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Bluebellies and Paupers; Trauma, Illness and Treatment During the First World War in Huddersfield

By Liam Wilde

I. Introduction

There appear to be two dominant views in the way of viewing the history of mental health. The first, is that our treatment of mental illness has always been progressive, that the inhumane practices utilised in the past are no more, and the reason for this comes from extensive experimentation with treatments. Take for instance, this extract (2013)

the York Retreat was set up by William Tuke. This was the first establishment in the UK to treat their patients as human beings and offer a therapeutic setting for them. […] Mechanical restraints were discontinued and work and leisure became the main treatment.

However, like many articles which focus on Tuke’s moral treatment, this section overstates his influence as immediate and everlasting. In reality, ‘England’s moral treatment was not that central in the medicalization of madness […] physicians saw Tukean moral therapy as a lay threat to their art and strove to avoid it or adapt it to their own practice’ (Merquior, 1991: p. 29). The aforementioned article also remarks that the insane were removed ‘from within work houses and provide[d] with a more sufficient and dedicated care system’. This jars considerably with first-hand accounts of Storthes Hall, which spoke with terror of their experiences. For instance, Thomas K, “thinks this place is a first class prison and that he is confined here for being a conscientious objector”, James G reported that “he is suffering here and that this is not a hospital” (WYAS, C416/5/159), and William H’s “attitude toward the medical staff is rather hostile since he regards them as partly responsible for his detention.” (WYAS, C416/5/157). It is notable that Thomas K.’s belief that he is confined to the asylum for being a conscientious objector has grounding in fact. Abuse of psychiatry to silence political dissent of view was, and still is, not uncommon, ‘diagnosis, detention, and treatment, for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society’ (Voren, 2016: p. 1) happened often, and ‘in many countries, political prisoners are sometimes confined to mental institutions and abused therein’ (Fadul, 2014: p. 41), due to the fact that asylums have a greater capacity to punish the people they house. Throughout the course of the First World War, Storthes Hall ‘took both the physically wounded and the mentally disturbed; some of the latter remaining there for life’ (p. 283), with the majority of patients ‘suffering from some form of delusional insanity precipitated by the strain of war’ (Brumby, 2015: p. 134) as well as those ‘suffering from shell-shock and gas inhalation’ (Hirst, 2015). One of the Hospital’s buildings, known as the ‘Acute’ building cared for soldiers solely and Storthes Hall as a whole cared for men and women predominantly from working class backgrounds and occupations, since it was part of an institution which offered free medical care. The clear majority of men are listed under the term ‘Labourer’ in casebooks, with fifty-seven patients out of three-hundred falling into this category. ‘Labourers’ held a clear majority over other patients committed to the asylums who were of varying occupations. Many were listed as millworkers, mechanics, miners,

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decorators and builders. While these occupations occurred irregularly in the casebooks, the term ‘Labourer’ appears consistently. This article examines the wide variety of practices and viewpoints of mental health during the First World War, such as the conflict between the emergence of Freudian psychoanalysis and the development of practices which sought the cure for mental illnesses in the body, where doctors often submitted their patients to intense and often traumatising treatment. This must be connected with conceptualisations of madness implemented by the rigid social structures of the Victorian Era, the morality of which was ground away in the war’s aftermath by disillusionment. As the writer and art collector Gertrude Stein famously put it ‘all of the young people who served in the war […] are a lost generation’ (Hemingway, 1994: p. 1).

II. Print Culture and Health

While a patient at Storthes Hall, George G. did not serve in the armed forces during the First World War on account of his age and frailty; his case illustrates the ability of war to permeate the conscious lives of everyday citizens. George was what could be considered a monomaniac. He is dismissed as ‘deluded’ by the doctors, recorded as making ‘numerous and inconsistent statements regarding the war. [He] says he means to stop it by altering the face value of the coinage and other ludicrous statements. He writes for interviews with Asquith and Lord Kitchener, says he can benefit the world with his ideas’ (1914) and he describes himself hallucinating the Kaiser. What is most intriguing about George’s case is that his hallucinations and ‘delusions’ correspond with the figureheads and images we immediately associate with the war, before these images and figureheads were even established as iconographic. George’s near monomaniacal obsession with Kitchener and Asquith reflects the manner in which the war was reported. The subject of the ‘Great War’ saturated every aspect of culture because of its alterations of the rigid pre-existing structures left by the Victorian era, most obviously, its latent sexism by women who took on the previous roles of men thereby addressing myths of sexual difference. As I have also attempted to elucidate, the War’s effect on medicine is no exception. This is exemplified in many artefacts from the era; take for instance these two advertisements.

