Salvete, readers!

With ANZAC Day fast approaching, I thought I would take a short break from my usual ramblings about classical history and historical fiction to share an essay on how the phenomenon of shell shock affected Australian medical attitudes toward psychiatry and mental illness during and after World War I.

World War I was catalytic in the history of Australian psychiatry. The war’s epidemic of shell shock prompted the gradual acceptance of Freudian ideas of the subconscious, and moreover altered medical perceptions of insanity. Prior to the war, Australian doctors followed their British counterparts in treating mental illness under value-laden terms such as “insanity” and “madness.” The mental hospital was yet to emerge as a facility for treating the mentally ill. Rather, the asylum system prevailed. Similarly, early psychiatrists were viewed by the medical community as immoral charlatans. However, the failure of traditional medicine and military discipline to cure shell shock pushed a few radical Australian and British doctors to experiment with Freud’s techniques and adopt his principles of the unconscious. However, Australia’s medical community was not willing to accept Freud wholesale. The urgent call for a cure made it necessary to streamline Freud’s ideas toward a more practical, therapeutic approach. Physicians also dropped the sexual component of Freud’s theories to render psychiatric principles morally palatable. Ultimately, the acceptance of psychiatry by Australian doctors would result in the abandonment of the asylum system in favour of the mental hospital, and the adoption of a more sympathetic attitude toward the mentally ill. As a result of shell shock, the nomenclature of mental illness became less judgemental and more clinical. These changes would have lasting effects in not only the military medical world, but also the civilian.

To contextualise shell shock within the history of Australian psychiatry, it is worthwhile first examining attitudes of the pre-war medical community toward mental illness. The Australian medical community followed that of the British in dealing with the mentally ill from the nineteenth century onward, as most doctors practising in Australia had trained in England, and were heavily influenced by British medical literature.[1] Australian physicians tended to view neurotics through the lenses of British modernity and moralism.[2] To this end, they treated neurotics as failures of mental and moral fibre. In men, mental illness was seen as a manifestation of “hysteria,” an effeminate weakness caused by personal lapse in masculine virtue. In the case of women, however, doctors viewed hysteria as an organic problem originating in malady of the uterus.[3] Social Darwinists also pointed toward madness as the result of supposed genetic predisposition toward, as Dr. Wolfsohn put it in 1918, “feeble-mindedness.”[4] Neurosis could be blamed upon degeneracy in subjects’ pedigree.

Doctors during the early twentieth century thus diagnosed mental illness by attaching labels to its victims, such as the aforementioned “madness” and “hysteria,” and also treated mental cases as “insane” or “lunatic.”[5] The employment of such a value-laden system of nomenclature in dealing with neurosis led physicians to view the mentally ill with contempt. At best, the insane were objects of pity, to be supported by community charity and the state. At worst, doctors viewed neurotics with scorn, a blemish upon the face of Australia.[6] Indeed, a limited minority of Australian doctors advocated a eugenic program of selective breeding, segregation, and state-sanctioned sterilisation of lunatics to breed out mental feebleness. This observation should be qualified, however. The idea of eugenics certainly held notoriety, but only a handful of doctors took it seriously.[7]

However, there can be little doubt that mental illness was little understood or appreciated in the years leading up to World War I.[8] Though some doctors felt compassion for lunatics, there was little question of curing them. The mentally unstable were treated as lepers– one may see this in the application of the term “alienist” to asylum doctors.[9] Asylums were often used not only to look after lunatics, but also to keep them safely away from society.[10] The asylum system thus provided a convenient rug under which the nation could sweep its mad men and women. To be committed was a crippling social stigma which was to be avoided at all costs.[11]

The application of the asylum system becomes immediately apparent upon examination of early reports on shell shock in the Medical Journal of Australia. As the nation’s most influential medical publication, the MJA was a cornerstone in shaping medical opinion on the treatment of the insane. The MJA’s first mention of shell shock comes from early 1915, in a brief sidebar:

 

It appears that a considerable number of recruits who were enlisted in Lord Kitchener’s army were found to be insane. These recruits are brought before the Medical Board, of which Dr. Milns is the Lunacy expert, and in all cases in which insanity in one or another form is discovered, are sent to the County Asylums or to their friends, after the necessary formalities are complied with…[12]

 

As the above passage illustrates, commitment to lunatic asylums or to private care were routine methods of treating madness at the war’s beginning. In the majority of cases, asylums were not the sinister places of legend. However, the asylum system was open to abuse, vividly demonstrated by inquiries into maltreatment and neglect in Britain’s infamous Bethlem Hospital and York Asylum.[13] Lunatic asylums were state-financed facilities, usually run by a small staff under a medical superintendent, most of whom lacked psychiatric training and were uninterested in psychiatry.[14] Essentially, asylums were caretaker facilities which theoretically provided care and sanctuary for the committed.[15] However, they were often overcrowded, understaffed and underfunded.[16] Maintaining the physical health of the insane was not a high priority for Australia’s state governments.

