Objectives The neurological response to psychological trauma during the Great War changed between the initial engagements, the final offensive and the later reflections of the Southborough enquiry.
Design At Queen Square, neurasthenia was a recorded diagnosis from 1890 and, for the next 30 years, between 4%–8% of all admissions were so described. The term ‘shell shock’ was first used in 1914 but the diagnosis burgeoned until, by 1918, it amounted to 25% of all admissions.
Subjects Early in the war, affected soldiers were rapidly evacuated to the UK, but attitudes changed after the Somme, because of the need to expedite return to the frontline. The use of ‘Electrical Therapy’ at Queen Square was an example of this imperative (Linden 2013).
Results Review of the case records suggests that ‘Shell Shock’ became an increasingly pejorative term as the condition was seen as a ‘contagious psychological response of the weak.’ The records show it was largely restricted to the lower ranks whilst officers were generally considered to have neurasthenia requiring a more gentle psychotherapeutic approach, occasionally involving transfer to specialist facilities.
Conclusions Ultimately, at Queen Square, the diagnosis and management of acute traumatic neurosis was driven by the needs of war but also by popular prejudice.
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