Shell-shock and its Lessons

Abstract

THROUGH the courtesy of the editor of NATURE I have had the opportunity of reading the long comment made by Prof. Elliot Smith, the distinguished anatomist, and by Mr. T. H. Pear, the equally able psychologist, upon my review of their little volume entitled “Shell-shock.” As was pointed out, the authors show a lack of practical knowledge of the law as applied to the insane, yet they assert that the main object of the essay is to secure a change in the statutes in order to provide the establishment of clinics in which, to use their own words, patients “afflicted with mental disturbances can be treated while still sane,” a problem with contradictory implications, but which is interpreted in the introduction to be “the painful probing of the public wound, the British attitude towards the treatment of mental disorder.” As has been stated in the review, this was a corollary that did not seem to follow from the essay, a view also shared by the Spectator (September 1), which says that “the authors' assumption, by the way, especially after the statements quoted from the first chapter that the unfavourable termination of shell-shock will be insanity, seems to us somewhat gratuitous.” One of the reasons given by the authors for seeking a change in the law is the fact that doctors in British asylums have no adequate knowledge of psychiatry to enable them “to co-operate with the medical schools and the teaching staffs of general hospitals.” I claim to be fairly intimate with the knowledge of mental diseases possessed by asylum physicians in this country, and I agree with the two authors' view of their own criticism, viz. that it is well open to the charge of being “superficial, uninformed, and even spiteful” (p. 115), although it is graciously allowed that “there are exceptions to this general statement.”