Hektoen International

A Journal of Medical Humanities

“Mental Cases” by Wilfred Owen: The suffering of soldiers in World War I

Alice MacNeill
Oxford, United Kingdom


Man with hair parted down middle with msutache and in British uniform
Wilfred Owen plate from Poems (1920).
Internet Archive via Wikimedia. Public domain.

Who are these? Why sit they here in twilight?
Wherefore rock they, purgatorial shadows,
Drooping tongues from jaws that slob their relish,
Baring teeth that leer like skulls’ tongues wicked?
Stroke on stroke of pain, — but what slow panic,
Gouged these chasms round their fretted sockets?
Ever from their hair and through their hand palms
Misery swelters. Surely we have perished
Sleeping, and walk hell; but who these hellish?

– These are men whose minds the Dead have ravished.
Memory fingers in their hair of murders,
Multitudinous murders they once witnessed.
Wading sloughs of flesh these helpless wander,
Treading blood from lungs that had loved laughter.
Always they must see these things and hear them,
Batter of guns and shatter of flying muscles,
Carnage incomparable and human squander
Rucked too thick for these men’s extrication.

Therefore still their eyeballs shrink tormented
Back into their brains, because on their sense
Sunlight seems a bloodsmear; night comes blood-black;
Dawn breaks open like a wound that bleeds afresh
– Thus their heads wear this hilarious, hideous,
Awful falseness of set-smiling corpses.
– Thus their hands are plucking at each other;
Picking at the rope-knouts of their scourging;
Snatching after us who smote them, brother,
Pawing us who dealt them war and madness.


World War I saw the first recognition of “shell shock” in soldiers; although misconceptions about the condition persisted, these men were not thought to be cowards when they succumbed to the weight of the horrific things they had witnessed. The soldier and celebrated English war poet Wilfred Owen himself was sent to Craiglockhart, a hospital in Edinburgh, Scotland for shell-shocked officers; perhaps here he saw for himself the suffering that drove him to write this poem. Not once in Mental Casesdoes Owen talk about the physical wounds of war; he was far more preoccupied with the mental scars that changed them irrevocably. He shocks by describing in stark detail the decline of men due to mental torment and lays the blame on those who sent them to the Front, making the reader of the time confront the idea that we all are ultimately responsible for these Mental Cases.”

Owen reflects on the destruction of the mind by using a structure with abnormalities in rhythm and form. There is no rhyme scheme to Mental Cases;” this fits with the gravity of his other work to stress the dull, prolonged pain of the soldiers’ suffering. Many lines, such as the first, have trochee pentameter. When read, the words sound heavy and then immediately fall,  adding to the sense of depression and removing any jauntiness from the rhythm; we know from the start there is nothing happy to be told. The stanzas are long, reflecting continuing misery. The irregular stanza length means there is no opportunity to develop a rhythm, and extending the final stanza to ten lines feels jarring and awkward. The eternity spent as “Mental Cases” stretches out before them; Owen does not want to make this poem feel in any way easy to read.

At times the grammar falters and the poem becomes difficult to read, such as “Why sit they here in twilight?” Owen uses this word order to reflect the mind falling apart. He chooses to emphasize certain words, such as “twilight” given prominence at the end of the line; the fading light can be sinister. Later Owen goes on to describe the patients almost as if they were monsters, but their memories of suffering in the half-light are the real tormentors. “Twilight” also reflects the idea that because of their illness, they have reached the end of their lives; they will never be normal again, continually plagued with the shocking scenes of war. At the end of the first stanza he questions “Who are these hellish?” Without a noun it is almost as if Owen cannot think of a word to describe the men after their experiences. The title Mental Cases seems impersonal and shocking, but reflects the reality of the stereotypes they faced at the time; they were viewed as medical cases and not people.

