COWARDICE AND SHELL-SHOCK.
FROM THE REPORT OF THE WAR OFFICE COMMITTEE OF ENQUIRY INTO
SHELL-SHOCK. 1922 - H M Stationary office; Pages 138-144
Cowardice is a military crime for which the death penalty may be
exacted. Some witnesses declined to define it and others did so with
Major Dowson, a barrister of considerable court-martial experience
said: "Cowardice is showing signs of fear in the face of the enemy."
Such a definition is not helpful to the medical officer who may be
called on to decide between cowardice and shell-shock. Cowardice, if regarded as a lack of or failure to show requisite
courage, renders discussion more feasible and assists us in
comprehending how the brave after much stress may temporarily fail to
show their wonted courage without deserving to be called by an
opprobrious term. Fear is the chief factor in both cowardice and emotional "shell-shock"
and it was for this reason that cowardice in the military sense was
made a subject of enquiry by the Committee.
Witnesses were agreed that cowardice should be regarded as a military
crime to be punished when necessary by death. Fear is an emotion common to all and evidence was given of very brave
men who frankly acknowledged to it. It is obvious then that fear alone does not constitute cowardice.
Colonel Allison remarked that with second lieutenants it was their one
fear, that they should show cowardice in front of their men.
Dr. Farquhar Buzzard said: "I quite see that fear passes to cowardice.
But fear is really an unconscious thing and has a very definite
physical manifestation." And again he remarked -" Cowardice is a
voluntary attitude taken up by an individual; he adopts a certain
attitude that he will not face a situation in which he believes certain
things will take place. That is cowardice, if you like to apply the
term, but the fact that my knees shake when I am looking over the side
of a building is an absolute physical thing over which I have no
Prof. Roussy noted the difficulty of distinguishing between cowardice
and emotional shell-shock. " Cowardice is lack of self-control of an
individual over himself. In the presence of a situation in which there
is an element of danger or in which there is an element likely to cause
fear, any man who can control himself is a courageous man, but he who
gives way, runs away or does certain other actions not esteemed worthy
is defined as a coward."
It may then be accepted that neither feeling fear nor manifesting the
physical signs of fear - pallor, shaking, tremors, quick pulse do not
of themselves constitute cowardice though they are more or less
essential to it. If the individual exercises his self-control in facing the danger he is
not guilty of cowardice, if, however, being capable of doing so, he
will not face the situation, he is then a coward. It is here that
difficulty arises in cases of war neurosis for it becomes necessary to
decide whether the individual has or has not crossed that indefinite
line which divides normal emotional reaction from neurosis with
impairment of volitional control.
Dr. Mapother said: “Frankly, 1 am not prepared to make a decision
between cowardice and shell-shock. Cowardice I take to mean action
under the influence of fear and the ordinary type of 'shell-shock' was,
to my mind, persistent and chronic “fear.”
Dr. Johnson thought that when the symptoms of fear, tremors, sweating,
tachycardia persisted or revived on slight emotional stimulation a
psycho-neurosis was present.Having regard to their terms of reference, the Committee have felt it
incumbent upon them to make some inquiry into "Shell-Shock" in
relation to courts-martial. As regards expert medical evidence and advice in courtmartial cases,
the system pursued in France in the late war seems to have been a
satisfactory one, namely, that when any medical question or a doubt arose
before or at a trial, or on subsequent review of the Proceedings, the
best possible expert advice available was placed at the immediate
disposal of the military authorities, either in the form of a board or
otherwise. We recommend that a similar plan should be followed in
The subject of courts-martial held during the war received exhaustive
investigation by Mr. Justice Darling's Committee immediately upon its
conclusion. The report of that committee is before us, and having
regard to its terms, the steps subsequently taken to carry out its
recommendations, and the evidence which has been given before us, we
anticipate that in any future war justice will be administered in a
thoroughly satisfactory manner, if the same or a similar policy if
Our conclusions are:
That the military aspect of cowardice is justified.
That seeming cowardice may be beyond the individual's control.
That experienced and specialised medical opinion is required to
decide in possible cases of war neurosis of doubtful character.
That a man who has already proved his courage should receive
special consideration in case of subsequent lapse.
