Shell Shock Symptoms were Not Attributed to Combat Amnesia
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In this series, we have been focusing on the synergistic interplay between the emotional problems related to combat stress and war-time brain injuries. The previous blog focused on Charles Myers’ 1915 case studies of three British soldiers injured in World War I, and what we believe to be his failure to properly factor in combat amnesia, loss of smell (and taste) and the neuropathological and biomechanical explanations for brain injury. See “A Contribution to the Study of Shell Shock” published in the British Medical Journal, The Lancet, on February 13, 1915. Here we will focus on the specifics of combat amnesia, with the next page relating to loss of smell and the next, the likely neuropathological explanations for these three symptoms.
Combat Amnesia in Myers’ Patients
Myers seemed completely ignorant about the nature of combat amnesia and its correlative symptom of confabulation. Each of his patients had hallmark examples of post-traumatic amnesia. Soldier #1’s recollection of the ambulance ride is a classic: “He thinks he must have slept on the ambulance, as he remembers nothing.” How telling that Myers initialized those words in the original, as if it was evidence for what he said needed no comment, the similarity to “hysteria?”
Soldier #2’s narrative begins with the statement: “Can remember nothing until he found himself in a dressing station at a barn lying on straw.” According to Myers’ narrative, the soldier’s description of how he got hurt is clearly contradicted by uninjured eye-witnesses.
Soldier #3’s bizarre theory that he must have been knocked into a lake is a pure example of confabulation. The soldier admitted it was something he deduced, not something he actually remembered. Myers states: “He does not know how he got there or how he left the cellar, but he remembers being in another hospital before he was admitted here.” What other explanation is there for such statement other than amnesia?
While 1915 is nearly 100 years ago, it still seems odd that a combat physician would not realize the significance of combat amnesia with respect to a diagnosis of injury to the brain. As I have often commented – there is a collective wisdom passed down through the ages with respect to the symptoms of brain injury. The most understood of those symptoms is amnesia. See my essay: The Boy who Could Not Remember, taken from an Alaskan Indian myth.
Yet, Myers ignored that wisdom and the evidence in his own detailed case notes. The result: the wrong diagnosis. Could it be that with the other innovations of modern warfare having their genesis in World War I, the horror of supplanting thousands of years of human experience with the arrogance of a “modern” diagnosis, also arose?
What has been the impact of Myers getting it wrong on Western medical thought? That is hard to measure. But his sarcastic reference to the obvious hysteria diagnosis was published in the leading medical journal of its time, The Lancet. Over the next 75 years, the culprit of a false diagnosis of “hysteria” seeps into almost all neurological diagnosis. Only by focusing on the clear cut neuropathological clues found in Myers’ detailed case studies, can this stain on neurological diagnosis be removed.
This series will continue with a focus on the significance of loss of smell and taste to a modern diagnosis of brain injury.