Mental Disease and Defect 



13 



by the stories of ''shell shock" are somewhat surprised to know 

 that it is only the neurosis of civil life placed in a new environ- 

 ment. It is only "nervousness" and not a new insanity. Those 

 persons are subject to it who have had a case of "nerves" under 

 other great stress. Since this has been discovered, the method 

 of treatment for patients has been entirely changed. Men who 

 were formerly sent back to the hospitals from the trenches with 

 slight shock are now encouraged by their regimental officers to 

 ^'carry on". They are not allowed to get the mental impression of 

 invalidism, but are given confident assurance of complete recovery. 



Many neurasthenics are taught to be so self -centered and obsessed by 

 self-pity and introspection that they unconsciously lay themselves open to 

 suspicion, by those who have no special medical knowledge, of being men- 

 tally afflicted. Nevertheless, neurasthenia and insanity are two totally 

 distinct diseases. The one does not merge into the other, and if a man's 

 case is diagnosed as neurasthenia and he subsequently becomes insane, an 

 error in diagnosis has been made and the early symptoms of insanity have 

 been mistaken for neurasthenia. I think it a matter of considerable 

 importance in the interests of neurasthenics, especially of the severer types, 

 and that this should be clearly recognized." 



The medical profession as well as the layman has learned 

 much from the war manifestations of disease which will aid in 

 the treatment of patients in civil life. Colonel Collie says : "It 

 is not cowardice, nor fraud, nor malingering, nor self-deception, 

 but a real disease." As many of the milder forms may be found 

 in almost any group of people, a knowledge of the best methods of 

 dealing with it would be most helpful to everyone. Most normal 

 individuals have moods, and these in exaggerated forms become 

 psychoses. A healthy, normal environment is the first essential 

 factor for cure. "Infinite patience, common sense at every turn, 

 and real but thoroughly disguised sympathy are essential in 

 those who undertake the care of such cases. "^ 



(c) Miscellaneous mental or nervous disturltances. In the 

 group designated as miscellaneous mental or nervous disorders 

 are included the drug habitues, choreics, and thyroid cases. They 

 are related to the insane, tho not necessarily actually belonging 

 to them. They may present as great problems to the social worker 

 and illustrate the need for restraint outside of institutions. 

 Since the passing of the Harrison law and its recent more strict 



8 Colonel Sir John Collie, M.D., A.M.S., "The Management of War Neuroses and 

 -Allied Disorders in the Army", Mental Hygiene, Vol, II, 1918, p. 3. 



