SHELL SHOCK AND ITS LESSONS, G. Elliot Smith and T.H. Pear, Manchester University Press, UK, 1917.
"It might seem that to publish a book on this subject at such a time is merely to irritate existing wounds. The topic is painful; perhaps one of the saddest of the many grievous aspects of the war. But a condition exists at present which is immeasurably more painful--the exaggerated and often unnecessary distress of mind in many of the sufferers and their friends, which arises from the manner in which we, as a nation, have been accustomed to regard even the mildest forms of mental abnormality. Of all varieties of fear, the fear of the unknown is one of the greatest. Not the least of the successful work performed in the special hospitals during the war has been the dispelling of this fear by helping the sufferer understand his strange symptoms (many of which are merely unusual for the patient himself) and, in the light of this new self-knowledge, to win his own way back to health."
p. 1 "...the nerve-stricken soldier..."
"...the troubles displayed in the many disorders classed under the official title shell-shock are extraordinarily numerous and different, and their removal necessitates a similarly varied repertoire of "opening moves" on the part of the physician."
"[shell-shock] has now come to possess a more or less definite significance in official documents and in current conversation. It is for this reason that we have chosen to use it rather than the more satisfactory, but less widely employed term, "War-Strain.""
p. 3 "These disturbances are characterised by instability and exaggeration of emotion rather than by ineffective or impaired reason."
p. 5 "The patient often discloses in the first interview the fact that he was displaying all his present symptoms before the arrival of the particular shell which laid him out."
p. 6 Onset described as, first, intense and frequent emotion (fear, excitement, anxiety, elation, depression) of all kinds, which along with noise and danger of trenches leading to lack of sleep; "bodily hardship...aggravates the disorders we have described." No outward signs may be evident.
p. 8 "While no signs of fear can yet be detected in the face, the body, limbs or voice, these disturbances of the respiratory, circulatory, digestive and excretory systems may be present in a very unpleasant degree, probably even intensified because the nervous energy is denied other channels of outlet." Suppressing fear for a long time is exhausting; sympathetic pain, distress, etc. are likewise exhausting to suppress.
p. 27 Treatment: "...a generous and easily digested dietary...quiet and congenial surroundings...shielding patients from disturbances, such as noises and the sight of wounded, which are likely to evoke painful emotions and vivid memories of their experiences at the front." Take care of physical ailments but don't exaggerate them, or anxiety about physical wounds will be added to shell shock.
p. 28 Strict adherence to military regulations is not recommended with these patients.
p.30 "there is a tendency to look upon any form of sympathy as a dangerous pandering to the patient's lack of willpower.
"This attitude often finds expression in leaving the patient alone to get better by his own efforts, or in suggesting to him that he is not so ill as he thinks he is, and that all he needs is some work to occupy his attention.
"The attempt if often made to justify such methods by the plea that it is "bad for the patient to talk to him of his worries." But how a physician is to rid a patient of the very root of all his trouble without first discovering and then discussing it with him is not apparent. Nor, again, is it any more rational merely to tell a man who is weighed down with some very real anxiety to "cheer up," or to "work in the garden," or "take a walking tour.""
pp 33-36 Isolation of the patient might work in civil cases, but not for shell-shock; also, the cost is prohibitive.
p. 38 "the incontrovertible fact that hypnotism has been proved to be a valuable therapeutic agent in the early stages of shell-shock." Should not be the entirety of treatment, and is not suitable for all cases.
p. 39 "In some cases hypnosis helps in more quickly breaking down resistances, which occur in patients too beset by their own false beliefs to be able easily to grasp the arguments and persuasions which the physician may have spent days and weeks in vainly endeavouring to get accepted." Can help with physical manifestations such as tremors, but if used too much in removing symptoms, other symptoms might crop up instead.
p. 50 The therapeutic value of work: occupies mind so patient can't dwell on his troubles; purely mechanical manual labor is unsuitable for this purpose.
p. 51 "A patient may be troubled not only by the terrible nature of the memory but by the recurring thought, "If I had not done," this or that, "it might never have happened." The reader will easily see how such a thought may arise in the mind...Now, such self-reproaches are frequently based upon entirely insufficient evidence, and if the medical officer is given the opportunity of calmly discussing their foundations with the patient, the result is often to reassure him and to enable him to view his past in an entirely new light. It is then, and not before then, that he will be able cheerfully to enter upon useful occupation and to benefit by it."
p. 54 Psychological analysis and re-education: "the resolution of the patient's mental condition into its essential elements...Re-education is the helping of the patient, by means of the new knowledge gained by analysis, to face life's difficulties anew."
"alienists have been doing this ever since insanity was first treated..."
p. 61 Dreams are important clues to the unconscious; goes on to discuss analysis.
Goes on to discuss cultural and social aspects of mental illness in British society.