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The advertisement on the left for ‘Peps’ is taken from the Dewsbury Reporter of November 17th 1916 and appropriates the anteriority that war inevitably constructs in setting people against one another. The advertisement pits the cold-sufferer against the germs as the First World War did to various nations. The concept of an ‘enemy’ is displaced for the ‘germ’ or invading virus, a word which may even, given the context and the connotations of the advertisement (the medicine is described as killing the invading virus) be interpreted as a play upon ‘German’. Additionally, the image of a soldier patrolling, and the imperative that the consumer must remain ‘on guard against coughs, colds and bronchitus’ immediately affixes the product to military practice and the phrase ‘strength to resist’ reinforces ideas of military vigilance. A very similar rhetorical device is employed in the second image (Dewsbury Reporter, October 16th 1915), which claims that ‘Germs and microbes of disease must be destroyed at all cost’, an imperative sentence which evokes the language of military rhetoric.

These artefacts are telling of attitudes towards war and health during the First World War. They demonstrate that it was not uncommon for companies offering protection for the general public to play upon the public’s existing attitudes and anxieties regarding the war in order to profiteer. They affix the imagery of the war to that of medicines and cures to a sanitised rendition of the trenches. Just as England claimed the Kaiser and his forces must be eviscerated, so did the general public believe the same must happen for their ailments. The First World War’s relationship with health is further exemplified by articles which professed to give medical advice from the era. On page two of any edition of the Dewsbury Reporter from the First World War era there is a section entitled ‘Talks on Health from a Family Doctor’, a column which gave suggestions to readers on how to stay healthy. It ran

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for several years, consistently throughout the period of the First World War, and when it appeared, it was often surrounded by a torrent of advertisements for health products such as Peps or Lifebuoy’s Soap. The column appropriated the register to be found in advertisements which manipulate the imagery of the front lines, often stretching the definition of what qualifies as doctor’s advice. It was often composed of articles which were short and didactic to the point of condescension. They often addressed the reader in the second person, and in doing so, simulate the relationship of a doctor to a patient. Take for instance, this excerpt of two short articles upon the subject of ambidexterity, taken from the Dewsbury Reporter of 23rd September 1915.

While what is said in these articles is, strictly speaking, true, the article merely offers ‘advice’ on an instinctive reaction. Nevertheless, the column plays well into the interest the general readership were made to have in the war by print culture. The theme of war persists in other articles from this column. Take for instance, an article from the Dewsbury Reporter of October 9th 1915 entitled ‘Anti-German Energy’.

The article primarily re-enforces the importance of rationing, describing that ‘no one ought to put on weight as fat’, while simultaneously associating health with combat, urging the public to maintain health purely for combative purposes. From this, it becomes clear that the public were ‘anxious to get them well as soon as possible so that to they may re-join the

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fighting line’1 and that journalism’s engendering of health and war became a practice which served a military end.

III. Attitudes Towards Mental Health in Huddersfield and Elsewhere

Attitudes and practices towards caring for and curing the mentally ill in the earlier quarter of the twentieth century self-perpetuated the manner in which those suffering from neuroses were looked upon. This is evidenced by the logic or iconography of the now questionable practices carried out upon patients at Storthes Hall. In looking at these practices, it becomes tempting to make the claim patients were thought of as lesser than the ‘sane’ and subsequently were treated as such, which cemented this fallacy. This is made largely apparent through methods of cure. For instance, one of the most controversial therapies utilised at Storthes Hall is called ‘Malaria Therapy’, used as a treatment for General Paralysis of the Insane, or GPI for short. This illness was a ‘stage of tertiary syphilis characterized by dementia and spastic weakness of the limbs (paresis). Deafness epilepsy and dysarthria may occur’ (O.I., 2016), and therefore can be viewed in relation to diseases such as Huntington’s or Parkinson’s. GPI sufferers typically exhibit symptoms analogous to these illnesses, with the disease attacking the body’s central nervous system. To cure this, the afflicted patient was (Littlewood, 2003: p. 50)

deliberately infected with malaria […] some wards had mosquito grills on the windows, designed to keep the mosquitoes in. After five or six attacks of malaria fever, quinine would be given the patient to alleviate the fever.

This was widely regarded as successful treatment for those suffering from GPI. Its positive outcomes became so widespread that the person who discovered that malaria improved the condition of GPI sufferers, Dr. Julius Wagner-Jauregg, was given the Nobel Prize in Physiology or Medicine in 1927 for “his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica” (2014). Nevertheless, this method of cure is, of course, now regarded as retrograde by first world medicine and has since been discontinued with the implementation of penicillin as a treatment for syphilis (2016) and the destruction of Juregg’s reputation after he became involved with the Nazi party. Some treatments which were practiced at Storthes and are regarded by some as ‘retrograde’ are, in some cases, still practiced – although the conditions of these treatments’ usage have changed since the years of the asylum. For example, Electro Convulsive Therapy (ECT) is continuously practiced, though now only with informed consent on behalf of the patient (2013). In most cases however, and for reasons which should be obvious to anyone familiar with the treatment, talking therapies are used as a substitute for the treatment. This has led to the claims that the history of American psychiatry is comparable to a pendulum, ‘In this metaphorical rendering, psychiatry has swung back and forth between extremes of 1 The notion of sending a soldier back to battle after being injured would not have appeared disturbing as it does now, due to mass censorship of pieces portraying the front lines in a negative light. As Stephen Badsley remarks: ‘After the first few months of the war, armies were able to ban newspaper journalists from visiting and reporting on the front-line troops. Instead, armies and navies issued official communiqués’. However, the Dewsbury Reporter was largely ambivalent towards the nature of the front lines; articles varied from displaying the wonders of comradery to descriptions of apocalyptic shelling.

