing had “thus far proved quite ineffective.”

In addition, Salmon concluded that the psychological elements in those suffering from war neuroses were “too obvious and too important to these cases to be ignored.” Treating the war neuroses was, he continued, “essentially a problem of psychological medicine.”

“The psychological basis of the war neuroses,” Salmon continued, was “an elaboration, with endless variations, of one central theme”:

“Escape from an intolerable situation in real life to one made tolerable by the neurosis… Not only fear…but horror, revulsion against the ghastly duties which sometimes must be performed, emotional situations resulting from the interplay of personal conflicts and military conditions, all play their part in making an escape of some sort mandatory.”

“The most obvious form of escape, death,” writes Shephard, “was not an option for most people. To flee or desert ran counter to the soldier’s ideals of duty, patriotism, and honor. Malingering was a military crime and unthinkable to those with a sense of discipline and propriety.”

For many men, wounds resolved the conflict between honor and self-preservation. For others:

“The neurosis provides a means of escape so convenient that the real cause of wonder is not that it should play such an important part in military life but that so many men should find a satisfactory adjustment without its intervention. The constitutionally neurotic, having most readily at their disposal the mechanism of functional nervous disease, employ it most frequently. They constitute, therefore, a large proportion of all cases, but a very striking fact in the present war is the number of men of apparently normal make-up who develop war neuroses in the face of unprecedentedly terrible conditions to which they are exposed… Approached from the psychological point of view the symptoms in the war neuroses lose much of their weird and inexplicable character. Most of them can be summed up in the statement that the soldier loses function which either is necessary to continued military service or prevents his successful adaptation to war.”

Salmon, in turn, was quite clear what the Americans should do:

  • First, the Army must rigidly exclude all “insane, feeble-minded, psychopathic and neuropathic individuals.”
  • Second, make sure that “treatment by medical officers with special training in psychiatry [was] available just as near the front as military exigency will permit.”
  • Third, patients were to be “reeducated in will, thought, feeling and function” by doctors who were “strong, forceful, patient, sympathetic and tactful.”
  • Lastly, the “resources to be employed” would include “psychological analysis, persuasion, sympathy, discipline, hypnotism, ridicule, encouragement and severity.”

If all this was done, Salmon argued, the Americans could expect to reduce considerably the “wastage” of men, have a more efficient army, and pay less in pensions.


It seems, based on his treatment, that no one doubted the veracity of Owen’s shell-shock diagnosis. Indeed, after only a few weeks on the front line, Owen had lived through a number of awful experiences:

  • On January 12, 1917, Owen was sent with his platoon to hold a dugout in no-man’s land and stayed there for 50 hours in the face of intense German shelling. “Those fifty hours,” he wrote home, “were the agony of my happy life. I nearly broke and let myself drwon in the water that was slowly rising over my knees…. One lad was blown up and, I am afraid, blinded.”
  • On another occasion, Owen and his men had to lie in the snow and the wind on the front line. “I thought of you and Mary,” Owen wrote, “without a break all the time. I cannot say I felt any fear. We were all half-crazed by the buffering of the High Explosions.”
  • After four days and four nights in the open snow, without relief, a week’s rest, and a “Tornado of shells,” as he and his men moved back up to the line in April 1917, where they stayed because they were courageously handling the horrors of the front.

Eventually, Owen’s commanding officer noticed him behaving strangely and sent him to see the doctor, who found him to be “shaky and tremulous and his memory confused.” He was labeled “neurasthenia.” As he told his mother, he did not “break down,” he was simply avoiding a break down.

Here is how one doctor defined “neurasthenia”:

“The mental troubles are many and marked; on the emotional side, there are sadness, weariness, and pessimism; repugnance to effort, abnormal irritability; defective control of temper, tendency to weep on slight provocation; timidity. On the intellectual side, lessened power of attention, defective memory and will power.”

After being evacuated to a “specialist centre” in France, the doctor there found Owen stammering, shaky, “nervy and highly strung,” and “liable to acute depression and self-distrust.” From France, he was evacuated to Edinburgh, where he was able to receive the treatment he needed from a doctor named Arthur Brock.

“The need for self-help,” Brock believed, took “precedence over every other form of therapy.” If “the essential thing for the patient to do is to help himself,” the “essential thing for the doctor to do — indeed the only thing he can profitably do — is to help him help himself.”

Ergotherapy, as Brock called his treatment, meant “the cure by functioning.”

One aspect of this therapy was physical: the patient had to “learn to do without things” and “impose a considerable amount of stoic discipline upon himself.” As part of his treatment plan, Brock liked to submit his patients to cold baths and swims, as well as early morning marches.

The crucial ingredient in Brock’s treatment plan, though, was work:

“When all is said and done, the essential ingredient of these patients resolves into ‘finding them their job’ — guiding them to it, keeping them at it, and only relinquishing them finally when their interests are sufficiently awakened to ensure that they will now ‘carry on’ of themselves.”

Brock’s methods worked dramatically well with Owen, and they had a decisive role in transforming him from a young man with a sense of failure to a confident and determined young poet with his own distinctive voice. Indeed, after receiving Brock’s treatments, Owen began to confront his own private terrors.

As Brock later put it, it was then that Owen began to “face the phantoms of his mind.”