Intended for healthcare professionals

Feature Christmas 2017: Time and Place

Different shell, same shock

BMJ 2017; 359 doi: (Published 08 December 2017) Cite this as: BMJ 2017;359:j5621
  1. Stoyan Popkirov, research fellow in neurology1,
  2. Simon Wessely, regius professor of psychiatry2,
  3. Timothy R Nicholson, honorary consultant neuropsychiatrist3,
  4. Alan J Carson, consultant neuropsychiatrist4,
  5. Jon Stone, consultant neurologist4
  1. 1Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Germany
  2. 2King’s Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
  3. 3Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  4. 4Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to: S Popkirov popkirov{at}

One hundred years on from the first world war, Stoyan Popkirov and colleagues review the German and British medical films that tell the same story of illness and healing

In both war and illness, we tell stories to frame our suffering. We create cultural narratives of national ideology or neurophysiology to cope with adversity. And those stories are not always beholden to history or histology but instead to creating meaning.1 One narrative with cultural tremors that reverberated throughout the 20th century, sparking changes in politics and medicine alike, was that of shell shock during the first world war.234

Never fully defined, at times overused, and even banned, shell shock became as much a story as a diagnosis. Its causes and presentations varied greatly, from blasts to breakdowns and from blindness to paralysis, shaped as much by the terror of those affected as by the conceptual frameworks of the times (table 1). The incomprehensible new horror of industrialised warfare manifested itself in a severe and mysterious epidemic affecting tens of thousands of soldiers on both sides of the war. It was a medical conundrum that led to a crisis in military personnel and needed to be understood urgently given the ongoing deadlocked war. Initial theories of blast related neuropathology were soon abandoned in favour of psychological aetiologies.234 The presentations of shell shock were recognised as functional disorders, highlighting beyond any doubt that “hysteria” could affect men too, and in large numbers.

View this table:
Table 1

Features of shell shock and related disorders

One way in which the story of shell shock was told was through the recently developed technology of film. Before the subsequent plethora of dramatised war movies, physicians produced short medical films showcasing actual patients and their ailments, as well as their treatment and recuperation.5 …

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