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emphasis on psyche […] and soma’ (Sadowsky, 2006: p. 1), that is, an oscillation between an emphasis on inner conflict or neurology, talking cures dominating the former school of thought and biochemical sources the latter. This is a debate which relates far beyond psychiatry and to the philosophies of the Renaissance which concern the properties of the ‘Mind’. It is worth noting that ECT was not practiced on traumatised service patients during the First World War; however, its far more dangerous predecessors, such as Cardival treatment and Chemical convulsive therapy were very popular treatments for shell-shocked soldiers (Simkin, 2016). Treatments such as these were ‘feared by patients and was considered dangerous by clinicians. ECT emerged from a desire to find a safer way to induce convulsions that would produce the same therapeutic effect’ (Sadowsky, p. 10). There are numerous arguments for and against shock therapies. One camp is highly critical of their usage, claiming that they ‘stand[s] practically alone among the medical/surgical interventions in that misuse was not the goal of curing but of controlling the patients for the benefits of the hospital staff’ (David J. Rothman, 1985, cited by Sabbatini). This is a notion represented famously in Ken Kesey’s One Flew Over the Cuckoo’s Nest, a novel based upon the author’s first hand experiences of working in a psychiatric institution, where a ‘patient’ is given ECT seemingly to subdue him. The opposing side, however, insist that when used appropriately, ECT can be incredibly effective in treating mental disorder. One physician claims ‘ECT works. There are a number of theories to account for its efficacy, but no consensus; its efficacy has nevertheless been conceded even by many hostile critics, whose concern has been with the safety of the procedure’ (Sadowsky, p. 9). Nevertheless, it is plainly suggestible that GPI should not have been treated at Storthes Hall to begin with due to its likeness to non-behavioural illnesses. These treatments suggest that precedence was given to correcting or ‘curing’ without concern for the general wellbeing of the patients. As Foucault (2001: p. 167) points out in Madness and Civilisation, an oft-cited landmark in anti-psychiatry writing:

The technique of cure, down to its physical symbols most highly charged with iconographic intensity […] is secretly organised around these two fundamental themes: The subject must be restored to his initial purity, and must be wrested from his pure subjectivity in order to be initiated into the world.

Treatment therefore can be seen as a means to purge the irrational or ‘diseased’ patient of the ailment, so that he or she might be restored to a more ‘functional’ state, ultimately warranting a distinction to be exposed between ‘cure’ and ‘care’ in this discourse of history, which appears to be what Foucault argues for in his book.

Patients of Storthes Hall were thought of as a community of people who operated on principles radically different from those of Huddersfield town. However, I would argue that this way of thinking about the insane stemmed from the confinement of the mentally ill and their subsequent silencing. Detaining these men and women in asylums allowed for the public to project varying manners of mythology upon the Hospital and its patients, as Mark Davis claims (2013: p. 5)

the old Victorian asylum was a place where legends were created. They were places of mystery where according to folk, ‘all sorts went on’. Even schoolchildren in the playground would taunt each other with, ‘You’re mental! You’re off to Menston.’’

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Therefore, storytelling became one of the major tools for preserving the notion of difference between pauper lunatics and the sane or ‘normative’ public. As a result, there came an insistence to divide the mentally ill from their more fortunate counterparts, though of course this is strictly not limited to the period of the First World War. As Peter Nolan comments ‘Societies have always sought to identify and contain madness’ (1993: p. 22). although it is notable that the origins of the ‘Lunatic Asylum’ are subject to inconsistencies. The first asylum in England is often thought of as Bethlehem Royal Hospital, whose nickname ‘Bedlam’ has itself become synonymous with madness. However, though Bethlehem was founded in 1247, it is unclear when the hospital began its care of the insane,2 though some have pinpointed the date 1377 (2003-2016). Others have attempted to identify the origins of the asylum elsewhere. For instance, although Foucault, in his work Madness and Civilisation, remarks that ‘Confinement was an institutional creation peculiar to the seventeenth century’ (p. 59) he simultaneously highlights (p. 40)

An act of 1575 covering both "the punishment of vagabonds and the relief of the poor" prescribed the construction of houses of correction, to number at least one per county. Their upkeep was to be assured by a tax, but the public was encouraged to make voluntary donations.

