Hypnotic abreaction of shell shock

1. Introduction

Version followed: the British First World War practice of hypnotic recall and emotional reliving ("abreaction") for shell shock, as described by William Brown (Lancet 1918; British Journal of Psychology, Medical Section 1920–21) and set against the variants of C. S. Myers and William McDougall, using the historical reconstruction by Brown, Van der Hart and Graafland (1999). J. A. Hadfield's version ("hypno-analysis") is named but his procedure is not drawn on from a primary text [uncertain].

This is a historical guide, not a treatment to adopt. It describes what clinicians did in 1914–1920, how it was received, why it faded and what of it survives. No current guideline recommends hypnotic abreaction for trauma, and nothing here should be read as a method for recovering memories. Memories produced under hypnosis are the client's experience as it emerges in that state, shaped by expectation and suggestion; even contemporaries (Rivers) warned that material found under hypnosis could be produced by the physician's suggestion [source: Rivers, Instinct and the Unconscious, 1920]. [synthesis]

What it was. Soldiers evacuated with "shell shock" often had functional (conversion) symptoms such as mutism, deafness, tremor, paralysis or gait disorder, together with amnesia for the event that preceded them. Some medical officers hypnotised these men and suggested they return to the scene, so that they re-experienced it with strong emotion, and then woke them and discussed the experience [source: Brown, Van der Hart & Graafland 1999; Manawatu Herald report of Brown, 1919]. William Brown worked near the front, including at No. 13 Casualty Clearing Station in 1917, where he saw Wilfred Owen before Owen went to Craiglockhart [source: Howorth 2000]. Hadfield is credited with coining "hypnoanalysis" for hypnosis used to retrieve memories in amnesic war patients [source: Wikipedia, Hypnoanalysis — secondary; uncertain], and wrote the chapter on treatment by suggestion and persuasion in Crichton-Miller's Functional Nerve Disease (1920) [source: Wellcome Collection catalogue; chapter contents uncertain].

Core idea of change (as its users held it). Brown's model was that a terrifying experience was repressed and split off together with its emotion, and that the dissociated memory-and-affect kept the bodily symptom going. Reviving the memory with "hallucinatory vividness" and letting the emotion be "worked off" was thought to release the symptom; he claimed results were better the more completely the emotion was revived [source: Brown, Van der Hart & Graafland 1999; Myers 1919; Manawatu Herald 1919]. Brown added an intellectual step, autognosis, to integrate the recovered material into the patient's life history. Myers and McDougall held instead that the active ingredient was reintegration of the split-off memory with the normal personality, not emotional discharge [source: Brown, Van der Hart & Graafland 1999].

2. Framework

There was no manual; what follows is the typical course reconstructed from the sources cited. Session counts and selection criteria were not reported in the sources cited [uncertain].

[source: Brown, Van der Hart & Graafland 1999; Myers 1919; Howorth 2000; Jones & Stone 2020]

• Training. RAMC doctors took three-month courses at Maghull (R. G. Rows) and Netley (C. Stanford Read), which taught brief interventions aimed at re-experiencing repressed memories and emotions from the front [source: Howorth 2000].
• Chronic cases were judged much less treatable, sometimes "no more than mental hygiene" [source: Brown, Van der Hart & Graafland 1999].
• Order of steps varied. Myers first restored the amnesia (with or without hypnosis), later treated bodily disabilities first and mental disturbance afterwards, and admitted that which order suited which case was unknown [source: Myers 1919].

Reception at the time. The practice was contested from the start. Myers doubted that emotional release was needed and called for controlled comparisons of restraint versus expression, and for follow-up on how long cures lasted. McDougall said abreaction could increase symptoms. Jung judged it actually harmful in a considerable number of cases [source: Myers 1919; Brown, Van der Hart & Graafland 1999]. Gordon Holmes blamed the failures of "psychoanalysts and hypnotists" on untrained staff [source: Jones & Stone 2020]. The 1920–21 British Journal of Psychology (Medical Section) symposium on the revival of emotional memories set out these positions [source: Brown, Van der Hart & Graafland 1999].

Why it fell out of use. Sources cited give partial reasons only [uncertain]: the Janetian dissociation-integration model behind it was eclipsed by Freudian theory after the war; military psychiatry valued rapid symptom removal and return to duty over understanding; doubts about relapse and harm were raised and never settled by trials [source: Brown, Van der Hart & Graafland 1999; Myers 1919]. Abreaction returned in the Second World War, by hypnosis (Sargant with Dunkirk evacuees, as reported in the press) and increasingly by drug-assisted interviews, covered in sibling guides in this family [source: Bailey, Gresham lecture; Wikipedia, Hypnoanalysis].

