Attitudes toward & treatment of PTSD in historical WWI and the Biggles books

[rachelmanija]

I will be doing a series of posts on Biggles/Worrals-related research I've done, in case it's of general interest and/or usefulness.

They will be linked at bigglesevents; if you have also done research to write Biggles or Worrals, or for your own work or just general interest but it's Biggles-relevant, please feel free to cross-post or link posts there. I'm hoping to get a convenient hub of useful and easily findable information there. They don't need to be essays like this! I will have more posts that are just collections of helpful links.

I completely failed to save my sources for this post, sorry; you should be able to find them by searching for key phrases.

Note: I am using the word PTSD for convenience; it's a much more modern word and was not used at the time periods I'm discussing. If you're interested in historical conceptions of PTSD, I have a lot of posts on it if you're willing to plow through my PTSD tag. Also, I'm using "pilots" as shorthand for any flying combatant.

The modern conception of PTSD and its treatment were founded by Dr. W. H. R. Rivers at the WWI hospital for shellshocked soldiers, Craiglockhart in Scotland. He pioneered talk therapy as a PTSD treatment. Dr. Rivers was considered an outlier at the time, including in Britain, where shellshocked soldiers were commonly seen as cowards and could be subjected to "treatments" that were essentially torture, such as electric shocks. Pat Barker's Regeneration trilogy is closely based on history and is excellent reading for more on Rivers and Craiglockhart.

Pilots were not treated at Craiglockhart so far as I'm aware. The article linked below has some information on how medical treatment for pilots was organized, and suggests that as airplanes were so new at the time, it was believed by medical personnel that flying itself posed special dangers (apart from the obvious) and so PTSD/combat stress suffered by pilots and other flyers may have been considered differently from that of infantrymen, as a medical condition rather than cowardice. It was not called shellshock, but rather nerves.

The Nervous Flyer: Nerves, Flying and the First World War

Note: I have yet to come across literally any source, nonfiction or semi-autobiographical fiction or heavily researched fiction, in which pilots' nerves are seen by pilots as medical rather than psychological.

The early Biggles books were directly based on Johns' own experience as a fighter pilot and on stories he heard from other WWI pilots. In them, nerves is treated as a normal and common occurrence. It's not seen as a form of cowardice or shirking, nor is it seen as a medical issue. It's consistently portrayed as a normal reaction to the extreme psychological stress of aerial combat and the extremely high casualty rates, which caused grief, the knowledge that you could die at any moment, and the belief you would die eventually.

Biggles suffers off and on from nerves throughout the WWI books. He's repeatedly sent away for leave to recover, though with the understanding that it's not a permanent cure, just a respite that will allow him to return and fight again until the next bout. By the time the war ends, he's drinking heavily and flying so recklessly that everyone around him recognizes it as a form of suicidality, and he's about to be posted home permanently to save his life when events intervene. Through all of this, he's shown (and shows to others in similar states) only understanding and sympathy.

The Worrals books I've read so far, which are set in WWII, don't feature anything we'd call PTSD, but they do show some brief combat stress reactions. Other pilots are sympathetic and explain that Worrals isn't showing any weakness, it's normal for anyone involved in combat, and it has nothing to do with her being a woman.

The general level of understanding and sympathy for pilots with nerves does seem to be higher than that for ground troops in nonfiction I've read about WWI. However, the general level of understanding and sympathy for ground troops with shellshock also seems much higher in the trenches than once they get sent away from them, unsurprisingly. So I think a big factor there is that pilots may have been more likely to be sent off for short breaks and less likely to be sent away for lengthy treatment where they risked falling into the hands of sadistic doctors. The extremely short lifespan of a pilot may have made it likely that they'd be killed before they had time to get sufficiently far gone that a short break wouldn't cut it.

Now let's go to Germany. There's some really interesting things going on there, primarily that Germany was conceptualizing civilian psychological trauma reactions as the same as ones caused by war. With a few exceptions that didn't catch on, this didn't happen in the US or England until much, much later. In pre-war Germany, PTSD was recognized as a phenomenon that could be caused by civilian trauma such as an industrial or train accident.

Pre-war, Hermann Oppenheim, a German Jewish neurologist, coined the term "traumatic neurosis." This was basically the idea that traumatic events caused physical effects; witness a horrific industrial accident, and you might have tremors, headaches, insomnia, etc afterward. He believed that it was essentially neurological (not psychological) in nature, and had a whole theory on it that is too complicated to summarize here but is NOT the current theory on the neurological aspects of PTSD.

