The Soldier at the Western Front – The Military Psychiatry in the First World War

“But it is also right that we had a people’s army that the man was forced to serve in the war that he wasn’t asked if he liked to go to war and you had to be prepared that people wanted to flee and the physicians played the part of machine guns behind the front, to repulse the fleeing.” (Sigmund Freud: Gutachten über die elektrische Behandlung der Kriegsneurotiker vom 14.10.1920 (trans.: Expertise on the use of electro shock therapy for war neurotics), quoted in: Riedesser/Verderber, p. 64)

This quote of Sigmund Freud illustrates the dilemma of the physicians during the First World War. On the one hand they were bound by their Hippocratic Oath to care for their patients the best they could. On the other hand the material battles of the First World War needed increasing numbers of soldiers and accordingly the army commands of the involved nations demanded the fastest possible recovery of the injured.

In this context the medical sector of psychiatry was especially challenged. Because apart from the physical wound soldiers received during the First World War psychological diseases increasingly appeared. Especially on the western front where the soldiers had to endure hours and days of artillery bombardments more and more soldiers became mentally ill. The most common symptom was trembling at the whole body or individual extremities (source 1). Because of this in the German-speaking area the term of “Kriegszitterer” (trans.: war tremblers) became accustomed. The German psychiatric system couldn’t handle the large numbers of these combat stress reaction (CSR) patients. Even the diagnosis wasn’t easy what can be illustrated by the difference in nomenclature. Apart from the term of “war tremblers” the term of “war neurotics” and “war hysterics” was used while the British used the term “shell shock patients” (source 2). What was worse, trembling wasn’t the only symptom: muteness, deafness (temporary) blindness and many other symptoms also could occur (source 3). A precise number of the CSR patients cannot be named due to the difficult diagnosis and the fragmentary sources. It can be estimated that Germany had around 200,000 cases.

Max Nonne suggests a traumatized soldier under hypnosis that he doesn’t need to tremble.
(Scene from an educative movie from 1917, Deutsches Ärzteblatt 2012, H. 9, p. 407)

The highest objective of the therapy for the military psychiatrist was to reintegrate the mentally deranged soldiers into a working environment or the service at the front respectively as fast as possible. Accordingly the main aim was to eliminate the symptoms. The methods ranged from hypnosis, over forced drill up to the quite painful electro shock therapy (source 4). CSR patients didn’t receive the same treatment as physically wounded, to the contrary they often were accused to be malingers. The aim of the treatment was to break the patients will through a mixture of suggesting, painful therapy and military drill. Finally the only choice for the patient was either to suppress the symptoms or to suffer even more. The cause of the CSR wasn’t even treated. A dominant opinion among military psychiatrist was that the mental derangements weren’t caused by the war, but that the concerned soldiers had been mentally ill already before the war. Accordingly neurosis would be caused by a weakness of character and a weak mental constitution. Social Darwinism played a certain part in this discourse. At the end of the war a change of mind was looming finally. Brutal methods, like those of Kaufmann, got into a defensive position, while psychoanalytical methods respective psychotherapeutically practices received more and more attention. Partially a full therapy replaced the pointless treatment of the symptoms. This discussion concerning the right treatment of CSR patients during the war can be reproduced according to the discourse in the relevant journal literature, especially in the fields of neurology and psychiatry (source 5).

After the war CSR patients more and more became a subject of the public attention, due to the fact that the topic was no longer only represented in professional journals but in the mass media as well (source 6). Furthermore the society experienced the return of CSR patients and literature often dealt with that topic (source 7). But it still was a long way until the final emancipation of CSR patients.

Felix Ruppricht, Dresden 2015

Bibliography

Wolfgang U. Eckert: Medizin und Krieg. Deutschland 1914 – 1924, Paderborn 2014.
Fiona Reid: War Psychiatry, in: 1914-1918-online. International Encyclopedia of the First World War, URL: http://encyclopedia.1914-1918-online.net/article/war_psychiatry/2014-10-08, letzter Zugriff: 22.01.2014.
Peter Riedesser und Axel Verderber: „Maschinengewehre hinter der Front“. Zur Geschichte der deutschen Militärpsychiatrie, 2. Aufl. Frankfurt am Main 2004.