I came across this document by accident, while looking for something entirely different, and thought it might be of interest.
Shell Shock and War Neurosis
The paper a short and fascinating read that sheds light on something not often discussed in a serious manner when we look at military history, namely how an army would deal with psychological conditions emerging as a result of combat exposure. ‘Shell Shock’ as a concept emerged in World War I, and would be treated in quite primitive ways, which presumably did little to help the victim recover. See e.g. this case and this write up on the matter of ‘Shell Shock’ by the War Office. While there is a lot of the ‘shot at dawn’ mythology, it appears that unless the conditions you suffered made you desert, in all likelihood treatment followed by either return to the unit or being invalided out was the likely outcome.
War Neuroses in Tobruk
The siege of Tobruk is an interesting case, as the population potentially affected was in a very limited area for a prolonged time, continuously exposed to danger, in and out of the line, and with no potential for relief. The number of cases, including those who were not treated locally, seems to have been quite low, well below 5% of the garrison, given these circumstances.
The paper is also highly interesting in discussing the recovery pathways, with ca. 80% of the soldiers suffering from these conditions subsequently being fit for either first-line or second-line duty, on a ratio of over 3:1. What is also interesting is the relatively sophisticated discussion of the role of age and previous/family medical histories, which would make interesting pointers for prevention I suppose.
A few months later, a short review was provided in The Lancet, thereby ensuring that medical professionals in the UK, who might have missed the original article as it appeared in an Australian journal, would become aware.
War Neurosis to Battle Exhaustion
While the term ‘War Neurosis’ was used as a professional description, rather than ‘shell shock’, within a short time this changed to ‘Battle Exhaustion’. This change does make sense, considering the very high recovery rates, which indicated that it was prolonged exposure to actual fighting, rather than being in the war that caused the condition.
As Alan Allport pointed out in an email, the experience from Tobruk, as written up in this paper, informed the approach of the British Army on how to deal with Battle Exhaustion, and it was widely applied by the time of the invasion of Normandy, albeit with divergences based on personalities of medical leadership. See e.g. Terry Copp’s article at this link. Regardless of these practicalities however, the British/Canadian approach was clearly superior to that of the Wehrmacht, where non-formalised, unit-integrated rest was made available in some units (see e.g. Rutherford and Wettstein “The German Army on the Eastern Front” for good examples of this), while higher ups often equated battle exhaustion with insufficient belief in the Nazi ideology, and the crime of Wehrkraftzersetzung (literally: ‘dissolution of combat strength’) was a catch-all crime that could be used to punish soldiers for not being able to function anymore.
In the end, Copp’s quote of van Nostrand seems apt: “Although there are wide variations in the capacities of normal soldiers to withstand stress, every soldier has his breaking point, and if this is reached, he becomes a liability to his unit.” although I would add, based on the numbers presented by Copp, that it was not just the capacity of the soldier, but the combat environment as well. High-intensity operations seem to have brought considerably higher levels of Battle Exhaustion, probably more so when they were not leading to success.
Tobruk, by comparison to the high-intensity battles in Normandy, was a relatively calm combat environment. Yes there were patrols, artillery strikes and bombings, but on the whole it was a long perimeter with low densities of forces, and outside of the battles of Easter and May 1941 it was a relatively quiet sector. Maybe that also accounts for the low share of Battle Exhaustion cases.
Further readinghttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61260-5/references https://wellcomecollection.org/works/v33yrqma/items https://www.awm.gov.au/sites/default/files/10834-awm-not-yet-diagnosed_v6_spreads-hires.pdf