The Legacy of WWI Shell Shock for PTSD-TBI

Writing in 2007 about Traumatic Brain Injuries, Washington Post reporter Ronald Glasser declared that improvised explosive devices (IEDs) in Iraq had “brought back one of the worst afflictions of World War I: shell shock. The brain of the soldiers is shocked, truly.”

As far back as the 1970s, efforts to formulate new diagnostic terminology for war veterans gained traction through analogies to shell shock: Post Vietnam Syndrome was said to be “like shell shock”; later on, PTSD was like Shell Shock; and now: Traumatic Brain Injury is like Shell Shock.

Trauma: The New `Coming Home’ Narrative for Veterans

The discourse of trauma has displaced all most all else from the coming-home news coverage of our current generation of veterans. In their 2013 book Beyond PTSD, the anthropologists Sarah Hautzinger and Jean Scandlyn write, “In most conversations where the topic of returning soldiers [comes up], PTSD is mentioned in the first few minutes.”  The centrality of Shell Shock to that discourse make its legacy a deserving topic for study.

As it turns out, the more we know about Shell Shock the more problematic PTSD and TBI become. And, more important for my purposes here, is the history of how shell shock played-out in German political culture during the inter-war period. Whereas the American anti-war movement currently fits wounded veterans into its cost-of-war calculus intended to dissuade military motives, the image of shell-shocked German veterans encoded the loss of national pride that demanded vengeance through more war. In that way too, the proper analogy between PTSD-TBI and Shell Shock of the World War I era suggests that their diagnostic value can be outweighed by their narrative value—a narrative that is vulnerable to appeals to militarism.

Hysteria and Cultural Imperatives in the `Making’ of Shell Shock

The untangling of this sticky-thicket of political history, cultural imagery, and medical science has to return to when and where it all began: World War I.  Doctors see soldiers with unexplained tremors, some gone blind or deaf, others mute, paralyzed. Charles Meyers, a British doctor, speculates that their behaviors are due to exploding shells on the front. So he calls it “shell shock.” But then soldiers who have yet to see combat appear with similar symptoms.

There had always been skeptics of the exploding-shells explanation for the symptoms known as Shell Shock. Fiona Reid notes in her 2010 book Broken Men that the British Army Medical Service outlawed use of “shell shock” in 1917. German soldiers who had never been under fire were more likely to present symptoms that those who had. The Freiburg physician Alfred Hauptmann, moreover, reasoned that soldiers with actual physical wounds should exhibit shell-shock symptoms—but they seldom did. Moreover, he thought, if shell explosions did directly cause neuroses, then soldiers would surely suffer these symptoms from firing their own weapons, a phenomenon that he had never observed.”

Dr. Joseph Babinski reasoned the symptoms may be “brought about not by the war itself but either by unintentional suggestion from doctors or by the patient’s auto-suggestion and imitation, words that cue for us the notion of hysteria, male hysteria, as a factor in the symptomology of Shell Shock.

Historian Michael Roth says shell shock in many ways resembled hysteria, a kind of “body speak,”—the bodily reappearance of ideas, fears, memories banished from consciousness. Freudians suggested that Shell Shock patients had repressed the conflict between fear and duty. What the patient was really afraid of was his own failure. The repressed memories of failure later reemerged as fantasies of the military accomplishments they thought were expected of them–false memories, replete with the physical symptoms attributable to combat—and conjured exploding shells.

But hysteria was a female disorder.  Doctors, wrote historian Elaine Showalter, were, “So prejudiced against a psychological cause that they just kept looking and looking”—some kind of wound on the body, evidence of a bomb blast, something physical. Anything but psychological.

Those doctors were men schooled in the tradition of the French neurologist Jean-Martin Charcot. At Salpertriere in Paris in the late 1800s, Charcot thought hysteria was caused by “brain lesions.” Charcot’s lesions theory was largely discredited when autopsies failed to reveal the lesions. But the brain-lesions theory was resurrected for medical approaches to WWI casualties. Herman Oppenheim in Germany believed that exploding shells created microscopic lesions in the brain causing paralysis. Conceivably, this model fit the anything-but-psychological imperative: that cause was external to the patient; exploding shells conjured the combat bona fides of the victim; the damage was physical—a very manly model.

Unfortunately for Oppenheim, even he had to admit that the sought-for lesions were “too small to be detectable.” Historian Ben Shepard notes that Oppenheim’s lesions-model was “comprehensively routed” even before the end of the war. Writing in his 2001 book A War of Nerves Shephard calls Shell-Shock “a common modern phenomenon: a medical debate, hedged with scientific qualifications, taken up by public opinion and the media.” In the words of Doctor William Johnson who had studied as a neurologist, won commendation for bravery at the battle of the Somme, and later treated war casualties, “Young soldiers prepare to become a case of shell-shock almost before the first shell drops near them.”