The medical community also looked upon psychiatrists and their profession with a suspicious eye for much of the early twentieth century.[17] Psychiatry was at this stage a largely untested field. Recent European advancements through the works of Freud and Jung were considered only pseudo-scientific by the British medical community.[18] Due to the aforementioned influence of British medical opinion over Australian, Australian doctors followed suit.[19] Freudian psychiatry was often rejected for nationalist reasons. Imperial loyalty to England forbade endorsement of radical “Teutonic medicine.”[20] Doctors also dismissed psychiatry as a quack profession. To an extent, this opinion was justified: the majority of psychiatrists of this era were not registered doctors.[21] Moreover, the medical community saw Freudian techniques of deep analysis of the subconscious as time-consuming, ineffective and wasteful.[22]

However, by far the greatest cause for concern for British and Australian doctors was the immorality of Freud’s theories regarding sexuality as the driving force behind human endeavour.[23] The Freudian principle that neurosis stemmed from repression of “infantile sexual libido” hardly gelled with Victorian or Christian moralism.[24] As Dr. Paul Dane put it in a furious letter to the editor of the MJA, the progress of psychotherapy was hampered even in 1926 by “the absurd criticisms and childish opposition of certain armchair philosophers.”[25] Though he had his adherents in Australia, Freud and his followers were seen as a corrupting force.[26] For this reason Australian medical schools did not offer psychiatric or psychological training until 1925.[27]

The sudden epidemic of shell shock during World War I, however, challenged such perceptions of psychiatry and dramatically altered Australian views regarding mental illness toward a more empathetic approach.[28] These changes were the result of a long, bitter dispute in the medical world between those who clung to the orthodoxy of traditional medicine and those willing to experiment with psychiatric therapies to treat shell shock.[29] The following paragraphs will outline this dispute and its results.

Shell shock posed a baffling dilemma to doctors at the front lines.[30] Men who had appeared rational were reduced to a state of being “acutely hysterical” after suffering trauma under fire.[31] Close observation of patients revealed that “….they are usually quite reasonable, and, strange to say, are capable of giving a lucid account of their condition in writing.”[32] Stranger still, victims often did not manifest physical symptoms.[33] While civilian psychiatrists immediately pointed to Freud’s theories, most military physicians clung to traditional organic explanations for war neurosis.[34] Initially, doctors surmised that sufferers of shell shock had “their nerves completely shattered by shell fire.”[35] Many surmised that the concussive effects of shell fire were to blame for the strange symptoms. It was reasoned that the effect of being buried, thrown, or blown up, had the effect of desynchronising the central nervous system, causing physical shock.[36] By the war’s ending, however, this theory was disproven, as many cases had not faced shell fire.[37]

Nonetheless, Australian doctors continued to seek an organic explanation for shell shock. The most striking example of this development comes from Dr. Sydney Penn, who in 1918 vehemently argued that “infection of the tonsils, sinuses, antra, or teeth” was to blame for shell shock.[38] Though this seems laughable by contemporary standards, accurate anatomical knowledge of the central nervous system was scant at the time.[39] On the other hand, it is also worth considering prejudice in the medical system against experimentation with psychiatry for the reasons described above. Bias is evident in the MJA’s reviews of medical literature: until the 1920s, the anonymous reviewers gave glowing praise to publications which provided an organic explanation for shell shock, while condemning psychiatric treatises as “exaggeration or simulation.”[40] Military doctors who clung to the tenets of traditional medicine attempted to find other causes for shell shock, and thus avoid the corrupting influence of psychiatry.

