Читать книгу Shell-Shock and Other Neuropsychiatric Problems - Elmer Ernest Southard - Страница 7

The order adopted for these groups (which roughly correspond to botanical or zoological orders) is a pragmatic order for successive exclusion on the basis of available tests, criteria, or information: the actual diagnosis is a product of still further differentiation within the several groups.

The case-histories of this book will show that

(a) most shell-shock is in group X, Psychoneuroses,

(b) the diagnostic delimitation problem is chiefly against I. Syphilopsychoses, III. Epileptoses, VI. Somatopsychoses,

(c) the finer differentiation problem is between X. Psychoneuroses and V. Encephalopsychoses. (See Epicrisis, propositions 9–12, 40–43, 72–73.)

I.	Syphilitic Psychoses	SYPHILOPSYCHOSES
II.	Feeblemindedness	HYPOPHRENOSES
III.	Epilepsy	EPILEPTOSES
IV.	Alcoholic, Drug, and Poison Psychoses	PHARMACOPSYCHOSES
V.	Focal Brain Lesion Psychoses	ENCEPHALOPSYCHOSES
VI.	Symptomatic (Somatic) Psychoses	SOMATOPSYCHOSES
VII.	Presenile-Senile Psychoses	GERIOPSYCHOSES
VIII.	Dementia Praecox and Allied Psychoses	SCHIZOPHRENOSES
IX.	Manic-Depressive and Allied Psychoses	CYCLOTHYMOSES
X.	Psychoneuroses	PSYCHONEUROSES
XI.	Other Forms of Psychopathia	PSYCHOPATHOSES

No conclusions are intended to be drawn in these introductory pages. Such conclusions as are risked are placed in the Epicrisis (see Section E). But so much can be said: If we are ever to surround the problem of Shell-shock (intra bellum or post bellum), we must approach it with no artificial and à priori limitations of its scope. We must not even agree beforehand that Shell-shock is nothing but psychoneurosis: that would be a deductive decision unworthy of modern science. In the collection of these cases, I have tried to place the topic upon the broadest clinical base. Samples of virtually every sort of mental disease and of several sorts of nervous disease have been laid down, some obviously not instances of Shell-shock, some mixed with clinical phenomena of Shell-shock, others hard to tell offhand from Shell-shock—the whole on the basis that we shall earliest learn what Shell-shock, the pathological event, is by studying what it is not. As the sequel may show, we are perhaps not entitled to regard Shell-shock, the pathological event, as always associated with shell-shock, the physical event. We shall, therefore, find in Section A (see tables on pages 6 and 7).

(1) Cases without either physical shell-shock, or pathological Shell-shock—psychoses of various kinds incidental in the war (--+).

(2) Cases with physical shell-shock but without pathological Shell-shock—psychoses of various kinds seemingly liberated by, aggravated by, or accelerated by the physical factor of shell-shock (+-+).

(3) Cases without physical shell-shock but with both symptoms of pathological Shell-shock as well as of other psychosis (-++).

(4) Cases with physical shell-shock, with clinical phenomena of Shell-shock, as well as of other psychosis (+++).

At the end of Section A, accordingly, we shall be left with two more formulae for discussion in Sections B, C, and D, viz:

(5) Cases without physical shell-shock but with symptoms of pathological Shell-shock (-+-).

(6) Cases with physical shell-shock and pathological Shell-shock (++-).

The data of Section A will solidly prove that Shell-shock, however picturesque the term for laymen or in the argot of the clinic, is medically most intriguing. As we cannot get rid of the term (even by suppressing it in parentheses or by condemning it to the limbo of the so-called), we must make the best of it by calling Shell-shock just the ore in the clinical mine. To say the least, the term is harmless: it merely stimulates the lay hearer to questions. These questions he must ask of the expert. But every time that the expert suavely states that Shell-shock is nothing but psychoneurosis, that expert runs the risk of hurting some patient who may or not have a psychoneurosis but has been called psychoneurotic. All the while, of course, the suave expert is perfectly right—statistically. In fine, the man you have called a victim of Shell-shock is probably a victim of psychoneurosis, but only probably!

Section A shows how he may—not probably, but possibly—be a victim of say ten other things. But it is not that he has an even chance of being one of these ten other things. As the reader watches the procession of cases in Section A, he will perceive that, amongst the ten major groups there studied, some have far greater diagnostic likelihood than others. Thus, syphilis, epilepsy, and somatic diseases will in the sequel prove more dangerous to our success as diagnosticians than, e.g., feeblemindedness or even perhaps alcoholism. But now let us look at these cases systematically, just as if we dealt with so many cases of Railway-spine or any other “incipient, acute, and curable” cases.