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Shell shock is a term coined in World War I by British psychologist Charles Samuel Myers^[2] to describe the type of post traumatic stress disorder many soldiers were afflicted with during the war (before PTSD was termed).^[3] It is a reaction to the intensity of the bombardment and fighting that produced a helplessness appearing variously as panic and being scared, flight, or an inability to reason, sleep, walk or talk.^[4]

During the War, the concept of shell shock was ill-defined. Cases of 'shell shock' could be interpreted as either a physical or psychological injury, or simply as a lack of moral fibre. The term shell shock is still used by the Department of Veterans Affairs to describe certain parts of PTSD, but mostly it has entered into memory, and it is often identified as the signature injury of the War.

In World War II and thereafter, diagnosis of 'shell shock' was replaced by that of combat stress reaction, a similar but not identical response to the trauma of warfare and bombardment.

Origin[edit]

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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.^[5] By December 1914 as many as 10% of British officers and 4% of enlisted men were suffering from 'nervous and mental shock'.^[6]

The term 'shell shock' came into use 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.^[6]

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.^[7]

At the same time an alternative view developed describing shell shock as an emotional, rather than a physical, injury. Evidence for this point of view was provided by the fact that an increasing proportion of men suffering shell shock symptoms had not been exposed to artillery fire. Since the symptoms appeared in men who had no proximity to an exploding shell, the physical explanation was clearly unsatisfactory.^[7]

In spite of this evidence, the British Army continued to try to differentiate those whose symptoms followed explosive exposure from others. In 1915 the British Army in France was instructed that:

Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it was due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe'. If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy', and he was to [be] labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension.^[8]

However, it often proved difficult to identify which cases were which, as the information on whether a casualty had been close to a shell explosion or not was rarely provided.^[7]

Shell Shock Live 2

Management[edit]

Acute[edit]

At first, shell-shock casualties were rapidly evacuated from the front line – in part because of fear of their unpredictable behaviour.^[9] As the size of the British Expeditionary Force increased, and manpower became in shorter supply, the number of shell shock cases became a growing problem for the military authorities. At the Battle of the Somme in 1916, as many as 40% of casualties were shell-shocked, resulting in concern about an epidemic of psychiatric casualties, which could not be afforded in either military or financial terms.^[9]

Among the consequences of this were an increasing official preference for the psychological interpretation of shell shock, and a deliberate attempt to avoid the medicalisation of shell shock. If men were 'uninjured' it was easier to return them to the front to continue fighting.^[7] Another consequence was an increasing amount of time and effort devoted to understanding and treating shell shock symptoms. Soldiers who returned with shell shock generally could not remember much because their brain would shut out all the traumatic memories.

By the Battle of Passchendaele in 1917, the British Army had developed methods to reduce shell shock. A man who began to show shell-shock symptoms was best given a few days' rest by his local medical officer.^[6] Col. Rogers, Regimental Medical Officer, 4th Battalion Black Watch wrote:

You must send your commotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the men and they know you and you know them (and there is a good deal more in the man knowing you than in you knowing the man) … you are able to explain to him that there is really nothing wrong with him, give him a rest at the aid post if necessary and a day or two's sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him.^[8]

If symptoms persisted after a few weeks at a local Casualty Clearing Station, which would normally be close enough to the front line to hear artillery fire, a casualty might be evacuated to one of four dedicated psychiatric centres which had been set up further behind the lines, and were labelled as 'NYDN – Not Yet Diagnosed Nervous' pending further investigation by medical specialists.

Although the Battle of Passchendaele generally became a byword for horror, the number of cases of shell shock were relatively few. 5,346 shell shock cases reached the Casualty Clearing Station, or roughly 1% of the British forces engaged. 3,963 (or just under 75%) of these men returned to active service without being referred to a hospital for specialist treatment. The number of shell shock cases reduced throughout the battle, and the epidemic of illness was ended.^[10]

During 1917, 'shell shock' was entirely banned as a diagnosis in the British Army,^[11] and mentions of it were censored, even in medical journals.^[12]

Chronic treatment[edit]

The treatment of chronic shell shock varied widely according to the details of the symptoms, the views of the doctors involved, and other factors including the rank and class of the patient.

