This talk by Amy Smith-Milne was an excellent pre-cursor to helping someone understand the perspectives towards the men who suffered from shell shock during World War 1. The work of doctors during the Victorian era would influence the treatment of mental illness during this war.
Using the example of Lieutenant Alexis Charles Doxant, V.C. as her basis for the introduction of her material Smith-Milne brought to light the conceptual frame-work from which she positioned her talk. She noted that this work was very much a work in progress and that this material was new.
A brief explanation of what a retro-diagnosis was explained to help her audience understand the perspective from which a historian would take when reading and researching medical documentation from a previous era. Noted was the influence of Charles Rosenberg in regard to this. There is a tendency for scholars of present to take symptoms of a historical subject and apply that knowledge to the situation being studied. But as medical science and its practice occurred in the past with specific set of knowledge the argument is made that one cannot attempt a diagnosis based on current knowledge. To accept the limitations of medical science and knowledge of that type is more historically significant because it is the circumstances of that time and place that shaped the attitudes and responses of the actors of that time.
An example of this is the description of “consumption”. This term was a catch-all for many pernicious and long-term diseases and medical conditions such at tuberculosis and cancer. If one extends the diagnosis retroactively then it shapes our perception and assessment of the situation in today’s terms and not in the terms of the society and the time in which one is observing.
An example of this are the terms used to describe war related psychosis and mental conditions. For example:
Soldier’s Heart/DaCosta Syndrome: Described by Jacob Mendes Da Costa during the American Civil War and is related to anxiety but the manifestations of the causality of the disease were related to previous illness and ill-fitting equipment and knapsacks.
Neurasthenia: In the latter part of the 19th Century this condition was thought to be caused by range of physical symptoms that caused a person to be depressed.
From this point of reference, the concept of “madness” was illustrated. Madness was a very real concept during the Victorian era and was related to a physical condition whereby “lesions” were present in the brain or the nervous system. These lesions would be the result of a physical malady, such as typhus, and that this illness would be the precursor and cause of the mental illness in the form of madness.
There was a tension between psychological and emotional versus the somatic causes of madness. Somatic causes where those relating to physical effects resulting in mental illness and as the British Empire had colonial and military resources stationed and serving all over the world there was a concern that the environment the people served in had a direct effect on their health. There was, as one concern, a worry about sunstroke and its impact to the health of the people that suffered from it. There was a direct correlation between suffering sunstroke or some other illness and the onset of mental disease. Thus, the connection with somatic symptoms was almost assured as verification as many people serving in temperate climates suffered the effects of sunstroke, malaria or a host of other ailments related to their service.
In the case of Doxat, a soldier that served with the British Forces in the 2nd Boer War, he was to suffer from “acute mania” that was attributed to him having suffered a fever that was most likely typhus. He was sent from South Africa to England for treatment for this mental condition. Thus, the somatic orientation of the cause and effect of Doxat’s psychiatric condition was consistently applied with the knowledge at the time. Further, the medical notes outline his biographic details only mentioned that he had military service. They did not touch on this service as having an influence into his trauma as Victorian medicine was more concerned with familial relations in this regard. If there was evidence of mental illness in the parents, then the cause was based on heredity or that the likelihood of mental illness was increased if one or both parents suffered some form of mental incapacity.
Also evidenced in the notes of Doxat’s case is a moral ambivalence, a lack of moral judgement on the cause of the “acute mania”. This application of not placing blame was consistently applied to patients of good moral character. But if the patient was suspect morally then the influence of that behavior to causing the mental aberration being experienced created judgement that was often reflected in the case notes. Thus, morally questionable behaviour involving drink, carousing, and other mores outside the ideal Victorian conception of what was good, or right was a contributory factor in the mental degeneration of the patient. Thus “unsteady habits” led to mental illness, while those practicing Christian Values must have other causal effects for the mental illness, and this was often found with heredity or physical illness as the culprit.
There also was a certain “fatalism” in the Victorian conception of mental illness. This fatalism was reflected by its understanding of suicide. That the mental illness did not exist until just prior to the victim of the suicide completed their final act. There was a certain expectation that people committing suicide were predestined to complete the act. There was some latent force at work and it only presented itself at the end of the person’s life, manifesting itself in the very act that defined them as mentally ill. This fatalism indicated that there would be no expectation of any preventative treatment as suicide was inevitable in some people.
There was a rudimentary study that tried to determine the incident or rate of “madness” in the military with the rate being, for other ranks, 1 in 479 soldiers being subject to this condition. Surprisingly, the study showed the rate of “madness” to be higher in the officer class.
The conception of mental illness, its cause and effects, during the Victorian Era shaped the experience of the medical field during the First World War. The experience of soldiers in the Imperial Forces and those of the C.E.F. attached to the B.E.F. determined how the soldiers would be treated on the Continent and in England. The Canadian experience was shaped by the need to treat soldiers who required treatment upon their return to Canada. Though the terminology changed to shell shock and/or neurasthenia during this period one can see some of the same influences. Case histories reflect biographical information based or heredity and if there where any prior illnesses and there is most definitely a bias towards the treatment of officers in comparison to other rank soldiers. There is a empathy towards the officer class and there are cases of 18th Battalion privates being judged on moral or even political grounds (i.e. a soldier suspected as being “socialist”).
The lecture was of value for its insight into the historical precedents that shaped the medical knowledge and philosophy for the treatment of shell shock in World War 1.