John T. MacCurdy, M.D. WAR NEUROSES. State Hospitals Press, Utica, NY, 1918.
p. 20 "...it is a striking fact that anxiety conditions in the pure state occur almost exclusively among officers. It is their task, not merely to keep their own feelings in subjugation, but to inspire the men beneath them with courage and enthusiasm."
First stage is extreme fatigue. "...fatigue in a clinical sense appears when other symptoms develop. These are a feeling of tenseness, a restless desire for action or distraction, irritability, difficulty in concentration, and a tendency to start at any sudden sound (without fear), the sound being usually that of exploding shells. This reaction of nervous starting is so common that it is universally known by the officers and men as "jumpiness." There is usually a slight improvement in the feeling of weariness toward night, as a certain degree of excitement accumulates which enables the individual to disregard his difficulties."
"The nocturnal symptoms are even more distinctive. There is great difficulty in getting to sleep, with a long period of hypnagogic hallucinations. Whatever has been the dominating experience of the day appears in troublesome vision before the eyes of the soldier, who although knowing that what he sees is not actually there, is still unable either to go to sleep or to awaken himself sufficiently to banish the visions. The only emotional reaction is a feeling of irritation with restlessness. Fatigue as such does not seem to produce fear. When sleep does come, it is often troubled by repeated dreams of the occupational type where the soldier is trying to do whatever was his task during the day, is having constant difficulty and meeting with no success in accomplishment. The sleep, too, is frequently interrupted by the man suddenly awakening with a jump, although he is not conscious of this waking being the result of any incident in his previous dream..."
p.21 Lack of sleep eventually leads to fear and horror at the sights around him.
p. 25 nightmares from anxiety: "nothing is distorted except that he is invariably powerless to retaliate, and his fear is infinitely greater than it ever is when he is awake in a situation that is at all similar...occasionally they are even totally free from fear during the day."
p. 27 "...these men, while still in the firing line, are apt to think more of themselves than they previously had thought, and consequently to get out of touch with their fellows. This latter tendency is almost universally present when the neurosis is firmly established. The patient suffers considerably from a lack of sociability, and of spontaneous affection. This is probably due, in part, to a sense of unworthiness which develops with a feeling of cowardice. As in almost any neurosis, there is considerable introversion. Many a patient wants to be alone, and, although he is always capable of making a good impression [p.28] socially in a formal way, he finds it difficult to exhibit any signs of affection...this finds expression physically through the symptom of impotence...either as such or in the form of its equivalent, lack of erotic feeling."
p. 28 "These symptoms continue acutely for a few weeks in some cases, sometimes for months in the more severe neuroses. All the more obvious symptoms tend to abate gradually without particularly painstaking treatment. The dreams grow less frequent, and usually disappear. Quite frequently the content changes when the patient has been away from the trenches for some time. Distortions occur whereby the setting comes to include more of the normal peace environment...normal dreams of civilian life which will suddenly be interrupted by the appearance of the enemy with bombs or bayonets." Sometimes this progresses to dreams in which dreamer shows fight, and then later begins to defeat his enemy.
[does not seem to refer at all to late-onset PTSD, but then, not enough time has passed for those cases to become evident]