Читать книгу Shell-Shock and Other Neuropsychiatric Problems - Elmer Ernest Southard - Страница 83

War strain; anxiety; confusion; fugue. Demotion and detail to the interior.

Case 75. (Barat, November, 1914.)

A lieutenant, 25, an officer in a regiment on active duty near the front, was called before a special board charged with desertion in the face of the enemy. He had been assigned to a certain position but not only had not complied with the order, but had wandered off to the British sector and been arrested there as a spy.

The prisoner was well developed, without stigmata; heredity, negative. His career in the army had been courageous and he had been advanced several ranks and was about to be given a medal for bravery. He said that he had been under a severe strain for several days.

One evening he had been given the order to attack. The artillery opened fire. He found that the Germans had erected barbed wire defences. The loss of men was terrific. His order was to shoot all who held back. A poor territorial crouched down and would not go forward—supplicating the prisoner not to shoot him. The prisoner spared him.

The next night the order to attack the German trenches was again given. This time he was overcome with anxiety and discouragement. The last he remembers was the order to attack. Next day he felt sick and his mind was foggy. He remembered leaving his regiment and wandering round for several days until he fell into the hands of the British and was arrested. Then he understood what he had done.

The prisoner asked to be allowed to return to the front. The testimony of one of the lieutenant’s men verified his statements. On the day before he left the front he had been anxious, had cried often, and would speak to no one. On the day he left the trenches without permission, he was nervous and disoriented.

There was no doubt that simulation could be ruled out; the differential diagnosis lay between a “confused state of emotional origin” and an “epileptic dazed state.”

For epilepsy there was a history of attacks with falling to the ground and loss of consciousness, without involuntary micturition or biting of tongue, during the time when he was a sergeant. Moreover, irritability and unwarranted suspiciousness had been present at these periods. However, there were no other epileptic symptoms; these two attacks were isolated and of quite long duration, leaving no headache or malaise after them. Also there was no basis for the diagnosis “epileptic dazed state,” since there was no abrupt commencement; the loss of consciousness was never complete (the subject was able to converse with persons while the attacks were on); and some remembrance was present of incidents during the attacks.

For Barat, the important points are that the attacks were preceded by long periods of anxiety and the disturbances resulted more from moral than physiological causes.

The importance of the psychological factors lead the author and his colleagues to the diagnosis “Mental confusion of emotional origin.”

The board decided to return him to the interior and give him a barracks position at the reduced rank of drill sergeant.