SYMPATHY + FIRMNESS (Mott).
112. More special devices, suggesting faintly the methods of animal training, may be used, as described in the following account of a new isolation and psychotherapeutic service established in May, 1915, at the Salpêtrière for soldiers with functional nervous diseases. The basic idea has long been held by Dejerine,—the avoidance of heterosuggestion by other patients, imitation, ill effects of visits from members of the family. The functional additions that come from near-by organic patients are among the disadvantages of the ordinary treatment. The isolation service of the neurological center is composed of 34 beds, arranged in two halls, with three extra rooms. Each bed is isolated. The régime in one of the rooms is more rigorous than in the other, and it is an advance for a patient to be moved from the first to the second room. The patient on wakening has no right to leave his box or communicate with his neighbors. He leaves only to be treated by hydrotherapy or electrotherapy. He takes his meals in isolation, receives no calls, and has no leave to go out. The physician sees the patient twice a day and carries on psychotherapy and motor reëducation, as well as special treatments.
Women nurses care for the patients. A system of control and of progressive rewards has been installed, being a sort of metric evaluation of the process of cure. As the cure proceeds the patient’s lot is progressively mitigated, or if he gets worse the regime is clamped down. Suppose a man a victim of paralysis of leg—the height to which he can lift his leg is measured in centimeters daily as well as the time during which he can hold the leg in air; or, the progress of an ankle, or of the forearm or the arm in a case of arm contracture, is measured. The grade obtained by our scholar in psychotherapy is inscribed upon a slate. Finally, walks, concerts, visits and eventually permission to go out into the town are granted.
113. Can Shell-shock neuroses be prevented, other than by stopping or modifying the war or by weeding out Shell-shock candidates as they volunteer or are drafted? Morton Prince offers points of some suggestive value. The very various proportions of neurosis observed in different units and arms of the service suggest that various degrees of preparedness may have played a part. Bernheim says suggestion is an idea accepted. Aside from a possible increase of simulation, much might depend on what idea administered really got accepted! Morton Prince’s plan is that the prevention must be based upon the education of the mind. This therapeutic education should be based, however, on a preliminary systematic study by a board of specialists in the psychoneuroses of (a) the mental attitude of minds generally toward shell fire, and (b) clinical varieties of this “shock” neurosis as it occurs in trench warfare, (c) its frequency and disabling incidence, and (d) the state of mind previous to the trauma of those suffering from it.
On the basis of the findings of such a study, first, the regimental surgeon through lectures and clinical demonstrations would be instructed systematically in the symptoms and pathology of the disease and the methods of psychotherapy for its prevention.
Second, soldiers, including officers, could then, in units of say 100, in turn be instructed in the nature of the disease through lectures by regimental surgeons. Shell-shock, they should be told, is a form of hysteria caused by mental factors. The work of the instruction should be done in France in the atmosphere of the war, wherein would be formed an attitude of healthy mental preparedness instead of an attitude of fear and mystery. Has mental hygiene this great scope? Is morale merely education?
114. What after all, is Morale? We hope to learn a little about it from this war for use hereafter, when we can say with the Florentine
e quindi uscimmo a riveder le stelle
And thence we issued out again to see the stars
Inferno, Canto XXXIV, 139.