In late 1917, a British woman named Elizabeth Huntley decapitated her own daughter. When the case went to trial, her friends and family testified that she had been a "jolly-hearted woman"—that is, "until the air raids." Her sister told the judge that the raids in London caused Elizabeth to shake and have delusions, and that she had become depressed. Her doctor had tried to get her out of London and away from her children, because during the raids they "screamed" and "worried her," but he was too late. She had a nervous breakdown during a raid, and murdered her child. They called it "air raid shock."

During World War I, the relatively new field of psychoanalysis was full of possibility and, unfortunately, thousands of new patients. The war’s destruction was not limited to the physical; the psychological devastation was immense, and soldiers returned home from the front every day exhibiting a range of new symptoms, including "hysterical paralysis," deafness, mutism, arthritis, facial spasms, “fear, disgust, fatigue,” “delirium,” “suicidal thoughts,” “stammer,” and more. Though we now recognize many of these as symptoms of post-traumatic stress disorder, doctors at the time struggled to find ways to categorize the rapid and widespread breakdown of the British mind. The solution for soldiers was the invention of a new condition: shell shock. The diagnosis and treatment of similar traumas in women, however, has been largely unexamined by historians.

The psychologist Dr. Charles S. Myers coined the term shell shock in an article for The Lancet in February 1915, after seeing a number of cases of mental distress in soldiers who experienced shells bursting near them at close range. Yet Myers quickly realized that many of the men exhibiting similar symptoms “had never been near an exploding shell, had not been under fire for months, or had never come under fire at all.” He admitted shell shock was “a singularly ill-chosen term,” and the British medical community quickly suggested "war neuroses" instead.  But the public had already latched onto the memorable alliteration, and “shell shock" has remained in popular discourse ever since.

Though a misnomer, historians have argued that shell shock provided a convenient way for doctors to separate the mental traumas exhibited by soldiers from the "effeminate associations of ‘hysteria.'” For centuries, hysteria was thought of as a uniquely female condition, used to explain everything from fainting to sexual desire. Victorian women assumed they were so susceptible to the disease that they carried smelling salts around with them, believing pungent smells could help keep their emotions in check. But while hysteria might have been accepted as an explanation for a Victorian woman's nerves, it was considered an inadequate, emasculating explanation for a male soldiers' mental health. Not only did medicine separate the experiences of men and women; the experience of the soldier was understood as uniquely difficult and traumatic.

It makes sense then that there is little evidence showing women at the time being treated for "shell shock"—the male and female minds, and their respective suffering, were considered distinct. But as the historian Susan Grayzel notes, Huntley's infanticide case and her "air raid shock" diagnosis pose difficult questions. Were air raid shock and shell shock considered similar, or even equivalent, conditions? "Was she in any way akin to those on the battlefields who suffered from similar war or fear-induced mental anguish? ... Under these circumstances—and it is hard to know to what extent Elizabeth Huntley was unique ... the blurring of the line indicating who exactly was under fire seems fully accomplished." If a woman at home in London could experience comparable mental distress to those in France and elsewhere, then not only would men no longer be the only ones “under fire;” women’s minds could be seen as equivalent to men’s, and their suffering just as great.         

The solution, it seems, was not to accept that reality: Instead, psychologists and doctors invented yet another new condition, called "civilian war neuroses.” The emphasis of “civilian” in the title is key, reinforcing a dichotomy between the home front and the war front. Medical authorities were willing to admit that those not directly in the line of fire—such as Huntley—were susceptible to the traumas of warfare, but were unwilling to completely equate the mental sufferings of soldiers and civilians.

Huntley was deemed "insane" and "unfit to plead," and was sentenced to Holloway Prison for adult women in north London, which is still operating today. Little else has been written about her case. But while her resolution may provide some answers for the diagnosis and treatment of civilian women, not all women at the time fit so neatly in the dual categories of shell-shocked solider and hysterical, "civilian" woman. Many women were on the firing line, suffering their own psychological trauma at the front, but their conditions seemed to have largely gone ignored and untreated—a gap in the understanding of women's experience of war that largely remains in histories to this day.

Hundreds of women worked in France and Belgium as nurses and ambulance drivers, right alongside the male soldiers, or "Tommies." Their experiences included tremendous violence and physical suffering; their diaries and letters home include descriptions of being fired on by enemy forces, who used the ambulances to gauge distance to the trenches; spending long nights trapped in No Man's Land; suffering amputations and broken bones from crashes and falling shells; and even getting hit with "secondary gas," as the acrid fumes clinging to the victims they were helping could burn their eyes.

They also wrote of mental anxieties and traumas that bore striking resemblance to the era’s understanding of "shell shock"—but they largely suffered them without diagnosis or treatment. If a female ambulance driver or nurse could not stand the strain of war, she was simply sent home. Unlike the male soldiers, women were expected to be mentally incapable of handling the trauma of war, and high female attrition was hardly a concern. The tremendous effort put into “curing” men with shell shock—87 percent of British troops diagnosed with the condition were returned to front line service within a month—was due to the army’s need for combat-ready men. The supply of women was not rapidly diminishing.

However, the diaries and letters of women stationed on the front reveal countless instances of women discussing their "shock" and reaction to the emotional stress around them. One woman wrote of a friend who had gone temporarily deaf, and another who had trouble with her vision, as a result of the stress and strain of their work. Several novels, poems, and memoirs also explore the themes of mental instability among women at the front. In Helen Zenna Smith's Not So Quiet, a female ambulance driver is sent home from France on "sick leave" after she witnesses a friend dying at the front, but she receives no medical attention. In The Forbidden Zone, Mary Borden's memoir of her time as a nurse in France, she describes herself as becoming "delirious" and feeling like she "seemed to be breaking into pieces." She was sent home because officials felt she was "tired."

Even with these documents, women's mental health during the war has received attention from only a handful of historians, with sensational cases like Huntley's as the exception. Instead, the focus remains on the male experience. Jay Winter argues that historians have turned shell shock “from a diagnosis into a metaphor,” a way to describe the “metaphysical” symptoms of war: soldiers who refused to be soldiers, men who refused to be "men." Even Elaine Showalter's seminal 1985 text on hysteria, The Female Malady, devoted its chapter on World War I entirely to men.

In a letter to her mother, a female ambulance driver wrote about her friend “Tommy,” who “stutters still poor soul.” Tommy suffered from one of the most recognizable symptoms of shell shock—and Tommy was not a male solider, but another female ambulance driver. Her symptoms and her nickname placed her in direct parallel to the Tommies fighting nearby, but her sex denied her similar status and treatment both during the war and afterwards, in histories of the conflict. If the only available terms for describing the mental trauma brought on by war are shell shock—a term only applicable to men—and civilian war neuroses, then women who served at the front have no place in the psychological understanding of warfare. The sublimation of their suffering at the time has led to ignorance of their experiences today.