Hysteria, head injuries and heredity: ‘shell-shocked’ soldiers of the Royal Edinburgh Asylum, Edinburgh (1914–24)

Abstract

This project illustrates as-yet-uncharted psychiatric patients from the Royal Edinburgh Asylum (REA) around the time of World War I, predominantly ‘shell-shocked’ soldiers. Primary patient notes help to elucidate definitions, symptoms and perceptions of ‘shell-shock’, in addition to its links with other psychiatric conditions. This includes general paralysis of the insane (GPI), alcohol excess, mania and melancholia. Whereas the majority of these patients were suffering from shell-shock, it is not once explicitly listed as a diagnosis; it was a term whose use was discouraged by the War Office and key medical experts from 1916 onwards. As such, this paper demonstrates effects that canonical views held by the War Office and military psychiatrists on shell-shock aetiology had on language used in psychiatric patient notes. The results corroborate wartime views that mental distress due to a physical head injury was preferable to shell-shock without obvious cause; that neurasthenia was a more desirable diagnostic label than hysteria; and that mental illness was predominantly due to an inherited flaw in someone's character. Language used by psychiatrists to describe their patients was influenced by contemporary perspectives on gender, class and mental illness. More broadly, this paper adds to discussions about definitions and symptomatology of shell-shock that are being uncovered in historical patient notes from this period.