The Parataxes: A Study and Analysis of Certain Borderline Mental States

The attempt to fit the war neuroses into the schema of the surgeon-general caused more than one psychiatrist to wonder what after all is to be understood by the clinical entities of psychiatry. Names have been used because of the necessity to label cases. If we ask ourselves why do we call this case hysteria and that neurasthenia and another psychasthenia the answer is that the cases so labelled bear a certain resemblance to the disease pictures which various writers have made familiar to our minds. We must however frankly admit that in many cases the picture that the patient presents is far from being identical with the classical type. In the war neuroses it usually fell short of the original. It did not present so many and such varied symptoms. It was not near so complex. It lacked the permanence and stability of its prototype.

In the complex of symptoms that the case does present there are frequently several traits which, if attended to individually, would lead to different diagnostic standpoints. Thus in some cases if we regard the coarse tics and tremors we are inclined to think of hysteria, but when we listen to a story of fatiguability, irritability, asthenia and various pains and aches, we consider the possibility of neurasthenia. And perhaps after having diagnosed the case hysteria, the tremors disappear and the fatiguability, asthenia, etc., remain and we are inclined to think that our case was primarily one of neurasthenia on which was grafted certain hysterical symptoms. And so it happens that different men seeing a case at different times or even at the same time but from different points of view, disagree in their diagnoses.

A sergeant in a statistical office once said to me: “Psychiatrists are hopelessly at sea in their diagnoses. If a typhoid case goes from one ward to another or has another ward surgeon take care of him, he usually remains a case of typhoid till he dies or is