Problems, politics and personalities in the treatment of mental and nervous casualties in the British Army 1914-1918. Incorporating a statistical and analytical study of 500 case histories.

The Great War of 1914-1918 continues to attract scholarly attention, not least in the field of neuropsychiatric medicine. The term 'shell shock' is firmly cemented into the language, such that it represents for many the entire", neuropsychiatrical experience of the war. This thesis challenges that view, seeking to establish a new point of departure for the study of Great War neuropsychiatrical medicine. Based on a major study of previously unresearched medical case histories, a much less central role is assigned to shell shock and 'war neuroses' generally. Novel aspects such as the effects of mental disorder on the smallest military social unit - what is called here the 'comradely group' - are explored. By maintaining throughout a clear distinction between functional nervous disorders and the ubiquitous exhaustion syndrome of 'neurasthenia'.. a radically altered view of their relative importance emerges. At the same time, much of the confusion and conflation of previous studies is avoided. The British Army's approach to these problems depended crucially on the availability of appropriately skilled medical practitioners. This thesis maintains that the historical hiatus between the public asylum medical service and the medical profession as a whole constituted an influential and previously unrecognised factor in the evolution of these policies and practices. As war approached, the growing influence of Freudian psychology raised questions as to where the legitimate authority on mental health matters should lie. When circumstances forced the Government to seek help from the asylums in coping with the rising tide of casualties of all kinds, the weight of advantage in this controversy swung decisively in favour of the asylum doctors. This, it is suggested, constituted a major factor in the developmental pattern of, mental health services in post-war Britain, a factor which has up to now been largely overlooked.