The First World War prompted increasing interest in psychodynamic explanations of neurosis because of the large number of serving soldiers who suffered from 'shell-shock.' Some exhibited deaf-mutism, blindness, amnesia, or other hysterical symptoms. Many complained of recurrent nightmares, or had waking visions of the horrors of the trenches which were of hallucinatory intensity. The devastating effects of prolonged lack of sleep were not fully appreciated. The term 'shell-shock', introduced in 1915, indicated the current belief that proximity to exploding shells, even without physical injury, could damage the nervous system. But the British Army was slow to accept the actuality of what we should now call post-traumatic stress disorder, and the diagnosis of shell-shock was no defence in cases where men had deserted:
Even as late as May 1916, said Colonel Myers, who was then the Consulting Psychologist to the Army, 'From a military standpoint, a deserter was either "insane" and destined for the "mad house", or responsible and should be shot'. (!2>
Shell-shock became such a problem that special hospitals had to be set up for its treatment. The official casualty figures show that there were 28 533 cases of shell-shock reported in France up to the end of 1917. (1.3,> It was gradually realized that even the bravest of men break down if the stress imposed upon them is sufficient. Some years later, study of Communist methods of interrogation reinforced the realization that no-one can indefinitely withstand intense stress accompanied by sleep deprivation . Study of what would now be called 'war neurosis' contributed to the general perception that psychological conflict was an important determinant of illness, and that the sufferer might be unaware, or only partially aware, of the opposing forces within his psyche.
During the 1920s, psychoanalysis began to interest English intellectuals. James Strachey, whose translation of Freud's writings was published as The Standard Edition of the Complete Psychological Works of Sigmund Freud between 1953 and 1974, had undergone analysis with Freud in Vienna in 1920. Interest in psychoanalysis permeated Bloomsbury to the extent of influencing Lytton Strachey's book Elizabeth and Essex. On Christmas Day 1928, Freud himself wrote a cautious letter to Lytton Strachey about the book. Lionel S. Penrose, who later became famous for his work on the genetics of mental handicap, was another intellectual who studied with Freud.
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