Three excerpts over eight days: they come from an American ambulance driver for the American Hospital, Leslie Buswell in 1916:

32nd Division in TrenchesSaturday. [July 3, 1916]
The bombardment going on now is terrific —I have been standing about a hundred yards from my little house and looked across the valley on Montauville — Bois-le-Prêtre — and watched the shells exploding by the dozens.

Monday, July 5th.
I was called away suddenly — an emergency — and this is the first moment I have had to myself since. I doubt if I shall ever forget the last thirty-six hours — they have been so full of work, apprehension, and horror.

Sunday, [July 11th].
. . .   I could tell you a multitude of stories — stories so horrible I cannot forget, so pathetic that tears are not rarely in my eyes. On Friday night, I was on Montauville duty —and a new regiment arrived — “Bon camarade ” to me at once — “How many wounded?” etc., — they asked. I could not tell them that they were going to a place where between their trench and the German trench were hundreds of mangled forms, once their fellow-citizens, — arms, legs, heads, scattered disjointedly everywhere; and where all night and all day every fiendish implement of murder falls by the hundred —into their trenches or on to those ghastly forms, — some half rotted, some newly dead, some still warm, some semi-alive, stranded between foe and friend, — and hurls them yards into the air to fall again with a splash of dust, as a rock falls into a lake. All this is not exaggerated. It is the hideous truth, which thousands of men here have to witness day and night.
Saturday night they came back, some of those poor fellows I spoke a cheery word to on Friday — no arms — no hands — no feet –one leg — no face — no eye — One glorious fellow I took had his hand off, and although it was a long trying drive to Dieulouard he never uttered a word. I touched his forehead when I arrived and whispered, “Bon courage, mon brave!” He looked at me a moment and answered, “Would God he had taken my life, my friend.”
To-day I went to take three wounded officers to Toul, some thirty kilometres, away, and before starting I went into the hospital to see if I could do anything for any of those butchered by “civilization.” I saw a friend — the man who had offered me a German bayonet. He beckoned me with his eyes and then — “Have they forgotten me? I have been here for five hours and both my legs are shattered.” It was true that every bed was full of wounded waiting to be dressed, but I went straight up to the médecin chef and told him that a friend was over there with both legs broken and could he be attended to? “Ah, we have been looking after the others first, as he must die, but I will do what I can.” I stood there and watched his two legs put into a position that looked human and then I bade adieux to a newfound friend. I think I am glad he will die. I would prefer to die than to be crippled for life, and if my turn comes I only hope I may not recover to be helpless.
It is no good trying to make you understand what horror really is —you must see a bit of it as we see it here to be able to semi-realize what that place, the Bois-le-Prêtre, is like. It was known by the Germans when held by them as ” Hexenkessel” (witches’ cauldron) and as “Wittenwalden” (widows’ wood).
I wish you would cut out and keep for me anything mentioned in the official reports about the Bois-le-Prêtre, Pont-à-Mousson, Quart-en-Réserve (probably the most mutilated, unthinkable place in the world), La Croix-des-Carmes, etc.

Shell Shock PatientA summary of a 2004 BBC program on World War I shell shock states that officers in the First World War would find men reeling from shock, hunger, and illness, and punish them for desertion or for straggling (I have some pictures in a book called Over There of such punishment).   According to Johanna Bourke, Great Britain treated 80,000 people for shell shock by war’s end, and the mental health system in the country afterward had to find capacity for its mentally wounded, not to mention a treatment program that would be of help.

The ambulance driver above had the advantage over soldiers stuck in the trenches: a place behind the front to live (although his shelter was frequently bombed); to look upon, touch, and aid casualties but not to live next to them for days;  better food and recourse to medical treatment; and a job which was to preserve life and not end it.  Yet he still describes the conditions that lead to so many being shell-shocked in World War I: the constant noise and bombardment; the loss of comrades and persons one admired; the lack of personal security; little sleep; the lack of facilities for those in need.

The conduct of war has changed markedly since World War I.  For one thing, we are assured that supply lines are better, although we face current equipment shortages and have faced problems for our troops in obtaining body armor.  Hospital facilities are greater, but we still do not understand all the preconditions, stresses, and treatments for shell shock or PTSD as it is now called.  In addition, no conduct of war by definition can guarantee that death and killing, wounds, maiming, sleeplessness and insecurity and horrible waste of life does not occur.  Our military endures these conditions of war; it should not surprise us that they frequently bring them home as well. 

Our best hope in aiding current veterans are:

1. to insist upon furloughs that aid a soldier in recovering from shock and trauma and may alleviate symptoms of sleep deprivation;

2. to give soldiers as much equipment as they need in order to protect themselves and each other;

3.  to reflect upon the conditions that they are under so that we might partially understand what exposures they may have had, and to be able to listen and understand if they want to discuss it;

4. to insist that our governments make adequate provision for treatment of any serviceman who is suffering greatly.

In Over There, from the introduction:

. . . Usually death was frightful.  A brave officer who had been through too much told Dr. Harvey Cushing in October 1918: 
“The chief trouble now is the dreams–not exactly dreams either . . .  right in the middle of an ordinary conversation, the head of a Boche that I have bayoneted, with its horrible gurgle and grimace comes sharply into view. . . . But the worst of all are the dying faces that come to me of the men. . .

All the supply chain in the world will not take away the moral dilemmas and the bad memories.  For our surviving servicemen with PTSD,  we can provide home and a way home.