A few months ago I wrote an article about the impact of the First World War on medical treatments for bodily injuries, diseases and infections such as those from burns and Typhoid fever. However, this told only half the story. As I cover here, the harm caused by the Great War was as much mental as it was physical. This post will look at the major developments made in psychological medicine in the immediate aftermath of a conflict that left at least 80,000 suffering from “shell shock.”
Advancements had to be made first in the attitude towards psychological breakdown before any progress could be made in its treatment. Thanks to the stigma of mental illness in society at the time, the British Army were initially bewildered by the number of casualties who reported no physical injury yet were suffering symptoms as wide-ranging as insomnia to uncontrollable shaking, and the high command were inclined to treat the situation as a disciplinary matter rather than a medical one, with little sympathy for sufferers.
Those who weren’t charged with desertion or other offences were frequently subjected to unsympathetic, painful treatments – isolation, restricted diet, aversion therapy, and electric shocks. Dr. Lewis Yealland, a neurologist based in London, was a major proponent of “Electric Shock Treatment” (now Electroconvulsive Therapy): an unforgiving method in which electric shocks were applied to the part of the body where symptoms presented, such as the throat of a mute patient. Success rates for these therapies were extremely poor – as low as two per cent.
Looking back today, this sounds more like punishment than treatment. Gradually, thanks to the work of doctors like W.H.R. Rivers, this began to change. As the stigma associated with shell shock lifted, treatments for the ailment became more sympathetic.
At Craiglockhart Hospital in Edinburgh, Rivers adopted a humane approach using a technique known as cognitive restructuring – looking at negative situations in a positive light. A poignant example of this can be found in Ben Shephard’s book A War of Nerves. It gives an account of a man, who having suppressed the memory of discovering his ‘friend’s mangled body’, suffered terrible nightmares about the experience every night. Rivers suggested that the condition of the body proved that he had been killed instantly, spared the agony of a slow death from his wounds. Encouraged, the man
‘dreamt that he went out into no-man’s land to seek his friend, saw his mangled body just as in his other dreams, but without the horror that had always previously been present. He knelt beside his friend to save for the relatives any objects of value, a pious duty he had fulfilled in the actual scene, and as he was taking off the Sam Browne belt he woke with none of the horror and terror of the past, but weeping gently feeling only grief for the loss of a friend.’
The government began to realise that change was needed, and soon more British Hospitals began to follow Rivers’ lead in their use of compassionate treatments. Training centres were set up at Maghull Hospital in Liverpool and the Royal Victoria Hospital in Netley, Hampshire, establishing techniques akin to today’s cognitive therapy, which placed great importance on the need to acknowledge and re-experience traumatic events based on individual analysis.
By 1939 there were 187 psychological clinics in the country. Medical schools began implementing compulsory psychological training for their students, and the Mental Treatment Act of 1930 encouraged voluntary patients and outpatients and abolished the term “asylum”, replacing it with the more sensitive “mental hospital.” The Cassel Hospital and Tavistock Clinic, two institutions that specialise in mental health cases, were established in the two years after the war, and have been ‘unequivocal forces for good in British life.’ The war forced a reconsideration of how Britain treated its mentally wounded soldiers, and proved to have a lasting effect in society at large.
Hopefully you have not left all of your revision to the last minute! But even if you have, these tips should help you.
First things first – relax. You cannot study well or absorb information if you are stressed. It may be last minute, but you are not out of time. And you’d be surprised at how much you can pack into your short-term memory.
Also make sure you take breaks. A common response to last-minute revision is to try and study for as long as possible. But you will remember more if you take regular short breaks and get enough uninterrupted sleep.
This is a tip that I first saw on TES and although it is described as a teacher activity, it is adaptable.
How it works: split topics into 5 minute chunks and make notes. That way you will only focus on the key areas and, get through a lot of information in just 60 minutes.
This leads me to an important tip – don’t sweat the small stuff.
When you are revising close to the exams, you need to prioritise on the major topics or key areas of each topic.
Instead of revising material you already know, try and identify your knowledge gaps and focus on filling them. It makes last minute revision both efficient and effective.
A good way of identifying gaps, is by using a checklist or the contents page of a textbook and ticking everything you feel confident on. That way, you can easily see areas that need more attention.