The British army, however, tended to view shell shock as the result of a lapse in military discipline.[41] This is highly significant, as Australians suffering from shell shock on the Western Front were treated in British hospitals by British doctors during the war.[42] However, the Australian Army Medical Corps were allowed jurisdiction in regard to the health and wellbeing of Australian troops.[43] The compassion exhibited by Australian doctors in their treatment and diagnosis of war neuroses is striking. Romanticisation should be avoided, however. During the war’s early years, the AIF followed the British line closely, though this never extended to executing shell shocked troops as cowards or malingerers as it sometimes did in the British army.[44] Empathy for Australian troops under the “hell of fire” was not the only cause, but also to a sense of confusion in dealing with neurosis.[45] Uncertain as to the correct treatment, yet unwilling to inflict the indignity of commitment or punishment upon the neurotic Anzac, Australian doctors were more inclined than the British to offer medical discharge to shell shocked patients.[46] The contrast between British and Australian treatment of shell shock may be attributed to their motives. In wartime, the British were foremost interested in quickly returning wounded soldiers to the battlefield: this was perhaps justified, as England faced the threat of invasion.[47] The AIF, though no less committed to the war, were not so pressed. Moreover, Australian soldiers were all volunteers. Australia’s rejection of disciplinary action as a countermeasure against shell shock is fortunate, as the results could be disastrous.

The prior failure of discipline and traditional medicine to deal with shell shock left a vacuum which psychiatry could fill during the interwar years. No doctor serving in Australia’s military during the war was a trained analyst.[48] Indeed, though shell shock taught doctors “as never before how immense the influence is of the mind upon the body,” many still remained sceptical of psycho-analysis due to the repugnancy of Freud’s sexual theories.[49] Freud argued that the roots of shell shock lay in childhood and were strongly influenced by sexual impulses.[50] Such ideas gained little currency even among Freud’s Australian followers. Of more interest to military doctors working with psychological trauma were the concepts of emotional repression and mental defence mechanisms as causes and treating shell shock victims using Freud’s “talking cure,” the precursor of modern counselling.[51]

Yet the moral stigma of psychoanalysis’ predilection toward sexuality remained.  Once more the answer came from England, in the pages of the Lancet.[52] In a revolutionary 1917 article, Dr. W.H.R. Rivers coolly argued in favour of psychoanalysis– with caution.[53] In his opinion, moral outrage was no excuse to neglect a potential cure for shell shock. He argued that psychiatry’s “undoubted merits are in serious danger of being obscured, or even wholly lost to view, in the conflict produced by the extravagance of Freud’s adherents and the rancour of their opponents.”[54] A more moderate approach would produce results. To a large extent, Australian doctors heard his plea. Before the year’s ending, articles discussing the treatment of psychological casualties abounded in the MJA. This shift may conceivably have never occurred if the British Lancet had not advocated it first.

            Such conciliations toward psychiatry came at a cost to its practitioners. Unsurprisingly, Freud’s concept of sexuality was first bogeyman to be exorcised from the practice of psychiatry in Australia: as J.W. Springthorpe said, “the war neuroses have completely shattered the original perverted notion of a sexual basis and has driven such Freudism into oblivion.”[55] The removal of the sexualised dimension of psychiatry ultimately proved a boon for psychiatrists, as it allowed them the freedom to explore psychiatric treatments without the condemnation of their peers.[56] Hypnotism as a means of exploring patients’ subconscious was another treatment experimented with, but ultimately dropped. Hypnotic suggestion ably treated the symptoms of shell shock, but did not address the disease.[57] In fact, hypnosis could do more harm than good. While showing immediate outward signs of recovery, a patient could be left with a festering psyche as hypnotic suggestion urged further repression of the problem.[58]

Doctors further streamlined the talking cure during the interwar years. To a large extent, doctors were pushed to reject Freud’s laborious methods of deep analysis—examination of complex tensions between patients’ id, ego, and super-ego— to resolve emotional traumas faced throughout life, in favour of a more expedient approach.[59] The immense pressures of time and resources upon wartime doctors had prompted a shift toward a new treatment, “abreaction.”[60] Abreaction served to resolve the suppression of a single traumatic event in patients’ lives. Unlike deep analysis, abreaction involved sessions over the course of weeks or months, rather than years.[61] The techniques of abreaction would evolve toward modern civilian counselling techniques over the course of the 1920s. Discharged military doctors who had embraced psychotherapeutic techniques were already pushing for their application in the civilian world by 1917.[62] One of the main results of army doctors’ experimentation with shell shock treatment was the development of occupational therapy; the process of removing the patient from their usual surroundings and allowing them to vent pent-up feelings and offering objective advice were key features of occupational therapy adapted from treatments developed during the war.[63]

