Understanding Battle Fatigue

Updated on May 7, 2018
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I've spent half a century writing for radio and print—mostly print. I hope to be still tapping the keys as I take my last breath.

Today, it’s called Post-Traumatic Stress Disorder (PTSD); it’s taken seriously and treated carefully. During the Great War it was often called cowardice and the treatment might be execution by firing squad.

As the war dragged on there was a growing recognition that the conditions in the trenches were driving some men mad.

According to BBC History “What medical officers quickly realized was that everyone had a ‘breaking point:’ weak or strong, courageous or cowardly - war frightened everyone witless.”

The field officers, whose job it was to send and lead men into battle, were less understanding. Many believed that some men were just trying to avoid doing their duty and the best way to deal with the problem was military discipline.


The Shock of Combat

It’s impossible to imagine what being in combat is like unless you’ve personally experienced it.

Those who have fought on a battlefield often describe it as a combination of extreme excitement and gut-wrenching terror. It’s also a huge assault to the emotions that can leave permanent mental health damage.

During the Great War, men had to spend days and weeks in a trench, sometimes under constant shell-fire. They had to live with the horrifying knowledge that at any second one of those shells could land close enough to blow them to pieces.

If they were lucky, the explosion would take someone else and they’d just be covered with a friend’s blood and innards. Under bombardment, the ear-splitting noise was constant so sleep was nearly impossible.

A shell-shocked British soldier receives help.
A shell-shocked British soldier receives help. | Source

Edward Toland was a Red Cross volunteer working close to the frontlines. In October 1916 he wrote in his diary about experiencing shell fire.

“There was a sound like the roar of an express train, coming nearer at tremendous speed with a loud singing, wailing noise. It kept coming and coming and I wondered when it would ever burst. Then when it seemed right on top of us, it did, with a shattering crash that made the earth tremble. It was terrible. The concussion felt like a blow in the face, the stomach, and all over; it was like being struck unexpectedly by a huge wave in the ocean. It exploded about two hundred yards from where we were standing, tearing a hole in the ground as big as a small room.”

A German soldier dives for cover.
A German soldier dives for cover. | Source

Knowing that at some point a soldier was likely to be ordered to go over the top added to the level of anxiety. And, when those attacks took place the soldiers lucky enough to survive would come back with hideous memories of what they had seen and done.

Shell shock was a kind of individual mutiny from war. The British Library notes that “Suicide offered another way out. It was much underreported, as at least 3,828 German soldiers killed themselves; a figure that does not reflect the numbers who simply walked into enemy fire or whose death was ambiguous.”

PTSD Symptoms

Shell shock, as it was then called, showed up as memory problems, altered mood, trouble concentrating, disturbed sleeping patterns, nightmares, frightening flashbacks, fatigue, muscle and joint pain, headaches, skin conditions, irritability, outbursts of anger, and episodes of anxiety and panic.

BBC History adds that Great War soldiers with shell shock often had uncontrollable diarrhoea and non-stop, severe anxiety: “Soldiers who had bayoneted men in the face developed hysterical tics of their own facial muscles. Stomach cramps seized men who knifed their foes in the abdomen. Snipers lost their sight. Terrifying nightmares of being unable to withdraw bayonets from the enemies’ bodies persisted long after the slaughter.”

Uncontrollable body twitches were another effect with some men having a stumbling gait when they tried to walk; others were unable to walk at all.


Treatment Ranged from Execution to Counselling

At the start of World War I, there was a very poor understanding of shell shock.

One therapy for the condition among ordinary soldiers was execution. Those who could not take the horrors of the battlefields anymore got little or no help from medical officers. The only diagnosis allowed was “cowardice in the face of the enemy” and the treatment was a firing squad. This was thought to put some backbone into the other troops and stop them from shirking their duty.

At first, shell shock was seen as a physical ailment; that the brain had been damaged by the shock waves from nearby explosions.