If you were injured in an accident and had a medical diagnosis, you were eligible for a pension. Traumatic neurosis, as it was literally a neurological injury equivalent to a spinal injury, would have been a medical diagnosis. So the entire concept was fiercely opposed by the government as it would have triggered pension payoffs. The government was joined in its opposition by heads of industry, the German medical establishment, and anti-Semites.

So they needed a different term and theory to cover all the people who had PTSD from industrial accidents, one which would not be pension-worthy and would discredit and discourage anyone trying to get a pension. They came up with "hysteria virilis" (male hysteria), aka "pension neurosis." This was defined as post-traumatic symptoms caused by being a hysterical, unpatriotic, effeminate wimp greedily gunning for a pension.

Note that they did not have any alternative to this idea - if you had post-traumatic symptoms, the only possible explanation was pension malingering.

When WWI started, soldiers were eligible for medical pensions. So the cheap assholes in the government and medical establishment again trotted out hysteria virilis/pension neurosis as their equivalent of shellshock. They conceptualized male hysteria due to war as similar to industrial accident hysteria, and decided the best cure was...

... more work! Very convenient for the war effort, too. They funneled shellshocked soldiers into other kinds of work, which... was better than electrocuting them, at least.

If you tried to get a pension for your shellshock, you had "pension neurosis" and were by definition greedy, selfish, lazy, and unpatriotic. Also, "Male hysteria" was conceived of as being proof that there was already something wrong with you, and that whatever happened in the war triggered but didn't cause it. It was literally considered proof that you had a pre-existing mental condition, and therefore you didn't warrant a pension. The more things change, the more they stay the same.

So if you were a German soldier and had PTSD, you would want to hide it if you wanted to stay in service, because revealing it would get you sent home in disgrace and very possibly also financial difficulties due to the lack of pension. After the war, it would still not be something you'd want to talk about because you'd be labeled a lazy coward gunning for an undeserved pension.

(Note: I don't want to make it sound like Germany and Britain were uniquely horrible to veterans with PTSD. France was, if anything, even worse.)

And now, back to Biggles. Erich von Stalhein was a spy in WWI, which at the time was not only a very secret profession but often considered a disgraceful one that a gentleman wouldn't engage in. It's a very lonely life where you can't talk to anyone about anything, and if you reveal the truth about yourself, people will dislike and despise you.

So when Biggles had issues with combat stress/PTSD, everyone around him was very supportive, made sure he was getting rest and leave without him even having to ask for it, and treated it as a completely normal reaction to unbearable stress. He clearly internalized that as how you deal with severe emotional stress in general - be supportive and matter-of-fact, don't treat it as anything weird, and reassure the person that it's normal and they'll be OK. This comes up again and again in the series - one example is in The Black Peril, when Ginger is upset over maybe killing someone and not even knowing if he had or not. Biggles is brisk but kind, and in a manner that suggests that he's had this conversation a lot before.

If von Stalhein had any issues with combat/espionage stress, he would have had to hide it, and probably would have internalized the general attitude about it to some degree as an example of how he's deeply flawed and doesn't deserve nice things. Which was literally the official position of his country's government and medical establishment: PTSD is proof that you don't deserve a pension and are also a bad person.

Another thing about von Stalhein vs Biggles is that Biggles' symptoms were very recognizably nerves/PTSD as it was conceptualized at the time: nervous tics, suicidal recklessness, impulsivity, obsession, rage, alcohol abuse, the belief that he will die. (Regarding the last: yes, reasonable to believe that he probably or likely wouldn't survive under the circumstances, but he was 100% sure of it.) So other people could very clearly see what was up with him and were sympathetic.

I'm not saying all of von Stalhein's issues are PTSD because he has a lot going on, but I do want to mention some lesser-known symptoms: depression, hopelessness, self-hatred, lack of trust, relationship difficulties/isolation, putting yourself in situations that you know are bad for you because you think you deserve it/think you don't have better options/are used to it. Even today, if you have that set of issues, people tend not to recognize it as PTSD and just think you're a fucked-up person. Which just perpetuates the problem.

What I'm saying is that this needs some fanfic.

Comments

[swan_tower]

I am morbidly curious about what France did.

[rachelmanija]

Similar to Britain, but worse. They tortured soldiers until they agreed to return to the front.

https://n.neurology.org/content/75/3/279

[philomytha]

This is fascinating. I knew some of the British side of things, but not so much of the German. Though it completely chimes with what I've seen in Babylon Berlin, which is a German-language crime drama set in 1929 Berlin, and has a lot about shellshocked soldiers there and the contempt with which they were viewed, especially in the first season where it's quite a big plot point. The hero is shellshocked and uses morphine to control the symptoms and also has various psychological therapies including hypnosis. It's a brilliant series.

