Traumatic neuroses; War neuroses; World War, 1914-1918 -- Health aspects; World War, 1914-1918 -- Veterans -- Mental health
In cases of mental disturbance, however, the general lines of treatment
cannot thus arbitrarily be determined merely by finding an appropriate
label. It is true that as in the treatment of bodily disease, certain
general principles must be observed, such as the provision of
abundant and suitable food, and the protection of the patient from
all disturbing influences. But the essence of the mentally afflicted
patient’s trouble is some particular form of anxiety or worry which
is _individual and personal_. The aim of the diagnosis, therefore,
should be not merely to determine the appropriate generic label for
the affliction, but rather to discover the particular circumstances
which have given rise to the present state. The special object of the
physician should be to remove or nullify the exciting cause of the
disturbance; and in order to do this it is essential that he should
discover the precise nature of the trouble. The diagnosis, therefore,
must be of a different nature from that demanded in case of physical
illness, where the condition may be adequately defined by some such
generic term as “lobar pneumonia” or “acute appendicitis,” and its
gravity estimated by the general condition and physique of the patient.
In the case of mental trouble, the physician has to make an individual
diagnosis, based not only upon an insight into the personality but also
into the particular anxieties of each patient.
But even when it is recognised that exact diagnosis of the particular
circumstances of each individual patient is essential, if the trouble
is to be treated rationally and with insight, there still remain many
difficult problems as to procedure.
Amongst those whom experience has convinced of the efficacy of
psychological treatment for this class of case, there are indications
of a divergence of opinion in the matter of procedure. Some believe
that it is sufficient if the medical man has discovered the real cause
of the trouble and explained it to the patient. Other workers look upon
a preliminary psychical examination merely as a means of diagnosis,
the unveiling of the hidden cause of the trouble; and consider that
the treatment should be the laborious and often lengthy process of
re-educating the patient, and so restoring to him the proper control of
himself. It is of the utmost importance to emphasise the undoubted fact
that those who maintain either of these views to the exclusion of the
other are committing a grievous and dangerous error, for there is no
sharp line of demarcation between the two procedures.
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