As psycho-analysis acquired a foothold upon Australian medicine, so too did the terminology of neurosis evolve toward medical jargon and thereby redefine psychosis as a medical rather than moral problem.[64] No longer would the sufferer of shell shock be labelled as hysterical or insane. The medical community came to view psychosis as a treatable clinical problem instead.[65] This new mode of nomenclature came about as doctors began to view mental cases with a less judgemental eye.[66] It was such a shift in attitude which prompted Drs. Smith and Pear in their seminal handbook on treating shell shock to suggest that:

 

The essence of the mentally afflicted patient’s trouble is some particular form of anxiety or worry which is individual and personal. The aim of diagnosis, therefore, should be not merely to determine the appropriate generic label for the affliction, but rather to discover the particular circumstances which have given rise to the present state.[67]

 

To an extent, this shift in attitude may be traced to issues of class. Those committed to asylums during the years leading up to the war were mostly vagrants, unemployed or itinerant workers. Madness, it appears, had been a condition almost exclusive to the poor.[68] Shell shock, on the other hand, did not discriminate between socio-economic classes. Well-educated officers too were susceptible to neurosis. One may argue, therefore, that shell shock for the first time presented Australian doctors with challenges of mental health from their own class.[69] Thus, the medical community came to the problem more sympathetically than they might have otherwise.

Such an attitude is clearly demonstrated in a 1919 MJA review. The author points out the “interesting fact that officers are especially prone to anxiety states, while most cases of compression hysteria fall among privates.”[70] Under terms later described in the MJA, these conditions amounted to essentially the same thing.[71] However, while the officer class was afflicted by a lamentable condition, the private was labelled under emasculative term of hysteria. If war neurosis did not afflict officers as well as privates, one may speculate that it would not have been such an over-riding concern for military doctors.

The most profound sign of the swing toward a clinical viewpoint is the replacement of the asylum system with that of the mental hospital. Indeed, the post-war treatment of shell shocked veterans was the main driver for the shift away from the asylum system. Among the earliest designated mental hospitals were those developed by the army for ex-servicemen in the mid 1920s.[72] The abandonment of the asylum was in the interests of returned Anzacs, as army’s Repatriation Department did not want its shell-shocked men made pariahs by the Australian community. Voluntary commitment to a mental hospital would carry less shame for the returned serviceman than the ignominy of the asylum.[73] To an extent, this was the case: numbers of patients treated by the repatriation hospital system soared from “1,570 in 1926 to 4,891 by 1939.”[74] The rise of the mental hospital was also a reaction to the medical community’s observation of the treatment of war neurotics in conventional hospitals, which caused some to rethink the curative befits of the asylum system.[75] As Dr. Paul Dane espoused,

 

Separate wards or special hospitals should in my opinion be provided.  If these psycho-neurotics are treated in an ordinary hospital, they are subjected to a good deal of uncalled-for criticism by the other patients who class some of them as “macroon;” the authority of the doctor is also gravely undermined by the same kind of criticism.[76]

 

The humane concern doctors such as Dane expressed for the wellbeing of their patients is commendable. However, it should be noted that other factors influenced the development of Australian mental hospitals. The Repatriation Commission hoped to ease the financial burden of pensions awarded to shell shock victims by curing them in such facilities.[77] Moreover, it was hoped that the research undertaken in state mental hospitals would be contusive to a psychological screening process in future wars, in order to avert the potential re-emergence of similar strains and increase the fighting effectiveness of the AIF.[78] The abandonment of the asylum system was a slow and steady process, the main beneficiaries of which were men. While mental hospitals were the preserve of male veterans during the interwar period, admissions of women to asylums increased dramatically.[79] It would take another World War for the psychological lessons learnt from the First to be cemented in the broader Australian community; nonetheless, the first steps had been taken.[80]

