[22] The translation is very free, but it fairly represents the sense of the German original.
[23] From a leading article on “War-Shock and its Treatment,” in the Manchester Guardian.
CHAPTER II.
Treatment.
In discussing the question of treatment we do not propose to deal with general therapeutic measures which every physician in charge of nervous or mental patients is hardly likely to neglect.[24] The importance of a generous and easily digested dietary is generally recognised: as also is the need for quiet and congenial surroundings, and for shielding patients from disturbances, such as noises and the sight of wounded, which are likely to evoke painful emotions and vivid memories of their experiences at the front. It is also obviously important that the physician should deal promptly and discreetly with any bodily ailments from which the patient is suffering, being careful neither to minimise their gravity and so give him any reason for the grievance that he is not receiving proper attention, nor by exaggerating them to add this anxiety to his other troubles.[25] These are questions which may confidently be left to the discretion of the physician in charge.
Firmness and Sympathy.
But there are certain other therapeutic measures commonly recommended in text-books for application in the cases of patients suffering from neurasthenic and hysterical troubles, which cannot be thus summarily dismissed. As many of these patients are irritable and childishly peevish, it is necessary that they should be treated with sympathetic firmness, tact and insight. But, unfortunately, the words “firmness” and “sympathy” are interpreted in a great variety of ways. While it is important, for purely therapeutic reasons, that discipline should be maintained, and that when the physician has decided what he considers the proper treatment for the patient this should be rigorously carried out, it is manifestly disturbing and injurious in many cases for the officer to insist upon all the exacting details of military rules and regulations. For the mentally healthy soldier, obedience to stern and even harshly rigid regulations is often vitally important; but an attempt by a medical officer to treat a ward of neurasthenic patients in this way usually has disastrous results.
Quite apart, however, from the military aspects of the case, the physician, without really investigating the history of a patient, may label his trouble “hysteria” and forthwith adopt a course of “firmness.” He may assume the attitude of doubting the genuineness of symptoms which are very real to the sufferer. Under the plea of helping to cure the patient the officer may assure him that there is nothing much the matter with him and that if he tries he will soon be all right. Such advice may be justifiable if based on a real insight into the state of the individual sufferer, but this knowledge can be gained only by a patient investigation of the cause of his trouble. If the advice is given without this insight, it is a mere shot in the dark. The fact that the device succeeds in a certain number of cases is no excuse for its general adoption. And when it “misfires” no one realises the fact more quickly than the patient himself. He realises that the officer does not appreciate his condition and his confidence is thereby destroyed.
It is useful, too, to consider for a moment the nature of treatment by “sympathy.” When we used the phrase “sympathetic firmness” we intended to indicate the insistence upon a strict observance of such methods of treatment as a real insight into the patient’s condition may suggest. The word “sympathy” was used in its literal sense of “feeling with” the sufferer. But there is no class of patients upon whom sympathy of the injudicious kind is more prone to work serious harm than the psychoneurotic. The knowledge of this fact is often the excuse for the adoption of the opposite attitude and the prescription of “firmness” which, as we have seen, may be equally unintelligent and injudicious.
But sympathy of the injudicious kind is not real sympathy. For unless the sympathiser has a true appreciation of the patient’s condition, and can look at things from his point of view, he cannot really feel with the sufferer. The latter may arouse in the would-be sympathiser tender emotions and sympathetic “pain,” but unless the sympathiser have insight, the pain, to put it crudely, is not likely to be “in the same place” as that of the patient. Such misplaced emotion and false sympathy, whether on the part of the doctor, the nurse, or the patient’s relations, may do much harm.
In mild cases of mental trouble, however, where the patient still retains a goodly portion of self-confidence and self-respect, this “petting” variety of sympathy may sometimes be effective. Such a patient may be cheered up by the presence of people sufficiently interested in him to be sorry for his condition; and it may help him to look on the brighter side of things and to forget his worries and anxieties. But often it is apt, by suggestion, to aggravate his troubles or even to discourage him from trying to recover.[26] Perhaps it would be more accurate to say that such treatment gives him no inducement to get better.