Some Notes on Traumatic Neurosis and Allied Conditions1

I HAVE chosen this subject for several reasons. First, it was my introduction to psychiatry; secondly, after this war, there will be very many patients, both service and civilian, suffering from the delayed effects of traumatic experiences, and thirdly, there is a group of patients who suffer shock from aggressive impulses. To some extent I feel that the basic principles of treatment of the external traumatic may be applied to the latter as well.

It may be worth while recording my impressions when I first encountered, in the autumn of 1919, the condition known as 'shell-shock'. I was still in the Army, having recently returned to England from the Middle East, where my only experience had been that of Battalion M.O. and work in a Field Ambulance. I was posted to a large Orthopædic Hospital, which had a psychiatric Division of about 250 patients and was put in charge of a 'villa' which accommodated 80 men, all acute cases of traumatic neurosis. My immediate reaction was that of being overwhelmed by this entirely new experience, which soon gave place to a feeling almost of terror lest all this 'emotion' which I was witnessing should get out of hand. Gradually, as I got down to talk to these men and to take their histories, their illnesses commenced to have a meaning. As the war was then over and most of them were wanting to be well enough to leave hospital and return home to civilian life and work, the idea of the illness being an escapist reaction from the danger zone did not enter the picture.

What did emerge, however, was that these men were living unwittingly not in the present but in that period of time, up to the moment of the trauma, which they had never been able to 'live past'. That experience, if completed in the manner in which it was imagined, and which they had witnessed in others so frequently, meant death to the individual himself, and beyond this point he could not pass. At that time I formed the opinion that one should reserve the word 'live' to