Shell shock in World War I redefined medical attitudes toward mental illness and led to the legitimisation of psychiatry in Australia. The epidemic challenged the conceptual validity of “madness.” The failure of traditional medicine to treat the problem pressed medical practitioners to adapt Freud’s theory of the subconscious mind and experiment with his techniques. This experimentation necessitated some changes to Australian psychiatry. However, the urgent call for a cure and strains upon resources led doctors to streamline Freudian notions in favour of an expedient, curative model. Australia’s medical community almost immediately exorcised Freud’s theories regarding human sexuality. This resulted in a sanitised version of psychiatry, which allowed Australian doctors the freedom to experiment with psychotherapy without the stigma of immorality. Such changes also aided the legitimatisation of psychiatry in Australia practitioners couched the practice of psychiatry in jargon acceptable to the medical community. No longer would mental cases be viewed as weaklings to be consigned to the asylum, but as patients suffering from curable illness. This shift in perception led to the gradual replacement of Australia’s asylum system with that of the mental hospital. Moreover, the psychiatric treatments developed by a handful of radical doctors in response to the crisis of shell shock would have lasting ramifications not only in the military medical world, but also the civilian. World War I thus marked a distinct turning point in the history of Australian psychiatry, leading toward public acceptance of psychiatric principles, and a greater medical awareness for the mentally ill.

 

Bibliography

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Dane, Paul. “The Psycho-Neuroses of Soldiers and their Treatment.” The Medical Journal of Australia. Vol 1, 25 April 1925, p. 427-30.

Downey, M.H. “The Management and Treatment of Early Insanity.” Australian Medical Gazette. Vol 2, 20 Dec 1911, pp. 719-24.

Freud, Sigmund. “Introduction.” In E. Jones (ed.), Psychoanalysis and the War Neuroses. Psychoanalytic Press, London, 1921, pp. 1-4.

 Jones, S. “Experiences in the Treatment of Voluntary Patients at the Psychiatric Clinic, Broughton Hall.” The Medical Journal of Australia. Vol 2. 4 September, 1926, pp. 316-19.

 Jones, W.E. “A Case of Shell Shock.” The Medical Journal of Australia. Vol 1, 4 March, 1916, p. 203-4.

 Jones, W.E. “Naval and Military News.” Medical Journal of Australia. Vol. 1, 16 January, 1915, p. 58.

 Lowson, J.P. “The Treatment of War Neuroses by Abreaction of the War Shock.” The Medical Journal of Australia. Vol. 2, 6 November, 1926, pp. 621-626.

 Maudsley, Henry. “Australasian Medical Congress, Brisbane, 1920.” The Medical Journal of Australia. Vol 2, 25 September 1920, pp. 324-6.

 McWhae, D.M. “Neuroses.” The Medical Journal of Australia. Vol 2, October 20, 1919, pp. 337-43.

 Morgan, Idris. “Hypnotic Suggestion.” The Medical Journal of Australia. Vol 1, 15 January 1927, pp. 85-92.

 Review. “Shell Concussion and War Neuroses.” The Medical Journal of Australia. Vol 1, 1 March, 1919, p. 173.

 Penn, Sydney. “A Plea for Adequate Recognition of the Part that can be Played in Shell-Shock by Septic Foci.” The Medical Journal of Australia. Vol 2, 10 August, 1918, pp. 115-6.

 Regnell, W.R. “The Psycho-Neuroses of War.” The Medical Journal of Australia. Vol 1, 7 June 1919, pp. 455-60.

 Rivers, W.H.R. “Freud’s Psychology of the Unconscious.” The Lancet. Vol 1, 16 June, 1917, pp. 912-14.

 Smith, E. and Pear, T. Shell Shock and its Lessons. Manchester University Press, Manchester, 1917.

 Springthorpe, J.W. “Twelve Months Service at the Front.” The Medical Journal of Australia. Vol 1, 29 April, 1916, pp. 355- 61.

 Springthorpe, J.W. “War Neuroses and Civil Practice.” The Medical Journal of Australia. Vol 2, 4 October, 1919, pp. 279-83.

 Summons, W.  “Medical Work Seen in the Australian Military Hospitals.” The Medical Journal of Australia. Vol. 2, 22 September, 1917, pp. 244-7.

 Wolfsohn, J.M. “The Predisposing Factors of War Psychoneuroses.” The Lancet. Vol. 11918, p. 177.

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 Cooter, M. Malingering in Modernity: Psychological Scripts and Adversarial Encounters in the First World War.” In M. Cooter and R. Harrison and S. Sturdy (eds.), War, Medicine and Modernity. Stroud, Sutton, 1998, pp. 125-9.

 Damousi, Joy. Freud in the Antipodes: a Cultural History of Psychoanalysis in Australia. Sydney, Sydney University Press, 2005.

 Finlay-Jones, R. “The Effect of War on the Theory and Practice of Psychiatry in Australia.” In H. Attwood and R.W. Home (eds.), Patients, Practitioners and Techniques. University of Melbourne Press, Melbourne, 1985, pp. 43-55.

