A CENTURY OF TRAUMA
Post-traumatic stress disorder has tormented an unknown number of soldiers over the past century. Andrew Duffy charts the evolution of the PTSD diagnosis through four harrowing tales.
War has inflicted psychological distress on an untold number of soldiers over the past century, but mental health issues in the military were not always treated the same way they are now. Andrew Duffy traces the history of post-traumatic stress disorder through four stories of suffering and service.
On the opening morning of the Battle of Vimy Ridge, Capt. Thain MacDowell ran toward enemy lines through a welter of mud and craters, sleet and machine gunfire.
He reached his objective, a German trench, only to find that he had become separated from most of his company. Joined by a pair of army couriers, MacDowell captured two machine gun placements, then climbed down a flight of steps into a deep dugout.
Around a sharp corner, he confronted a roomful of German soldiers. He turned and shouted to an imaginary group of Canadians behind him to hold their grenades. Seventy-seven Germans surrendered.
He sent the prisoners up the stairs in groups of 12 to conceal the fact they were surrendering to just three Canadian soldiers.
“They had plenty of rations but we had a great time taking them prisoner,” MacDowell wrote in a dispatch later that day, April 9, 1917.
His act of courage and deception would earn him the British Empire’s highest decoration for military valour. One of four Canadians awarded the Victoria Cross at Vimy Ridge, MacDowell was the only one still alive six months later when he returned home to Brockville on sick leave.
MacDowell was not sick in the conventional sense: He was suffering from what military doctors called “war neurasthenia,” or shell shock. His symptoms included depression, insomnia, headaches, irritability, fever, perspiration, difficulty concentrating and decreased energy. He also had a slight speech impediment.
MacDowell was one of 10,000 Canadian soldiers diagnosed with shell shock during the First World War.
The condition baffled doctors and challenged military leaders, who didn’t know how to deal with the flood of traumatized soldiers that accompanied every major battle.
Some attributed the phenomenon to emotional weakness or malingering. More than 300 British and Commonwealth soldiers were executed for cowardice or desertion during the war, including 23 Canadians.
An unknown number of them suffered from what today we would call post-traumatic stress disorder (PTSD).
War has inflicted trauma on successive generations of Canadian soldiers whose psychiatric injuries have been variously labelled shell shock, battle exhaustion, combat stress reaction and PTSD. The evolution of that diagnosis has traced a century of conflict: It is a story of service and science and suffering.
CAPT. THAIN MACDOWELL
In February 1915, British psychologist Dr. Charles Myers was the first to identify the phenomenon of shell shock. In the medical journal The Lancet, Myers recounted the case histories of three soldiers traumatized by shell explosions.
Curiously, he said, the soldiers’ hearing was little affected, while other functions such as sight, smell, taste and memory were damaged.
“The close relation of these cases to those of ‘hysteria’ appears fairly certain,” he concluded.
Hysteria was a mental disorder, attributed mostly to women at the time, which typically featured nervousness, fainting or fits. Shellshocked soldiers could be rendered mute or left with partially paralyzed limbs.
Some doctors theorized that shell shock was the result of a physical brain injury caused by soldiers’ repeated exposure to blast waves from exploding shells — a new part of industrialized warfare.
Others pointed to afflicted soldiers who had never been in an explosion to argue that the condition was due to a weakness of the nervous system, “neurasthenia,” triggered by the general stress of war.
The world’s first personality test was developed in an attempt to identify recruits with the “emotional instability” that could put them at risk for shell shock.
Treatments were mostly experimental, and sometimes, horrifying.
In December 1916, Myers spearheaded the establishment of specialized medical units near the front lines to assess and treat traumatized soldiers using Freudian talk therapy. Theorizing that shell shock was a stress disorder, he believed a patient had to relive his experience to reintegrate the traumatic event with his conscious mind.
A Canadian psychiatrist, Dr. Lewis Yealland, was the leading proponent of an altogether different school of thought: that shell shock was a kind of personal failure.
Yealland, a clinician at London’s National Hospital for the Paralyzed and Epileptic, was convinced he could recondition traumatized soldiers through the power of suggestion. He regularly accompanied those suggestions with powerful electric shocks, and sometimes, cigarette burns. He used electrotherapy on 196 patients during the war, and published his results in a disturbing 1918 book, Hysterical Disorders of Warfare.
No one, including Yealland, could suggest that war hero Thain MacDowell lacked battlefield courage or personal fortitude.
Awarded the Victoria Cross in June 1917, MacDowell was hospitalized in England and sent home to Canada in October. He spent three months at Brockville General Hospital where, according to his medical history, he suffered a nervous breakdown.
In January 1918, after a period of rest, he was deemed fit for service again: “Officer shows much improvement since last examination — has regained his emotional control. No attacks of crying since Nov. 17.”
