Our reasons for writing this book will be explained by the book itself. We desire here gratefully to acknowledge the help of several friends who have considerably facilitated our task. Our thanks are due to Major R. G. Rows, M.D., R.A.M.C., for his unfailing interest, encouragement and help; to Captains W. H. R. Rivers, M.D., F.R.C.P., F.R.S., and J. W. Astley Cooper of the R.A.M.C., and Mr. E. Gleaves, M.Sc., for their valuable suggestions and assistance in the preparation of the manuscript; to Captain W, E. Sawers Scott, M.D., R.A.M.C., Dr. Albert Hopkinson and Mr. W. Percy Stocks, F.R.C.S., of Manchester, for help in other ways; and to our colleague, Professor H. Bompas Smith, for reading the proofs and helping us to eliminate some of the more glaring literary defects. To the Editor of the Lancet we are indebted for permission to use part of an article written by one of us. The stream of requests for fuller information and explanation that poured in upon the author of that article made the writing of this book an unavoidable duty.
G. E. S. & T. H. P.
THE MEDICAL SCHOOL,
THE UNIVERSITY of MANCHESTER,
Some account of the reasons for the appearance of this book is due to the reader. During the last year we have been asked repeatedly, both by members Of the medical profession and the lay public, to write a simple non-technical exposition of the ascertained facts of that malady, or complex of maladies, for which we have adopted the official designation "shell-shock." Until recently such an attempt would have been premature and largely speculative. But it is now possible to collate the medical reports, not only from our own army, but also from those of France and Russia. Valuable and suggestive data have, furthermore, been obtained from such of the German medical journals as have reached us. The facts described in the various accounts which we have seen are in close agreement. The conclusions in this book, therefore, are not based upon our experience alone.
Our object in thus publishing a brief and simple description of these facts is twofold: first, to make them available to those who have neither the time nor the special knowledge necessary for consultation of the medical journals; secondly, to call attention to the obvious significance of these truths for the future welfare and happiness of the nation.
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 o£ 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 to 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.
It is because we believe that a singular probing, of the public wound - the British attitude towards the treatment of mental disorder - though painful, is justifiable and necessary, that we have written the concluding chapters of this book. For it cannot be too strongly urged that the shifting and unstable blend of apathy, superstition, helpless ignorance and fear with which our own country has too long regarded these problems is rapidly becoming our exclusive distinction. It must be realised that America, France, Germany, and Switzerland have long ago faced the problem in the only practical way - the scientific one. And to the long list of sciences which we all agree must be cultivated more assiduously after the war should be added but not at, or even near, the end - psychiatry, the science of the treatment of mental disorders.
Not patriotic motives alone urge this reform, but common sense and common morality. For shell-shock has brought us no new symptoms. Its sole ground of difference from other disordered states of mind lies in its unusually intense and wide-spreading causes. The problems of shell-shock are the every-day problems of "nervous breakdown." They existed before the war, and they will not disappear miraculously with the coming of peace. The war has forced upon this country a rational and humane method of caring for and treating mental disorder among its soldiers. Are these signs of progress merely temporary? Are such successful measures to be limited to the duration of the war, and to be restricted to the army? Germany has applied them for years to the alleviation of suffering among her civilian population, with a success which has made her famous - outside England. Can we be content to treat our sufferers with less sympathy, insight and common-sense than Germany?
It is at this time, while our country is anxiously considering how best to learn the lessons of the war, that we wish to call attention to one of these lessons which is in danger of being overlooked.