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Skip to 0 minutes and 10 secondsWe call it PTSD, Post-Traumatic Stress Disorder. But what's the history of this condition? Well, the short answer is that it was first recognised and diagnosed at the time of the First World War, and the name for it was shell shock. And in a way, literature, poetry in particular, has a particularly close relationship to this history. Because one of the first doctors who really understood shell shock and how it should be treated was Dr. W. H. R. Rivers, who ran a residential facility for wounded First World War soldiers, at Craiglockhart, near Edinburgh. And among the people he treated there in latter part of the First World War were the poets Siegfried Sassoon, Wilfred Owen, and Robert Graves.

Skip to 1 minute and 3 secondsSassoon and Owen indeed met and formed their great friendship at Craiglockhart. And some of their finest war poems reflect their experience there. Pat Barker's novel, Regeneration, which was very successful as a novel and a film, explores this whole area. But fascinatingly, when I began work on trying to find out what was the earliest example of a war poem that was somehow reflecting the experience of shell shock, I found that it happened much earlier in the war, indeed just within a few months of the war beginning. The poet in question was called W. W. Gibson-- not anybody that we read now. I'm not sure I'd even heard of him before doing this piece of research.

Skip to 1 minute and 49 secondsHe was a very popular poet among the group of so-called Georgian poets, writing in the reign of King George V in the period immediately before the First World War. He didn't join up himself, but he was very interested in reading in the newspapers about the experience of soldiers on the Western Front. And indeed he interviewed the returning wounded soldiers even in those first few months of the war. And so it was that in October of 1914, just a few months after the war began, he published a poem. It was published in a liberal newspaper, a newspaper that was probably arguing implicitly against the fact of the war going on. It was called 'The Messages,' and I've got it here.

Skip to 2 minutes and 37 secondsIt's written, to begin with, in the voice of a returning soldier. 'I cannot quite remember. There were five dropt dead beside me in the trench, and three whispered their dying messages to me. Back from the trenches, more dead than alive, stone deaf and dazed, and with a broken knee, he hobbled slowly, muttering vacantly. I cannot quite remember. There were five dropt dead beside me in the trench, and three whispered their dying messages to me. Their friends awaiting, wondering how they thrive, waiting a word in silence, patiently. But what they said or who their friends may be, I cannot quite remember. There were five dropt dead beside me in the trench, and three whispered their dying messages to me.'

Skip to 3 minutes and 27 secondsThe returning soldier, losing his memory, partially deaf and dazed, haunted by the memory of those who dropped dead beside him in the trench. Now at that point, in autumn 1914, the word 'shell shock' wasn't available to describe that experience. But clearly, that is the experience that is being described. It was a few months later, in early 1915, that a captain in the Royal Army Medical Corps called Charles Myers published an article in The Lancet called 'A Contribution to the Study of Shell Shock-- Being an Account of Three Cases of Loss of Memory, Vision, Smell and Taste, Admitted into the Duchess of Westminster's War Hospital in Le Touquet.'

Skip to 4 minutes and 15 secondsAnd a few months later, there was another article in the British Medical Journal called 'Remarks on Cases of Nervous and Mental Shock Observed in the Base Hospitals in France.' So that's where the word 'shell shock' comes from. I'm joined by Andrew Schuman, general practitioner and poetry-lover. Andrew, this account of shell shock, what we now call PTSD, involving loss of memory but also interference to vision, smell, and taste, what's going on there? What's the connection between mental trauma and this effect on the senses? I think it's a loss of connection, between structures in the brain that we now know to function in the ordinary situation to receive external stimuli, that tell us whether to flee, the fight or flight reflex.

Skip to 5 minutes and 15 secondsAnd the structure in question is the Amygdala. The Greeks called it Amygdala, which is the Greek word for 'almond.' This almond-shaped structure. That's very deep within the brain, deep to the temporal lobes just above the brain stem. So it's a very ancient structure. And it's the first structure that lights up when these first stimuli of perceived or possible danger enter your brain and the Amygdala fires up, gets you ready to flee or to freeze, or the fight or flight reflex. Now, that's the most ancient structure. There's another structure called the Hippocampus, which is a seahorse-shaped structure that the Greeks called the Hippocampus, which is Greek for 'seahorse.' And that regulates the Amygdala. It's a bit higher up in the brain.

Skip to 5 minutes and 57 secondsAnd there's this interplay between the two that allow you to downplay the initial reaction, so you don't over-exaggerate your response to an external stimulus. You wake, for example, in the middle of the night, the sound of breaking glass, the Amygdala will fire up. Very soon, that'll be damped down. And then the more conscious areas of the brain will take over even further and you realise there's a bird flying through the window. It's not a robber gaining entrance to your house. So these structures deep within the brain are firing up automatically to begin with. And the problem, we think, with Post-Traumatic Stress Disorder is there's a problem with the communication between the two.