The historical inconsistency and the neglect of English asylums in the work of the philosopher is typical. As many critics of Foucault like to point out, ‘there is ample evidence of medieval cruelty towards the insane […] in the late Middle Ages and the Renaissance, the mad were already often confined to cells, ails or even cages’ (Merquior, 1991: p. 28) . Others like to pinpoint a shift in the care of the mentally ill elsewhere. Ann Littlewood appears to comment that the period in which institutional structures were given prevalence and dominance over their subjects is ‘the end of the 19th century’, when ‘the asylums [became] overwhelmed by the sheer number of patients […] Society was becoming increasingly intolerant of deviance, though this deviance was not clearly identified’ (p. 9). This indefinability of deviance which Littlewood highlights allowed a multitude of people to be submitted with little reasoning. As an article from the Manchester Guardian comments, ‘Many people were under the impression that the men in the mental hospitals were ‘peculiar’ constantly. As a matter of fact, three-quarters of them, three-quarters of the time were as sane as anybody else.’ (Anon., p. 12). It was therefore never entirely certain what the deviances of people in the ‘madhouses’ were or whether their reason for admission amounted to mental illness.

The separation and rigid stigmatisation that came with the asylum therefore enabled Huddersfield’s townspeople to create elaborate narratives of the mentally ill.3 The unwillingness of the people of Huddersfield to embrace the people of Storthes existence is reflected geographically. Marked on the map is the location of the now derelict building where the mentally ill of Huddersfield inhabited. The asylum was located at a considerable

2 Bethlem was originally used as ‘a center for the collection of alms to support the Crusader Church and to link England to the Holy Land’ (Vincent, 1998)3 At this point is notable that the etymology of the phrase ‘‘going round the bend’ originates from the fact that ‘many an asylum […] could be found at the top of an impressive curved drive, effectively hiding the institution from the prying eye of the public’ (Davies, p. 4).

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distance to the town centre, a reflection of readiness to separate the irrational from the rational.

Composite map created from Ordnance Survey maps of Huddersfield published in 1908. The section highlighted in red, referred to on the map as ‘West Riding Lunatic Asylum’, is Storthes Hall Asylum.

This allowed the asylum to be simultaneously present and absent; the institution occupied a liminal space. Its existence as a place of confinement was negated by the unwillingness of the townsfolk to fully acknowledge the patients of the asylum. In an account of English asylums by C.W.M Jacobi (1841: p. 28), it is suggested that those admitted to asylums should be removed from the everyday lives of the townsfolk for it is

so annoying and inconvenient, from the intrusive curiosity excited by the patients, and the incessant scrutiny to which they are exposed at every step they take abroad; the difficulty of completely releasing them from the usual noise and tumult of society, however desirable it may be that many of them should enjoy this liberation, is so much increased

Jacobi additionally describes a desire to ‘remove the raving, screaming, dirty, and highly fatuous patients to as great a distance as possible from the rest’ (p. 29), a description which engenders the sane and insane as the antithesis of one another. Unreason becomes associated with filth and squalor whereas sanity is associated with its opposite. Intertwining the anteriority of those suffering from disorder and the normative, healthy public therefore became perceived as a threat to social stability. Consequentially, Jacobi suggests that the establishment should be situated elsewhere, in a pastoral environment under (p. 26)

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a mild sky, in an agreeable, fertile, and sufficiently dry part of the country, where the surrounding scenery, diversified with mountains, valleys, and plains, is calculated to enliven the spirits of the beholder, and invite him to wander and explore its beauties.

Storthes Hall adheres in exactitude to this. It was situated in ‘an area of approximately 630 acres and is situated six miles south east of Huddersfield in the Urban District of Kirkburton in the County of York’ (Spencer, 1985: p. 1) . The sublimity of the asylum’s surroundings meant that it was an attraction for nature-lovers who enjoyed taking walks around the asylum; one account remarks that it is ‘a spot of surpassing beauty and loveliness, a fitting retreat for the poet or artist’ (Hobkirk, 1859). It is also noted by that same author that those wanting to take a walk around Storthes Hall must be Naturalist’s ticket holders of the Huddersfield Literary and Scientific Society, ‘for none others are at present are permitted’ (p. 41). The asylum’s hospital buildings comprised of ‘three main sections, the Boiler House and Laundry Block in the centre, with the Admission Hospital to the north-east and the Main Buildings to the South’, whereas Storthes as a whole consisted of two further sections, making a total of ‘three sections: (i) The Storthes Hall Hospital (Including The Mansion), (ii) The Farm and Gardens, (iii) The Woodlands’ (Spencer, p. 1).

