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Shell-shock and other neuropsychiatric problems

Chapter 543: Case 510. (Rivers, February, 1918.)
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About This Book

The work assembles nearly six hundred clinical case histories drawn from wartime medical literature to document combat-related neuropsychiatric disorders. It presents concise case protocols illustrating varied symptom patterns, diagnostic dilemmas, malingering and simulation, therapeutic interventions, and treatment outcomes, and includes bibliographic references and introductory commentary. Sections juxtapose cases to illuminate contested diagnoses and to inform postwar rehabilitation and mental-hygiene efforts, aiming to provide clinicians and reconstruction workers with detailed clinical material for recognizing, classifying, and managing neuropsychiatric consequences of war.

Rationalization of war memories, without redeeming feature as nucleus.

Case 510. (Rivers, February, 1918.)

An English officer was flung by shell explosion so that his face struck the ruptured and distended abdomen of a dead German. The officer did not immediately lose consciousness and got distinct impressions of taste and smell and an idea of their source. After a period of unconsciousness he came to, vomiting and much shaken. He carried on several days, still troubled by vomiting and haunted by taste and smell images. Several months later he was observed by Rivers suffering from horrible dreams, in which the battle experience was faithfully reproduced. He got no relief except when he went into the country, far from every suggestion of war. Rivers’ psychotherapeutic plan of finding a redeeming feature in the experience, upon which the patient might concentrate, failed because there was no redeeming feature. Accordingly, it was thought best that the man should leave the army and seek the conditions that had given him slight relief.

Re psychoanalysis and its modifications, see remarks under Case 496, under which several favorable opinions were mentioned. Boschi in his report on French conditions gives no reference concerning psychoanalysis or hypnosis. Bruce has found blended with the war dreams many episodes quite alien to the war, and considers that the patient’s ante-bellum history is of importance, since ante-bellum emotions may be revivified by the war. Craig states that he has not been impressed favorably by the results of psychoanalytic treatment. Arinstein from Russian experience gives preference to Dubois’ psychotherapy over hypnosis and psychoanalysis. Nonne states that the data of the war prove that hysteria is neither a degenerative disease according to classical theory, nor a disease based upon Freudian principles.