Shell shock at Maghull and the Maudsley: models of psychological medicine in the UK.

The shell-shock epidemic of 1915 challenged the capacity and expertise of the British Army's medical services. What appeared to be a novel and complex disorder raised questions of causation and treatment. To address these pressing issues, Moss Side Military Hospital at Maghull became a focus for experiment in the developing field of psychological medicine as clinicians from diverse backgrounds and disciplines were recruited and trained at this specialist treatment unit. By contrast, the Maudsley wing of 4th London General Hospital expanded from the neurology department of King's College Medical School and drew upon the neuropathology research of Frederick Mott at Claybury Asylum. By focusing on the psychodynamics of environmental factors, doctors at Maghull offered an alternative to the physicalist hypotheses (heredity and neuropathy acquired as a result of disease or aberrant behavior) explored at the Maudsley. To understand the cause and pathology of shell shock, both institutions admitted a diverse range of patients and experimented with treatments. The individual attention offered to service patients who were not psychotic allowed psychiatry to develop in a way that had not been possible in the county asylum system. The design and operation of Maghull and the Maudsley provided models for departments of psychological medicine in the post-war period.