Owen uses metaphors throughout the poem. He calls the men “purgatorial shadows” of their former selves, reduced to ghostly figures. They are caught between life and death, heaven and hell, in purgatory, a place of temporary suffering. Except, as stressed by the hopelessness in the poem and the length of stanza, nothing suggests a cure. Their suffering will continue as they relive the horrors of the Front. It could imply they have sinned because of the killing they were made to carry out under orders; again they are being punished because of our instruction. This imagery emphasizes their dehumanized appearance; they look dead, no longer belong in the world of the living, and are “shadows.” Later, Owen describes emotional emaciation as if  they are wasting away; the devastating emotional effect of the war is shown by saying it “gouged these chasms.” Their “eyeballs shrink tormented” like they are afraid, cowering in the refuge of their minds where they still find no comfort.

There is further imagery with the simile “baring teeth that leer like skulls’ teeth wicked.” Awkward to read, as if in a nightmare, the confused and hellish quality gives the impression Owen is trying to get his frantic thoughts onto paper. Forming it in this way emphasizes the word “wicked” to give an insight into the way the patients suffering from shell shock were seen, like cowards evading their duty. Using “skulls” adds to the idea of the soldiers being like the living dead, and “baring” shows they were thought of like animals. With the simile he reflects the change brought about by their mental torment; no longer are they thought of as “innocent tongues,” but “wicked” ones that “leer.”

Owen also uses personification to make their living nightmare real. He describes their minds as those “the Dead have ravished;” a vivid image with Death taking everything from them, gorging on their suffering and taking sustenance from it. The Dead could also represent the killed soldiers who have come back to persecute them; he extends this theme further when he says “memory fingers in their hair,” memories so closely entwined they will not let go, always trying to creep back in. By personifying this, their suffering becomes physical as well as mental, and the pain they suffer feels like it was brought about by an act of aggression. If their suffering has been caused by someone, then we are the ones responsible for sending them out there. As well as “always must they see these things,” Owen shows how they “hear” them, too. The sibilance of “stroke on stroke of pain” emphasizes that their misery is on-going. The two ideas seem almost paradoxical; a stroke should be something loving and tender, but instead it is repeated to show the monotony of neverending suffering. Alliteration in the second stanza with “murders, Multitudinous murders” brings our attention to the number of lives that have been lost. Calling them “murders” highlights the soldiers’ obsession, something they cannot rid themselves of.

The “set smiling corpses” are forced to appear to the world as normal with a “hilarious, hideous, awful falseness” that Owen derides; the smile is now an emotionless action. Memories of war are described with abnormalities in nature, where “sunlight seems a blood smear,” like the red sky warning of danger. Every morning brings a new day of remembering horror and the night brings haunted nightmares; each new day marks no redemption from their suffering in the “twilight” of “purgatory” because it opens “like a wound that bleeds afresh,” relied upon to torment them. Owen finishes the last stanza with a series of non-finite verbs. “Plucking,” “picking,” “snatching,” and “pawing;” verbs associated with anxiety or distress makes the soldiers seem frantic, and the non-finality emphasizes that their suffering will always continue. The agitation is aimed at “us who smote them, brother;” showing we are all guilty in reducing these men to mental wrecks. The use of the word “smote” is archaic, showing that we are guilty for slaughtering “the seed of Europe,” taking the power of God on ourselves to decide the life or death of these men. He says we “dealt them war and madness” like a hand of cards in a game, so emphasizing the futility of the war and reducing it to nothing more than a game.

Not once in Mental Casesdoes Owen talk about the physical wounds of war; he was far more preoccupied with the irrevocable mental scars it left. Using the structure and language of the poem, Owen  shows us the terrible consequences of war and blames those who sent the men to the Front, making them confront the idea they are ultimately responsible for these Mental Cases.”



ALICE MACNEILL is a medical student in her fourth year with a keen interest in medicine and the humanities, in particular the representations of psychological suffering in literature. This essay was written during her recent special study module during which time she was able to explore the portrayal of many different aspects of medicine in literature.


Spring 2018  |  Sections  |  War & Veterans

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