Re Biggles's matter-of-factness about his own feelings, I noted in a book I was just reading - Biggles Makes Ends Meet - that after witnessing a plane crash and catch fire, Biggles mentions to the others that it's playing over and over in his head and upsetting him. He gets sympathy from the others, and he also articulates what will help him, which is to say, not sitting around thinking about it but some kind of distraction.

And that is a very accurate set of symptoms for EvS - and Biggles does pick up on the idea that he's suffering psychologically, though he likely doesn't conceptualise it as necessarily related to his own 'nerves', but he does keep talking about how unhappy and emotionally wounded EvS is, he's obviously perceiving some of this. So as you say, ripe for fanfic.

[rachelmanija]

Though it completely chimes with what I've seen in Babylon Berlin, which is a German-language crime drama set in 1929 Berlin, and has a lot about shellshocked soldiers there and the contempt with which they were viewed, especially in the first season where it's quite a big plot point. The hero is shellshocked and uses morphine to control the symptoms and also has various psychological therapies including hypnosis. It's a brilliant series.

Okay, I MUST see this. Where can I find it?

Biggles is surprisingly okay with talking about his feelings a lot of the time. (Maybe his lack of doing so in Terai is an indication of just how upset he is, that he feels like he has to repress for all he's worth.)

Yeah, Biggles can tell that something is psychologically wrong with EvS (and will talk anyone's ear off about it whether they care or not - mostly not). I actually wonder about EvS's childhood. He comes across as someone who had baggage already before the war. Not necessarily what we'd think of as trauma/abuse, but he really doesn't come across as someone who had a loving childhood. When Biggles says maybe he never experienced the milk of human kindness, I tend to think he's right and that goes way back.

[scioscribe]

This is amazingly helpful, and I'm bookmarking it for future Biggles writing.

It also struck me, in both the WWI and WWII short stories, how kind Biggles is when a pilot under his command seems to "crack up" immediately under the strain. Away from them, he's matter-of-fact about the notion that the men will probably have to be sent home, but with them, he's reassuring--normalizing the reaction, telling them that it's okay, recommending that they take a walk or some time to think about it, etc. And it's almost more meaningful kindness because he thinks it's likely he'll never see them again: there's no sense that he's trying to patch them back up into being useful pilots. He's just dealing with it all in a nonjudgmental but compassionate way as a matter of course.

[rachelmanija]

Yes, I really liked that. He's trying to do what's best for them, whether or not that means they'll stay in his squadron. He also seems practiced at it - you get the sense he's done this before and while he absolutely means it, he's also got the routine down. Which is SO SAD.

It's also legitimately a good way to talk to people in trauma-induced crisis states. I would absolutely take him as a partner if I was going on a crisis call.

Speaking of things Biggles is heartbreakingly good at: comforting the dying. There's a line in "The Decoy" that says he's like a mother talking to her ailing child.

BRB, crying forever.

[sheron]

Yes, I loved that!

It's also the way he's with Algy: he's certain that his cousin is going to die the first time they fly out because he's seen it so often with newbies before, but he *still* does everything he can to make sure Algy can learn the ropes and protects him. It's one of those little tid bits that made me fall in love with these books.

[cefyr]

This was really interesting! I had heard some of it, but I didn't know about the pensions. That's horrible but not very surprising. Also I suppose it would make a certain amount of sense to people that pilots were treated a bit differently, because they could be seen a little more as individuals.

I'll keep an eye out for any relevant facts or links I run across in future fic writing!

[rachelmanija]

Excellent, I look forward to it.

[black_bentley]

I've got an entire book on my TBR about shellshock on the Somme and the impact it had on troop numbers and effectiveness because so many officers were unfit for duty due to PTSD. When I get round to it, I'll do a post on it!

Craiglockhart's a fascinating place, and the treatment received by patients very much depended on which doctor they were assigned to, as they took different approaches.

[rachelmanija]

Yes please to the book post.

I always think of Craiglockhart as synonymous with Rivers, but of course he didn't personally treat everyone.

[sheron]

So when Biggles had issues with combat stress/PTSD, everyone around him was very supportive, made sure he was getting rest and leave without him even having to ask for it, and treated it as a completely normal reaction to unbearable stress. He clearly internalized that as how you deal with severe emotional stress in general - be supportive and matter-of-fact, don't treat it anything weird, and reassure the person that it's normal and they'll be OK.

Yep! I noticed this too and it's great.

