The main thing here, according to Binswanger, is the psychotherapy. The patient was told almost daily in the course of conversation, first, that the illness was being cured; secondly, that upon recovery he would be employed in the future only on the postal service. He was told that he would have to avoid marked physical exertion, of course, but that he still would be fit for office work and could serve the fatherland in this way. Still he could not be transferred back to the hospital, he was told, unless he became entirely well, so that he could move with perfect freedom.
February 23 the patient was performing daily exercises in walking and standing; the spasm became very slight on standing, and often would entirely cease, but it remained still plainly present in the legs; the trunk and arms were free. External irritations were now less prone to excite spasm. Sleep became quiet and dreamless. He was transferred to the nerve hospital, able to move about freely in house and garden and only tremulous after long walks and considerable bodily and mental fatigue. He was given a week’s furlough home. He wished very much to get into the postal service; at the time of the report he had not attained this goal. He had renewed attacks of trembling upon exertion, and was transferred at the end of June to a convalescent home.
Shell-shock; emotion: Hyperkinesis, fear, dreams.
Case 328. (Mott, January, 1916.)
A private, 21, was with 30 men carrying sandbags in the daylight, under shell fire. He was thrown into a deep hole by an explosion, climbed out, and saw all his mates dead.
He was admitted to the Fourth London General Hospital, June 20, 1915, having been at Boulogne for a fortnight. He was lying in bed on his back, making continuous jerky lateral movements of head, and movements of arms, especially of the left arm. He was groaning slightly, now and then raising his eyelids with a staring expression of bewilderment and terror. He was able to mutter answers to questions. He would occasionally raise his right hand to his forehead. If he was observed, these movements became exaggerated. They ceased in sleep. He muttered even when unobserved. He continually said, “You won’t let me back.” Asked as to dreams, he replied, “Guns.” Voluntary movements were made, which prevented obtaining reflexes. When his pupils were to be examined by a man in uniform, he showed a marked facies of terror; his pupils were dilated; the eyes opened wide, the brows were furrowed, and there was an anxious scowl. The flash of an electric light produced the same effect.
June 24 the patient was much better. He said the explosion which had killed his friends after he had been only a few weeks at the front, was the first serious event in his service. He kept seeing it again, with bright lights and bursting shells. Sometimes he would hear the men shouting. In dreams he both saw and heard shells and men. There was pain in the back and right side of the head.
June 26 he was improved but still had pain in the back of the head, especially when trying to remember, and a slight tremor of the hands. He had been given hot baths at Boulogne on account of being very cold and shivering. He had always felt sick at the sight of blood. He was boarded for Home Service six months after admission.