There were so many officers and men suffering from shell shock that 19 British military hospitals were wholly devoted to the treatment of cases. Ten years after the war, 65,000 veterans of the war were still receiving treatment for it in Britain. In France it was possible to visit aged shell shock victims in hospital in 1960.^[4]

Physical causes[edit]

2015 research by Johns Hopkins University has found that the brain tissue of combat veterans who have been exposed to improvised explosive devices (IEDs) exhibit a pattern of injury in the areas responsible for decision making, memory and reasoning. This evidence has led the researchers to conclude that shell shock may not only be a psychological disorder, since the symptoms exhibited by sufferers from the First World War are very similar to these injuries.^[13] Immense pressure changes are involved in shell shock. Even mild changes in air pressure from weather have been linked to changes in behavior.^[14]

There is also evidence to suggest that the type of warfare faced by soldiers would affect the probability of shell shock symptoms developing. First hand reports from medical doctors at the time note that rates of such afflictions decreased once the war was mobilized again during the 1918 German offensive, following the 1916-1917 period where the highest rates of shell shock can be found. This could suggest that it was trench warfare, and the experience of siege warfare specifically, that led to the development of these symptoms.^[15]

Cowardice[edit]

Some men suffering from shell shock were put on trial, and even executed, for military crimes including desertion and cowardice.^[16] 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.^[17] 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.^[17] 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. After almost a year of giving one of his patients electric shocks, putting cigarettes on his tongue, hot plates at the back of his throat, etc., a British clinician, Lewis Yealland, said to his patient, 'You will not leave this room until you are talking as well as you ever did... You must behave as the hero I expected you to be.'^[18]

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.^[19] 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'.^[20] On 7 November 2006, the government of the United Kingdom gave them all a posthumous conditional pardon.^[21]

Commission of enquiry[edit]

The British government produced a Report of the War Office Committee of Enquiry into 'Shell-Shock' which was published in 1922.^[22] Recommendations from this included:

In forward areas

No soldier should be allowed to think that loss of nervous or mental control provides an honourable avenue of escape from the battlefield, and every endeavour should be made to prevent slight cases leaving the battalion or divisional area, where treatment should be confined to provision of rest and comfort for those who need it and to heartening them for return to the front line.

In neurological centres

When cases are sufficiently severe to necessitate more scientific and elaborate treatment they should be sent to special Neurological Centres as near the front as possible, to be under the care of an expert in nervous disorders. No such case should, however, be so labelled on evacuation as to fix the idea of nervous breakdown in the patient's mind.

In base hospitals

When evacuation to the base hospital is necessary, cases should be treated in a separate hospital or separate sections of a hospital, and not with the ordinary sick and wounded patients. Only in exceptional circumstances should cases be sent to the United Kingdom, as, for instance, men likely to be unfit for further service of any kind with the forces in the field. This policy should be widely known throughout the Force.

Forms of treatment

The establishment of an atmosphere of cure is the basis of all successful treatment, the personality of the physician is, therefore, of the greatest importance. While recognising that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority by the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided by such physical methods as baths, electricity and massage. Rest of mind and body is essential in all cases.

The committee are of opinion that the production of hypnoidal state and deep hypnotic sleep, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.

They do not recommend psycho-analysis in the Freudian sense.

In the state of convalescence, re-education and suitable occupation of an interesting nature are of great importance. If the patient is unfit for further military service, it is considered that every endeavour should be made to obtain for him suitable employment on his return to active life.

Return to the fighting line

Soldiers should not be returned to the fighting line under the following conditions:-

(1) If the symptoms of neurosis are of such a character that the soldier cannot be treated overseas with a view to subsequent useful employment.

(2) If the breakdown is of such severity as to necessitate a long period of rest and treatment in the United Kingdom.

(3) If the disability is anxiety neurosis of a severe type.

(4) If the disability is a mental breakdown or psychosis requiring treatment in a mental hospital.

It is, however, considered that many of such cases could, after recovery, be usefully employed in some form of auxiliary military duty.

Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.