The doctors themselves were not impervious to the influence of popular culture. In his 1985 essay “Shellshock and the Psychologists,” Martin Stone wrote of the early war period that, “Shellshock had, it seemed, caught both the sympathy and imagination of the public who [in turn] raised psychoneuroses to the dignity of a new disease before which doctors seemed well-nigh helpless.” In short form, Stone is suggesting that cultural forms beyond the boundary of science itself led the way to the diagnostic category known as Shell Shock.

One of those “cultural forms” was the technology of culture-production. Historians of psychiatry are in wide agreement that camera photography influenced Charcot’s analyses of women hysterics. Anton Kaes in his 2010 book Shell Shock Cinema: Weimar Culture and the Wounds of War says moving-picture cameras, deployed by then for mental health diagnoses, played the same role in the making of Shell Shock. There was a synergy, he suggests, between early film itself—jumpy, with abrupt juxtapositions, and silent—and the symptoms it purported to capture—spastic movements, contortions, and muteness.

Nearly a century later, one can imagine that the oddness of body-images appearing in these rough-hewn films, even healthy bodies, as seen for the first time by young men, perhaps even before the war years, suggested to them that certain positions and postures carried mental health implications when viewed by the public—“Look how crazy the guy in the film looks!

The `Victim Veteran’ as Political Imagery

Kaes, also sees the filmic image of World War I veterans as essential in the political culture of inter-war Germany. In the 1920 film The Cabinet of Dr. Caligari—some of you might know it as a Halloween horror film—the zomboid character Cesare steps from a coffin under the influence of the mysterious Doctor. Cesare begins to move in a stiff and jump-cut motion that resembles the movement later associated with shell-shock victims. Indeed, says Kaes, Cesare “might have been case number 365, as recorded in a 1919 medical collection called Shell-Shock and Other Neuropsychiatric Problems.

The political effect of shell-shock imagery in German culture was studied by Siegfried Kracauer for his 1947 book From Caligari to Hitler. Films like Caligari, he said, used the medical imagery of shell shock to suggest to Germans that the loss of the war had also been a social and cultural shock to their pride and national identity; metaphorically, shell shock was the unseen wound carried by veterans, and as well, the body politic as the silent disease of national trauma demanding vengeance through more war.

In the United States, losses in World War I worked similarly to galvanize a stronger sense of national identity. In her 2010 book Bodies of War, Lisa Budreau refers to the American “cult of the fallen soldier” produced by the war, that she said provided “justification for the nation in whose name the war had been fought.” “The notion of heroic death was readily invoked,” she wrote, “to assuage the grief of the living while furthering the interests of the nation.”

The American institution of “Gold Star Mothers” was born in this Post WWI social climate. The black adornments signifying grief and mourning traditionally worn by survivors of soldiers killed in action was supplemented by gold stars that counterbalanced funereal symbolism with that associated with honor, accomplishment, and achievement—a gold star as a “reward” writes Budreau. A New York Times editorial on the gold-star concept claimed that, “Multitudes in mourning were not good for the country.”  “There is no better death than this,” the editorial went on, saying the “manifestation of glory rather than of a private grief becomes the patriotic citizen.”

As the “cult of the fallen soldier” was forming in the United States, its more virulent strain was growing in Germany. The wounded Germany symbolized by the Shell Shocked Cesare in Caligari had also been betrayed on the home front by pacifists, Communists, women, and Jews. The grounding-image of the sell-out was the stabbed-in-the-back German veteran, spat on when he returned home, his uniform shed in shame at the rail station lest it be ripped from him by the traitors.

Those twin images—of soldiers bringing the war home with them as “hidden injuries” of trauma, and soldiers disparaged by liberals and radicals as villains in an unpopular war—were revivified in American imagination in the years after the U.S. defeat in Vietnam.

Debunking `The Invisible Wound’

The task of debunking those images is assisted by what we now know about Shell Shock and, in the case of veterans defiled on the home front, the mythical character of the German stab-in-the-back legend made evident by Klaus Theweleit in his book Male Fantasies, a study of German literature in the inter-war period.

The “unseen wound” of trauma gained legitimacy with the inclusion of PTSD in the 1980 DSM, but the same sort of empirical issues that challenged the veracity of Shell Shock—recall those Shell Shock patients never exposed to exploding shells—dogged the validity of PTSD. In 1973, psychiatrist Peter Bourne wrote that the psychiatric casualty rate in Vietnam was greater among non-combat troops than combat.

