Shell-shock and other neuropsychiatric problems

by Elmer Ernest Southard

There is something to be said for the idea that in man also the higher and more complex specimens are more susceptible to Shell-shock, that is, to the neuroses of war, than are the lower and more simple combatants. Some statistics indicate that officers, who are in the main of a higher and more complex organization than the private soldiers, are much more susceptible than are private soldiers to the neuroses of war. Doubtless we shall not be able to verify these statistics until long after the war and, so far as I know, no very inclusive statistics have been presented.

On the whole, I judge from the case history literature that the feeble-minded, unless they be of that very high level sometimes called subnormal, are not particularly susceptible to the neuroses. It is obvious that idiots and, for the most part, imbeciles, do not get into military service. As for what the English term the feeble-minded or what we in America are now terming morons, it may well be that our draft boards do not always exclude. High French authorities have specifically determined in certain instances that the high-grade feeble-minded would be perfectly suitable for certain branches of the service. There is the case, for example, of a sandwich man of Paris who somehow got into the French army and was being perpetually sent to look for the squad’s umbrella and the key to the drill ground, but sang and swung his gun with joy as he went to the front, and apparently did very well there. This man had been a state ward and, as you know, well-trained state wards are frequently exceedingly good at elementary forms of drill.

Then there is another case of an obvious imbecile who was quite without any idea of military rank and often got punished for treating his superiors like his comrades and was the butt of his section, but on the firing-line remained cool, careless of danger—a magnificent example to his comrades—at last surrounded and taken prisoner. Here the story might have ended and the folly of enlisting imbeciles in the army might have seemed perfectly plain, except that our imbecile forthwith escaped from the Germans, swam the Meuse and got back to his regiment!

Here then are cases in which the slight degree of hypophrenia—it seems unwise to give it the opprobrious title “feeble-mindedness”—would have been entirely inconsistent with the development of Shell-shock. Such men are, perhaps, too simple to develop neuroses. On the other hand, it would appear that certain of the slight degrees of hypophrenia, such as we might find in so-called subnormal or stupid persons, would prove capable of “catching Shell-shock” as it were, and then find themselves entirely incapable of rationalizing the situation. In short, there may be a group of psychic weaklings, just complex enough to fall into the zone of potential neurotics, but just simple enough to render the processes of rationalization (or what one author terms autognosis) and of psychotherapy in general entirely unavailing.

After the war we may be confronted with a number of persons with their edges dulled by the war experiences. One has met even brave officers who, after months of furlough, still maintain that they will never get back to their normal will and initiative. Whether these hypoboulic persons have not been reduced to subnormality so as to resemble the slighter degrees of hypophrenia or feeble-mindedness can hardly be determined now. They will form important problems in mental reconstruction, for with the best will in the world, the occupation-therapeutist with all her technic, may be unable to force or coax the will of such hypoboulics into proper action. Nor will the ordinary environment of home and neighborhood turn the trick properly. Expert social work in adjustment, both of the returned soldier to his environment and of the environment to the returned soldier, may be necessary. I speak of this problem here not because these persons are hypophrenic or feeble-minded in the ordinary sense, but we must constantly bear in mind our experience in the teaching of hypophrenics (both in the schools for the feeble-minded and in the community) when we are facing problems of mental reconstruction.

60. As for alcoholism, Lépine’s figures bespeak its importance as a hospital-filler and a good deal of prime interest surrounding alcoholism has been developed in the war; but on the whole, so far as I can determine from the war case literature, there is little or no direct relation between alcoholism and Shell-shock, despite the fact that in a number of instances alcohol has complicated the issue and very possibly helped in a general demoralization of the victim. However, the alcoholic amnesias and particularly a few instances of the so-called pathological intoxication have exhibited a certain medicolegal interest, recalling what was just said above about the responsibility of a drunken epileptic. Alcohol remains, I should say, pending exact monographic work upon this topic, purely a contributory factor for the war neuroses.

It must be that the exigencies of the war have prevented full reports of alcoholic cases; or perhaps they are regarded as of such every-day occurrence as not to demand case reports. The alcohol and drug group is represented by 17 cases ([Cases 86-102]).

The so-called pathological intoxication is illustrated in Cases [86] and [87]. [Case 86] was entirely amnestic for an attack of hallucinations in which he tried to transfix comrades with a bayonet. [Cases 87-97] are cases of disciplinary nature,—the majority from a German writer, Kastan. [Case 88] illustrates desertion in alcoholic fugue, and [Cases 90-92] are three further cases of desertion in alcoholism.

Cases [94] and [95] give a partial explanation of some German atrocities. At least, here are cases in which the atrocities, with attempted murder and rape, are described more or less fully in transcripts of medicolegal reports. [Case 98] throws a curious cross-light upon the war, in that a drunken soldier got an unmerited long leave after paying 100 sous for an injection of petrol in his hand. [Cases 99-102] are cases of morphinism, illustrating the effects of the war upon the fate of morphinists.