Shell Shock in 1915 becomes Combat Fatigue by World War II and PTSD in 1980

In World War I, PTSD—known as shell shock then—was such a problem that ‘forward psychiatry’ was begun by French doctors in 1915. Some British doctors tried general anesthesia as a treatment (ether and chloroform), while others preferred application of electricity.

Imagine suffering from PTSD and being strapped down to a table with electrodes attaches followed by jolts of electricity to shock you healthy.

In 1917, four British ‘forward psychiatric units’ were set up. Hospitals for shell-shocked soldiers were also established in Britain, including (for officers) Craiglockhart War Hospital in Edinburgh.

Patients diagnosed to have more serious psychiatric conditions were transferred to the Royal Edinburgh Asylum.

Near the end of 1918, the use of anesthetic and electrical treatments to treat shell shock was gradually replaced with modified Freudian psychodynamic intervention. The efficacy of ‘forward psychiatry’ was controversial.

Psychodynamic therapy focuses on unconscious processes as they are manifested in a person’s present behavior. The goals of psychodynamic therapy are a client’s self-awareness and understanding of the influence of the past on present behavior.

In 1922 the British War Office produced a report on shell shock with recommendations for prevention of war neurosis. However, when World War II broke out in 1939, this seems to have been ignored.

Then during World War II, the term ‘combat fatigue’ was introduced as breakdown rates became alarming, and the value of pre-selection was recognized.

At the Maudsley Hospital in London in 1940, barbiturate abreaction (an emotional release resulting from mentally reliving through the process of catharsis, a long-repressed, painful experience) was advocated for quick relief from severe anxiety and hysteria, using i.v. anesthetics: Somnifaine, paraldehyde, Sodium Amytal. ‘Pentothal narcosis’ and ‘narco-analysis’ were adopted by British and American military psychiatrists.

However, by 1945 medical thinking gradually settled on the same approaches that had seemed to be effective in 1918.

The term PTSD was introduced in 1980.

In the UK the National Institute for Health and Clinical Excellence (NICE) guidelines for management (2005) recommend trauma-focused Cognitive Behavioral Therapy and consideration of antidepressants. Source: Pub

Discover The public image of PTSD and the Vietnam Veteran


Lloyd Lofthouse is a former U.S. Marine, Vietnam Veteran, journalist and award winning author.

His second novel is the award winning love story and suspense-thriller Running with the Enemy. Blamed for a crime he didn’t do while serving in Vietnam, his country considers him a traitor. Ethan Card is a loyal U.S. Marine desperate to prove his innocence or he will never go home again.

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