“There is no justification,” says Gaupp, “for calling every instance of this a case of malingering or simulation. There are quite capable men of irreproachable character whose nervous system is positively unfitted for the hardships and horrors of war. They have enthusiasm and the best of intentions but these cease to inspire them when the horrors and terrors come. Their inner strength rapidly decreases, and it only requires an acute storm to break upon the nervous system (such as the explosion of a shell or the death of comrades) for their self-control to vanish completely. Then automatically their condition changes into what is popularly called ‘hysteria.’ The exhausted mind then feels that it is no longer master of the situation, and therefore ‘takes refuge in disease.’ At first, as a rule, obvious signs of terror and anxiety (trembling, twitching, etc.) manifest themselves; if these are cured there still remain chronic symptoms of hypochondria and despondency. Time, however, has its effect in many of these cases.”[22]
If a patient comes into the hands of a physician before the processes of rationalisation and systematisation have become established, the medical officer should be able to meet his difficulties, and help him correctly to interpret his unusual experiences by explaining to him their origin and nature.
“The application of discreet sympathy and tact by a physician who endeavours to discover something of the man’s past mental history may be able to reassure a patient upon his particular trouble with the happiest of results. To a man quite unacquainted with text-books or speculation on psychology there can be no darker mystery than the working of other people’s minds. To such a man the natural conclusion is that his own mental processes are universal and normal. But if, as a result of some nerve-shattering experience of warfare his mind suddenly develops a trick which was quite unknown to him before, though this development may be far from abnormal, to the troubled patient it may seem to be an unquestionable symptom of madness.”[23]
Many of the cases in which a patient has merely needed reassuring have been of this type. A short and very simple explanation of some elementary facts of psychology is often sufficient to bring about an immense change in the man’s condition, which has led to his curing himself. And this is the ideal method of cure.
It may seem that an inordinate amount of space has been devoted to the demonstration of a simple truth, that mental, like bodily disorder, should be treated early, or complications may ensue. But there are reasons for giving so much prominence to this aspect of the subject. The chief is that in our own country, mental disorder is seldom treated in its early stages. Nearly all our elaborate public machinery for dealing with this distressing form of illness is devised, and in practice is available, only for the advanced cases. This war has shown clearly a truth which, of course, was already known before to many doctors, but never adequately appreciated by the general public, that a case of advanced mental disorder may pass not only through various milder stages on its way, but that if intercepted at these earlier stages, it may frequently be cured with ease.
Another point which should be emphasised is this: shell-shock involves no new symptoms or disorders. Every one was known beforehand in civil life. If by any stretch of the imagination we could speak of a specific variety of disease called shell-shock, it would be new only in its unusually great number of ingredients. And the most gratifying truth of all is that even this hydra-headed monster, if caught young, can be destroyed.
From the fact that shell-shock includes no new disorders the important inference may be drawn that the medical lessons taught by the war must not be forgotten when peace comes. The civilian should be offered the facilities for cure which have proved such a blessing to the war-stricken soldier.
FOOTNOTES:
[1] There are no sicknesses, there are only sick people.
[2] This subject has been lucidly discussed by C. Burt, “Psychology and the Emotions,” School Hygiene, May, 1916.