MacDowell returned to England in February 1918, and spent the year in officer training as the First World War raced towards its bloody conclusion. He returned to Canada in December, one month after the armistice, and again sought help.
A medical history taken at the time says: “Officer states that he tires easily and cannot sleep. Has not slept well since Nov. 1916. He may sleep 3 to 4 hours a night if there has been no excitement.”
(In November 1916, MacDowell was thrown into the air by a shell blast at the Somme; he earned the Distinguished Service Order for his role in capturing three machine gun posts during the same battle.)
In January 1919, MacDowell was made commanding officer of a demobilization unit in Ottawa, where he was also an outpatient at the Sir Sandford Fleming Convalescent Home. He could only manage the work for a few months. By August 1919, he was an in-patient at Montreal’s Ste. Anne de Bellevue Hospital, complaining of depression, insomnia, restlessness and irritability.
“He tires very easily and in all work loses interest,” reads his medical case history.
In Montreal, he was prescribed massage and hydrotherapy, a popular method for treating mental illness in the early 20th century. Warm, continuous baths were used to treat agitated patients; they were often bathed in a darkened room for hours, sometimes days, at a time.
In October 1919, after MacDowell was deemed medically unfit for service and discharged, he returned to Ottawa, where he slowly recovered his mental health. His military file does not disclose what treatment he received.
For five years, he worked as private secretary to the minister of defence, and in 1929, married Norah Hodgson, of Montreal. They had two sons. He later entered the mining business as an investor and executive.
MacDowell died of a heart attack in March 1960. He was 69.
SIGNALMAN
WILLIAM (TED) PATRICK
In the Second World War, signalmen maintained communication links between front-line officers and headquarter staff who managed the battlefield.
Enemy forces regularly used signalmen — they carried radios on their backs — to aim their artillery since they knew officers would be nearby. It made Signalmen William (Ted) Patrick a target in 1944 as he fought his way north through Italy with the Irish Regiment of Canada. He suffered perforated eardrums from shells exploding so close to him.
Patrick’s Italian campaign had other harrowing moments. In the Moro River Valley, he saw a heavily pregnant woman ripped open by a landmine. During another advance, he had to cover the lighted dials of his radio as German soldiers walked past him into an ambush.
He did not seek help for the profound anxiety he suffered.
Infantry soldiers like Patrick were the primary victims of “battle exhaustion” in the Second World War. Research by Canadian military historian Terry Copp, a professor at Wilfrid Laurier University, found that 90 per cent of Canada’s battle exhaustion cases came from ground troops.
In part, that was a reflection of the Royal Canadian Air Force’s uncompromising attitude toward aircrew members who developed psychiatric problems and refused to fly. Such airmen were branded as “lacking in moral fibre” or LMF; they were often demoted or dishonourably discharged.
The Canadian Army took a more pragmatic view. Its senior psychiatrist, Col. Frederick Van Nostrand, wanted battle exhausted soldiers treated quickly while close to the front lines so they could be promptly returned to action.
It meant that as Canadian forces fought through Normandy, hundreds of soldiers were treated each week at field dressing stations for acute battle stress. Typically, they were sedated for 24 hours, given two days of rest, and counselled by a therapist. Many were returned to action only to suffer another breakdown.
Battle exhaustion cases represented one-quarter of all wounded soldiers among Allied forces. Those numbers caught military planners by surprise in Canada, where medical officers had tried to weed out recruits with emotional instability.
“The methods that were used were no better than flipping a coin,” Copp, the author of two books on the history of combat stress, said in an interview. “None of it worked in terms of predicting who would break down or who would not break down under conditions of combat.”
In a prophetic report filed at the end of the war, Van Nostrand said he was unsure doctors would ever solve “the vast problem of the psychiatric breakdown of soldiers during war.”
“It is my opinion,” he wrote, “that the methods now employed in the British, American, and Canadian armies will not materially lower the incidence of psychiatric casualties in a fighting force.
“There are various reasons for these opinions but two of them are fundamental: First, there is direct conflict between the needs of the service and the needs of the individual soldier as assessed by his physician. Secondly, the attitudes and behaviour of the successful soldier are contrary to most of his previous teaching. He must not allow death or mutilation of his comrades to prevent him from reaching his objective, and finally, he must pretend that he is glad to risk his life for that cause.”
Van Nostrand pleaded with military planners to accept that normal people cannot always manage the exceptional stress of war. “Every soldier has his breaking point,” he warned.
Ted Patrick had bumped up against his breaking point.
After the Second World War, Patrick returned home to Ottawa and buried his memories. It was a common approach. He married, took a job in the civil service, and launched a bee-keeping business to supplement his income.
All the while, however, the tide of war washed over his subconscious. Patrick sometimes attacked his wife in the middle of the night, believing her to be an enemy soldier; she eventually began to sleep in a separate bedroom. Other times, he would wake up sobbing.
