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.

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Is defeat in Stoke the beginning of the end for Paul Nuttall?

The Ukip leader was his party's unity candidate. But after his defeat in Stoke, the old divisions are beginning to show again

In a speech to Ukip’s spring conference in Bolton on February 17, the party’s once and probably future leader Nigel Farage laid down the gauntlet for his successor, Paul Nuttall. Stoke’s by-election was “fundamental” to the future of the party – and Nuttall had to win.
 
One week on, Nuttall has failed that test miserably and thrown the fundamental questions hanging over Ukip’s future into harsh relief. 

For all his bullish talk of supplanting Labour in its industrial heartlands, the Ukip leader only managed to increase the party’s vote share by 2.2 percentage points on 2015. This paltry increase came despite Stoke’s 70 per cent Brexit majority, and a media narrative that was, until the revelations around Nuttall and Hillsborough, talking the party’s chances up.
 
So what now for Nuttall? There is, for the time being, little chance of him resigning – and, in truth, few inside Ukip expected him to win. Nuttall was relying on two well-rehearsed lines as get-out-of-jail free cards very early on in the campaign. 

The first was that the seat was a lowly 72 on Ukip’s target list. The second was that he had been leader of party whose image had been tarnished by infighting both figurative and literal for all of 12 weeks – the real work of his project had yet to begin. 

The chances of that project ever succeeding were modest at the very best. After yesterday’s defeat, it looks even more unlikely. Nuttall had originally stated his intention to run in the likely by-election in Leigh, Greater Manchester, when Andy Burnham wins the Greater Manchester metro mayoralty as is expected in May (Wigan, the borough of which Leigh is part, voted 64 per cent for Brexit).

If he goes ahead and stands – which he may well do – he will have to overturn a Labour majority of over 14,000. That, even before the unedifying row over the veracity of his Hillsborough recollections, was always going to be a big challenge. If he goes for it and loses, his leadership – predicated as it is on his supposed ability to win votes in the north - will be dead in the water. 

Nuttall is not entirely to blame, but he is a big part of Ukip’s problem. I visited Stoke the day before The Guardian published its initial report on Nuttall’s Hillsborough claims, and even then Nuttall’s campaign manager admitted that he was unlikely to convince the “hard core” of Conservative voters to back him. 

There are manifold reasons for this, but chief among them is that Nuttall, despite his newfound love of tweed, is no Nigel Farage. Not only does he lack his name recognition and box office appeal, but the sad truth is that the Tory voters Ukip need to attract are much less likely to vote for a party led by a Scouser whose platform consists of reassuring working-class voters their NHS and benefits are safe.
 
It is Farage and his allies – most notably the party’s main donor Arron Banks – who hold the most power over Nuttall’s future. Banks, who Nuttall publicly disowned as a non-member after he said he was “sick to death” of people “milking” the Hillsborough disaster, said on the eve of the Stoke poll that Ukip had to “remain radical” if it wanted to keep receiving his money. Farage himself has said the party’s campaign ought to have been “clearer” on immigration. 

Senior party figures are already briefing against Nuttall and his team in the Telegraph, whose proprietors are chummy with the beer-swilling Farage-Banks axis. They deride him for his efforts to turn Ukip into “NiceKip” or “Nukip” in order to appeal to more women voters, and for the heavy-handedness of his pitch to Labour voters (“There were times when I wondered whether I’ve got a purple rosette or a red one on”, one told the paper). 

It is Nuttall’s policy advisers - the anti-Farage awkward squad of Suzanne Evans, MEP Patrick O’Flynn (who famously branded Farage "snarling, thin-skinned and aggressive") and former leadership candidate Lisa Duffy – come in for the harshest criticism. Herein lies the leader's almost impossible task. Despite having pitched to members as a unity candidate, the two sides’ visions for Ukip are irreconcilable – one urges him to emulate Trump (who Nuttall says he would not have voted for), and the other urges a more moderate tack. 

Endorsing his leader on Question Time last night, Ukip’s sole MP Douglas Carswell blamed the legacy of the party’s Tea Party-inspired 2015 general election campaign, which saw Farage complain about foreigners with HIV using the NHS in ITV’s leaders debate, for the party’s poor performance in Stoke. Others, such as MEP Bill Etheridge, say precisely the opposite – that Nuttall must be more like Farage. 

Neither side has yet called for Nuttall’s head. He insists he is “not going anywhere”. With his febrile party no stranger to abortive coup and counter-coup, he is unlikely to be the one who has the final say.