Grangegorman and the treatment of soldiers trauma
Today the revitalised Grangegorman campus, with its many young and eager students, offers an uplifting and poigant sight, given its historic role in the treatment of those mentally and physically challenged.
Part of that legacy was an often unheralded one – the role of Grangegorman in the treatment of soldiers suffering from trauma, as a result of World War One (WW1).
The treatment focused on the effect of intense trench warfare and exposure to constant high explosive shelling. World War One was, after all, an intense close-quarters combat with a level of mechanised conflict never before seen.
The trauma was known as ‘shell shock’ and more collectively as PTSD – Post Traumatic Stress Disorder and was relatively unacknowledged then, just as wider mental challenges were often unexplored. Its symptoms were disturbing flashbacks, nightmares, acute nervousness and exceptional and intense deliriums.
Almost 200,000 Irishmen fought in World War One, with an estimated 40,000 killed and many more wounded and psychologically damaged. In this context, the contribution of Grangegorman was numerically quite small. However, it was vital and pioneering and it contributed notably to the further development of this very important area.
The work was different to the treatment of physical injury, which was obviously also considerable and took place mainly in hospitals in Britain, but also in Ireland. In Dublin, physical care took place in hospitals such as those in Drumcondra, the Adelaide and in the military care facilities at St George V (now St Brichin’s) and Leopardstown.
The patients were treated at Richmond War Hospital, a facility on the grounds of the Richmond District Asylum in Dublin, located at Grangegorman. Between 1916 and 1919, it treated 368 patients, of whom about half were diagnosed as having recovered.
The facility was also overseen by Gordon Holmes, a pioneering British neurologist, originally from Dublin, who had worked in the war zone and deepened the understanding of PTSD.
Holmes medical role in the army was an important one, for it was neurologists who initially attended the nervous patient—not psychiatrists, who worked in the asylums with the psychotic and organically impaired. This changed as the awareness of shell shock grew.
Despite the limitations on its resources, Grangegorman was regared as ‘a generally forward-looking institution that pointed the way for future reform of Ireland’s asylum system and, along with the other war hospitals, brought significant changes to the practice of psychiatry’.
According to the Resident Medical Superintendent at Grangegorman, over half of the patients ‘were successfully treated and enabled to return to their homes without the blemish of having been certified insane’.
Obviously, in what was a more macho era, a certain stigma attached to PTSD, which probably added to the soldiers trauma. The Army was also initially unwilling to acknowledge the impact of PTSD for fear that it would demoralise the fighting troops.
However, this official reluctance changed with the prospect of having ‘disturbed’ soldiers ‘behind the lines’, creating instability, and so the soldiers were sent back to hospitals such as Grangegorman for treatment.
By today’s standards, the symptoms might also seem predictable and entirely comprehensible, according to the case histories of soldiers admitted, with descriptions of anxiety, fatigue, neuralgia, headache and depressed mood.
There was the actual loss of speech or hearing, although treatment was applied to reverse these conditions.
Hallucinations of sight and hearing were sometimes present, but most of the soldiers were quite conscious of the hallucinations, and realised that they were abnormal, and were, therefore, not to be regarded as ordinarily insane patients suffering from hallucinatory state.
In one case, recorded at the hospital, Private VW’s ‘tongue [was] tremulous. Speech stammering and hesitating’. Mentally, he ‘has headache every now and again and suffers from noises in his head at times’, and had also complained of ‘visions’ and ‘insomnia’.
Private VW had apparently been ‘blown out of a trench’ at the Battle of Arras, in 1917 and since then ‘his speech has been affected’.
However, rest and treatment had a positive effect. Later, Private VW ‘states he had no voices in his head since he came here and that he is feeling much better’. Two weeks later, Private VW was ‘bright and cheerful and is looking much stronger. He states he feeling very much better’.
This improvement was sustained, and one month after admission Private VW continued ‘to improve. He states he is now feeling all right in every way except that he is not physically strong. Sleeps and eats well’. Two months after admission, Private VW was ‘discharged and sent to his home’.
Another case involved Lieutenant ST, a single, 19-year-old lieutenant admitted also from King George V Hospital. On admission, he had a cough and his ‘tongue and limbs are tremulous’.
