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Shell-shock and other neuropsychiatric problems

Chapter 59: Case 49. (Kastan, January, 1916.)
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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.

Unfit for service: Question of feeblemindedness.

Case 49. (Kastan, January, 1916.)

Walter N. was declared unfit for military service in 1912, on the ground of mental incapacity. He had shown this clearly during his period of training. He committed a number of slight offences secretly, but not so secretly but that they were immediately discovered and punishment meted out therefor. He could do nothing without aid. It appears that his mental weakness had not been noticed in school, but that his employers had thought him both feebleminded and irresponsible. Nevertheless he always executed orders properly. While in hospital in 1912, he had occupied himself very little, sitting indifferently, quiet and dreaming. At that time, he had shown poor calculating ability and decreased power of perception. It also appears that he did not grasp the nature of simple orders, the requisite associations being disturbed.

Despite this history, on September 11, 1914, he found himself being transported. He claimed to be very tired. Upon reaching the city, he picked up a large stone and raised his arm as if to strike the transport leader. While N. was being bound by the transport leader in consequence, he kicked at his leader’s shins.

In the clinic he resisted examination, moving his legs without speaking, staring at the floor, moaning frequently, sitting motionless with head hanging, answering monotonously repeated questions, but turning his head at a loud noise. He felt ill. It appeared that he was oriented and that his knowledge was well preserved although his calculation ability was poor.

It would seem that psychiatric examination, possibly with the aid of psychological work, would have excluded Walter N. from the army.