Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918Southard, Elmer Ernest
History
Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918
Southard, Elmer Ernest
War neuroses; World War, 1914-1918 -- Medical care; World War, 1914-1918 -- Psychological aspects
A reservist, 31, was in the hospital about Christmas, 1914, for
rheumatism, when suddenly he became excited and was sent to the Charité
Psychiatric Clinic. He was restless all night, moving about in bed,
grinding his teeth, and continually getting up. He had a blank and
astonished expression; his breathing was rapid and forced. There were
no pyramidal tract symptoms, but muscular power was diminished,--more
on the right than on the left. While the knee-jerks were being tested,
the legs moved (seemingly psychogenic). Irregular hypalgetic zones
were found, and pain was less well felt on the right side than on the
left. Answers to questions on mental examination were made with the
appearance of effort, the patient breathing deeply and rapidly, head
drooping, forehead wrinkling, and eyes glancing about in an astonished
way. “How many legs has a horse?” After long cogitation, the man
counted slowly,--1, 2, 3, 4. “What’s your wife’s name?” “Marie--Marie,
I think.”
In the interpretation of this case, the functional paresis and
hypalgesia of the right side, the functional pseudoclonus obtained
during the knee-jerk test, the mental situation,--rather suggestive
of a hysterical pseudodementia or a “Ganser” dazed state,--make the
probable diagnosis at first sight psychogenic. Left to himself,
however, the patient assumed a stereotyped unchanging posture; he would
suddenly cry out, without particular emotion, that he was to be shot
or executed; there was a tendency to rhythmic repetition of certain
answers to questions, with the suggestion of perseveration.
After a time, pronounced rhythmic, and then stereotyped, movements
started in. Suddenly negativistic phenomena, with refusal of food and
self-accusatory ideas set in; speech stopped altogether. Information
from his relatives showed that he had been peculiar for some time and
had for years occasionally said that he was going to be shot.
Here then, instead of a hysterical pseudodementia, was a case
of hebephrenia or perhaps catatonia. Possibly there had been no
pseudodementia, but actually an elementary disorder in the associative
process. Possibly the defects which the patient early showed, in his
responses, for example, were really genuine schizophrenic blocking.
According to Lewandowsky, almost all cases of neurasthenia, of
hysteria, and of the so-called traumatic neuroses, stand out very
clearly as functional. Bonhoeffer is far less certain that the
diagnosis can be made readily in all cases. Antebellum conditions have
not been continued in wartime; hysteria was a female affair antebellum,
but under war conditions, it is found necessary to draw many
differential diagnoses in the male betwixt schizophrenics, epileptics,
and psychotics, on the one hand, and hysterics on the other.
Public-domain text, read in full here on John Shaqi.
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