By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so … were getting pensions for ‘soldier's heart' or Effort Syndrome. There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg.^[8]

War correspondent Philip Gibbs wrote:

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.^[5] By December 1914 as many as 10% of British officers and 4% of enlisted men were suffering from 'nervous and mental shock'.^[6]

The term 'shell shock' came into use 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.^[6]

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.^[7]

At the same time an alternative view developed describing shell shock as an emotional, rather than a physical, injury. Evidence for this point of view was provided by the fact that an increasing proportion of men suffering shell shock symptoms had not been exposed to artillery fire. Since the symptoms appeared in men who had no proximity to an exploding shell, the physical explanation was clearly unsatisfactory.^[7]

In spite of this evidence, the British Army continued to try to differentiate those whose symptoms followed explosive exposure from others. In 1915 the British Army in France was instructed that:

Shell-shock and shell concussion cases should have the letter 'W' prefixed to the report of the casualty, if it was due to the enemy; in that case the patient would be entitled to rank as 'wounded' and to wear on his arm a 'wound stripe'. If, however, the man's breakdown did not follow a shell explosion, it was not thought to be 'due to the enemy', and he was to [be] labelled 'Shell-shock' or 'S' (for sickness) and was not entitled to a wound stripe or a pension.^[8]

However, it often proved difficult to identify which cases were which, as the information on whether a casualty had been close to a shell explosion or not was rarely provided.^[7]

Shell Shock Live 2

Management[edit]

Acute[edit]

At first, shell-shock casualties were rapidly evacuated from the front line – in part because of fear of their unpredictable behaviour.^[9] As the size of the British Expeditionary Force increased, and manpower became in shorter supply, the number of shell shock cases became a growing problem for the military authorities. At the Battle of the Somme in 1916, as many as 40% of casualties were shell-shocked, resulting in concern about an epidemic of psychiatric casualties, which could not be afforded in either military or financial terms.^[9]

Among the consequences of this were an increasing official preference for the psychological interpretation of shell shock, and a deliberate attempt to avoid the medicalisation of shell shock. If men were 'uninjured' it was easier to return them to the front to continue fighting.^[7] Another consequence was an increasing amount of time and effort devoted to understanding and treating shell shock symptoms. Soldiers who returned with shell shock generally could not remember much because their brain would shut out all the traumatic memories.

By the Battle of Passchendaele in 1917, the British Army had developed methods to reduce shell shock. A man who began to show shell-shock symptoms was best given a few days' rest by his local medical officer.^[6] Col. Rogers, Regimental Medical Officer, 4th Battalion Black Watch wrote:

You must send your commotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the men and they know you and you know them (and there is a good deal more in the man knowing you than in you knowing the man) … you are able to explain to him that there is really nothing wrong with him, give him a rest at the aid post if necessary and a day or two's sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him.^[8]

If symptoms persisted after a few weeks at a local Casualty Clearing Station, which would normally be close enough to the front line to hear artillery fire, a casualty might be evacuated to one of four dedicated psychiatric centres which had been set up further behind the lines, and were labelled as 'NYDN – Not Yet Diagnosed Nervous' pending further investigation by medical specialists.

Although the Battle of Passchendaele generally became a byword for horror, the number of cases of shell shock were relatively few. 5,346 shell shock cases reached the Casualty Clearing Station, or roughly 1% of the British forces engaged. 3,963 (or just under 75%) of these men returned to active service without being referred to a hospital for specialist treatment. The number of shell shock cases reduced throughout the battle, and the epidemic of illness was ended.^[10]

During 1917, 'shell shock' was entirely banned as a diagnosis in the British Army,^[11] and mentions of it were censored, even in medical journals.^[12]

Chronic treatment[edit]

The treatment of chronic shell shock varied widely according to the details of the symptoms, the views of the doctors involved, and other factors including the rank and class of the patient.