I love this one. The best way to know any topic is to teach it. And whilst you may not have the time or opportunity to actually teach others a topic, you do have time to write your own exam paper.
In writing an exam paper, you will be forced to think about the topic in-line with the style of questions you will face in the real thing. The most useful part here is writing the mark scheme.
Look at sample material from your exam board and write in their style. This will help you revise topics and improve your exam technique.
A quick, and more importantly an effective way to revise, is by using visual aids like mind maps.
Think about memory tricks and visual aids to avoid trying to remember large chunks of text or lots of terminology.
Recently in TES news, exam board AQA shared some feedback to teachers about what to avoid. What does this mean for students?
Here is what they said.
One of the most useful skills you can develop as a GCSE student, of any subject, is to learn how to mark exam answers.
It is the single-most powerful method to understand what the examiner wants from you.
Most exam boards provide past papers and mark schemes for free, through their websites. Use them.
A great way to learn what the assessment objectives mean, is to do some research. There are many useful YouTube videos that discuss these. You may even find some exemplar work to view – mark it yourself and see if your final grade matches theirs.
Many GCSE exam questions provide guidance on what to include in answers. Despite this, AQA found students struggled with the less structured questions.
Here is an example of a guided question (English Literature):
How does Priestley explore responsibility in ‘An Inspector Calls’?
Here is an example of a less structured question:
Compare the ways poets present ideas about power on ‘Ozymandias’ and one other poem from ‘Power and Conflict’.
Neither of these questions are easy. The first does at least tell us what to write about, though. The second is a lot more open-ended and therefore harder. Approaching them needs to be practiced.
I am going to tweak this one slightly and translate it to: ‘practice past papers’.
Learning the topics is one thing. But understanding an exam question, recalling your learning in its context and writing full-answers in timed conditions, is no mean feat.
The more you practice, the better you will become. If you are starting to time yourself, try and assign yourself 1 minute per mark. So, if a question is worth 20 marks, it should take you no more than 20 minutes to answer. You won’t be able to achieve this a first but, if you practice, you will be surprised at how quickly you improve.
There are many ways to learn online. You can participate in online one-to-one lessons, remote classroom sessions, e-learning or a combination of all three.
Since online lessons do not lend themselves to a traditional way of teaching and learning, some people are sceptical about them. And they are entitled to be, because online courses aren’t for everyone. For most, though, it is a convenient and effective way to learn.
That’s a big question and a difficult one to answer because everybody has different learning preferences.
But, as a general guide, online learning should work well if you:
• Are organised, motivated and self-disciplined
• Have the right equipment
• Do not have serious learning difficulties
• Wish to learn a subject that lends itself to the medium. A practical course like hairdressing, for example, may not be suitable.
There is the obvious advantage of being able to work in an environment you are comfortable in without needing to travel. This is great for most learners, regardless of age. However, it is also true that for some, specific learning environments, like a classroom, work better.
Usually online courses allow you to go at your own pace. This presents an advantage for most people but particularly for mature students who may have other commitments. Since online courses have less overheads for course providers, they are often cheaper than face-to-face learning.
Aside from these specific advantages, online learning shares most of the advantages of face-to-face learning. This is because, with classroom software and even video calling software like Skype, you can do things like sharing screens. So viewing work or learning material is not a problem.
Homework can be completed and marked electronically. Since you may need to take your exam by hand, written practice can be carried out during lessons.
So, should I enrol on an online course?
The only real way to know whether it is right for you is to try a few different types of online learning. See whether you find the teaching effective. Discover if you have the discipline to see it through.
One thing, however, is always true. If you can welcome this modern learning method, you will open the doors to a wide range of learning opportunities.
Whether you are an adult learner or a teenager who is juggling multiple subjects, working efficiently and effectively can be challenging.
But it doesn’t have to be. The solution lies in being organised – specifically with your time.
Whether you prefer a handwritten calendar or an electronic one, think about colour coding it.
Perhaps you could assign a different colour for each subject. Or maybe a different colour for different aspects of your life.
This is a great visual method to ascertain whether you are spending enough time on your learning, and helps you dedicate a solid part of your day to it rather than thinking ‘I’ll do that later’ and never quite getting around to it.
