They Called it Shell Shock: Combat Stress in the First World War By Stefanie Linden. Helion and Company Limited. 2016. £19.99 (hb). 272 pp. ISBN 9781911096351

By creating psychological casualties on a mass scale, the First World War drew British psychiatry from the margins of the asylum system to a position of national importance. The management of shell shock was both a military and a medical emergency. This original study by Stefanie Linden compares the presentation and treatment of functional neurological disorders in Germany and the UK. Based on research into case notes at the National Hospital for the Paralysed and Epileptic in Queen's Square, London, and the Charité in Berlin, she found significant differences in symptom patterns of servicemen invalided from the frontline with severe or intractable disorders, despite similar diagnostic criteria, specialist expertise and management techniques. Although functional motor or sensory symptoms (shaking, trembling, paresis, contractures, difficulty walking, speaking or hearing) were common to both samples, 28% of German patients exhibited pseudo-seizures or fitting in the absence of epilepsy or a head wound, in contrast to 7% of British soldiers admitted to the National Hospital. Further, psychogenic fits were widely reported in German medical literature during the war but were considered rare by British doctors. Physicians in Germany associated functional seizures with youth and low social status, but no significant difference could be detected in the age or rank of the two samples. This important, transnational comparison of a post-combat syndrome suggests that culture framed expressions of distress through prevailing beliefs about neurological illness.

Not only does Linden explore the symptomatology of shell shock, causal explanations and the treatments offered in Britain and Germany are also analysed. Detailed descriptions of individual patients are offered, tying their illnesses to the soldiers' battlefield experiences. Specific chapters explore themes of desertion, suicide and the short-lived opportunities offered to women doctors. Linden also presents a nuanced view of Lewis Yealland, the junior doctor commonly accused of the brutal treatment of servicemen. Although the application of electric shock is not denied, she argues that Yealland integrated its use with suggestion, demonstration of preserved function and the communication of a physiological illness model. This compelling narrative is driven by the clinical records, which demonstrate beyond any doubt the capacity of war to ruin the lives of young men.