There were so many officers and men suffering from shell shock that 19 British military hospitals were wholly devoted to the treatment of cases. Ten years after the war, 65,000 veterans of the war were still receiving treatment for it in Britain. In France it was possible to visit aged shell shock victims in hospital in 1960.^[4]

Physical causes[edit]

2015 research by Johns Hopkins University has found that the brain tissue of combat veterans who have been exposed to improvised explosive devices (IEDs) exhibit a pattern of injury in the areas responsible for decision making, memory and reasoning. This evidence has led the researchers to conclude that shell shock may not only be a psychological disorder, since the symptoms exhibited by sufferers from the First World War are very similar to these injuries.^[13] Immense pressure changes are involved in shell shock. Even mild changes in air pressure from weather have been linked to changes in behavior.^[14]

There is also evidence to suggest that the type of warfare faced by soldiers would affect the probability of shell shock symptoms developing. First hand reports from medical doctors at the time note that rates of such afflictions decreased once the war was mobilized again during the 1918 German offensive, following the 1916-1917 period where the highest rates of shell shock can be found. This could suggest that it was trench warfare, and the experience of siege warfare specifically, that led to the development of these symptoms.^[15]

Cowardice[edit]

Some men suffering from shell shock were put on trial, and even executed, for military crimes including desertion and cowardice.^[16] 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.^[17] 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.^[17] 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. After almost a year of giving one of his patients electric shocks, putting cigarettes on his tongue, hot plates at the back of his throat, etc., a British clinician, Lewis Yealland, said to his patient, 'You will not leave this room until you are talking as well as you ever did... You must behave as the hero I expected you to be.'^[18]

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.^[19] 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'.^[20] On 7 November 2006, the government of the United Kingdom gave them all a posthumous conditional pardon.^[21]

Commission of enquiry[edit]

The British government produced a Report of the War Office Committee of Enquiry into 'Shell-Shock' which was published in 1922.^[22] Recommendations from this included:

In forward areas

No soldier should be allowed to think that loss of nervous or mental control provides an honourable avenue of escape from the battlefield, and every endeavour should be made to prevent slight cases leaving the battalion or divisional area, where treatment should be confined to provision of rest and comfort for those who need it and to heartening them for return to the front line.

In neurological centres

When cases are sufficiently severe to necessitate more scientific and elaborate treatment they should be sent to special Neurological Centres as near the front as possible, to be under the care of an expert in nervous disorders. No such case should, however, be so labelled on evacuation as to fix the idea of nervous breakdown in the patient's mind.

In base hospitals

When evacuation to the base hospital is necessary, cases should be treated in a separate hospital or separate sections of a hospital, and not with the ordinary sick and wounded patients. Only in exceptional circumstances should cases be sent to the United Kingdom, as, for instance, men likely to be unfit for further service of any kind with the forces in the field. This policy should be widely known throughout the Force.

Forms of treatment

The establishment of an atmosphere of cure is the basis of all successful treatment, the personality of the physician is, therefore, of the greatest importance. While recognising that each individual case of war neurosis must be treated on its merits, the Committee are of opinion that good results will be obtained in the majority by the simplest forms of psycho-therapy, i.e., explanation, persuasion and suggestion, aided by such physical methods as baths, electricity and massage. Rest of mind and body is essential in all cases.

The committee are of opinion that the production of hypnoidal state and deep hypnotic sleep, while beneficial as a means of conveying suggestions or eliciting forgotten experiences are useful in selected cases, but in the majority they are unnecessary and may even aggravate the symptoms for a time.

They do not recommend psycho-analysis in the Freudian sense.

In the state of convalescence, re-education and suitable occupation of an interesting nature are of great importance. If the patient is unfit for further military service, it is considered that every endeavour should be made to obtain for him suitable employment on his return to active life.

Return to the fighting line

Soldiers should not be returned to the fighting line under the following conditions:-

(1) If the symptoms of neurosis are of such a character that the soldier cannot be treated overseas with a view to subsequent useful employment.

(2) If the breakdown is of such severity as to necessitate a long period of rest and treatment in the United Kingdom.

(3) If the disability is anxiety neurosis of a severe type.

(4) If the disability is a mental breakdown or psychosis requiring treatment in a mental hospital.

It is, however, considered that many of such cases could, after recovery, be usefully employed in some form of auxiliary military duty.

Part of the concern was that many British veterans were receiving pensions and had long-term disabilities.