Skip to 6 minutes and 38 secondsSo the almond and the seahorse are not communicating. The seahorse isn't damping down this over-stimulated Amygdala. And if that doesn't happen, then you get this over-exaggerated response. These over-exaggerated neurological pathways being set up. And then if the disorder develops, then these pathways get set up and the loops can't be broken. So you get this recurring image, these recurring nightmares, both nightmares by night, but also living nightmares, where the image is played over and over again, these recurring loops of the original experience that can't be controlled. So this poem here seems like a marvellous account of exactly that, because the key to the poem is this repetition, 'I cannot quite remember.' But at the same time, he can't quite forget.

Skip to 7 minutes and 27 secondsAnd that in a way is exactly the sort of the tragedy, if you like, of PTSD.

Skip to 7 minutes and 35 secondsYou want to forget the bad thing that's happened, but you can't. But then somehow, you can't remember some of the other good things in your life. So it's a horrible thing, isn't it? Do you think there's a way that reading a poem that crystallises that experience might actually be helpful to people who have maybe had a traumatic experience themselves to know, 'I am not alone.' Someone else has had this experience. I think it is, because a lot of the experience of post-trauma is it creates--, you become isolated, withdrawn. And it becomes something that you experience alone.

Skip to 8 minutes and 18 secondsAnd I think the more-- And one of the features that can protect against PTSD developing is a perceived sense of social support, so you can have other people banding together, the 'Band of Brothers.' Historically, that's perhaps why a 'Band of Brothers' for many other reasons is formed, because you get this support network, which can somehow allow you to stop this disorder developing. But if you experience it alone, then you get this recurring-- and we end with ellipses at the end. It just goes on and on. It has no end. So that's interesting, the idea that a sort of social support group is something that can really help with PTSD.

Skip to 8 minutes and 59 secondsWilfred Owen was treated for what was then called shell shock, that we now call PTSD, at the Craiglockhart Hospital. Then after he was discharged from there, he was in Scarborough in a sort of recovery facility waiting to be redeployed back to the front, where of course eventually he was killed. But he wrote a poem there called 'Mental Cases,' where he just looks around the room at all these other soldiers who have been afflicted with shell shock. And he begins, 'Who are these? Why sit they here in twilight?' But there's a real sense that because he's part of a group, there's a way that the poem can help them to begin to share the experience.

Skip to 9 minutes and 45 secondsAnd that perhaps can be a form of catharsis. I think it is the sharing. And we see that, for example, at the end of Owen's poem the 'Disabled,' that he's left alone. And I think he says at the end, 'Why don't they come?' The nurses, he's referring to-- 'Why don't they come?' And he's so alone. And certainly in my practice, one of the biggest killers is isolation and loneliness, so, nowadays as then-- people being isolated and lonely, not having reassurance, not having social support, not having all the backup and humanity. And this touch-- there such important thing about touch. I think Albert Schweitzer said, 'Man belongs to man.

Skip to 10 minutes and 22 secondsMan has claims on man,' this thing that makes such a difference, both physical and metaphorical touch, that joins us together and has a healing quality. And that's how this feeds into that. You start linking both currently and historically with other people who experience what you've experienced and you become less alone. I think that's one of the many vital functions of any form of literature that joins you to others.

Physiology of PTSD: Discussion with Andrew Schuman GP

We begin by discussing the origins of PTSD with Dr Andrew Schuman.

We talk about some of the earliest descriptions of the symptoms of shell shock, which were published in medical journals during the First World War. These articles, published in the Lancet and the British Medical Journal, observe that the traumatic experiences of war interfere not just with soldiers’ memories, but also with their senses, their vision, smell and taste. Andrew talks to us about the physiology behind these symptoms, explaining how trauma disrupts communications between different structures in the brain, causing sufferers to feel anxious and alert despite no longer being in danger.

During our conversation, we discuss Wilfrid Wilson Gibson’s poem ‘The Messages’:

The Messages

“I cannot quite remember…. There were five
Dropt dead beside me in the trench—and three
Whispered their dying messages to me….”

Back from the trenches, more dead than alive,
Stone-deaf and dazed, and with a broken knee,
He hobbled slowly, muttering vacantly:

“I cannot quite remember…. There were five
Dropt dead beside me in the trench, and three
Whispered their dying messages to me….

“Their friends are waiting, wondering how they thrive—
Waiting a word in silence patiently….
But what they said, or who their friends may be

“I cannot quite remember…. There were five
Dropt dead beside me in the trench—and three
Whispered their dying messages to me….”

Wilfrid Wilson Gibson (1878–1962)

W. W. Gibson, Collected Poems 1905-1925, (Macmillan; London, 1929). Poem reproduced with kind permission of the Wilfrid Gibson Literary Estate.

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