Shell-shock and other neuropsychiatric problems

Case 472. (Collie, May, 1915.)

Sir John Collie remarks that sometimes one has to recommend a pension knowing that what amounts to a fraud is being perpetrated. A seaman, 25, got newspaper notoriety after receiving some not very serious bruises of head and back. Two months later, when seen by Sir John Collie, he was a victim of bent back. He was finally able to remove his clothes and put them on with some alacrity, although at first he declared he could not. Woebegone during examination, he was noted to laugh and gossip with strangers outside. A physician had diagnosticated it as an obscure spinal lesion, but as he was fit to work, he was sent back.

Forty-one days later he put himself on the sick-list again. Pluck and nerve were gone beyond recall, according to his physician. In hospital his appetite was good, he slept well, and he had no troubles except an hysterical loss of sensation. There followed 33 days in hospital, three weeks in a convalescent home, and return to work for a month. Unable to stoop or kneel for pain, he was thought organic.

Sir John found him without desire to get well, hysterical, and suffering “from pensionitis, a self-made neurasthenic for medico-legal purposes.” He was placed for four months in a nerve hospital. On leaving this hospital he was still in the bent-back position, and went into a pantomime display when asked to touch his toes. Four weeks in the convalescent home found the following: The attending physician now suggested locomotor ataxia as the correct diagnosis! Sir John Collie was asked to report finally as to the fitness for work. Well assured that the patient was really a malingerer, Sir John nevertheless certified him as permanently unfit for further service as a case of traumatic neurasthenia, venturing to predict that after receiving the pension, he would be at work within six months. He received the pension (25 s. a week for life), and Sir John Collie’s ability at prediction was justified by his return to work, at the end of exactly six months.

Re malingerers, Glueck remarks that a malingerer, besides being a malingerer, is a worthless sort of person in any event, and calls attention to the fact that special stresses may reduce men to lower cultural levels, to which lying and deceit may be more appropriate. Glueck remarks that the lay mind does not readily appreciate that a man with mental disease may at the same time be a malingerer of additional mental symptoms. It may be added that the professional mind is sometimes equally slow to appreciate the fact.

D. TREATMENT AND RESULTS OF SHELL-SHOCK.