By 1939, some 120,000 British ex-servicemen had received final awards for primary psychiatric disability or were still drawing pensions – about 15% of all pensioned disabilities – and another 44,000 or so … were getting pensions for ‘soldier's heart' or Effort Syndrome. There is, though, much that statistics do not show, because in terms of psychiatric effects, pensioners were just the tip of a huge iceberg.^[8]

War correspondent Philip Gibbs wrote:

Something was wrong. They put on civilian clothes again and looked to their mothers and wives very much like the young men who had gone to business in the peaceful days before August 1914. But they had not come back the same men. Something had altered in them. They were subject to sudden moods, and queer tempers, fits of profound depression alternating with a restless desire for pleasure. Many were easily moved to passion where they lost control of themselves, many were bitter in their speech, violent in opinion, frightening.^[8]

One British writer between the wars wrote:

There should be no excuse given for the establishment of a belief that a functional nervous disability constitutes a right to compensation. This is hard saying. It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness. But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to ‘shock' because they get something out of it. To give them this reward is not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state by implication that an unconscious cowardice or an unconscious dishonesty will be rewarded.^[8]

Development of psychiatry[edit]

At the beginning of World War II, the term 'shell shock' was banned by the British Army, though the phrase 'postconcussional syndrome' was used to describe similar traumatic responses.^[12]

Society and culture[edit]

Shellshock Live Free

Shell shock has had a profound impact in British culture and the popular memory of World War I. At the time, war writers like the poets Siegfried Sassoon and Wilfred Owen dealt with shell shock in their work. Sassoon and Owen spent time at Craiglockhart War Hospital, which treated shell shock casualties.^[23] Author Pat Barker explored the causes and effects of shell shock in her Regeneration Trilogy, basing many of her characters on real historical figures and drawing on the writings of the first world war poets and the army doctor W. H. R. Rivers.

Modern cases of shell shock[edit]

Although the term 'shell shocked' is typically used in discussion of WWI to describe early forms of PTSD, its high-impact explosives-related nature provides modern applications as well. During their deployment in Iraq and Afghanistan, approximately 380,000 U.S. troops, about 19% of those deployed, were estimated to have sustained brain injuries from explosive weapons and devices.^[24] This prompted the U.S. Defense Advanced Research Projects Agency (DARPA) to open up a $10 million study of the blast effects on the human brain. The study revealed that, while the brain remains initially intact immediately after low level blast effects, the chronic inflammation afterwards is what ultimately leads to many cases of shell shock and PTSD.^[25]

See also[edit]

References[edit]

1. ^'Post-traumatic stress disorder (PTSD) - Doctors Lounge(TM)'. www.doctorslounge.com.
2. ^'A Short History of The British Psychological Society'(PDF). British Psychological Society. British Psychological Society. Retrieved 9 November 2019. Although he later came to regret it, it was Myers who coined the term ‘shell shock'
3. ^'Is Shell Shock the Same as PTSD?'. Psychology Today.
4. ^ ^abHochschild, Adam (2012). To End All Wars - a story of loyalty and rebellion, 1914-1918. Boston, New York: Mariner Books, Houghton, Mifflin Harcourt. pp. xv, 242, 348. ISBN978-0-547-75031-6.
5. ^Jones, Fear and Wessely 2007, p. 1641
6. ^ ^abcMcLeod, 2004
7. ^ ^abcdJones, Fear and Wessely 2007, p.1642
8. ^ ^abcdeShephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914–1994. London, Jonathan Cape, 2000.
9. ^ ^abMcleod, 2004
10. ^McLeod 2004
11. ^Wessely 2006, p443
12. ^ ^abJones, Fear and Wessely 2007, p.1643
13. ^'Combat Veterans' Brains Reveal Hidden Damage from IED Blasts - 01/14/2015'. Retrieved 12 August 2016.
14. ^Dabb, C (May 1997). The relationship between weather and children's behavior: a study of teacher perceptions. USU Thesis.
15. ^van der Hart, Onno (2001). 'Somatoform Dissociation in Traumatized World War I Combat Soldiers: A Neglected Clinical Heritage'. Journal of Trauma & Dissociation. 1: 38.
16. ^'BBC Inside Out Extra - Shell Shock - March 3, 2004'. Retrieved 24 August 2020.
17. ^ ^abWessely 2006, p442
18. ^'From shell-shock to PTSD, a century of invisible war trauma'. PBS NewsHour. 11 November 2018. Retrieved 4 October 2019.
19. ^Wessely 2006, p440
20. ^Taylor-Whiffen, Peter (1 March 2002). 'Shot at Dawn: Cowards, Traitors or Victims?'.
21. ^'War Pardons receives Royal Assent'. ShotAtDawn.org.uk. Archived from the original on 6 December 2006.
22. ^'Report of the War Office Committee of Enquiry into 'Shell-Shock''. Wellcome Library. HMSO. Retrieved 13 August 2020.
23. ^While Sassoon did not in fact suffer from shell shock, he was declared insane at the instigation of his friend Robert Graves in order to avoid prosecution for his anti-war publications.
24. ^'The Shock of War'. Smithsonian. Retrieved 13 February 2019.
25. ^'Preventing Violent Explosive Neurologic Trauma (PREVENT)'. www.darpa.mil. Retrieved 13 February 2019.

