A man’s particular nervous malady is likely to be of common occurrence in the nerve-hospital; it does not render him conspicuous, and therefore an object of fussy solicitude, galling pity, or suspicious contempt, as is too often the case in other institutions. If unwounded, he need not suffer the taunt of “having nothing to show” as his reason for staying in hospital. Further, while in the special hospital, more importance is attached to some of the patient’s symptoms, less disturbance is produced by others. The occurrence of a “fit” is viewed by the rest of the men in this class of hospital in a truer perspective, and the patient does not find himself a nine-days’ wonder, as he so easily may do in a small auxiliary hospital full of straightforward wound cases.
Up to this point we have discussed the various troubles subsumed under the term shell-shock in what may be termed its initial and middle stages. In the middle stage, the patient having recovered from the severe and acute symptoms constituting the former phase, is left with a motley residuum of troubles, the chief of which we have enumerated on pages 12, 13. In distinguishing between this middle stage and that which follows it, we may perhaps ask the reader to assist us by recalling the difference between a mechanical mixture and a chemical compound. In the former the ingredients of the mixture remain unaltered and unaffected by the proximity of other substances, as for example when sugar is mixed with sand. In the compound, on the other hand, chemical action and reaction occur between the components so that not one of the substances is immediately recognisable in the complex, as for example when carbon, hydrogen and oxygen combine to form alcohol, which resembles none of them.
Now it would be distorting the facts of mind to suggest that while the third stage of shell-shock is a compound (as it undoubtedly is) the middle stage is a mixture. For the very essence of mind is its compound nature. But what we wish to point out is that in this middle stage the abnormalities have had very little time to react upon each other, with the result that there is some resemblance to a state of mixture, the phenomena existing temporarily side by side, so to speak. In this stage a patient may be troubled simultaneously by several unusual mental occurrences, such as terrifying dreams during very light sleep, loss of memory for certain periods of his past, and inability to understand or to carry out complex orders. For a short time in his “bowled-over” state he may be worried by the separate attacks, of these various troubles at different periods of the day and he may be too overwhelmed to try to understand or to attempt to see relations between them. This state of mind, in which the patient is still his “old self,” though a somewhat overturned self, resembles the mechanical mixture in our illustration. The reader may obtain some idea of this condition if he recalls any one day in his own experience when “everything seemed to go wrong”; when at one moment he was turning to face this difficulty, at another, that, but still retained to a great extent his usual attitude towards the world.
As has been pointed out, however, the state of “mechanical mixture” is utterly alien to the normal mind, which tends rapidly to interpret, in the light of its own experience, and to integrate as far as possible, its events, however incongruous they may be. The mind cannot, for any length of time, allow a new experience to remain strange or undigested. It must gather in and assimilate that event to the systematised complex which we call its own past experience. It follows that the ultimate result upon any particular mind of a new experience, if it be of a personally significant nature, will depend almost entirely upon the past history of that mind.
Thus for example the question whether the patient can or cannot satisfactorily stand up to his new troubles will be determined not only by his disposition, temperament and character, but also by his previous personal experience.
It is thus obvious to anyone who gives the matter any serious consideration, that the manifestation of a severe psychical shock must necessarily be determined in a large measure by the nature of the mind upon which the injury falls. It would be idle to pretend therefore, that, in diagnosis, the story of the patient’s past experience can be left out of account, for the manifestation of the injury will obviously depend largely upon the individual patient’s “mental make-up.”
Faced by the existence of a number of unusual mental phenomena the patient will inevitably succeed in time in inventing for himself, explanations of their co-existence. This “rationalisation,”[15] as it is called, is a perfectly normal process which is constantly going on in every individual, yet it plays a great part in complicating the mental disorders of the middle stage, and thereby intensifying the patient’s ultimate distress. For instance, he may not be more than temporarily disturbed by the unusual experiences we have mentioned[16] if they assail him separately. But, given time, he will soon begin to connect their appearances, and will argue to himself that these phenomena can have only one meaning: that he is mad or rapidly becoming so. And in this completely erroneous procedure he will be aided and abetted, not only by his own ignorance of the relation of mental normality to abnormality, but also by the general tendency of the uneducated to class everything unusual in the mental sphere as “mad.” Once he is convinced that he is in this state he may easily lose all hope of getting better, thereby increasing enormously the gravity of his case. Completely illogical, but to him entirely satisfactory explanations of his condition will then multiply.
As we have mentioned, this rationalisation is no unusual phenomenon in ordinary life. It will be clear to anyone who gives the question a moment’s thought that few of the non-scientific[17] beliefs held by even a highly educated person have ever been logically reasoned out from fundamental principles. In fact such principles frequently cannot be reached, for the very good reason that they have never been consciously conceived by the individual. One’s views on religion, politics, or the relations and rights of the sexes may exhibit in their outer casings a semblance of rational structure: their core, however, is not reason but emotion. As James expresses it:—
“In its inner nature, belief or the sense of reality is a sort of feeling more allied to the emotions than to anything else ... reality means simply relation to our emotional and active life. This is the only sense which the word ever has in the mouths of practical men.... Whenever an object so appeals to us that we turn to it, accept it, fill our mind with it, or practically take account of it, so far it is real for us and we believe it. Whenever, on the contrary, we ignore it, fail to consider it or act upon it, despise it, reject it, forget it, so far it is unreal for us and is disbelieved.... Whatever things have intimate and continuous connection with my life are things whose reality I cannot doubt.”[18]
Few people, however, realise this truth so clearly, or express it so lucidly, as Professor James. Often we believe that we are logically convinced when in reality we have been convinced first, and have invented reasons for our conviction afterwards. But many of our beliefs and attitudes have been implanted in us in childhood or early youth by processes which could not by the wildest stretch of imagination be called logical. And not the least important of those beliefs are those held by the average Briton with regard to insanity.[19]