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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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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