Since "Case 1" of shell shock, we still need to make far more progress. Photo: Getty
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100 years since the first case of shell shock, it’s time to prioritise mental health

It’s 100 years since the first documented case of shell shock today. What progress should we be making a century on?

One hundred years ago today, on the morning of the 31 October 1914, a 20-year-old private ventured out into firing line of the First World War for the first time.

We know from frontline reports that he and his platoon had just left their trench when they were "found" by the German artillery.

The explosions sparked chaos and confusion as everyone dived for cover. The young soldier was separated from his comrades and became tangled in barbed wire.

As he struggled to free himself, three shells rained down on him, missing him by only a few feet. Witnesses said it was sheer miracle that he survived.

But when the young man was admitted to hospital a few days later, it was clear to the medics that his close brush with death had left a mark on him the like of which they had not seen before.

History hasn’t remembered the young private’s name. Today we know him only as "Case 1" from a seminal report published early in 1915 by a Cambridge professor and army doctor called Dr Charles Myers.

It detailed the first documented cases of what Myers came to describe as "shell shock".

More than 80,000 members of the British Army had been diagnosed with the disorder by the time the First World War came to an end, including the famous war poets Siegfried Sassoon and Wilfred Owen. 

It was the first time that the authorities had ever been confronted with mental health trauma on such a scale.

Today most of them would have almost certainly been diagnosed as suffering from forms of post-traumatic stress disorder (PTSD).

But when Myers was writing, the science of psychological injury was still in its infancy. And the Army didn’t know how to respond.

At first the breakdown of men under the intense pressures of conflict was seen more as a question of character. In the worst cases, patients were accused of cowardice or even desertion. There are appalling accounts of young men who desperately needed treatment for their condition but who were instead court martialled and sent to face the firing squad.

Soon it became clear however that the condition could not be written off as cowardice.

Myers came across countless soldiers mentally wrecked by what they had gone through. They included an officer haunted by memories of going out into "No Man’s Land" to look for a missing soldier only to find his friend’s body blown to pieces.

By the end of the war, Myers and his colleagues had developed pioneering techniques to treat their patients. A real but gradual change began in the way they were viewed by society.

When the Second World War came decades later, the psychological toll of combat was much better recognised. Army doctors were trained to recognise and treat the symptoms. The importance of rest and recovery away from the frontline was much better understood.

This progress is all part of a journey that we are still on a century later.

Today the long-term effects of combat stress are much more deeply studied than ever before. But the problem has not gone away.

Roughly one in every 25 British troops who served in Iraq and Afghanistan are at risk of developing PTSD, with the proportion much higher among soldiers in direct combat roles.

The mental health charity Combat Stress – founded a year after the conclusion of the First World War – currently has a caseload of more than 5,400 veterans across the UK.

Last year they reported a 57 per cent increase in veterans from Afghanistan being referred to them – a number that is expected to rise as the last UK forces depart Camp Bastion.

The latest figures show that on average it takes 13 years after a veteran is discharged before they seek treatment with Combat Stress, many of them having tried and failed to access the help they need through the NHS.

It feels like a modern echo of challenges that our soldiers faced a hundred years ago. It underlines why we cannot afford an ounce of complacency.

This week alone experts from the Royal College of Psychiatrists and others have raised concerns that the government is failing to honour the military covenant.

A cross-party report by MPs has separately highlighted how many veterans suffering from PTSD risk falling victim to alcohol abuse, domestic violence, even entering the criminal justice system.

A century on since doctors first examined that young private – "Case 1" – there is clearly still much more we need to do to help those we ask to put themselves in danger for our country.

Mental health stigmas are diminishing, but they have not yet disappeared. This moment from history shows it’s time we prioritised the mental health not only of our veterans, but of everyone.

Dan Jarvis is the MP for Barnsley Central, a former Major in The Parachute Regiment, and Labour’s lead on the First World War centenary

Dan Jarvis is the Labour MP for Barnsley Central and a former Major in the Parachute Regiment.

Photo: André Spicer
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“It’s scary to do it again”: the five-year-old fined £150 for running a lemonade stand

Enforcement officers penalised a child selling home-made lemonade in the street. Her father tells the full story. 

It was a lively Saturday afternoon in east London’s Mile End. Groups of people streamed through residential streets on their way to a music festival in the local park; booming bass could be heard from the surrounding houses.

One five-year-old girl who lived in the area had an idea. She had been to her school’s summer fête recently and looked longingly at the stalls. She loved the idea of setting up her own stall, and today was a good day for it.

“She eventually came round to the idea of selling lemonade,” her father André Spicer tells me. So he and his daughter went to their local shop to buy some lemons. They mixed a few jugs of lemonade, the girl made a fetching A4 sign with some lemons drawn on it – 50p for a small cup, £1 for a large – and they carried a table from home to the end of their road. 

“People suddenly started coming up and buying stuff, pretty quickly, and they were very happy,” Spicer recalls. “People looked overjoyed at this cute little girl on the side of the road – community feel and all that sort of stuff.”

But the heart-warming scene was soon interrupted. After about half an hour of what Spicer describes as “brisk” trade – his daughter’s recipe secret was some mint and a little bit of cucumber, for a “bit of a British touch” – four enforcement officers came striding up to the stand.

Three were in uniform, and one was in plain clothes. One uniformed officer turned the camera on his vest on, and began reciting a legal script at the weeping five-year-old.

“You’re trading without a licence, pursuant to x, y, z act and blah dah dah dah, really going through a script,” Spicer tells me, saying they showed no compassion for his daughter. “This is my job, I’m doing it and that’s it, basically.”

The girl burst into tears the moment they arrived.

“Officials have some degree of intimidation. I’m a grown adult, so I wasn’t super intimidated, but I was a bit shocked,” says Spicer. “But my daughter was intimidated. She started crying straight away.”

As they continued to recite their legalese, her father picked her up to try to comfort her – but that didn’t stop the officers giving her stall a £150 fine and handing them a penalty notice. “TRADING WITHOUT LICENCE,” it screamed.


Picture: André Spicer

“She was crying and repeating, ‘I’ve done a bad thing’,” says Spicer. “As we walked home, I had to try and convince her that it wasn’t her, it wasn’t her fault. It wasn’t her who had done something bad.”

She cried all the way home, and it wasn’t until she watched her favourite film, Brave, that she calmed down. It was then that Spicer suggested next time they would “do it all correctly”, get a permit, and set up another stand.

“No, I don’t want to, it’s a bit scary to do it again,” she replied. Her father hopes that “she’ll be able to get over it”, and that her enterprising spirit will return.

The Council has since apologised and cancelled the fine, and called on its officials to “show common sense and to use their powers sensibly”.

But Spicer felt “there’s a bigger principle here”, and wrote a piece for the Telegraph arguing that children in modern Britain are too restricted.

He would “absolutely” encourage his daughter to set up another stall, and “I’d encourage other people to go and do it as well. It’s a great way to spend a bit of time with the kids in the holidays, and they might learn something.”

A fitting reminder of the great life lesson: when life gives you a fixed penalty notice, make lemonade.

Anoosh Chakelian is senior writer at the New Statesman.