Sources[edit]

• Coulthart, Ross. The Lost Diggers, Sydney: HarperCollins Publishers, 2012. ISBN9780732294618
• Jones, E, Fear, N and Wessely, S. 'Shell Shock and Mild Traumatic Brain Injury: A Historical Review'. Am J Psychiatry 2007; 164:1641–1645
• Hochschild, Adam. To End all Wars - a story of loyalty and rebellion, 1914-1918 Mariner Books, Houghton, Mifflin Harcourt, Boston, New York, 2011. ISBN978-0-547-75031-6
• Leese, Peter. Shell Shock. Traumatic Neurosis and the British Soldiers of the First World War, Palgrave Macmillan, 2014. ISBN978-1-137-45337-2.
• Mcleod, A.D. 'Shell shock, Gordon Holmes and the Great War'J R Soc Med. 2004 February; 97(2): 86–89.
• Myers, C.S. 'A contribution to the study of shell shock'. Lancet, 1', 1915, pp. 316–320
• Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists, 1914-1994. London, Jonathan Cape, 2000.
• Wessely, S.The Life and Death of Private Harry FarrJournal of the Royal Society of Medicine, Vol 99, September 2006

External links[edit]

• An Address on the Repression of War Experience, by W.H. Rivers, 4 December 1917
• Our Present Needs a Past: A Historical Look at Shell Shock Tedx Talk by Annessa Stagner on YouTube

Shellshock 2 is an impressive sequel by all accounts. 6 years later, it's still an addictive and active romp. A diverse community with a friends system in-game that reaches globally to other players who are logged in from many different websites, like ArmorGames and the like. Though it's frustrating that there is a 'Friends Cap' of 12 player profiles. It makes no sense that the game forces you to delete older friends to make room for new ones.

Something I had discovered a few months ago when I picked this game up for the first time in several years. I was a level-capped veteran in Shellshock 1, and right off the bat, it allows you to cash in on that experience when you start anew in this version. I had left off my progress on this game at level 37, and it remembered all of the progress I had made- the weapons I had leveled up with experience, the custom tank I had unlocked with accumulated Tank Coins, and the stats I had divvied into Fuel, Traction, Armor, and Luck. I was at a great position to level up into the levelcap at 50.

But there are new tricks! Emblems next to certain names showed a number within a diamond. Prestige rank! Once at level 50, you're given the option to start over at level 1, and climb through the ranks to gain access to powerful Prestige weapons. There are 10 weapons, and if you prestige further than that, you're showing off. All of the XP progress you've made is kept, even the upgrade points put into your tank, but you're unlocking your arsenal all over again, which is challenging starting off as a rookie flanked by high level, high weapon-toting tanks all around you.

The community is still the worst part about it. Lots of racists, homophobes, and toxic idiots permeate the chat. You can mute them, but you can't mute their ability to ping the map with markers, arrows, and visual clutter. You can't report people, and you can't block them from entering rooms if you're trying to kick them out and keep them out. They can rejoin over and over and over again and you'll have to kick them manually every time. You also can't kick players out in mid-game if you're the host, which would've saved some headaches with particularly abusive or griefing players before they could screw over their team past a point of no-return.

