The Impact of Total War on the Practice
of British Psychiatry
EDGAR JONES AND SIMON WESSELY
It is generally accepted that modern warfare has exercised a significant influence on the evolution of psychiatry in the twentieth century. Stone, for example, argued that the identification of shell shock and attempts to treat the disorder were "an important and dynamic episode in the development of psychological medicine in Britain" in that they brought Freudian concepts of neurosis into "the mainstream of mental medicine and economic life and set psychiatry's field of practice squarely within the social fabric of industrial society."1 Similarly, Merskey concluded from his study of shell shock that "the maturation of psychiatry occurred in the course of World War One; it then became a speciality with potential for the community." Prominent figures like "T. A. Ross, D. K. Henderson and Millais Culpin," he added, "all received an impetus to work outside the psychiatric hospitals from their own wartime experience."2
Whilst it was undoubtedly true that World War I drew physicians with an academic interest in psychology into the armed forces and that psychiatric questions became of paramount importance during the conflict, the expertise acquired by these individuals appears to have been dissipated. They did not continue to exercise a great influence over either military or civil medical services once the armistice had been signed. By contrast, World War II, which drew large numbers of civilians into the front line and created a total conflict, saw more lasting effects. Psychiatric specialists were recruited into the services in both selection and training roles, and also for the treatment of psychologically traumatized servicemen. In addition, it was feared that modern bombers would obliterate entire cities, undermining the
1 Martin Stone, "Shellshock and the Psychologists," in W. F. Bynum, Roy Porter, and Michael Shepherd,
eds., The Anatomy of Madness: Essays in the History of Psychiatry, 3 vols. (London, 1985), 2: 265–6.
2 Harold Merskey, "Shell Shock," in German Berrios and Hugh Freeman, eds., 150 Years of British
Psychiatry (London, 1991), 261.