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Detail from the very same 1908 map of Huddersfield.

Asylum architecture itself becomes particularly important when considering that the buildings were seen as part of the cure. It was felt that there was a ninety percent increase in the likeliness of the patient being cured if (s)he is treated as separate from his/her home environment (Yanni, 2007). The architecture of Storthes Hall’s buildings bears a strong relationship to that of the era in which Jacobi was writing, its components a classic example of an imposing Victorian building.

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Main entrance to Storthes Hall, early 20th century. ©Huddersfield Local Studies Library

The main administrative building, for instance, was a structure of grandeur, a semi-gothic building with spires and arches, replete with an enormous breadth. The main hospital building was a pavilion which comprised of ‘eight wards, four on either side of a central block […] There are also two detached blocks having one ward in each, separated from the admission building by a distance of 100 yards’ (Spencer, p. 2). However, some did not find it an imposing structure; an ex-nurse in an article for the Huddersfield Daily Examiner recounts that she ‘didn’t find Storthes Hall a foreboding place – just an exceptionally large one. “It was vast,” she said […] “It was so big that during our lunch break we were given extra time to walk to and from the canteen. If you were sent on an errand it could easily take half-an-hour to walk there”’ (2013). Furthermore, The Acute Hospital, referred to colloquially as ‘The Mansion’ (top left) was ‘originally a late 18th century residence built from local stone and in Georgian style, is a three storey building with spacious cellars’; as a hospital, it comprises of ‘the main residence having bed space and day space for 74 patients, offices, kitchens, scullery and stores’ (Spencer, p. 3), which adheres to notions that Storthes was constructed as a ‘self-contained community in its own right. It even had its own fire engine’ (2013).

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Aerial view of Storthes Hall, 1990, showing the extent of the complex. ©Kirklees Council

IV. Storthes’ Soldiers and their Symptoms

In the Males casebook for Storthes Hall (WYAS, C416/5/113) spanning the years 1914-15, the story of a patient transferred to Storthes Hall from South Shields is recounted. John H. was originally committed to an asylum for ‘Imbecility’. In the casebook he is described as ‘Morose and stupid, careless in dress and in manner, incapable of taking care of himself’. In the casebook’s log, doctors berate his behaviour; with it repeatedly noted that ‘He does not occupy himself’. The doctors’ apparent frustration with John in the case notes relates to Storthes Hall’s methods of cure. It was insisted upon that patients participate in ‘a programme involving the therapeutic use of occupational tasks’ (2014), a form of treatment first pioneered by Samuel Tuke’s ‘York Retreat’. Due to the centrality of recreational treatments, it is therefore likely that John would have been viewed as, in some sense, refusing treatment. As Ann Littlewood (2003: p. 57), an ex-nurse and one of Huddersfield’s most eminent historians on the topic of Storthes Hall insists

When the asylum was planned in 1900, some provision for sport, mainly in the form of cricket was made […] In the years before the First World War, recreation for many of the inmates centred around long, supervised walks. […] it was [later] realised that patients would benefit from the stimulation of music and dancing, visit and holidays outside the environment of the hospital and interaction with volunteer visitors.

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This would later develop into insistence on work therapy. While Littlewood’s description of recreational therapies leans towards a positive view of treatment, it is worth submitting to some scrutiny, as she does herself on occasion. She describes how ‘exercise was taken under strict supervision’ and that ‘all wards were locked and patients had few rights. They were subject to a disciplined and disciplinarian regime’ (p. 32). This is evidenced by the fact that it was not uncommon for asylums in England to, rather paradoxically, force recreation upon their patients. An account of Norfolk County Asylum reports that patients ‘Respond[ed] to barked commands from nursing staff, they marched around the 30 acres surrounding the asylum’. Of that same institution, it was commented that “Great control is gained over the patients […] and the task of taking a vast number for air and exercise becomes comparatively easy” (2016). Though this account dates from 1849, there is evidence to suggest that the stark authoritarianism described persisted into the twentieth century. The Lunacy Act of 1890 did not guarantee the dissolution of inhumane treatment, but the abolition of previous forms of inhumane treatment, such as the discontinuation of the use of mechanical restraints. However, the implementation of the act did mark the beginning of a change in how the mentally ill were treated and therefore perceived; during ‘the first decades of the 20th century the Government’s agenda changed radically […] state intervention and social welfare were becoming increasingly accepted and health policy was dominated by enthusiasm for prevention and early treatment’ (Moncrieff, 2003: p. 9).