And yeah, von Stalhein's absolutely depressed towards the end of it. The easiest way to see it is to read his earlier books (Biggles & Co / Secret Agent) and compare his body language (easy, relaxed, flirty, often smiling) with his bodylanguage towards the books closer to Hatchet (remote, emotionless - at least to Ginger's POV, frozen, distant, unsmiling). It's just so obvious that he's deeply Not Okay but of course he doesn't have any way of dealing with it.

Fiiiic

[sholio]

I love how clearly you can tell that von Stalhein is suffering from severe depression even while he's covering as hard as he can, you never get his POV and only see him in brief glimpses from book to book, and the characters (and the author!) don't actually have the modern terminology for it. But it's still visible.

[mildred_of_midgard]

Fantastic write-up, posts like this are my favorite!

[rachelmanija]

Thank you!

[sholio]

This is wonderful; thank you for writing it up! It's also incredibly inspiring.

I can easily see Biggles, in the immediate post-WWI period, expecting to recover his "nerves" quickly after combat is done, and frustrated and miserable that he's still having some of the symptoms even though he hasn't been a dogfight in months. Shouldn't everything be fine now? (Please someone write this.)

Also, von Stalhein locking himself in his lodgings and drinking himself incoherent because it's the only outlet he has and he can't let on to anyone that he's increasingly falling apart. Please someone write this too.

[rachelmanija]

So glad you liked it!

I really like both those ideas.

One of the classic things that happens to combat vets is that they're exhausted throughout the war because they have little time to sleep and what sleep they do get is often interrupted, and are delighted to get home where they can FINALLY get a chance to sleep without interruptions, only to discover that they can't sleep and end up even more exhausted than before.

[snowynight]

It's depressing but unsurprising to read about the horrible treatment of veterans. I haven't read the Biggles series, but your analysis makes me interested.

[rachelmanija]

If this post intrigued you, I would check out The Camels are Coming or Biggles of the Camel Squadron. (Camels as in Sopwith Camel, a biplane, not literal camels. There are literal camels in Biggles Flies East, an excellent and tense WWI espionage book but not one which much deals with PTSD.)

[minoanmiss]

Truest last line ever. I don't even go here but I can picture the pillow talk between bouts of gentle lovemaking where Biggles convinces Von Stalheim that he's not a coward, he's been injured as surely as with a bullet or a knife...

[genarti]

Oh, this is a fabulous post! Thank you for it, and for the general initiative to create and encourage more historical research resource posts. :D

I didn't know that about the German conception of PTSD at the time. What an incredibly, depressingly efficient way to encourage everybody to do their darnedest to hide everything and work through it. As they say: thanks, I hate it! Not that electroshock torture is any better, obviously, but the cynicism of the pension prevention is really something.

[rachelmanija]

I'm glad you appreciated it! I only recently found sources on German conceptions of PTSD. I remember trying to look it up in grad school and finding basically nothing, or nothing in English.

A podcast episode that seems relevant.

[kathmandu]

I have not personally done research on this, but the podcast 'As My Wimsey Takes Me' focused on the Peter Wimsey series which likewise takes place largely between the wars. Some of the novels deal with things like PTSD and 'nervous disorders', so the podcast did a special episode, with a guest specialist, on the psychology and neuroscience of the time. A large chunk of that episode focuses on the history of battle fatigue / shell shock / PTSD and the theories and responses at the time.

It was a good, approachable intro for me, might be the same for other people.

https://asmywimseytakesme.com/episode-13-5/ to listen to the episode or download the transcript.

Re: A podcast episode that seems relevant.

[rachelmanija]

Thank you very much!

[hyarrowen]

Heavens, I had no idea about bigglesevents. I take it this is tyour doing. Thank-you!

[luzula]

Very interesting post, even if one is not in Biggles fandom! : )

[regshoe]

Seconding this—really fascinating (if somewhat grim) history, thank you for writing it up!

[alias_sqbr]

I'm not into Biggles (though I do enjoy your posts) but this was really interesting!

[rachelmanija]

Thank you!

[sovay]

In case it has not crossed your radar, I stumbled across this book [edit: via this review, specifically] while looking for something else and thought it seemed relevant to your interests: Joanna Bourke, Dismembering the Male: Men's Bodies, Britain and the Great War (1996).

[rachelmanija]

Thank you! Excellent review.

[mecurtin]

An additional wrinkle, only recently confirmed: "shell shock" was only partly PTSD. Exposure to high-energy blast waves & sounds can cause blast neurotrauma, as has been found in modern soldiers exposed to IEDs (Here's the scientific paper). It turns out that the literal shock waves from shelling barrages could cause a specific kind of brain damage.

Among the reasons pilots were treated better may have been that they *didn't* have shell shock, "only" PTSD.