Patrick scrupulously avoided the legion hall and regimental reunions — anything that brought the war to mind. He was also extremely cautious. He didn’t like to go to unfamiliar places; he was, he said, like a rat that stayed close to a wall.
“I would not take a chance on getting hurt or having the family hurt. I was always extremely cautious and went around danger,” he once told an interviewer.
It wasn’t until the 1980s that Patrick was finally diagnosed with PTSD; his psychiatrist urged him to confront his wartime trauma.
The methods that were used were no better than flipping a coin. None of it worked in terms of predicting who would break down or who would not break down under conditions of combat.
TERRY COPP, military historian, professor,
Wilfrid Laurier University
Talking about his experiences — and sharing his memories — eased Patrick’s anxiety. Late in life, he became a dedicated volunteer at the Canadian War Museum and travelled to Holland for ceremonies to commemorate the country’s liberation.
He died in February 2015.
LT. GORDON FORBES
Gordon Forbes, 76, of Orléans was on board HMCS Kootenay 50 years ago during the worst peacetime disaster in the history of the Royal Canadian Navy — an event that would colour much of his life.
On Oct. 23, 1969, HMCS Kootenay was in the North Atlantic, returning to Halifax from a NATO naval exercise. At 8:21 a.m., during a full power trial — a drill to test the destroyer’s performance at top speed — an explosion ripped through the ship’s engine room. A mass of flames shot from a broken gearbox, setting fire to the 10 men inside of the room.
Only three escaped alive.
Thick black smoke quickly filled the lower decks, but its source wasn’t readily apparent to those on the bridge, including Lt. Gordon Forbes, the ship’s weapons officer who was responsible for Kootenay’s 50 tonnes of ammunition.
Engineering Officer Al Kennedy, one of those to escape the engine room, stumbled into the bridge, blackened and badly burned: “Fire in the engine room,” he announced.
That posed problems. The ship’s firefighting equipment was stored near the engine room, and the ship’s main ammunition magazine was immediately behind it. A sailor reported the bulkhead between the two was already hot.
Divers donned tanks and masks to descend into the smoke: They retrieved the ship’s firefighting equipment and rescued sailors trapped by the blinding smoke. Forbes sprayed down the magazine to reduce the threat of a catastrophic explosion.
“If the magazine had blown up, it would have destroyed the ship,” he told this newspaper.
It took about three hours to bring the fire under control; the magazine was then flooded to better stabilize the munitions.
Those on board were told not to talk about the disaster, which had killed nine of their fellow sailors. “No one really knew how to deal with it,” said Forbes.
At the time of the Kootenay disaster, the Vietnam War was in full swing: In 1969, the number of deployed U.S. troops peaked at 549,000.
Curiously, few soldiers reported battle fatigue symptoms in Vietnam. Army officials attributed that development to limited battlefield exposure: Soldiers were rotated through the war on oneyear tours of duty. It gave them a firm date by which their wartime ordeal would end. Many military planners thought the problem of battlefield stress injuries had been solved.
Instead, of course, it had simply gone to ground. Tens of thousands of soldiers returned from Vietnam traumatized: afflicted by nightmares, insomnia, depression, rage, paranoia and addictions.
Psychiatrists labelled the phenomenon delayed psychiatric trauma or “post-Vietnam syndrome” since some thought the disorder was unique to Vietnam.
It was the first time that psychiatrists recognized that stress injuries were not always immediate, but could announce themselves months, even years, later.
Psychiatrists who worked with Vietnam veterans lobbied to have the disorder formally recognized, and in 1980, the authoritative American Psychiatric Association made PTSD part of its Diagnostic and Statistical Manual of Mental Disorders.
The formal recognition of PTSD had profound consequences and allowed for better diagnosis and treatment. Therapists recognized the same disorder in Holocaust survivors, sexual assault victims, first responders — and others afflicted by traumatic events such as the Kootenay explosion.
Sub-Lieut. Clark Reiffenstein, one of those who donned scuba gear to plunge into the ship’s smoke-filled lower decks, died of suicide one month after the fire. He was posthumously awarded the Star of Courage.
Many other Kootenay sailors struggled with alcoholism, nightmares and anxiety.
In 1990, Gordon Forbes was diagnosed with clinical depression soon after retiring from the navy. He suffered from paranoia and had difficulty sleeping. His condition was later linked to PTSD and recognized as a service injury by Veterans Affairs Canada.
It was one measure of the advance in the military’s approach to psychiatric infirmity. “I was very pleased that they started to recognize PTSD,” he said, “and not just throw people out of the service on medical grounds, which is what happened to people who went to get help after the Kootenay fire.”