A 1983 article in the American Journal of Psychiatry reported five cases whereupon men had presented PTSD symptoms. Three of the men said they were former prisoners of war. “In fact,” the authors found, “none had been prisoners of war, four [of the five] had never been in Vietnam, and two had never even been in the military.” Right into the present, it is nevertheless, common for the press to report that 30 to 50 percent of Vietnam veterans suffer from PTSD—despite the fact that only about 15% of U.S. soldiers there saw combat. Similar data disparities trouble the PTSD claims related to Iraq. The British report a PTSD rate about one-fourth that of the Americans—a gap one British scholar attributes to the American expectation that its troops will return traumatized.

Danger! Betrayal Narratives for Lost Wars

The concern is how the imagery of wounded veterans—wounds both seen and unseen—play out in political culture. It is clear to me that stories of spat-on veterans worked the same way in the United States after the war in Vietnam, as did the stab-in-back-legend in Germany, to form a betrayal narrative for the loss of the war. The image of trauma-stricken veterans enhances that narrative, adding to the recognition of combat-related emotional damage, the culturally constructed traumas of diminished manhood, hostile homecomings, and the neglect of an ungrateful public.

Brought to life for Americans in Hollywood films like Hamburger Hill and Coming Home, the real war seemed to have been at home—and, as Rambo had it, it was on the home front that the war was lost. It was a loss to be avenged through attacks on individual and groups deemed to have sapped our manliness: liberals in Congress, radicals on campus, and . . . Jane Fonda the personification of the seditious femininity that erodes our will-to-war. Lost in the fog of victim-veteran constructions is the real story that thousands of active-duty personnel and veterans turned against the war.

Since the loss of the war, the American political culture has been driven by feelings that something more than a military defeat was sustained in 1975: pride, sense of global standing, confidence in our place as “city on the hill.” We’ve become a nation of hurt, not hope; an avenging victim-nation. Having suffered the shock and trauma of defeat, we now inflict “shock and awe” on others.

The American anti-war movement of the 1960s and 1970s was wont to make analogies between U.S. expansionism and German imperialism—we were new Nazis, it was said. Whatever the merits of that analogy for that time, the better analogy today is with post-WWI Germany. Like inter-war Germany, we are steeping in a revanchist political culture that longs for a restoration of a mythical America, an America that never was.

Myths are group stories, stories as real as the people who tell them—as real as the group, the nation, that the stories create. We know that Anton Kaes is right—the “invisible wound,” enlivened by images of shell-shocked WWI veterans, led Germany back into war and its destruction in WWII; enlivened by its images of defiled and PTSD-stricken veterans, the U.S. sought collective remedy for its “Vietnam syndrome” in its Gulf War slaughter of retreating Iraqis—a slaughter abetted by a US presence in Saudi Arabia that supercharged the Jihadi movement right into the World Trade Center.

Shell Shock, PTSD, and now TBI are socially constructed diagnostic categories with heavily-gendered themes; they ply the mythologies of national identity and the sensitivities of what it means to be a man; their use in the manufacture of domestic scapegoats for losses abroad, and the incentive to remilitarize is a demonstrable danger.

A nation bonded by its commitments to avenge its hurts and unable to distinguished hurts inflicted by Self and Other—is a danger to all.

*Presented in earlier form at the conference “World War I: Dissent, Activism & Transformation” at Georgian Court University, October 18, 2014.

Jerry Lembcke is Associate Professor Emeritus of Sociology at College of the Holy Cross in Worcester, Mass. He is the author of The Spitting Image: Myth, Memory and the Legacy of Vietnam and  Hanoi Jane: War, Sex, and Fantasies of Betrayal. His newest book is PTSD: Diagnosis or Identity in Post-empire America? He can be reached at

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Jerry Lembcke is the author of nine books including The Spitting Image: Myth, Memory, and the Legacy of Vietnam (NYU Press, 1998), Hanoi Jane: War, Sex, and Fantasies of Betrayal (UMass Press, 2010), and Dissenting POWs: From Vietnam’s Hoa Lo Prison to America Today (Monthly Review Press, 2021. His The Cult of the Victim Veteran: MAGA Fantasies in Lost-War America came out with Routledge in July 2023. Jerry’s opinion pieces have appeared in The New York Times, Boston Globe, San Francisco Chronicle, and The Chronicle of Higher Education. He has been a guest on several NPR programs including On the Media.