The subject under review has been most forcibly
brought home by this great European War. The manifestations
are Protean, and to the patients afflicted, such symptoms
are as real as those due to organic disease.
The oáuses of the psycho-neuroses of the War - the functional disorders under the name of "Shell Shock'
- are emotion and concussion.
The continued and long mental strain of anticipation;
the nauseating sights around; the new methods of trench
warfare with exposure to cold, wet, etc., associated
with loss of sleep, all help in lowering the vital
resistance of the nervous system of even the strongest
men and prepare the way for the crisis.
The main etiological factor is emotion.
Traumatism alone seldom gives rise to psycho-neurosis.
Most of these nerve war-strain disorders result
from the same etiological factors, and can be
differentiated from organic diseases and their method
of treatment is more or less the same.
It is necessary in all cases to exclude organic
disease and to recognise that these psycho-neuroses are
different from cases of malingering.
The prognosis on the whole is good.
Treatment must be adopt ed at once s must be
scientific, individual, and consists mainly of psycho-therapy, psycho-electrical methods and re-educative measures.
Alter the war a serious problem will have to be
faced, namely: - what is to be done with our War Cripples,
not only the physical but the mental.
Briefly the problem resolves itself into the
profession and the laymen understanding the psychological
aspect of these conditions, recognising that they are
real, that treatment for such must be scientific, that
"colonies" will be useful and necessary for the "mental
war cripples" which will be free from the asylum stigma,
and where technical workshops, etc., will be erected to
fit these men for new employments or re-educate then
in their previous trade or calling.
Out -patient clinics for psychical disorders should
be established and be under University control.
In conclusion, it is noteworthy that the German
view of, and treatment of, the psycho-neuroses of the
war is similar to that of our own.
The Germans lay great stress on some form of
employment or course of instruction, in various kinds
of work, and general industries of the district.
Medical Officers state the kind and amount of work to
be done, and inspect the men once a week. Carpentry has
been found by them the most satisfactory for strengths
the muscles of the men, for their return to the front.
A point is made of always praising and encouraging the men.
Kuhn states "that there are more examples of
neuroses in the general wards of Military Hospitals than
there are in the Nervous Hospitals and that patients
with functional nervous disorders are often treated for
heart disease, disease of the lungs, Sciatica, Myalgia,
etc." In some cases these disorders are of ideogenous
origin, . occurring while away from the front, such cases
having little psychical resistance and readily affected
by psychical influence".
Again Kuhn recommends psychical measures first,
and lays great importance on the personality of the