3. Guiding principles

These are the principles practitioners of the time held; each is followed by what a modern clinician should take from it. Modern readings are [synthesis].

• Symptoms are held in place by a split-off traumatic memory (Brown, Myers, McDougall). Modern reading: functional symptoms after trauma deserve a trauma history, but the link is a hypothesis to explore with the client, not something to prove by uncovering.
• Restoring the memory restores function (Myers: restoring memory brought back speech and voluntary movement). Modern reading: there is no need to induce recall; work with what the client can tell awake, at a pace they control.
• Emotion must be revived fully (Brown) versus emotion should be calmed (Myers) versus reintegration matters more than discharge (McDougall, Jung). Modern reading: emotional engagement with the memory is now delivered in a graded, consented, client-controlled form (exposure-based therapies), not as a single cathartic flood.
• Treat early and near the front (Brown). Modern reading: the forward-psychiatry idea of early, brief, expectant care survives, but within a voluntary, client-centred frame.
• Integration after recall (Brown's autognosis; McDougall's re-association). Modern reading: meaning-making and integration of the experience into the life story is central to trauma work; it does not require hypnosis.
• Distrust quick cures (Myers: a symptom removed while the underlying disturbance stays is not a cure; enthusiasts overrate their methods). Modern reading: measure durability, not speed.
• Avoid dependence on the hypnotist (raised by Myers as a claimed risk). Modern reading: aim for the client's self-efficacy; teach self-regulation skills rather than relying on the therapist's influence.
• Corroborate before believing hypnotic material (Rivers). Modern reading: never treat hypnotically produced content as historical fact.

[source: Myers 1919; Brown, Van der Hart & Graafland 1999; Rivers 1920]

4. Intervention inventory

How to read this section: each entry describes a historical procedure as the sources cited report it, then gives its modern status. Because hypnosis or abreaction must not be presented as a way to recover accurate memories, no hypnotic recall or regression wording is offered for re-use. Where an element survives in current practice, illustrative modern wording is given and labelled. Induction methods, session length and numbers of sessions were not described in any source cited [uncertain].

4.1 Early selection and forward treatment

• Purpose and when used (then): treat men with acute functional symptoms and amnesia as soon as possible, near the line, before symptoms "fixed"; Brown held abreaction was easier in the field [source: Brown, Van der Hart & Graafland 1999]. Men not recovered within about two weeks at clearing stations went to UK hospitals [source: Howorth 2000].
• Steps (as reported): identify the soldier with a conversion symptom (mutism, deafness, tremor, paralysis) plus a gap in memory around a blast or burial; treat at a casualty clearing station or advanced neurological centre; if not recovered, evacuate [source: Howorth 2000; Brown, Van der Hart & Graafland 1999]. Formal selection criteria were not found [uncertain].
• Example language: none recorded.
• Watch for: the military aim (rapid return to fighting) shaped every choice; consent in the modern sense was not sought [synthesis]. Modern status: the principle of early, brief, normalising care survives; early hypnotic or forced reliving does not, and routine single-session debriefing after trauma is not recommended in current guidelines [synthesis; uncertain].

4.2 Hypnotic induction (light hypnosis)

• Purpose (then): create a state in which the amnesic period could be reached and suggestions would take effect. Light hypnosis was widely used to reinforce suggestion, and one contemporary (William Johnson) held the doctor's personality mattered more than the technique [source: Jones & Stone 2020].
• Steps: not described in the sources cited [uncertain]. Some clinicians reached the same material by free association instead (4.9) [source: Brown, Van der Hart & Graafland 1999].
• Example language: not supplied (see note above).
• Watch for: Myers recorded the claim that hypnosis made patients dependent on the hypnotist, and asked whether this was inevitable [source: Myers 1919]. Modern status: clinical hypnosis today is used by licensed clinicians within their competence, with informed consent and screening; for trauma it is used for calming, ego-strengthening and symptom management, not memory retrieval [synthesis].