Mentally, Lieutenant ST was ‘dull and depressed and his memory is confused. He complains of pains and noises in his head and insomnia. He is unable to give a collected account of himself. He cannot give many particulars of his service. He, however, states that he served at Salonika and in France and came home suffering from shell shock’.
On his first night at the RWH, Lieutenant ST ‘remained quiet and slept well during the night’. One week after admission, Lieutenant ST was ‘somewhat brighter and more cheerful but his memory is still confused.
Two weeks after admission, he was still ‘improving gradually. He states he is feeling much better and that his head is much less troublesome’. One week later, Lieutenant ST was ‘transferred to Belfast War Hospital’ which also dealt with soldiers for mental and psychological problems.
By today’s standards, the treatments might seem rudimentary and often primitive but they were a big step on from the existing treatment which was effectively none, apart from what was ‘self administered’ by the patient through the use of alcohol or hard physical exertion as an escape.
Hospital treatments were more psychological in tone, regarding war neurosis as attributable, at least in part, to unconscious psychological conflict in the soldier’s mind.
This idea led to treatments such as hypnosis and abreaction, which involved soldiers re-experiencing or re-living traumatic memories in an effort to purge them of their emotional impact. In all cases there was a strong emphasis on prompt treatment, cognitive re-structuring of traumatic experiences (i.e. thinking differently about the past) and collaboration with the therapist in the search for a cure.
Many of these therapies had certain similarities with current cognitive and behavioural approaches to post-traumatic stress disorder (PTSD), focusing on altering patterns of thought and behaviour in order to reduce symptoms.
There were, however, other approaches to the management of shell shock which certain authorities viewed as equally if not more effective than approaches based on discipline, hypnosis, reexperiencing or abreaction. These included, most notably, approaches based primarily on rest and less intrusive forms of therapy.
After the war, the War Office Committee of Enquiry into ‘Shell-Shock’ addressed the issue of treatment in a comprehensive Report (1922), drawing attention to the importance of rest in preventing shell shock in the first instance, including frequent leave and immediate rest in cases showing initial symptoms of nervous breakdown.
Morale depended chiefly on a sense of security and comfort, the report said. Officers should be assiduous in their concern for their men. Removal from the front and visits home lessen the incidence of ‘shell-shock’.
In its final recommendations, the Committee warned however against the indiscriminate use of therapies based on discipline, hypnosis, re-experiencing or abreaction. There was instead astrong emphasis on the curative properties of simple ‘rest of mind and body’.
In my own project, the Lion and the Shamrock, there is a section called Personal Stories, where the descendents of soldiers from World War One are interviewed.
A recurring feature is that veterans often simply didn’t talk about their war time experiences, or referred to them obliquely for fear of reactivating the trauma.
Or they just drank and smoked incessantly afterwards, to deal with the impact. Or not ‘deal’ with it, more likely : an extraordinary amount of experience was bottled up, for understandable reasons.
However, for many, the aftermath was an ongoing nightmare- literally so, for it was often at night that the worst anxieties occurred.
This trauma added to what was already a difficult transition to civilian life for many Irish veterans, much more so than after other conflicts. This was because of a sense of waste about a long war which, by 1918, seemed pointless and unnecessary.
But also, in Ireland the politically landscape had completely changed after the 1916 Rising and the arrival of Irish Independence, and veterans who had fought in the British army were officially shunned. The great political changes meant they no longer felt welcome, having been sent off on their military adventure like conquering heroes.
In this context, the treatment of PTSD at Grangegorman was laudatory and humane. It was also consistent with the considerable help and assistance given by the British authorities to veterans, quite in contrast with the hands-off approach of the new Irish State.
However, the concept of post traumatic stress was then in its infancy, and veterans were expected to just ‘get on with it’, which in fairness, many did and it should be acknowledged that many veterans did resume their civilian lives without any apparent problems.
But this was to mask what was going on below the surface and it is to great credit of the then authorities for Grangegorman, that they engaged in treating this trauma.
It was also consistent with the hospital’s long term history in dealing with mental health, and with the military. Today, a small road adjoining Grangegorman at Rathdown Road, is named Marne Villas, in remembrance of the great battle of WW1 and of the men who suffered there.