 Gammage, B. The Broken Years: Australian Soldiers in the Great War. Penguin, Hammondsworth, 1975.

 Garton, Stephen. “Asylum Histories: Reconsidering Australia’s Lunatic Past.” In Catherine Colebourne and Dolly MacKinnon (eds.), ‘Madness’ in Australia: Histories, Heritage and the Asylum. Brisbane: University of Queensland Press, 2003, pp. 11-23.

 Garton, Stephen. The Cost of War: Australians Return. Oxford University Press, Oxford, 1996.

 Garton, Stephen. Medicine and Madness: a Social History of Insanity in New South Wales, 1880-1940. New South Wales University Press, Kensington, 1988.

 Kosky, R. “From Morality to Madness: a Reappraisal of the Asylum Movement in Psychiatry, 1800-1940.” Australian and New Zealand Journal of Psychiatry. No. 20, 1986, pp. 180-7.

 Leese, Peter. Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War. Palgrave McMillan, Hampshire, 2002.

 Lewis, M. Managing Madness: Psychiatry in Australia 1788-1980. AGPS Press, Canberra, 1988.

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 O’Neil, W.M. A Century of Psychology in Australia. Sydney University Press, Sydney, 1987.

 Shephard, Ben. A War of Nerves: Soldiers and Psychiatrists 1914-1994. Pimlico, London, 2002.

 Stone, Martin. “Shell Shock and the Psychologists.” In W.F. Bynum, Roy Porter, Michael Shepherd (eds.), The Anatomy of Madness: Essays in the History of Psychiatry Volume II. Tavistock Publications Ltd, London, 1985, pp. 242-71.

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Endnotes

[1] Michael Tyquin, Madness and the Military: Australia’s Experience of the Great War, Australian Military History Publications, Sydney, 2006, p. 87.

[2] M. Cooter, Malingering in Modernity: Psychological Scripts and Adversarial Encounters in the First World War,” in M. Cooter and R. Harrison and S. Sturdy (eds.), War, Medicine and Modernity, Stroud, Sutton, 1998, p. 126.

[3] This idea is perhaps best illustrated in M.H. Downey, “The Management and Treatment of Early Insanity,” Australian Medical Gazette, vol 2, 20 Dec 1911, p. 724.

[4] J.M. Wolfsohn, “The Predisposing Factors of War Psychoneuroses,” The Lancet, vol 1, 1918, p. 177; Tyquin, Madness and the Military, p. 34.

[5] Tyquin, Madness and the Military, p. 18.

[6] Tyquin, Madness and the Military, p. 46.

[7] Stephen Garton. Medicine and Madness: a Social History of Insanity in New South Wales, 1880-1940, New South Wales University Press, Kensington, 1988, p. 60.

[8] E. Smith and T. Pear, Shell Shock and its Lessons, Manchester University Press, Manchester, 1917, p. 94.

[9] Peter Barham, Forgotten Lunatics of the Great War, Yale University Press, London, 2004, p. 105; Simon Wessely, Shell Shock to PTSD, Taylor and Francis Press, Haboken, 2005, p. 50.

[10] Garton. Medicine and Madness, p. 4.

[11] Smith and Pear, Shell Shock and its Lessons, p. 84.

[12] W.E. Jones, “Naval and Military News,” Medical Journal of Australia, vol. 1, 16 January, 1915, p. 58.

[13] Garton. Medicine and Madness, p. 14.

[14] M. Lewis, Managing Madness: Psychiatry in Australia 1788-1980, AGPS Press, Canberra, 1988, p. 35; Martin Stone, “Shell Shock and the Psychologists,” in W.F. Bynum, Roy Porter, Michael Shepherd (eds.), The Anatomy of Madness: Essays in the History of Psychiatry Volume II, Tavistock Publications Ltd, London, 1985, p. 242.

[15] R. Kosky, “From Morality to Madness: a Reappraisal of the Asylum Movement in Psychiatry, 1800-1940,” Australian and New Zealand Journal of Psychiatry, no. 20, 1986, p. 181.

[16] Garton. Medicine and Madness, p. 60.

[17] Stone, “Shell Shock and the Psychologists, p. 266.

[18] A.G. Butler, The Official History of the Australian Army Medical Services in the War of 1914-18 Volume III: Special Problems and Services, Australian War Memorial, Canberra, 1943, p. 61.

[19] Tyquin, Madness and the Military, p. 87.