So, while John H. would have been perceived as lazy for refusing to engage in the hospital’s activities, the symptoms which the doctors identify in the patient are analogous to depression or ‘melancholia’, likely prompted by his experiences in the war. This therefore, becomes an indication of the phenomena defined in 1917 as Shell Shock. The phenomena was articulated ‘by a medical officer called Charles Myers’. However, ‘Myers rapidly became unhappy with the term, recognising that many men suffered the symptoms of shell shock without having even been in the front lines’ (Bourke, 2011), the ‘symptoms’ which Myers refers to likely being closely associated with Post Traumatic Stress Disorder (PTSD), a widespread disorder often conflated with the phenomena of Shell Shock – though this has come to be understood as somewhat of a fallacy. As Loughran argues, ‘shell shock is not PTSD or, more correctly, the historical construct of shell shock does not correspond to the historical construct of PTSD’ (Loughran, p. 103). Shell Shock was a paradox. It was an attempt by those struggling to define or articulate the nature of trauma, and subsequently failing, as they were unable to compare their experiences with those who had experienced the trenches. As Loughran also notes, ‘The experiences and symptoms of these men were bewilderingly diverse, and so were the explanations put forward for the disorder’ (p. 102). That is, the apparent and varied symptoms of ‘Shell Shock’ bore few links or correlations between each other to define a concrete disorder such as PTSD, and indeed some of the symptoms correspond to other disorders. For instance, a phenomenon that shares similarities with accounts of Shell Shock and what it seems John was experiencing is a Mild Traumatic Brain Injury (MTBI). In contrast to PTSD, whose characteristic symptoms include ‘intense fear, helplessness, or horror […] persistent re-experiencing of the traumatic event’ (p. 103), a MTBI is ‘caused by high velocity explosions’ and is associated acutely with ‘memory loss, depression, and anxiety’ (p. 109). This phenomenon has been identified in recent years and is frequently diagnosed in soldiers returning from Iraq and Afghanistan, leading to suggestions that soldiers of these conflicts share an affinity with those of the First World War. As an article from The Guardian comments “this is the first war since the First

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World War where the major cause of injuries is blasts” (Addley and Taylor, 2007). It is difficult to tell precisely the nature of John’s experiences; they are veiled by the doctors’ frustration and annoyance towards the patient. John’s depression is foregrounded in the casebook by descriptions of his refusal to leave his bed. It is also noted he insists on remaining alone, that he does not want to ‘speak or associate with others’. The doctors describe him as highly self-depreciative, with it noted that he is ‘constantly cussing himself’ and that he is prone to violent and destructive behaviour, with his temperament noted as highly irritable.

It is widely accepted that the turning point in psychiatry in the twentieth century came with the publication of the psychoanalytic works of Sigmund Freud. These highly influential essays were (gradually) translated into English in the early 1920’s by a variety of budding psychoanalysts, though they were not translated in full until Virginia and Leonard Woolf’s Hogarth Press published Freud’s complete works in English4. Storthes Hall appeared to readily accept the father of psychoanalysis’s ideas. As an article from the High Royds Hospital website remarks, in an extract from a Report by the Storthes Hall Group Management Committee originally published in 1954

Storthes Hall Hospital has played an important part in the process of enlightenment and progress which has been made since the turn of the century […] what was then called the “New Psychology” based upon the work of Freud, enabled the psychiatrist to understand the thought processes of the mentally afflicted.

However, this came as a slow process. British institutions were reluctant to accept the principles of their recurrent enemy, however important works of German philosophy and psychology have come to be. In his deeply influential essay, ‘Beyond the Pleasure Principle’, first translated into English in 1922 by C.J.M Hubback, Freud (1995: p. 597) describes patients which have been ‘given a risk to life’, whose disorders ‘have been given the name of ‘traumatic neurosis’’. He goes on to describe how a ‘terrible war which has just ended gave rise to a great number of illnesses’, and terms the experiences of these patients separately as ‘war neuroses’. The insistence Freud gives on terming the consequences of a ‘breach of stimuli’ in soldiers as ‘war neuroses’ can be viewed as a reiteration of the notion that institutions ‘had no intention of treating these unfortunate men as ordinary lunatics’ (Anon., 1915: p. 261-263), as Parliament claimed in 1915. The priority given to service patients placed an unprecedented amount of stress on institutions which cared for the poverty stricken or insane, ‘during the 1914-1918 war many asylums, including Storthes Hall, were required to provide accommodation for injured front-line soldiers and sailors (Littlewood, p. 30). As a result, there was considerable overcrowding within Storthes. The hospital was built with the estimated capacity of 1,500 but towards the end of the Great War, the number of patients held at Storthes Hall increased to 2,136 (p. 48). However, as I will elucidate ‘Soldiers suffering from shell shock should not have been labelled as insane and should not have been sent to lunatic asylums’ (Reid, 2015), as it becomes clear the manner in which they were treated served to exacerbate existing stigma as it formed a double bind; ‘ex-servicemen and their families deeply resented the twin stigmas of insanity and poverty’ (Reid, 2015). One of the ways in which Storthes Hall attempted to help and

4 Virginia was herself a sufferer of bipolar disorder and wrote poignantly of mental illness and the nature of trauma; see Mrs. Dalloway and The Waves for instances of this.

