Invisible Disability

Born in 1882, Edward Baxter was originally from Cheltenham and enlisted for the army in 1913, a year before the First World War began. As a soldier, he received a gunshot wound to his left calf while serving in France. However, his files show that when the Ministry for Pensions was evaluating his case, they was decided that this counted as ‘no disability’. Instead, he was awarded a pension for a diagnosis of myalgia which originated in June 1916 and was deemed to have been caused by ‘exposure, stress and strain’ – all of which people are forced to endure during trench warfare.

His first pension was granted on 14 November 1916 for 56 weeks at a value of 8s 3d and his myalgia was evaluated at 30% disablement. Percentage disablement could range from less than 20% up to 100% and indicated the authority’s opinion on how much this disability would affect the man’s life. Consequently, Edward’s situation shows that, though the ministry recognised his disability needed compensating, they did not think his myalgia would have a great impact on his life.

His 6th and final pension, which was granted in February 1922, shows something interesting. The disability for which his pension was granted changes from myalgia to neurasthenia. A memorandum attached to the form shows that the Medical Branch had determined he was suffering from both myalgia and neurasthenia, but neurasthenia was the primary disability.

Neurasthenia was a term first used by George Beard, an American neurologist, in 1869 for a diagnosis of ‘the exhaustion of the nervous system’ and is therefore a psychological condition and is not predominantly associated with war or trauma because the sufferer is ‘easily overwhelmed by the ordinary stresses of life’ [Cheung, 1998]. Meanwhile, the term ‘shell shock’ was first used in The Lancet, a medical journal, in February 1915 and early medical opinion saw this as a ‘physical injury’ for which a soldier could be discharged from the army with a pension [Alexander, 2010]. However, by 1916, it was seen by some as a psychiatric disorder or ‘neurasthenia or weakness of the nerves’ [Alexander, 2010]. At the end of the war, shell shock was seen as being of two categories: ‘emotional shock’, and ‘concussive or commotional shock’ and the term was already being avoided by the medical authorities by 1917, but remained in general vocabulary as a term for war trauma [Alexander, 2010]. Post Traumatic Stress Disorder is a more modern term for a ‘psychiatric syndrome caused by exposure to traumatic events’ [Alexander, 2010].

Still image from the 1916 film The Battle of the Somme, showing a traumatised soldier who was believed to have been suffering from ‘shell shock’ being received at a medical station behind the lines. Copyright: © IWM. Original Source:

The PIN26 files show multiple cases like this where an original diagnosis changes to neurasthenia. This reflects how common it was for men to suffer psychological trauma due to the effects of the war, as well as the effects of illness or other disabilities, and supports the fact that sometimes men did not display symptoms of psychological disability until later on, after the war – this may explain why his diagnosis does not change until later on [Reid, 2010].

Mental health issues were socially stigmatised at the time and the effects of injury, both physical and psychological, may have prevented men from adhering to the societal view of masculinity as it intersected with class [Reid, 2010]. For example, psychological trauma was referred to differently according to a man’s rank – usually, officers were seen as suffering from neurasthenia, while ordinary soldier were seen as suffering from hysteria; working-class men like Edward were also seen, by some, as more susceptible to neurasthenia due to their perceived lower intelligence, but this opinion changed through the war as more officers displayed symptoms of neurasthenia [Reid, 2010]. Hysteria was viewed as a feminine condition and therefore it emasculated the men and devalued their suffering [Loughran, 2018]. Accordingly, ‘working-class soldiers were not treated as well as middle- or upper-class officers’ by society generally [Reid, 2010]. How socially contentious shell-shock and other invisible psychological conditions were is exemplified by Lord Gort’s opinion that ‘shell-shock was actually a lack of morale, and so punishable’ and he believed that those suffering from it after the war were purely ‘predisposed to mental illness’ [Bogacz, 1989, pp. 236-39].

Despite this, psychological disabilities like neurasthenia were not always stigmatised more than physical disabilities and it was sometimes respected [Reid, 2010]. The delay in the revision of his diagnosis may also indicate the difficulty and reluctance in diagnosing psychological injuries and disabilities as they are ‘less visible and more open to question from authority’ [Meyer, 2004, p. 120] as well as frequently being socially stigmatised. As neurasthenia became more widely diagnosed it became, in some respects, less invisible. Furthermore, broad attitudes towards psychological disabilities such as neurasthenia developed through the war so that the general view changed from seeing it merely as caused by a lack of morale to being a recognised and respected condition.

Click on any of the words below to find out more 

                                                                   Hysteria      Emasculate

                            Melancholia  Neurasthenia  Malingering 

                                                            Rehabilitation  Post traumatic stress disorder 

                                           Shell-shock   Invisible disability