Effective learning doesn’t depend on how many hours you put in. It depends on what you do in that time.
So when organising your learning time, don’t simply slot study periods into your diary. List what you will specifically work on during that time. This will not only help you stay on-track but also ensure that you are making steady progress in all areas that need attention.
Don’t forget to schedule in some relaxation too!
Look ahead at your learning schedule and think about what you need to do now, and what can wait until tomorrow (so to speak).
It can be overwhelming when you have a long list of tasks – especially if you feel like all of them had to be completed yesterday. But when you zoom in, you will see that you can divide your list into manageable chunks.
This will help you actually complete your list and is a great strategy if you have a tendency to procrastinate.
We all like the feeling of being successful. So when we find something difficult, we can often be tempted to avoid it. This is the opposite of what you need to do. Think about it: if you spend more time on things you find hard, they will soon become easier.
Tips 1 to 3 feed into this – if you dedicate specific time to the harder topics, and prioritise them over ones you have already mastered, your learning will be more effective.
Some of us work better in the mornings, others at night. Still others find it is easier to work in the afternoon. Find out what your own peak learning time is. It will be when you make the most progress, feel freshest and absorb learning best.
Cramming before an exam is tempting and in principle, it can be effective. But only as long as you choose your study time wisely.
War is the only proper school for a surgeon.
The First World War was a watershed moment in history. Never before had such a relatively short period in time seen such seismic shifts in technology, society and culture. The newly industrialised nature of the conflict and parallel stalemate of the trenches, all under near-constant artillery bombardment, was fertile ground for rapid innovation. In just four years the battlefields of France and beyond saw the introduction of tanks, militarised aircraft, machine guns and chemical warfare. But what war harms, society inevitably must find ways to heal. These novel technologies of death and destruction brought with them wounds and bodily disorders completely new to medicine, and as a result the medical field would embark on a journey of similarly hasty scientific advancement.
The nature of trench warfare meant that, with soldiers’ bodies protected most of the time, there were a disproportionate amount of head and facial injuries. Surgeons were at a loss as to how best to treat these horrific wounds and burns, often stitching together open wounds with no time to consider the consequences of the healing process.
At Sidcup in London, a New Zealand-born, British-trained surgeon, Harold Gillies, was a crucial figure in the development of reconstructive surgery. Gillies advocated a highly experimental, never-before-seen method of treating facial gunshot and burn victims with skin grafts – taking tissue from, for example, the chest or leg and using it to repair the face – a technique still in mainstream use today. In a pre-antibiotic age, his pioneering “Pedicle Tube,” a tube of skin leading from the donor site to the graft site, allowed blood flow from a healthy area of the body to the injured area, nourishing the graft tissue, and preventing infection.
Other advancements in the treatment of physical injury included the Thomas splint, developed by Welsh surgeons Hugh Owen Thomas and Robert Jones, which drastically reduced the number of deaths from broken bones, and the mobile X-ray unit, invented by Marie Curie in France and launched onto the battlefields with the help of 150 female operators.
It wasn’t just physical injury that soldiers risked on the frontlines. Disease, including the 1918 flu pandemic, accounted for around one third of military casualties, while around six million civilians perished due to disease and war-related famine. After seeing the widespread death caused by Typhoid fever during the Second Boer War, a British bacteriologist called Almroth Wright lobbied the British Army to provide 10 million vaccines against the disease to its troops on the Western Front, preventing, by some estimates, around half a million deaths.
Infection originating from wounds was also rife, thanks in part to the foul conditions in the trenches, where lice and mud were ubiquitous. An antiseptic solution developed by the French-British partnership of Alexis Carrel and Henry Dakin drastically reduced the need for amputation due to sepsis.
From the ashes of war progress so often springs, the decay and destruction of conflict powering innovation and change. The First World War was billed as the war to end all wars, a title that as we well know could not have proved further from the truth, but soldiers and doctors of subsequent conflicts benefited immeasurably from the new medical knowledge, technologies and techniques that emerged from it.