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merely worsened matters was by insisting ‘service patients’ ‘wear a distinctive uniform, costing 3s 9d’ (WYAS, C488/1/5: p. 45). As Alice Brumby (p. 122-3) remarks

There is little to suggest that patients either received these uniforms, or, if they did, where the differences were. […] the distinctive given to service patients itself connoted the stigma of the mentally ill to many people, a letter by George S. identifies that “People outside look at you with scorn and ridicule because of your garb, which causes the greatest disgrace imaginable.”

Attempts to separate ‘service patients’ from ‘pauper lunatics’ further complicated medical and social tensions, as the garbs service patients wore implied difference or the priority they were given over pauper lunatics. Service patients were colloquially referred to as ‘the ‘blue-coats’ or ‘bluebellies’’ (Hirst, 2015), though it is unclear whether this term was perceived as derogatory.

Freud returns to the subject of ‘war neuroses’ later in his essay, defining as (Freud, p. 607) ‘traumatic’ ‘any excitations from outside which are powerful enough to break through the protective shield’, which ‘provokes a disturbance on a large scale in the functioning of the organism’s energy’ and has the ability to ‘set in motion every possible defensive measure’. Freud additionally attempts to make the distinction that (p. 598)

‘Anxiety’ describes a particular state of expecting the danger or preparing for it, even though it might be an unknown one. ‘Fear’ requires a definite object of which to be afraid. ‘Fright’, however, is the name we give to the state a person gets into when he run into danger without being prepared for it.

While in most cases what Freud describes here is true, for many service patients ‘Anxiety’ and ‘Fear’ became intertwined because of the nature of conflict. The enemy, for many soldiers was at once a known and unknown threat. Soldiers fighting on either side would have been unable to know the opposing force because of the positioning of the trenches. As men fighting in the First World War, they were necessarily opposed to one another by way of their nationality. Many veterans also reported the panic they experienced in battle altered the way in which they saw the men in the opposing trenches. I want to revisit a classic of war poetry to provide an example; Wilfred Owen’s Dulce et Decorum Est. The language Owen employs is exemplary of the terror that soldiers experienced. He describes how ‘All went lame; all blind;/Drunk with fatigue; deaf even to the hoots’ (1921: ln. 6-7), first highlighting the impaired faculties of the soldiers, and drawing attention to their inability to observe their surroundings due to delirious exhaustion. In addition, the phrase ‘blind’ in the context of the poem gains a secondary, metaphorical significance, relating to ‘The old Lie; Dulce et Decorum est/Pro patria mori [It is sweet and right to die for one’s country]’ (ln. 28). Additionally, the fear experienced by many service patients which I previously described is signalled by Owen in the lines ‘An ecstasy of fumbling,/Fitting the clumsy helmets’ (ln. 9-10), a line which furthers the poem’s sense of hysteria and the aforementioned impairment. The unreality experienced by First World War soldiers is reflected by many of the service patients’ neuroses. The Storthes Hall Males Casebook of 1914-15 (WYAS, C416/5/113) describes a patient, George D, as ‘coherent in speech but violent in conduct’ and ‘subject to ideas which have no foundation in fact’. George was

