Terminology
1. Shell-shock, a lay term, usually refers to the medical entity or disease-group: functional neurosis, or more briefly, neurosis.
The history of the term Shell-shock will repeat that of Railway Spine in the last century; the term will fall into disuse when the cases subsumed thereunder get their exact medical diagnoses—which, statistically speaking, will prove to be as a rule psychoneuroses, either hysteria (pithiatism), neurasthenia (nervous exhaustion, “prostration”), or psychasthenia (obsessive neurosis).
2. But the laity cannot be got to use the term Shell-shock in this exact sense, because the laity cannot make exact diagnoses.
In the post-bellum and reconstruction period the physician will need to guard against regarding all cases called Shell-shock as really neuroses, merely on the ground that Shell-shock is probably neurosis. Laymen will in the reconstruction period succumb to the lure of the 100 per cent and gossip about cures and failures in the same loose manner that is but too familiar in discussions of Lourdes, Christian Science, the Emmanuel Movement. It will be worth while to preserve a certain generality and comprehensiveness for the term Shell-shock, which will stand to medicine as the term weeds stands to botany.
3. In short, keep the connotation but try not for any denotation of this lay term Shell-shock in the lay mind!
The dangerous history of the term dementia praecox may be recalled. Neither dementia nor praecox is an exact term except for the statistical majority of cases of schizophrenia. Yet does not the layman hearing the term dementia feel entitled to assume that a victim must be demented or become so?
4. The term Shell-shock appears to be a perfect term for the ordinary man, as it means much and little, connotes enormously and denotes a minimum and casts the lay hearer back upon the expert.
But confronted by the term Shell-shock, the ardent social worker or the ordinary man fails to get any incorrect notion about the nature, and especially about the prognosis, of the condition. If there is any suggestion of prognosis, it is the correct suggestion of curability possibly conveyed by the suddenness implied in the term shock; but I defy the ordinary man to get from the ordinary term Shell-shock very much that denotes anything in particular. All he gets is an enormous connotation. This connotation may run back for the race into tree stumps, savages brandishing spears, palatial decorations, the protrusion of animal spirits, the Leyden jar (sometimes familiarly known as the “shock bottle”), and the aspen shaking of the man in fear or its interior equivalent. But whether the slang runs back so far or no, and whether the shell is a shell of powder or a shell of fear, and whether the shock is of solid particles or in a moral sense, the problem is implicitly laid down in the slang (see historical discussion, Shattuck Lecture).
5. The terminological difficulties are clarified somewhat by the French distinction of états commotionnels and états émotionnels in the Shell-shock group.
The French very neatly distinguish what they term états commotionnels from états émotionnels. They think of the états commotionnels or commotional states much as we think of commotio cerebri, that is, of a physico-chemical happening in the brain of an essentially curable (or reversible) nature; that is, of something that falls short of being, as they say, lésionnel, namely, as bringing about a structural lesion. That is, they distinguish a brain with a visible focal lesion from one which has sustained a physical jar or commotion, and they distinguish the effects of both of these from the états émotionnels or emotional effects of an injury. The nomenclature here brings out one of the most fundamental difficulties in the whole field of so-called Shell-shock, namely, the distinction between structural conditions, microscopic or macroscopic, on the one hand, and functional conditions of a psychopathic nature, on the other. The commotion would affect the neurones themselves in some perhaps invisible but still genuine physico-chemical way, whereas the emotion would affect these neurones merely after the manner of the normal emotional life, except that the neurones would perhaps deliver an excessive stream of impulses.
6. Terminology, especially in the matter of explanations to laymen (Americans demand monosyllabic explanations as a preliminary to taking suggestions!), is not always assisted to clearness by physicians on account of the old ontological fallacy that Charcot insisted on.
Would that the medical profession understood neuroses at their true value! Only too frequent is the impression on the part of the profession that imaginary symptoms are by the same token non-existent! I have even heard a physician well-trained in somatic lines say that Shell-shock did not exist because Shell-shock was nothing but neurosis, and neuroses were characterized by imaginary symptoms,—accordingly neuroses, being imaginary, do not exist! All of which reminds us that many of the profession were entirely skeptical when Charcot made his original observations. Some men here in America felt that, whereas hysteria might occur in Paris, it did not occur to any extent in America. The Shell-shock data of this war will abundantly prove to the profession the existence of the neuroses, and I feel that physicians will have to brush up their ontology to the extent of conceding that a symptom may be in a sense imaginary and yet not in any sense non-existent.
7. Babinski points out a case of hysterical paralysis of a leg which led the patient to lean so heavily upon his arm as to produce an organic crutch paralysis. It would be to no point to argue that the hysterical paralysis was here non-existent. Of course we shall have to meet the false analogies drawn from methods of cure. If a paralysis can be cured in a few minutes by the electric brush, or by hypnosis, or on emergence from chloroform, or by some other modern miracle.
8. Is it too much to ask the profession not ever to say that this rapid and seemingly miraculous cure was brought about because the disease was non-existent?