(b) Special causes of shock, such as death of comrades near by, near-by shell explosions and blowing up of trenches;
(c) Fatigue and exhaustion with lowered capacity of resistance.
The men themselves find that they have
(d) undergone a change of character, having become irascible, unable to sustain interest and attention; solitary and morose, and less capable of self-control. Anxiety, worry and a state of morbid expectancy set in. Everyday trifles are exaggerated.
But below these cases are still deeper ones, such as
(e) revival of horrible memories and terrifying dreams of war scenes, together with memories of incidents of past life.
(Rows attributes to Dejerine the idea that the cause of all cases of hysteria and neurasthenia must be sought in antecedent emotion.)
Emotion compels attention, and to such a degree in some cases that the memories and attendant fears and anxieties cannot be expelled. Hallucinations and delusions may then develop. The patient is largely incapable of reasoning about his status; he lacks “insight into the nature and mode of origin of his mental illness. This insight can be provided by explaining to him in plain language the mechanism of simple mental processes, by enabling him to understand that every incident is accompanied by its own special emotional state, and that this emotional state can be re-awakened by the revival of the incident in memory.” The patient and the physician now “begin to realize that they have some ground in common.… The mystery of the illness will be swept away and the physician will be able to … show him how he can educate himself to regain that which was lost.” “The patient can be induced to face the trouble.” “The excessive emotional tone will thus be stripped away and the patient will thus become able to appreciate the real value of the incident.” “The reëducation must vary with each case in order to overcome the difficulties connected with the specific cause which has been discovered.”
Rows’ work has been done at the Red Cross Hospital at Maghull, and several of the Maghull cases have been reported in Elliot Smith and T. H. Pear’s book on Shell-shock. A somewhat similar point of view has been maintained by Wm. Brown, who has suggested the neat term autognosis for psychoanalysis. W. A. Turner speaks of the Maghull point of view as one of modified psychoanalysis.
111. Or again a species of combination of the manière forte and the manière douce (operations, shall we say with William James, of the “tough-minded” and the “tender-minded” respectively?) may be used as in the formula