MALINGERING AND SHELL-SHOCK.
On this subject the ample evidence heard by the Committee revealed some
difference of opinion both as to the prevalence and the practicability
of detection of malingered shell-shock. When closely considered this divergence of views is found to be to some
extent more apparent than real and the bulk of evidence is not much at
variance. Such discrepancy as exists is partly explicable as arising
from the use of the term malingering and as to whether it is
interpreted in a limited or broad sense. Again, in those who have been
exposed to the stress of battle with its danger, noise, and terrors,
there is frequent difficulty in deciding how much of conscious and how
much of unconscious motive there may be in the actions of the possible
malingerer, since in either case the fundamental instinct of
self-preservation is presumably present.
The dividing line between malingering and functional neurosis may be a
very fine one and many "shell-shocks" are of hysterical nature; in most
there is a halo of hysteria according to Sir F. Mott.
Hysteria was called " La Grande Simulatrice " by Charcot as quoted by
Prof. Roussy so that simulation is common to both malingered
“shell-shock” and to much genuine “shell-shock." Further, if we bear in mind how the incidence of shell-shock varied
with the morale of different units it may be comprehended how equally
competent observers have arrived at different conclusions.
preliminary observations the deductions which the evidence appears to
justify may now be formulated:
(1) True malingering, meaning the action of one who deliberately
attempted imposition in pretending to be suffering from "shell-shock,"
was of rare occurrence or, as one witness expressed it, " absolute
malingering was very common."
(2) Partial malingering, exaggeration of symptoms or prolongation of a
condition no longer remaining was far from uncommon and frequently
arose from a desire to avoid service or for a continuation of pension.
Such form of malingering was found most difficult to deal with even by
specialists owing to the doubt which often existed in their minds as to
the degree of intention present.
(3) Quasi-malingering, skrimshanking, skulking. In this group
there are included those who, with little or no pretence decamped from
the battle as opportunity arose, pleading "shell-shock" as the excuse
for their evasion. Their numbers were great. For the most part they
made but feeble if any attempt at deception and ultimately by
persuasion or command returned to duty.
“Shell-shock” became recognized as a handy excuse, and, indeed, a
suggestion also to the many who were ready to avail themselves of any
subterfuge to escape from the terrors of the front. If this breaking away of men in small and large numbers is to be
classed as malingering, then it must be allowed that malingering
occurred in unprecedented proportions. As a defence in court-martial cases "shell shock" was so frequently
pleaded as to be spoken of as a "parrot cry" by a witness of much
experience of courts-martial.
The Detection of Malingering.
(a) In the Front Line. The pronounced case of acute shock cannot be doubted, and mild “shell
shock.” cases are best dealt with as being simple exhaustion. It is
patent that an exhaustive neurological examination, even if the medical
officer were capable of'conducting it, is impracticable. The medical officer, however, may discriminate, and if he knows the
character and personality of the man, observes in how far his behaviour
appears to be voluntary or involuntary, and makes use of such further
observation as circumstances permit of, he will be assisted in
deciding the false from the true.
(b) Away from the Front Line. Though
the clumsy malingerer may be easily detected, the able one or
the mental defective may occasion considerable difficulty to the
medical officer in arriving at a conclusion completely free from doubt.
In all cases of consequence the examiner should be specially versed in
The presence of fine tremors, quick
pulse and sweating, if persistent
or readily excited by slight emotional stress, may, according to some
authorities, be accepted as indicative of psycho-neurosis. Space
does not permit of considering all the details in making a
differential diagnosis, but Dr. Mapother, who is quoted below, mentions
many, and suggests that cases which show none of the signs of emotion
impossible of simulation are very suspicious.
Reviewing the evidence, which was ample, on the subject of malingering
and "shell-shock" it is evident that close and often prolonged
observation may be necessary, that occasionally doubt may still remain
and that in all important cases the decision should be made by a
specially trained physician well acquainted with functional nervous
SUMMARY of the more important evidence on which the above report on
Malingering is based.
