September 27, 191 7] 



NATURE 



65 



We regret that Sir Robert Armstrong-Jones has so 

 forgotten the amenk'es of discussion as to make the 

 unwarranted statement that, " as stated in the intro- 

 duction, the object of the volume is to rouse a feehng 

 against the British attitude towards the treatment of 

 mental disorder." We are living in busy times, but 

 cannot a reviewer be expected to read at least the first 

 three pages of a book with some care? 



From the last-quoted statements the reviewer pro- 

 ceeds :— " Naturally, therefore, and also avowedly, the 

 work is written for the general reader ayid, not for the 

 medical practitioner'' (our italics). There is no excuse 

 for this statement of your reviewer's, which is in 

 direct conflict with the first paragraph of the intro- 

 duction. There it is clearly stated that we were asked 

 by members of the medical profession to write the 

 book, for whom it is obviously and primarily intended. 

 But if your reviewer is inclined to say on behalf of 

 his professional brethren, " Lord, we thank Thee that 

 we are not as other men," we might refer him to a 

 leading article in the Lancet of September i, pp. 352-53, 

 in which the opposite point of view is expressed in no 

 uncertain way. 



Again, reference is made to our "constant effort 

 ... to convince the public of the necessity for reform 

 in the treatment of the insane . . . which does not 

 appear to follow as a corollary from a disquisition on 

 shell-shock." As we have already pointed out, the 

 main purpose of the book is to appeal for the reform 

 in the treatment (or, perhaps it would be more correct 

 to say quite frankly, an appeal for the treatment) of 

 incipient mental disorder in patients while they are 

 still sane. Further, on the first page of our book we 

 explained why we used the pooular and official term 

 " shell-shock," and directed specific attention to its in- 

 adequacy ; moreover, on the second page of the intro- 

 duction we pointed out that "the problems .of shell- 

 shock are the everyday problems of nervous break- 

 down." 



What we have already mentioned in this letter, and 

 urged again and again throughout the book, is that 

 the war has forced us to adopt measures for the treat- 

 ment of such troubles, and that the lessons so learned 

 ought to compel those in authority to provide for 

 civilians afflicted with nervous breakdown facilities 

 such as have been proved to be so eminently success- 

 ful in the case of soldiers. 



Your reviewer's disquisition on heredity, viewed even 

 from the purely logical point of view, is so self- 

 destructive that we are sorely tempted to leave it as it 

 stands; but as he once more imputes to us statements 

 which we did not make, we are forced to direct 

 attention to them. 



In our discussion of the bearing of the question of 

 heredity upon the problems of insanity (chap, iv.) we 

 did not compare the heredity of tuberculosis with that 

 of insanity, as your reviewer claims, but the attitude 

 of the public towards this question — a vastly different 

 matter. We speak also (p. 78) of " an attempt justly 

 to appreciate the relative influence of heredity and 

 environment in the- case of tuberculosis." Your re- 

 viewer's paraphrase of this is, "the authors are men 

 of science who deny that there can be a true inherit- 

 ance of any microbic disease " ! This is a not unfair 

 sample of • the methods he has adopted consistently 

 throughout his truly remarkable review. 



Arguing in favour of the hereditary factor in the 

 production of shell-shock, he claims that, after digging 

 into the family histories of his patients three genera- 

 tions back for a history of " insanity, epilepsy, 

 paralysis, neurasthenia, or parental alcoholism," he 

 got a positive result in 33 per cent. Might we ask 

 Sir Robert whether it has occurred to him that this 

 implies a negative result in 67 per cent. ? Moreover, 

 among his 33 per cent, does he ask us wholly to 

 NO. 2500, VOL. 100] 



eliminate, as a causal factor in producing neurasthenia, 

 the influence of the worries and emotional disturbances 

 produced by the social environment upon those who 

 have to live with a drunkard, an irritable neurasthenic, 

 or a lunatic? 



"In the absence of this information" (of some neu- 

 rotic affection in three generations), he says, " it would 

 be incorrect to state that shell-shock cases presented 

 no neurotic family history." We agree, but who made 

 so strange a statement? 



If your reviewer's statements on this point have any 

 meaning, it must be the unworthy insinuation that 

 shell-shock is in some way due to heredity. It is true 

 that in 67 per cent, of his cases he was unable to bring 

 into his widely spread net of hereditary influences 

 (assumed to be contributory) any trace of the causal 

 factors to which he quite gratuitously pins his faith. 

 Every reader of Nature must be personally acquainted 

 with some soldiers suffering from shell-shock, and 

 among them men who before the war were the 

 strongest, bravest, most daring, yet level-headed, mem- 

 bers of the community, and with a clean and untainted 

 family history. These are the men against whom Sir 

 Robert Armstrong-Jones makes his unfounded insinua- 

 tions. These are the men who are said to belong to 

 those psychopathic breeds with " some deeply ingramed 

 defect only curable by extinction of the stock or by its 

 repeated crossing with other more stable stocks " ! 



What possible justification can there be tor branding 

 with this wholly undeserved stigma some of the best 

 and noblest members of our race? 



Yet these dogmatic claims are made by your re- 

 viewer just after he had confessed that "we have no 

 definite knowledge of what is inherited"! 



There are still, however, some more statements "to 

 nail to the counter." 



The writers of the book did not claim, as your re- 

 viewer says they did, that " there is no anatomical 

 evidence ... in the cases of psychoneuroses which 

 they had treated" (our italics). Our reference (p. 87) 

 was to those cases of psycfioneurosis which yield to 

 psychical treatment — an entirely different matter. 



We fully agree with the remark : — "That shell-shock 

 is entirely of psychic origin and can be overcome by 

 psycho-therapeutics is too sweeping a statement." We 

 do not know who is responsible for this statement, but 

 we certainly did not make it. 



If we "appear to underrate . . . the implications con- 

 nected with physical changes," we hasten to remove 

 such a mistaken impression. 3ut we suspect that your 

 reviewer somehow omitted to read pp. 7 and 8 of 

 our book, in which we not only mention these matters, 

 but also refer our readers for further information to 

 Prof. Cannon's important book on "Bodily Changes 

 produced by Fear, Pain, Hunger, and Rage." 



In thus reviewing the review on " Shell-shock and 

 its Lessons," we have confined ourselves (except in the 

 first paragraph) to the issues raised by the critic, who 

 has succeeded in misrepresenting our book with such 

 consistency. 



In conclusion, however, may we be permitted once 

 more to repeat that the chief plea of our book has 

 been entirely ignored in this lengthy review? That 

 plea is for the institution of clinics (attached to general 

 hospitals and medical schools) in which sufferers from 

 the milder and early stages of mental disorder may be 

 studied and treated, and thus be helped before, and not 

 only when, they have become so dertnged that intern- 

 ment in an asylum is necessary 



Our book is a real attempt to suggest a remedy for a 

 grave social evil, and measures for the advancement 

 of knowledge and for scientific research. Whether our 

 suggestions are wise or the reverse, at any rate the 

 problems thev deal with are of vast importance and 

 worthy of serious consideration. The evil we are 