Soon, doctors realized something far more complex was happening. British Army psychiatrist Charles Myers thought soldiers were dealing with traumatic experiences by walling them off from their conscious thoughts. This suppression was causing outward symptoms such as trembling, loss of hearing and vision, and other physical symptoms.

Dr. Myers worked with his patients to bring their buried memories back into their conscious thoughts. He believed they had to confront their mental demons in order to conquer them.

Electro-shock therapy was tried.
Electro-shock therapy was tried. | Source

The most severe cases were shipped back to Britain for treatment but the endless slaughter soon overwhelmed the hospitals. Many seriously ill men were simply discharged with a pat on the back and a wish for “Good luck.” Usually, they carried their deep mental injuries to their graves.

According to the Dutch website The Great War “medical officers were told not to diagnose lower ranks as shell-shocked. Eventually the term became forbidden altogether.”

Dr. Myers’ ideas on how to deal with shell shock were largely right. However, he faced a lot of resistance to his treatment program from the military establishment and he became discouraged and despondent.

Shell Shock among Canadians

The Canadian War Museum says “Doctors diagnosed almost 10,000 Canadians with shell shock during the war. Medical treatment ranged from the gentle to the cruel.”

The gentle therapy, as developed by Doctor Myers, involved rest in a peaceful and quiet environment. Occupational therapy, such as basket-weaving, helped men recover. Psychiatric counselling was also given to aid recovery.

The cruel treatment was favoured by Dr. Lewis Yealland, a Canadian-born physician at Britain’s National Hospital for Paralysed and Epileptic. He used electric shock therapy as described by an article in the Smithsonian Magazine (September 2010) and “clamps and machines that mechanically forced stubborn limbs out of their frozen position were other strategies.”

Firstworldwar.com adds that “Yealland treated a mute soldier by tying him in a chair, applying electric shocks to his throat while encouraging him to ‘remember, you must behave as the hero I expect you to be ... A man who has gone through so many battles should have better control of himself.’ ”



Siegfried Sassoon (1886–1967)

No doubt they’ll soon get well; the shock and strain

Have caused their stammering, disconnected talk.

Of course they’re ‘longing to go out again,’ –

These boys with old, scared faces, learning to walk.

They’ll soon forget their haunted nights; their cowed

Subjection to the ghosts of friends who died, -

Their dreams that drip with murder; and they’ll be proud

Of glorious war that shatter’d their pride...

Men who went out to battle, grim and glad;

Children, with eyes that hate you, broken and mad.


Therapy for Shell Shock

PTSD is now recognized as a profound psychological disorder. Talk therapy is used in treatment today by getting the patient to discuss the issue directly. Sufferers are taught about the nature of the condition; that it is caused by extreme stress and is not a sign of personal weakness.

Patients learn how to manage their anger and anxiety, and improve their communication skills. Also, they are taught relaxation techniques that help them overcome emotional and physical symptoms.

Pharmaceuticals may also be part of the therapy, particularly anti-depressants such as Zoloft and Paxil.

Bonus Factoids

The term “shell shock” was coined by soldiers in the trenches. Army psychiatrist Charles Myers used the phrase in 1915 in a medical journal article to describe the severe mental breakdowns he was seeing among front-line troops.

In the past, PTSD has been known as war neurosis, combat stress, battle fatigue, shell shock, and, during the American Civil War in the 1860s, it was called soldier’s heart.

It wasn’t until 1980 that PTSD was recognized with a formal diagnosis.


  • “How Did Soldiers Cope with War?” Matthew Shaw, British Library, undated.
  • “Shellshock.” Canadian Museum of History, undated.
  • “Shell Shock during World War One.” Professor Joanna Bourke, BBC History, October 3, 2011.
  • “The Shock of War. Caroline Alexander, Smithsonian Magazine, September 2010.
  • “Lewis Yealland.” Michael Duffy, Firstworldwar.com, August 22, 2009.
  • “Shell Shocked.” Dr. Edgar Jones, American Psychological Association, June 2012.
  • “An Unexpected Epidemic of Shell Shock.” Rob Ruggenberg,

    greatwar.nl, undated.

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