Dr. Mapother. There was not a hard and fast distinction between either
of the common types of Neurosis and simulation. The degree of awareness of intention and motive to deceive might vary
even in the same cases at different times. I think most cases of Anxiety Neurosis were wholly genuine to start
with. Many remained so throughout but some were consciously protracted
and exaggerated later. A few added features not to be explained as
effects of fear; more settled down to emphasis of one feature of the
original syindrome. Most cases of " Conversion Hysteria " were consciously simulating or
exaggerating at first. Eventually the production of symptoms became
automatic and some achieved belief in their own symptoms. None of the
so-called trophic changes were proof of genuineness.
In Dr. Mapother's opinion any case showing none of those signs of
emotion impossible of simulation was suspicious.
The following were such signs of
emotional disturbance as could be
accepted as excluding conscious simulation: Tachycardia;
Diffuse and forceable cardiac impulse. Vasomotor changes, sweating,
flushing. Enlargement of thyroid; Fine tremor of face and tongue; Fine
tremor of hands of a quality only distinguishable by experience;
Stammer only distinguishable by experience; "Increased tendon
jerks only distinguishable by experience;
Increase of supinator and triceps jerks much more important than of
knee jerks; Insomnia and evidence of nightmares;
Polyuria; Diarrhoea confirmed by
Specially suspicious points were profusion and alleged intensity of
subjective symptoms with absence of the above. Intensification of those signs of emotion produced by voluntary
muscles with disappearance of those impossible of imitation; especially
condensation of the general reaction of fear into one such feature as
stammer and an exaggeration of this. Discrepancy of subjective symptoms with conduct; Variation of
symptoms when unaware of observation; Variation in accordance with
Other points were - Attitude, towards
symptoms, e.g., emphatic repudiation of “mental
origin;” Attitude towards treatment and towards recovery;
Attitude towards discipline and occupation; Evidence of moral
sense in other relations, e.g., general
untruthfulness, financial dishonesty, the meaner kinds of sexual
Dr. Hurst : After much investigation of the subject I came to the
conclusion that the signs of genuine neuroses and simulation are
identical, and that simulation can only be diagnosed with certainty in
the very cases in which a malingerer has been detected in flagrante
delicto, or when he confesses that he is shamming.
Dr. Johnson. Simulation was rare, but exaggeration of symptoms common.
In the forward areas a valuable combination of symptoms indicating
Fine tremors. Sweating. Tachycardia. A full experience and knowledge of men combined with adequate training
in the subject of Psycho-neuroses forms the surest safeguard against
being imposed on by the malingerer.
Dr. Gordon Hoinies considered that experienced and properly trained
officers could usually detect simulation. There was great difficulty in
accurate diagnosis in those who exaggerated or prolonged symptoms.
During the battle of the Somme a large number of men deserted from the
line on the claim that; they had "shell-shock."
Dr. Farquhar Buzzard : I think there were very few people
I should like to say were, absolutely inalingering.
Dr. W. Brown stated that in 1,000 cases he had found 28 cases of
serious malingering, all of whom had confessed to him. Most with
malingering had loss of memory, and he considered feigned amnesia was
Squadron Leader Tyrrell, referring to his front line experiences, said
he depended on his knowledge of the man, observation, judgment as to
whether his behaviour, etc., was voluntary or involuntary, and in the
exercise of common sense in distinguishing the genuine from the feigned
Dr. Hampton: Many cases were on the border line between conscious and
Lieut-Colonel Scott Jackson: Many cases of neurasthenia and 'shell-shock ' were skrimshanking of the worst type.
Major Adie: " We did not see much malingering."
Dr. Wilson, in speaking of men who took advantage of an attack to get
away, said: "I do not know how much malingering there is in
these cases; it is almost impossible to tell."
Colonel Campbell considered " shell-shock " a favourite method which
malingerers employed to get away from the battle front; in a unit with
poor morals this form of skrimshanking becomes contagious.
Dr. Dunn said: " In acute shock a man abandons himself to his terror. 1
have not seen an attempt to simulate it, and I cannot imagine such an
attempt deceiving anyone."
Colonel Jervis considered the number of emotional breakdowns was slight
as compared to the number " swinging the lead."
Colonel Soltau thought information in a suspect case could be obtained
by observation during sleep and also by suddenly awakening the case. He
had only detected two malingerers himself.
Major Longmore remarked that in court-martial cases "ShellShock "
became a. parrot cry as a defence.