4.3 Hypnotic restoration of amnesia ("hypno-analysis")

• Purpose (then): fill the gap in memory for the event, on the theory that restoring the memory would restore speech and movement. Myers reported that restoring the memory, with or without hypnosis, brought back speech and voluntary control; hypnosis was also said to reveal the man's thoughts and surroundings during his confused or stuporous period [source: Myers 1919]. Hadfield named this use of hypnosis "hypnoanalysis" [source: Wikipedia, Hypnoanalysis; uncertain].
• Steps (as reported): under hypnosis the patient was led back to the time of the event and asked to recount it; the recalled account was then carried into waking awareness (see 4.7) [source: Brown, Van der Hart & Graafland 1999; Myers 1919]. Hadfield's own steps are not drawn on here [uncertain].
• Example language: not supplied.
• Watch for: Rivers warned that an "experience" found under hypnosis might be produced by the physician's suggestion, and wanted independent corroboration; he also noted that memories sometimes returned spontaneously, months or years later, without hypnosis [source: Rivers 1920]. Kardiner (1941) reported hypnotic recall without therapeutic benefit [source: cited in Brown, Van der Hart & Graafland 1999]. Modern status: abandoned. Hypnotically refreshed memory is treated as unreliable; clinicians should not use hypnosis, suggestion or imagery to fill amnesic gaps [synthesis].

4.4 Emotional reliving under hypnosis (Brown's abreaction)

• Purpose (then): discharge the emotion bound up with the repressed memory; Brown claimed better results the more completely the emotion was revived [source: Brown, Van der Hart & Graafland 1999].
• Steps (as reported in Brown's cases): (1) hypnotise; (2) suggest the man is back at the scene and let him live through it as if present — in one acute case "as if in the trenches"; (3) allow full emotional expression: in a 1919 case report a gunner knocked out at Ypres two years earlier shouted at a comrade, re-enacted laying and turning the gun with his trembling right arm, and showed strong emotion; (4) wake him; (5) check the symptom and the waking memory. The gunner's tremor stopped on waking, he shaved himself the next morning for the first time in two years, and he could now recall the whole incident [source: Manawatu Herald 1919 report of Brown's paper; Brown, Van der Hart & Graafland 1999].
• Example language: not supplied (re-use would be hypnotic regression to trauma).
• Watch for (as contemporaries reported): symptom increase, a "new emotional shock", relapse until emotion was fully relived (Brown's deaf-mute case regained speech only after reliving the event in a dream) [source: Brown, Van der Hart & Graafland 1999]. Myers argued much of the display was re-enactment rather than new emotion [same source]. Modern status: the single-flood catharsis model is not used. Emotional engagement with trauma memories survives in graded, consented forms (prolonged exposure, narrative exposure therapy, trauma-focused CBT, EMDR), with readiness checks, grounding and closure [synthesis].

4.5 Calm hypnotic recall with emotional restraint (Myers' variant)

• Purpose (then): restore and reintegrate the memory without encouraging emotional outbursts; Myers reported results at least as good as Brown's by discouraging the patient from giving full rein to emotion [source: Myers 1919; Brown, Van der Hart & Graafland 1999].
• Steps (as reported): hypnotic recall of the event (4.3) while the physician used a suggestive, calming manner, encouraging composure; aim was to unite the "emotional personality" with the normal one [source: Brown, Van der Hart & Graafland 1999]. Detailed steps not found [uncertain].
• Example language: not supplied.
• Watch for: Myers called for controlled comparison of restraint versus expression, which was never done in his era [source: Myers 1919]. Modern status: the stance that arousal should stay within a tolerable window during memory work survives in phase-oriented trauma treatment [synthesis].

4.6 Direct suggestion for symptom removal ("somatic redintegration")

• Purpose (then): remove the bodily disability directly. Myers distinguished this from "mental redintegration" (uncovering the conflict) and said their relative value was unknown [source: Myers 1919].
• Steps (as reported): during hypnosis, suggest that the function will return; in one acute mute, amnesic soldier, Brown suggested speech would come back within minutes, combined with reliving [source: Brown, Van der Hart & Graafland 1999]. Light hypnosis to reinforce suggestion was common; others (Hurst) relied more on persuasion and re-education without hypnosis [source: Jones & Stone 2020].
• Example language: not supplied.
• Watch for: Myers: quick removal of a symptom while the mental disturbance persisted was not a true cure, and the symptom could return on slight provocation [source: Myers 1919]. Distinguish from coercive "suggestion": Lewis Yealland's disciplinary use of painful electric shocks, shouted commands and isolation was a different, coercive practice [source: Howorth 2000; Jones & Stone 2020]. Modern status: for functional neurological disorder, current care uses explanation of the diagnosis and physiotherapy- and psychotherapy-based rehabilitation [synthesis; uncertain].

