REVIEWS 531 



psycho-neuroses stand first and are among the most persistent as well as the most 

 difficult to deal with and to cure. Any text-book or pamphlet, therefore, which 

 can serve as a helpful guide must deserve to be counted as so much economical 

 gain in the reconstruction after the war. 



The Abbe Girard once said that the number of synonyms in a language was 

 the best indication of the richness of that language, and in this particular we have 

 no need to bewail the copiousness of our own, for the terms shell-shock, war- 

 shock, psychasthenia, neurasthenia, anxiety neurosis and hysteria have all been 

 applied to almost identical symptoms, and in the general scheme of cases de- 

 scribed in the present volume, we think it would have been more relevant and 

 more precise and therefore more discriminating if the term "war-shock" had been 

 selected, for it would then include the authors' groups — viz. "all those mental 

 effects of war experience which are sufficient to incapacitate a man from the 

 performance of his military duties," those causes, in fact, which the joint-authors 

 purpose to treat ; reserving "shell-shock" for actual physical and material damage 

 to the nervous system from concussion, gas, or other local injury ; and it is a fact 

 of experience that the symptoms of so-called "shell-shock" are rarer in the 

 trenches than behind the lines, at the base or at home — an additional reason why 

 the term " war-shock" would seem to be the more preferable. 



The authors insist upon an emotional shock or some frequently repeated emo- 

 tional stimulus as the chief cause, with which we do not agree ; but they rightly 

 assert that the forced {i.e. voluntary) suppression of the outward signs of an emotion 

 tends in persons with certain temperaments, dispositions and character, to dissocia- 

 tive dissolutions ; because the emotions are denied the normal outlet channels and 

 they emerge through the "mental conflict" as a discharge along some other (pro- 

 bably more strange, bizarre or unusual) channel. The authors point out there are 

 at least three stages in emotional " shell-shock," the initial period, rarely discover- 

 able to the outside observer, being the stage of auto-suggestion or of incubation ; 

 then the middle period, during which the feelings, emotions and ideas that are in 

 the mind exist in a state of flux ; and the final period, during which all the morbid 

 states are being assimilated and associated, eventually seizing upon the mind 

 as systematised or rationalised notions, ideas which McDougall has described 

 as being "intellectualised." The incubatory stage is well known to those who 

 watch the development and the result of fear ; the encouragement of the riding- 

 master or the huntsman, for instance, to induce the tyro to remount after a " spill " 

 is the psychological application of treatment during this stage ; but it is during 

 the middle period of flux that the authors recommend individual treatment in 

 shell-shock, and this by hetero-suggestion, or hypnosis or isolation, the endeavour 

 being to re-educate the sufferer through sympathy, and the strong and firm appeal 

 which is made by the personality of the doctor, although naturally, the whole 

 environment — i.e. all who are in charge of the case — should similarly be the 

 encouraging factor. The authors lay too much stress, the reviewer thinks, upon 

 the value of dreams, even if they can be correctly interpreted ; but the phenomena 

 connected with dreams, their classification, the connection between the psychical 

 life of the dream and that of the waking hours, together with the variable codes of 

 interpretation, render dreams far from being a constant diagnostic help or value 

 in treatment. The third chapter is devoted to the dream; to psychological 

 analysis ; and to re-education. A clear account is given of the crystallisation of a 

 delusion or belief, which is precisely similar to that occurring in the integrations of 

 healthy mental life. Much importance is attached to the unconscious factor of the 

 mind, and considerable attention is devoted to the formulation and the answering of 