In 2018 the BBC reported that over the last three years the number of children who are being homeschooled in the UK has risen by around 40%. It’s not hard to see why; for parents, ensuring their child’s schooling is top quality is vital, and home schooling is definitely worth consideration as the new school year starts. Whether you’re considering homeschooling for your little ones or terrible teens, choosing to self-teach offers the perfect method for many parents who seek a more hands-on approach in their children’s education. In the UK, as a parent you must ensure your child receives a full-time education from the age of 5, moving through Key Stages 1-3 and on to GCSE and potentially A-Level education.
So is homeschooling right for you? Whatever the age or abilities of your child(ren), learning from home presents many benefits. Let’s look at a few of these advantages, which may help you decide.
Two of the main reasons influencing UK parents’ decision to choose homeschooling include protecting their children’s mental health and the ability to avoid exclusion. Being in a large classroom environment can present a number of challenges for children, including exposure to bullies, feelings of inadequacy from being around superior-performing peers and being singled out for being ‘different’ from other children. Many children may feel as if they simply don’t ‘fit in’. Home schooling offers a solution to avoid these situations and protect your children’s mental health and wellbeing.
The chance to learn one-to-one rather than one-to-many offers many children the chance to feel fully involved and immersed in their own learning. This increases their chances of remaining engaged and interested in their studies. This also allows you, as a parent, to build a stronger bond with your child; to be able to identify their strengths and weaknesses and work with them on these. It is attention that they may not get in a large classroom environment.
Homeschooling allows your child to proceed through their education at their own pace rather than that of scheduled class. Every child is unique, with their own abilities, and these abilities may vary from subject to subject. If your child needs more help with Mathematics and less so with English, you can adjust their learning schedule accordingly.
This means more healthy sleeping patterns and time to study – you have the time to flex your child’s learning timetable around your lifestyle and circumstances. You can take holidays when you want, too. A definite win-win.
Homeschooling offers many benefits over more traditional school classroom study. It’s worth weighing up the pros and cons of both options before making a decision to homeschool of course, and there are plenty of resources to do this, including the UK Government’s website, which can provide further advice.
Too often we are inundated with stories of successful people’s morning routines, such as getting up at 5am to practice yoga, replying to emails and ticking off half a to-do list before even starting the working day. However, while this idea of always creating a productive morning may be inspiring to some, it may not sound remotely achievable – or appealing – to you and many others.
Oxford academic Dr Paul Kelley believes that our body’s natural rhythms are not set for such early morning starts. He called for a shift in the standard 9-to-5 work pattern of employees, claiming that the natural body clock is not accustomed to it: workers end up sleep deprived, affecting performance and output levels. Dr Kelley proposes that a more efficient starting time of 10am would suit us better during our working years, leading to lower levels of exhaustion and better gene function.
Similarly, Dr Kelley believes that children should not be expected to start school until 10am either. It is an idea that has been put to the test by a groundbreaking Oxford University experiment, and its results appear to support him. Grades increased significantly and rates of illness more than halved over a two-year period, illustrating the positive impact that better sleeping hours can have on teenagers’ performance in school. According to Dr Guy Meadows, co-founder of The Sleep School, schoolchildren in Britain take sixth position as the most sleep-deprived in the world. Losing 10 hours of sleep a week is a direct result of students being forced to get up too early since the adolescent biological rhythm is ready for sleep at midnight, as Dr Kelley points out.
As these findings and beliefs demonstrate, it is absolutely fine to not follow the standard daily work pattern imposed on us by society when it comes to our own study time. Some of us naturally work better in the evenings and into the night, meaning our mornings start off a little later than those of early-risers; others prefer to sacrifice a few hours of sleep in the morning for an earlier bedtime. Part of the journey through Higher Education is finding out what study rhythm works best for us individually and utilising it accordingly. There’s no sense in starting weekend study sessions at the crack of dawn if you know your brain won’t be buzzing with motivation until a few hours later. Likewise, if the thought of staying in the library past dinner time fills you with dread, adjust your routine to suit when your mind feels most active.
One of the things to battle with is the guilt resulting from later starts to the day, with longer hours spent in bed synonymous with attributes of laziness and lack of direction. However, as science shows, biological factors have a lot to do with how our bodies respond to traditional work patterns. It’s time for a societal change and a better understanding of our natural body rhythms.