[20] Stone, “Shell Shock and the Psychologists, p. 255.

[21] Garton. Medicine and Madness, p. 84.

24 J.P. Lowson, “The Treatment of War Neuroses by Abreaction of the War Shock,” The Medical Journal of Australia, vol 2, 6 November, 1926, p. 621;Tyquin, Madness and the Military, p. 71.

[23] Joy Damousi, Freud in the Antipodes: a Cultural History of Psychoanalysis in Australia,Sydney, SydneyUniversity Press, 2005, p. 32.

[24] Paul Dane, “Psychoanalysis and Psychotherapy,” The Medical Journal of Australia, vol 2, 18 December 1926, p. 853; Stone, “Shell Shock and the Psychologists, p. 255.

[25] Dane, “Psychoanalysis and Psychotherapy,” p. 853.

[26] Damousi, Freud in the Antipodes, p. 35.

[27] W.M. O’Neil, A Century of Psychology in Australia, Sydney University Press, Sydney, 1987, p. 27.

[28] Damousi, Freud in the Antipodes, p. 35.

[29] Stone, “Shell Shock and the Psychologists, p. 246.

[30] Butler, Official History Vol III, p. 106.

[31] Jones, “Naval and Military News,” p. 58.

[32] Jones, “Naval and Military News,” p. 58.

[33] Stephen Garton, The Cost of War: Australians Return, OxfordUniversity Press, Oxford, 1996, p. 143.

[34] Tyquin, Madness and the Military, p. 28.

[35] Jones, “Naval and Military News,” p. 58.

[36] W.E. Jones, “A Case of Shell Shock,” The Medical Journal of Australia,  4 March, 1916, p. 203.

[37] R. Finlay-Jones, “The Effect of War on the Theory and Practice of Psychiatry in Australia,” in H. Attwood and R.W. Home (eds.), Patients, Practitioners and Techniques, University of Melbourne Press, Melbourne, 1985, p. 48. Smith and Pear, Shell Shock and its Lessons, p. 21; W. Summons, “Medical Work Seen in the Australian Military Hospitals,” The Medical Journal of Australia, vol. 2 22 September, 1917, p. 246.

[38] Sydney Penn, “A Plea for Adequate Recognition of the Part that can be Played in Shell-Shock by Septic Foci,” The Medical Journal of Australia, vol 2, 10 August, 1918, p. 115.

[39] Smith and Pear, Shell Shock and its Lessons, p. 99.

[40] Reviews, “Shell Shock and War Neuroses,” The Medical Journal of Australia, vol. 1, 1 March, 1919, p. 175.

[41] Stone, “Shell Shock and the Psychologists, p. 250.

[42] Tyquin, Madness and the Military, p. 87.

[43] Tyquin, Madness and the Military, p. 104.

[44] Tyquin, Madness and the Military, p. 88.

[45] J.W. Springthorpe, “Twelve Months Service at the Front,” The Medical Journal of Australia, vol. 1, 29 April, 1916, p. 359.

[46] Finlay-Jones, “The Effect of War on the Theory and Practice of Psychiatry in Australia,” p. 48.

[47] Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War, Palgrave McMillan, Hampshire, 2002, p. 70.

[48] Butler, Official History Vol III, p. 126.

[49] W.R. Regnell, “The Psycho-Neuroses of War,” The Medical Journal of Australia, vol. 1, 7 June 1919, p. 455.

[50] Sigmund Freud, “Introduction,” in E. Jones (ed). Psychoanalysis and the War Neuroses, Psychoanalytic Press, London, 1921, p. 2.

[51] Stone, “Shell Shock and the Psychologists, p. 256.

[52] Stone, “Shell Shock and the Psychologists, p. 257.

[53] W.H.R. Rivers, “Freud’s Psychology of the Unconscious,” The Lancet, vol.1, 16 June, 1917, p. 912; However, Shephard points out that Rivers was not the first to do this: in fact, the such first adaptation in the history of military medicine came from Dr. David Eder, while working with Australian snipers evacuated from Gallipoli. B. Shephard, A War of Nerves: Soldiers and Psychiatrists 1914-1994, Pimlico, London, 2002, pp. 85-6.

[54] Rivers, “Freud’s Psychology of the Unconscious,” p. 912.

