Patricia Casey: 'The mental cost of war laid bare at home and abroad'
There is a tendency to idealise history, then to revise it when our knowledge or our perspectives change. Revisionism has been a feature of our dialogue about the role of Irish people in World War I and in subsequent offensives at home, including the War of Independence and the Civil War.
World War I concluded in November 11, 1918, with the signing of the armistice. For psychiatrists, like myself, the Great War has a special resonance. In an article in 'The Lancet' in 1915, Dr Charles Myers described soldiers who were involuntarily shivering, crying, fearful and had constant intrusions of memory as a result of what they experienced in the trenches and battlefields. He called it shell shock. This term is not used in psychiatry today, having been replaced by the more recent term post-traumatic stress disorder (PTSD), also first described following the war in Vietnam.
While doctors on the front line in France were sympathetic to the plight of these soldiers, the army administration was not and saw it as a form of indiscipline, banning use of the term for a period. By the end of the war more than 80,000 cases were diagnosed. Poets Robert Graves, Wilfred Owen and Siegfried Sassoon wrote movingly about the emotionally broken men who survived its worst offerings.
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Irish soldiers fought bravely in the war, too, and suffered psychologically. The numbers are unknown but around 20,000 wounded men returned home and were either in convalescence or on disability. Some with psychological damage were hospitalised in what were the Richmond War Hospital (on the grounds of what subsequently became known as Grangegorman Hospital and later St Brendan's) and the Hermitage War Hospital, as well as in around 100 auxiliary hospitals around the country. These were usually private houses. Irish doctors did not have the expertise in treating shell shock that the British had. Their methods are captured very convincingly in the 'Regeneration Trilogy' by Pat Barker.
Efforts to provide care in Ireland were thrown into chaos during the War of Independence and most of these hospitals closed by 1919. There remained a meagre 32 beds in Leopardstown Park House for those suffering with shell shock, and a waiting list for admission of 762. By then there were 30,000 men in Ireland in receipt of disability pensions from the British government as a result of World War I.
Just two months after the armistice, on January 21, 1919, an election returned a Sinn Féin government in Ireland and it declared independence from Britain. That same day, two members of the Royal Irish Constabulary were shot dead by members of the Irish Republican Army (IRA) in Co Tipperary and so began the War of Independence. Ireland will begin its commemoration of that war shortly. It ultimately led to the formation of an independent Ireland, but with partition as the cost.
Into that culture returned the Irishmen who fought in France, many already suffering with shell shock. They found a vehemently anti-British attitude and a country starting a guerrilla war against the country for which they had risked their lives a few months previously. Life was very uncertain and deeply unsettling for these men who had expressed allegiance to the British then, but now were expected to wage war against them. Those who were disabled due to shell shock could not get sufficient respite or treatment and sympathy was in short supply for people seen as turncoats.
Data on the numbers involved is uncertain but some historians suggest 20pc of soldiers in World War I experienced shell shock and it is estimated almost a quarter of a million Irishmen fought in that war.
Some did join the Irish Army, although having already been affected by their experiences in France would have been vulnerable in the face of new trauma that the War of Independence would bring. Tom Barry, organiser of the famous ambush in Kilmichael, Co Cork, had fought on the Somme, although there is no suggestion he was traumatised by his experiences.
Others included Emmet Dalton and Maurice Meade. It has been claimed by historian Stephen O'Connor that more than 200 ex-British servicemen joined the IRA during the War of Independence.
There is anecdotal information that British ex-servicemen were ostracised and assaulted in the new independent Ireland. In a book by JD Stover, 'The Irish War of Independence', the reality of soldiers requiring help is confirmed.
A new insight was that not only were the soldiers themselves victims but that there were secondary victims such as family members and neighbours who were often subjected to unexpected searches. Those escaping the internment camps were also identified as suffering. Those who suffered shell shock during this war were treated in what was now Grangegorman Hospital and Dr Vincent Ellis, the assistant medical director, took a special interest in this.
There are stories of some IRA soldiers being given a safe house in a padded cell there, in the guise of mental illness. Others, who were captured by the British and after torture showed evidence of mental illness, were sent to Broadmoor Hospital in England. War is cruel and when we mark our independence as a nation next month we should not forget that it was won in blood and fear.
As Wilfred Owen wrote:
"And some cease feeling/Even themselves or for themselves/ Dullness best solves/The tease and doubt of shelling".
Patricia Casey is consultant psychiatrist in the Mater Hospital and emeritus professor of psychiatry at UCD