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himself subject to hallucinations, with the casebook noting that he frequently imagines Germans are approaching him, which can be seen as an explanation for his outbursts of violent behaviour, a ‘defensive measure’ as Freud describes it. Additionally, the Storthes Admissions Register for 1915-17 (WYAS, C416/5/8) describes William Henry H., a patient suffering from ‘Recent Mania. He is talkative and excitable’. He sees himself getting ‘the V.C. [Victoria Cross] for finding the Kaiser. He is described as being in fairly good health and condition’, but it is also noted that he is ‘upset about the Kaiser and the German spies’. William and George were both eventually discharged as cured; nevertheless their experiences can inform us of the way in which service patients experienced their memories. George’s hallucinations of approaching ‘Germans’, for instance, encapsulates a wide and difficult to imagine number of people, the term ‘Germans’ applied collectively describes something almost unknowable. How can one person imagine any number of people who served in the armed forces? Likewise, William’s fears of German spies operating in subterfuge highlights the unknowability of the enemy. His hallucinations are closely associated with an inability to perceive in exactitudes, causing the patient considerable anxiety. Both George and William’s hallucinations, though it is difficult to say, may not have seized upon exact objects, but would have taken the form of innumerable soldiers of German forces, transfigured by their fractured mental states. This unfathomability became reflected in the arts after the events of the First World War, as many people chose to break with the notion that experiences can be represented. It became apparent that it is difficult to say if we experience our surroundings in exactitudes. Take for instance a painting by George Grosz, titled ‘Explosion’. The painting is held by the Museum of Modern Art in New York and can be seen by clicking on this link: http://www.moma.org/collection/works/80347?locale=enThe painting was first exhibited in 1917, towards the end of the First World War, and relies heavily upon its use of colour to represent its subject; it maligns notions of ‘form’, portraying twisted and disconnected limbs and metal alike. Grosz’s painting attempts to represent the blind panic experienced by soldiers like George and John in the event of an explosion, an event which it is likely they revisited many times in their minds. Additionally, German expressionist Otto Dix created a number of prints collectively entitled ‘Der Krieg’ which have been described as both ‘apocalyptic’ and nightmarish. Again, the image can be viewed here: https://www.theguardian.com/artanddesign/gallery/2014/may/14/art-apocalypse-otto-dix-first-world-war-der-krieg-in-pictures#img-1. The contorted figures of the soldiers foregrounds a sense of unreality. Their features are obscured by gasmasks and their ‘fingers are curled like claws’ (Jones, 2014); this, paired with the monochromatic palette used by Dix, serves to highlight the bleak and disturbed unreality of trench warfare which overwhelmed many soldiers experiencing war neuroses. These paintings both, therefore, attempt to convey something which it was difficult to service patients suffering from shell-shock to describe. Upon the admission of a military patient suffering from trauma, it appears that the first thing the doctors would check for was a disintegration of their ability to describe their experiences and ailments. In several cases, the first thing noted by doctors is whether the patient has the ability to speak or describe. While all patients who have been noted here were reported as ‘functional’, this consistently-used practice is indicative that doctors had to care for many patients who were not.

V. Conclusion

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I began this essay by writing about the two strands of theory that appear to be prevalent in discussions of mental illness and its treatment in British asylums such as Storthes Hall. However, the debates recorded in this document demonstrate that the practices and choosing how to view medical practices both in present day and retrospectively are deeply intertwined. Both psychiatry and psychology, much like Storthes Hall Asylum itself, are part of something wider than their individual components, that is, the wider overarching debate about what the mind is and how its disorders must be treated. Indeed, as much as central control of government attempted to keep spheres of war and mental health (in its goriest details) separate by separating service patients from ‘ordinary lunatics’, it almost inevitably became the case that conflict permeated every aspect of public and private life. This is reflected in the manner in which Storthes Hall attempted to separate ‘pauper lunatics’ from ‘service patients’, who, as the title given to them implies, were not treated as common patients in the asylum, an attitude which appears to insist that patients’ disorders were not initially associated with ‘mental’ faculties. This appears to have had a noticeable influence on psychiatric case studies of service patients, with many cases contemporary with conflict appearing virtually unreported in casebooks. As the reader paying close attention to my sources will see, I was only able to find four ‘service patients’ amidst three hundred cases recorded. This was always to be an issue in enquiring into the lives of people whose sufferings went publicly unreported (which set the mould for the ‘Private’) which, within the context of the First World War can be attributed either to mass censorship or public disinterest. In my opinion, it was a combination of both. However, I am pleased to note that research and the conversation of mental health has experienced a surge lately. I found that many of the articles I came across were written in the past five years, very few predating 2010, which can be attributed to increased aspirations to break the stigma attached to mental health, leading to a greater interest in how this stigma was constructed by institutions.

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Bibliography

Archive sourcesWYAS, C416/5/113, Male Patient Casebook (1914-16).

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(2013). ‘Huddersfield History: Behind Walls at Storthes Hall’. The Huddersfield Daily Examiner, 12th June 2013. Retrieved from http://www.examiner.co.uk/lifestyle/huddersfield-history-behind-walls-storthes-4884019

(2014). ‘Historic Figures: William Tuke’. BBC History. Retrieved from http://www.bbc.co.uk/history/historic_figures/tuke_william.shtml

(2016). ‘Daily Life in the Asylum’. Historic England. Retrieved from https://historicengland.org.uk/research/inclusive-heritage/disability-history/1832-1914/daily-life-in-the-asylum/

(2016). “The Nobel Prize in Physiology or Medicine 1927". Nobelprize.org. Web. 9 Jun 2016. Retrieved from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1927/

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Newspaper articles

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(1915). Anti-German Energy’. Dewsbury Reporter, October 9th 1915, p. 2.

(1915). Disabled Soldiers Problem’. Dewsbury Reporter, 23rd September 1915, p. 2.

‘Take Peps and Be on Guard Against Colds, Coughs and Bronchitus’. Advertisement taken from Dewsbury Reporter, November 17th 1916.

‘Up Guards and at ‘Em’. Advertisement taken from Dewsbury Reporter, October 16th 1915.

‘Mental Cases Among Ex-Servicemen’. The Manchester Guardian (undated).

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