You can either play in Deathmatches where each tank has HP represented in a red health bar, and Armor represented just above it with a blue armor bar. Or you can play for Points- every tank is invincible, armor is an unseen factor that reduces the damage a shot will make on you, and the game's length is determined by turns. From 5 turn quick games to 30 turn long games.

There's an option for Wind which can effect how certain shots behave, but not all. The wind can be set to low, medium, or high, and each have their respective XP bonus at the end of the match. There are some that argue that having High Wind in a game means 'More XP' but you're actually losing more XP than you're gaining from the bonus because of the shots you're missing or incomplete shots that would benefit from standing still over a target now moved askew by wind. Wind isn't worth it in my opinion, unless you're just trying to switch it up and do something a little different or more challenging.

Games can be played Free For All or with Teams. If you play it in Free For All, there's a common unspoken rule in the community about 'No Neighborshooting' in Deathmatches, because that's just seen as rude and cheap to them. Don't be surprised if some bloviating nutsack takes it personally if you neighborshoot in a Free For All.

In Team settings, a lobby can dictate if tanks are going to shoot one at a time, or if teams shoot together at once, or if everyone shoots at the same time. Individual Shot rooms take longer at a more relaxed, controlled pace. Sometimes it's beneficial to communicate to your team if you're trying to line up a shot on someone, because in a Team-Shot or All-Shot environment, sometimes damage from one weapon can cause another weapon to miss...communicating is beneficial in these circumstances, and you can do that publicly to the room or you can whisper to your teammates. I'll warn you though, if you have a maximum room of 6 tanks going for the longest setting at 30 turns on Individual Shot? I guarantee you that half of the room will quit before the game finishes, because those games take ages to complete. They seriously take a very long time, and it can be quite boring. If you died in a Deathmatch, you have the option to play Pong in-game while you wait for the game to wrap up...but that quickly gets stale and dull. Frustrating, because you'll lose whatever XP you've gained in the match if you leave early.

Also frustrating is if a teammate quits early, the game decides randomly which teammate gets to control the tank when it's supposed to be their turn. Say it's a 3 tank team, you're dead and the middle one quits, they could still give the controls to the other guy while you're sitting on your ass with nothing to do. The tank retains however the original player had leveled its stats (Fuel, Traction, Armor), and the game randomly selects one shot for you to use, and this will earn the shooter no XP benefits. These substitute tanks also cannot interact with boxes that are dropped in-game, nor damage multipliers. It already sucks and is a huge disadvantage when a teammate quits, but these added handicaps to the dead tank make it into a kind of slap in the face.

The game is standard 'Free to Play, Pay to Win' format, incentivizing you at every turn to spend precious and rare tank coins on things in-game.

From the mundane and exorbitantly expensive chrome/gold rims, to items like 'The Reinforced Barrel' which adds a percentage chance of critical damage to any shot. Or the dick-move Grappling Hook, which can yank a Box dropped on the field to you immediately, regardless of if you were close to it or not. Often-times stealing said box from a teammate or enemy right under their noses.

Boxes are sought after, they'll very rarely drop Tank Coins, which are hard to come by. They'll also drop weapons, sometimes premium weapons from weapon packs, deluxe arsenals, or even one's that exceed what your level has access to (this outcome is largely based on how you've leveled up your Luck stat, which I'll get to later). Uncommonly they can contain items you can use on the battlefield.

Arguably the most useful item is the Jetpack, which is great for leaping short distances to spread out from teammates, or to get yourself out of a compromising situation in the bottom of a pit or crater. The next most sought after item is the Tracer, which, when used once, plots the trajectory of your shot based on the angle and power you have set up at the time of activation...it's single-use, and can mean the difference in adjusting how you shoot a Sniper shot. There are also supply drops, which randomly equips you instantaneously with 5 new shots that you have access to (in case your current loadout is shit) and lastly, there's a shield bubble, which lasts a single turn rotation. Everyone hates it when you use the shield, it's never a cool or respectable move to protect yourself with the bubble, you will be chastized, boo'd, and hated for it. Never use the shield. Only bitch cowards use the shield.