4.7 Gradual waking with re-association (McDougall)

• Purpose (then): carry the recovered memory across into ordinary consciousness so that the split closed [source: Brown, Van der Hart & Graafland 1999].
• Steps (as reported): wake the patient slowly while linking the recovered memories to his present surroundings in the ward [source: Brown, Van der Hart & Graafland 1999]. Details not found [uncertain].
• Example language: none recorded.
• Watch for: McDougall warned that breaking the dissociative barrier could itself be a new emotional shock with return of symptoms [same source]. Modern status: orienting a client to the present at the end of any emotionally intense session survives as grounding and closure [synthesis].
• Illustrative modern closure wording (no hypnosis): "Let's come back to the room. Notice your feet on the floor and name three things you can see. You're here, today, and that was then." (illustrative)

4.8 Autognosis: waking integration (Brown)

• Purpose (then): an intellectual, waking step after reliving: help the patient understand the recovered experience and place it in his life history, so the dissociated material was integrated [source: Brown, Van der Hart & Graafland 1999].
• Steps (as reported): after waking, discuss the event with the patient, relate it to his earlier life and present symptoms, and help him make sense of it. Session structure not found [uncertain].
• Example language: none recorded.
• Watch for: contemporaries noted patients often had more than one traumatic event, so one account rarely explained everything [source: Wikipedia, Hypnoanalysis, citing Brown 1921 — secondary]. Modern status: this is the element closest to current practice: making meaning of trauma and integrating it into the life narrative (cognitive processing, narrative exposure, phase 3 of phase-oriented models) [synthesis].
• Illustrative modern wording (no hypnosis, client-led): "Looking at what you've told me, what do you make of how that day has shaped things since?" (illustrative)

4.9 Free association as an alternative route to the memory (McDougall, Rivers)

• Purpose (then): explore the origin of the dissociated state without hypnosis. McDougall's first step, "exploration", used hypnosis or free association; Rivers reported war amnesias resolved by hypnosis or free association, sometimes months or years later [source: Brown, Van der Hart & Graafland 1999; Rivers 1920].
• Steps: waking talk in which the patient says what comes to mind about the gap; details not found [uncertain].
• Example language: none recorded.
• Watch for: Rivers himself sought independent corroboration because of the risk of suggestion [source: Rivers 1920]. Modern status: clinicians accept partial amnesia as part of the client's experience and do not set out to fill it [synthesis].

4.10 Emotional readjustment, persuasion and re-education

• Purpose (then): after exploration, help the patient face his fears and rebuild confidence (McDougall's second step, "emotional readjustment"); persuasion and re-education were also the mainstay of non-hypnotic schools such as Hurst at Seale Hayne [source: Brown, Van der Hart & Graafland 1999; Jones & Stone 2020]. Hadfield wrote the chapter on treatment by suggestion and persuasion in Functional Nerve Disease (1920) [source: Wellcome catalogue; chapter contents uncertain].
• Steps: explanation of the symptom as functional and reversible, encouragement and graded practice of the lost function; details for Hadfield not found [uncertain].
• Example language: none recorded.
• Watch for: in some hands persuasion became coercion (Yealland), which is not the same method [source: Howorth 2000]. Modern status: explanation and graded rehabilitation survive in functional neurological disorder care; graded approach to feared situations survives in exposure therapy [synthesis].

4.11 Spontaneous reliving in dreams (observation, not a technique)

• Brown reported a returned deaf-mute soldier who recovered the memory under treatment but regained speech only after reliving the event in a dream [source: Brown, Van der Hart & Graafland 1999]. Recorded here because it was used as evidence for the abreaction model, not because it was induced.

5. Handling problems

5.1 Problems recorded at the time

• Symptoms got worse after abreaction (McDougall); abreaction harmful in a considerable number of cases (Jung). Response then: some switched to calm recall (Myers) or put integration ahead of discharge (McDougall, Jung) [source: Brown, Van der Hart & Graafland 1999].
• New emotional shock when the amnesia was broken; removing amnesia could stir harmful emotions and fresh repression (McDougall; Brown 1920–21) [same source].
• Relapse after quick symptom removal (Myers) or until emotion was fully relived (Brown) [source: Myers 1919; Brown, Van der Hart & Graafland 1999].
• Chronic cases, often with secondary gain, were largely refractory [source: Brown, Van der Hart & Graafland 1999].
• Dependence on the hypnotist was a stated concern [source: Myers 1919].
• Suggestion contaminating the recovered account (Rivers); hypnotic recall without benefit (Kardiner 1941) [source: Rivers 1920; Brown, Van der Hart & Graafland 1999].
• Untrained operators blamed for failures (Holmes) [source: Jones & Stone 2020].
• No deaths or specific injuries from hypnotic abreaction were reported in the sources cited; documented harms are symptom worsening, retraumatisation and relapse as above [uncertain beyond these].