In 2010, Forbes published a book, We Are As One, about the disaster and its emotional aftermath. Researching and writing the book, he said, was a cathartic experience for everyone involved: “I had so many men come up to me after I wrote the book and say, ‘I thought I was the only one.’ ”
MASTER CPL. NATACHA DUPUIS
Ten years ago, in March 2009, Master Cpl. Natacha Dupuis was put in charge of her first mission with the reconnaissance squadron of the Royal Canadian Dragoons: a weeklong patrol in Kandahar Province.
Qualified as a tank gunner, she had served in Bosnia and was on her second tour of duty in Afghanistan.
Leaving the Forward Operating Base Frontenac, a military outpost near Kandahar, Dupuis led her unit to a hilltop camp on the first night of the patrol.
The next morning, as the unit departed, a massive explosion ripped into the armoured vehicle behind Dupuis’ vehicle. The 14-tonne Coyote was blown into the air and landed on its roof.
Dupuis helped to collect the remains of two dead soldiers, one of whom was cut in half, while preparing for a secondary attack that never came.
Her team was quickly evacuated, but Dupuis kept reliving the incident and reimagining the terrible scene. For days, unable to turn off her flow of adrenalin, she couldn’t sleep. A psychiatrist prescribed her sleeping pills, but she struggled through each day and often sought out a private place to cry.
She willed herself through her final two months of service in Afghanistan.
As soon as she returned home to Petawawa, however, she fell apart: Dupuis suffered powerful flashbacks and panic attacks that left her gasping for air. Diagnosed with PTSD, she transferred to Ottawa, then took a leave. She left the military for good in 2014.
Her story is a familiar one. A Veterans Affairs Canada report last year revealed that about 16 per cent of Canada’s Afghan veterans — more than 6,700 soldiers — have been diagnosed with PTSD.
The PTSD rate remained high in Afghanistan even though the military had tried to carefully prepare soldiers for the stress of war.
Soldiers were briefed about the nature of stress injuries and the importance of seeking early treatment. Those leaving Afghanistan were given an overseas decompression period and repeatedly screened for PTSD or related afflictions. But the “psychological inoculation” of soldiers did little to reduce the overall incidence of PTSD.
“I personally feel I was absolutely ready to face going to Afghanistan,” said Dupuis.
“I was given very good training and it showed. We were able to react to the IED attack. But how do you prepare people to see a horrible scene like that?”
After her diagnosis, Dupuis explored a variety of treatments, including cognitive therapy, a kind of talk therapy designed to help patients identify negative patterns in the way they perceive and deal with everyday events.
At Montfort Hospital, she tried a newly developed treatment, eye movement desensitization and reprocessing (EMDR), which had been shown to help people process their traumatic memories through a series of guided, rapid eye movements. The therapy is believed to mimic the beneficial effects of rapid-eye movement (REM) sleep, which plays a role in the healthy storage of emotional memories.
“EMDR was really difficult,” said Dupuis. “It would drain me a lot because it takes you right back to the trauma: You would feel like you are still there.”
Dupuis worked with a massage therapist, who helped her with meditation and breathing techniques, and also became involved with Soldier On, an organization devoted to helping injured soldiers through athletics. She co-captained Team Canada at the 2017 Invictus Games in Toronto, and won three gold medals.
“For me, I think the big breakthrough came with sport — but I had to be ready for that breakthrough,” Dupuis said. “It’s a very complex recovery process.”
Although she still suffers the occasional flashback — fireworks or big crowds can trigger them — Dupuis has returned to work as a peer counsellor with the Operational Stress Injury Social Support unit of Veterans Affairs Canada.
She helps soldiers and veterans with PTSD. “I share my experience,” she said, “and try to give them hope that it is possible to have a better life.”
Some of Canada’s most decorated soldiers have suffered the effects of PTSD, including William Barker, Tommy Prince and Romeo Dallaire.
It underlines the fact that a century after shell shock was first described in a medical journal, doctors still can’t predict who will suffer PTSD when exposed to the horrors of war, or why some soldiers are affected and not others.
Through statistical analysis, researchers know women are more likely than men to develop PTSD; that people with pre-existing psychiatric conditions are more vulnerable; and that risk increases with each additional overseas deployment a soldier undertakes.
Scientists are also slowly coming to understand what actually happens in the brain of those with PTSD: Research suggests the amygdala, an almond-shaped region of the brain that processes emotions, is overactive along with parts of the prefrontal cortex that promote fear. They’re now examining PTSD-altered brains on a neuronal level, which raises the potential for targeted new treatments.
Dupuis, however, said soldiers experience PTSD so differently that it’s hard to believe there will ever be a single cure — other than an end to war.
“The brain, I think, has its limits: I think there’s only so much a human can take.”
I was very pleased that they started to recognize PTSD and not just throw people out of the service on medical grounds, which is what happened to people who went to get help after the Kootenay fire.
LT. GORDON FORBES