The management of psychological casualties from large-scale attritional combat: shell shock, British military doctors and generals in the First World War.

A significant challenge faced by the British Army during the First World War was how to manage large-scale psychological casualties in a context of increasing manpower shortages. The high numbers threatened to undermine the fighting strength of the British Expeditionary Force and prompted the introduction of standardized regulations and treatment programmes. Fundamental disagreements about their design arose between three groups: senior regular medical officers, civilian specialists who had volunteered for Territorial or wartime service, and the generals responsible for the conduct of the war. A fierce debate arose between those who believed that medical expertise should drive casualty policy and those who thought that military goals were paramount. With growing shortages of replacement troops, shell shock was increasingly framed as a manpower issue in France to retain as many soldiers as possible on the frontline, reducing the authority of specialist clinicians. A growing realism of what could be endured in the trenches and what could be achieved by the treatment of severe cases informed different policies overseas and at home. The War Office Committee of Inquiry set up in 1920 was a tacit admission that the challenges created by the recognition of shell shock had not been solved during the conflict.