[55] J.W. Springthorpe, “War Neuroses and Civil Practice,” The Medical Journal of Australia, vol. 2, 4 October, 1919, p. 280. This response may also be seen in Dr. George E. Rennie’s speech at the 1920 Australasian Medical Conference, as reported in the MJA: “He stated that, while he had long recognised the value of psycho-therapy, he had been prejudiced against the doctrine… on account of the unjustifiable reference of almost everything to sexual impulses.” Henry Maudsley, “Australasian Medical Congress, Brisbane, 1920” The Medical Journal of Australia, vol. 2, 25 September 1920, p. 324; Damousi, Freud in the Antipodes, p. 36.

[56] Damousi, Freud in the Antipodes, p. 35.

[57] Smith and Pear, Shell Shock and its Lessons, p. 40; Idris Morgan, “Hypnotic Suggestion,” The Medical Journal of Australia, vol. 1, 15 January 1927, p. 87. Morgan reports a case in which his shell-shocked patient, having been subjected to hypnosis, suffered a relapse weeks later.

[58] Smith and Pear, Shell Shock and its Lessons, p. 43.

[59] Tyquin, Madness and the Military, p. 71.

[60] Tyquin, Madness and the Military, p. 71.

[61] Lowson, “The Treatment of War Neuroses by Abreaction of the War Shock,” p. 621.

[62] Smith and Pear, Shell Shock and its Lessons, p. 108; Springthorpe, “War Neuroses and Civil Practice,” p. 281.

[63] Finlay-Jones, “The Effect of War on the Theory and Practice of Psychiatry in Australia,” p. 51.

[64] Stephen Garton, “Asylum Histories: Reconsidering Australia’s Lunatic Past,” in Catherine Colebourne and Dolly MacKinnon (eds.), ‘Madness’ in Australia: Histories, Heritage and the Asylum, Brisbane: University of Queensland Press, 2003, p. 15.

[65] Butler, Official History Vol III, p. 56.

[66] Damousi, Freud in the Antipodes, p. 35.

[67] Smith and Pear, Shell Shock and its Lessons, p. 48.

[68] Garton, Medicine and Madness, p. 187.

[69] Leese, Shell Shock, p. 113. Although Leese exclusively focuses upon the British army, his argument that class shaped medical perceptions of shell shock is clearly echoed through the MJA article quoted below. Tyquin, on the other hand, suggests that this was not the case in the AIF, “where soldiers particularly recognised, and deferred to, ability before hierarchy.” Tyquin, Madness and the Military, p. 88. This may have been the case in the army, however it does seem to contradict the evidence exhibited in the MJA.

[70] Review, “Shell Concussion and War Neuroses,” p. 173.

[71] D.M. McWhae, “Neuroses,” The Medical Journal of Australia, vol. 2, October 20, 1919, pp. 338, 339.

[72] Tyquin, Madness and the Military, pp. 100-101

[73] S. Jones, “Experiences in the Treatment of Voluntary Patients at the Psychiatric Clinic, Broughton Hall,” The Medical Journal of Australia, vol 2, 4 September, 1926, p. 316.

[74] Tyquin, Madness and the Military, p. 148. However, Tyquin does not consider that these numbers are to some extent artificially inflated by the Great Depression. It is likely that the numbers rise so dramatically due to veterans’ desire for a war pension awarded on the basis of shell shock, as a partial replacement for livelihoods lost in the 1929 crash.

[75] Kosky, “From Morality to Madness,” p. 181.

[76] Paul Dane, “The Psycho-Neuroses of Soldiers and their Treatment,” The Medical Journal of Australia, vol. 1, 25 April 1925, p. 430.

[77] Finlay-Jones, “The Effect of War on the Theory and Practice of Psychiatry in Australia,” p. 51.

[78] A.D. Carbery, “Some Medical Aspects of Recruiting for War,” The Medical Journal of Australia, vol. 2, 3 August 1927, pp. 365-70; Finlay-Jones, “The Effect of War on the Theory and Practice of Psychiatry in Australia,” p. 49.

[79] Tanja Luckins, “Crazed with Grief? The Asylum and the Great War in Australia,” in Catherine Colebourne and Dolly MacKinnon (eds.), ‘Madness’ in Australia: Histories, Heritage and the Asylum, University of Queensland Press, Brisbane, 2003, p. 169.

[80] W.M. O’Neil, “The Teaching and Practise of Psychology in Australia in its First Phases,” in Mary Nixon and Donald Taft (eds.), Psychology in Australia, Oxford University Press, Oxford, 1977, p. 15.