5.2 When a client today asks for hypnotic regression or "getting the memory out" [synthesis]

• Explain that hypnotic recall does not reliably uncover what happened and can create confident but inaccurate memories; offer trauma-focused treatments with stronger support (prolonged exposure, cognitive processing therapy, trauma-focused CBT, EMDR, narrative exposure therapy).
• Respect partial amnesia: work with what the client can access awake; do not suggest content.
• Illustrative: "We don't need to fill in every gap to help with how this is affecting you now. Let's start with what you do remember, at a pace you can manage." (illustrative)

5.3 Overwhelm or dissociation during any trauma-memory work [synthesis]

• Before memory work: check readiness (stable enough to tolerate distress, grounding skills practised, current safety, no active psychosis or uncontrolled substance use, suicide risk assessed).
• During: keep arousal tolerable; stop if the client loses contact with the present; use grounding (orientation to date and place, sensory focus, feet on floor); follow the dosing and closure rules of the protocol you are trained in.
• After: close every session with grounding and a check that the client is oriented and safe to leave; plan between-session support.

5.4 Clients who went through abreactive or hypnotic treatment in the past (e.g. older veterans, family accounts) [synthesis]

• Ask about the experience and any worsening that followed; validate distress caused by treatment.
• Do not treat memories produced in those sessions as either confirmed or false; work with their meaning and current impact.
• Offer standard trauma-focused care with explicit consent and client control, contrasted plainly with what happened before.

5.5 Recognising echoes in current practice [synthesis]

• Red flags: promises that one cathartic session will "release" trauma; regression to find hidden memories; therapist-led content about what "must" have happened; pressure to relive without preparation or consent; judging progress by the size of the emotional display.
• Legitimate exposure work differs: it is consented, prepared, graded, client-controlled, uses memories the client already has, and closes with grounding.

5.6 What survives in modern trauma treatment [synthesis, building on Brown, Van der Hart & Graafland 1999]

• The idea that avoided trauma memories maintain symptoms, and that engaging with them helps, survives in exposure-based therapies.
• The Janetian sequence (stabilise, process, integrate), which Myers and McDougall leaned towards, has regained ground and underlies phase-oriented treatment of complex trauma and dissociation [source: Brown, Van der Hart & Graafland 1999 for the revival of Janet's model].
• Early, brief, expectant care near the point of injury survives in military mental health in a voluntary form.
• Discarded: hypnosis to recover memories, single-session catharsis, and treatment shaped by return-to-duty pressure rather than the patient's interest.

Sources

Sources:

• Brown P, Van der Hart O, Graafland M (1999). Trauma-induced dissociative amnesia in World War I combat soldiers. II: Treatment dimensions. Aust N Z J Psychiatry 33:392–398
• Myers CS (1919). The study of shell shock: a final contribution. The Lancet, 11 January 1919
• Manawatu Herald, 30 October 1919: report of William Brown's case at the joint Aristotelian Society / British Psychological Society / Mind Association meeting (Papers Past)
• Howorth PW (2000). The treatment of shell-shock: cognitive therapy before its time. Psychiatric Bulletin 24:225–227
• Jones E, Stone J (2020). Article on Arthur Hurst and shell shock at Seale Hayne. J R Coll Physicians Edinb 50(4):436–43
• Rivers WHR (1920). Instinct and the Unconscious (publisher reading sample)
• Devine H (1918). Epitome of Brown W, The treatment of cases of shell-shock in an advanced neurological centre (Lancet, 17 August 1918). J Ment Sci 64:388 — bibliographic record only
• Wellcome Collection catalogue: Crichton-Miller H (ed.) (1920). Functional Nerve Disease: an epitome of war experience for the practitioner
• Wikipedia: Hypnoanalysis (secondary)
• Bailey R. From shellshock to psychiatry (Gresham College lecture materials)

Further reading (not drawn on): Brown W (1918), The treatment of cases of shell shock in an advanced neurological centre, Lancet; Brown W (1920–21), The revival of emotional memories and its therapeutic value, British Journal of Psychology (Medical Section), with replies by Myers, McDougall and others; Hadfield JA (1920), chapter on treatment by suggestion and persuasion, in Crichton-Miller (ed.), Functional Nerve Disease; Brown W (1921), Psychology and Psychotherapy; Kardiner A (1941), The Traumatic Neuroses of War.

Further reading (not drawn on): history.rcp.ac.uk blog "The petrification of terror".