61. That war makes nobody go mad in the asylum or lay sense of the term has been abundantly proved by the data of this war—and this conclusion is of value in our medical endeavors to establish a proper lay conception of the nature of Shell-shock. Consider first schizophrenia (dementia praecox).
That the causes of dementia præcox, still unknown as they are, lodge more in the interior of the body or in special individual reactions of the victim’s mind, seems to be shown by the phenomena of this war, since there seems to be no great number of dementia præcox cases therein produced. To be sure, some schizophrenic subjects do get into the service, and sometimes their delusions and hallucinations get their content and coloring from the war. Thus a Russian, wounded in the army, developed delusions concerning currents running from his arm to the German lines and felt that he was, so to say, the Jonah of the Russian front, as he could determine shell fire to the spot where he was by the arm currents.
Now and then a case shows a scientifically beautiful admixture of ordinary dementia præcox phenomena with the effects of shell wound or shock. A picturesque case from the standpoint of German psychiatric diagnosis is one of a soldier who boxed the ear of a kindly sister who tried to steer him from a room where the examination of another patient, a woman, was going on. On the whole, the eminent German psychiatrist who examined him felt that the case was really one of psychopathic constitution, as he had shown somewhat similar irascibility on a slight occasion before. However, much to the astonishment of all, the patient developed further symptoms. His ego got terribly swollen. At last he was fain to utter a denunciation of the entire Junkertum and of the Kaiser: he said in fact that he was an Inhabitant of the World and not of Prussia merely. Over here we allow such persons to edit newspapers and write books with impunity, but the eminent German psychiatrist, before mentioned, was constrained to alter his diagnosis of this cosmopolite from psychopathic constitution to dementia praecox!
The group is represented by 16 cases ([Cases 147-162]).
62. There are four cases ([Cases 148-151]) of a disciplinary nature. The first ([Case 148]) was actually arrested as a spy because he was making drawings near a petroleum tank. Of two cases of desertion, one was due to a fugue of catatonic nature ([Case 149]), and the other ([Case 150]) was one of desertion with behavior suggesting schizophrenia. However, this man was determined to be responsible for his act, and condemned to 20 years in prison. This latter case might be considered also in connection with [Group III (the epilepsies)], [Group IV (the pharmacopsychoses)], and possibly [Group XI (the unresolved psychopathias)].
[Case 151] was likewise alcoholic and disciplinary: the man went so far as to keep a cigar in his mouth while the captain was rebuking him and was, in fact, an old sanatorium case, afflicted with some sort of degenerative disease, presumably dementia praecox.
63. That schizophrenic symptoms may be aggravated by service is shown likewise in the case that follows, namely, [Case 152], a man who had been hearing false voices for some two years, had heard his own thoughts, and felt his personality changing. The military board decided that the mental disease had been aggravated by service. [Case 153] might offhand be regarded as a malingerer, as he shot himself in the hand. Upon military review, a delusional state set in, and in the course of no very long time a state of schizophrenic apathy. In point of fact, however, this man had already been in several hospitals for previous examination, and had served in the army in relatively normal intervals. [Case 154] is that of a dementia praecox who volunteered for three years in French infantry but forthwith gave indications of mental deterioration. This case of a dementia praecox volunteer may be compared with [Case 36]: that of a superbrave imbecile who swam the Meuse, back from a German prison; with [Case 47], that of the feeble-minded person with an insubordinate desire to remain at the front; with [Case 163], a maniacal volunteer; and [Case 175], a neurasthenic volunteer.
64. Diagnostic questions are brought up by [Cases 155-166], in the former of which Bonhoeffer made at first a diagnosis of some form of psychogenic disease, possibly hysterical, but had eventually to alter the diagnosis to hebephrenia or catatonia. [Case 156] was possibly one of Shell-shock, though the man remained on duty for a month with but one symptom, trembling of the arm. For nine months he showed a variety of symptoms apparently consistent with the diagnosis hysteria, but then developed catatonic and paranoic symptoms clearly warranting the diagnosis dementia praecox.
65. Schizophrenia may not only be aggravated by service, but as [Case 157] shows, war experience may have a definite effect upon the content of hallucinations and delusions. Thus, a man wounded in the left shoulder built up the idea of currents running from his left arm to the Germans, such that if anything were touched by the arm, bombardment of the Russians would at once start up. The arm, in short, was charmed.