Every 10 tank coins you earn can be spent on a Tank Upgrade point. I found out you only naturally achieve a Tank Upgrade token once a level for the first 50 levels. There isn't a single bar that should be below 1/4th's full.
-Traction should be maxed out. This is the stat that enables you to climb out of steep hills and terrain so you aren't stuck by some crater that's formed around you.
-Armor should be at 75% or full. That blue bar will help you last longer in Deathmatches, and lessen the damage you'll take in Points matches.
-Fuel definitely needs more than 50% of it upgraded- This is your movement range, and I shouldn't have to go into detail about how moving further is helpful, especially when coupled with good Traction stats.
-Luck may increase your chances of getting more Tank Coins and advanced weaponry on box drops in-game. It may be the least useful stat, because box drops are random and undependable in-game, but at the very least it could enable you to get an unexpected edge in combat, or at least a reward to dampen the blow of an inevitable loss.

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But how you level up your tank is completely up to you, and will help with your survivability.

Or at least, as much as you can. There are extremely unfair weapons in the game; it's not balanced very well. Many deluxe/premium weapons take no effort to aim and wreak absolute high damage havoc. I got burned out many years ago trying to level up as a proud vanilla tank using no Deluxe weaponry, and you cannot compete against bought advantages. There are some that claim that not everyone buys these things with money, it just takes a lot of time to grind to the point where you can redeem tank coins for these things...and there are others that brag about their salary and gloat about how any and everything that can be maxed out in the game HAS been maxed out...and I encountered this shameless creature a few days ago in 2018. So I imagine it speaks well for KChamp games that they're still getting business from the cashcow that is Shellshock 2.

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But for all the frustration I've experienced with people that were made better by bought advantages, and for all the times I'm annoyed by a stoner or kid slacking off in school messing up in a team environment, there have been some fun moments when it all goes according to plan. A clutch trick-shot with a Sniper bouncing off the border at the edge of the map... the wind guiding a luckily arranged volley of asteroids... Nuking 2/3rds of a team, or rarely, all 3 tanks of an enemy team. Watching some high-level asshole's weapon backfiring on him in the worst possible way... Even something as simple as the addiction of monitoring the candy-blue experience gauge on a weapon that you're trying to maximize it's potential by leveling up. There's a reason there's still an active community here. It just works! And that's really special and rare in a flash game.

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Be warned, it'll suck you in. There'll be bad games that'll see you staring a 'gg' in the face because you got killed by Firestorm and a Galaxy that caught a Double Damage modifier in the first round and you didn't have the opportunity to even shoot yet. There'll be idiots on your team that may be hellbent on ensuring that you lose, intentionally or unintentionally. You may need to communicate to a teammate who doesn't speak a language that you know, and sometimes, in more relaxed environments, that can be kinda cool. I had Google Translate up in another window and I was copy-pasting back-and-forth chatting with someone from Germany who didn't know very much english. Moments like that stick with me. Moments when I was nearing level 50 and I felt like the big-dick hero in the room protecting lower-leveled players in a Free For All felt good too. Finding yourself in a team that just 'clicks' and works...and the best moments are when it's a really nice room filled with nice people, chatting it up and joking around, having fun. No pressure, no animosity, just a couple of strangers from different time zones shooting each other with little tanks.

I could recommend this game to someone that wants a simple turn-based accuracy game. Sometimes I can recommend it as an online chatroom thats ALSO a game. I'm still blown away its community is as active as it is. It slows down a bit at certain times, and other times there'll be pages of rooms looking for tanks to join. If you got a modest amount of disposable income, I suppose you could add to the likelihood that you'll have a good time. But I don't recommend doing that until you know that you'll be spending enough time in this game to make back your money's worth in enjoyment. Trust that they definitely want you to spend money on this.

It's an extremely competent game, free to play, pay to win, learning how shots behave and practicing your aim are the keys to success...and grind, baby, grind.

This gem from 2012 still holds up through the test of time.