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Christopher D. Green
York University, Toronto, Ontario
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By William H.R. Rivers (1920)
Posted March 2000
In the secondary title of this book I have indicated that one of its main aims is to give a biological view of the psycho-neuroses. My purpose is to bring functional disorders of the mind and nervous system into relation with the concepts concerning their normal mode of working, which are held by the biologist and the physiologist. It will, I hope, help my readers to understand this purpose if I sketch briefly the conditions out of which this aim arose, and the general lines of the process by which the study of a certain group of the psycho-neuroses has led me to the views here set forth.
One of the most striking features of the war from which we have recently emerged -- perhaps its most important feature from the medical point of view -- has been the enormous scale on which it produced those disturbances of nervous and mental function which are grouped together by the physician under the heading of psycho-neurosis. The striking success in coping with the infectious diseases, which in all other recent wars have been far more deadly than the weapons of the enemy, shows that modern medicine war prepared for this aspect of the war, and had ready for use the main lines of treatment which would take the sting from these scourges of warfare. Surgery also was forewarned and forearmed for its task of dealing with the wounds inflicted by modern weapons. Any increase in the deadly power of these weapons is due to the greater number they can reach rather than to the greater deadliness of the injuries they inflict upon the individual. Though surgery has made great advances during [p. 2] the war, these are only developments for which the surgeon was prepared and involved no radical alteration in his outlook.
The case is very different when we turn to the field presented by psycho-neurosis. Though the Russo-Japanese war might have led physicians to expect psycho-neurosis on an extensive scale, the medical administration of our own and other armies was wholly unprepared for the vast extent and varied forms in which modern warfare is able to upset the higher functions of the nervous system and the mental activity of those called upon to take part in it. Moreover, before the war, the psycho-neuroses had interested few practitioners of medicine. Common as these disorders are in civil life, they are left almost without notice in medical education, while those who had paid special attention to the subject were torn asunder by fierce differences of opinion, not only concerning the nature of these disturbances of nervous and mental function, but also in regard to the practical measures by which they might be treated or prevented. The outbreak of the war found the medical profession with no such common body of principles and measures as those which enabled Medicine and Surgery to deal so successfully with the more material effects of warfare upon the human organism.
In accordance with the general materialistic tendency of medicine the first stage of this branch of the medical history of the war was to ascribe the psycho-neuroses of warfare to the concussions of shell-explosion, an attitude crystallised in the unfortunate and misleading term "shell-shock" which the general public have now come to use for the nervous disturbances of warfare. It soon became clear, however, that the great majority of the functional nervous disorders of warfare are not traumatic in the strict sense, but occur in pronounced forms either in the complete absence of any physical shock, or after exposure to shell explosions of a kind very unlikely to have caused physical injury. It became evident that the shell-explosion or other event which forms the immediate antecedent of the illness is only the spark which sets into activity a morbid process for which the mental stresses and strains of warfare have long prepared the ground. Once it is recognised that the essential [p. 3] causes of the psycho-neuroses of warfare are mental, and not physical, it becomes the task of the physician to discover the exact nature of the mental processes involved, and the mechanisms by which these processes are so disordered as to produce the vast diversity of forms in which the morbid state appears.
In civilian practice cases of psycho-neurosis fall into two chief groups set up by very different conditions. One of these groups, usually called traumatic neurasthenia, is especially known as the sequel of railway accidents, and since this form of neurosis closely resembles that due to warfare, our knowledge of war-neurosis might have advanced more rapidly if this had been taken as a guide. Owing, however, to its comparative rarity, the traumatic form of psycho-neurosis was less known than that arising out of the stresses and strains of ordinary life. Progress in our knowledge of this second group was hindered by wide differences of opinion concerning the nature of the factors to which its various forms are due. Many failed to recognise that, though the essential pathology of war-neurosis must be the same as that of civil practice, the factors concerned in this pathology might be very different.
The situation was especially complicated by the existence of a definite theory of psycho-neurosis which, though it succeeded in bringing into a co-ordinated scheme the vast diversity of form in which functional nervous and mental disorders become manifest, had yet not merely failed to meet with general acceptance, but was the subject of hostility exceptional even in the history of medicine. This hostility was almost entirely due to the fact that the author of the theory, Sigmund Freud of Vienna, found the essential cause of every psycho-neurosis in some disturbance of sexual function. Further, the process of psycho-analysis, which formed Freud's chief instrument, of inquiry, led him to the view that these disturbances of sexual function often went back to the first few years of life and implied a sexuality of the infant which became an especial ground for the hostility and ridicule of his opponents. At the beginning of the war the medical profession of this and other countries [p. 4] was divided into two sharply opposed groups; one, small in size, which accepted the general principles of Freud, either in their original form or as modified by Jung and other disciples; the other, comprising the vast majority of the profession, who not merely rejected the stress laid upon the sexual, but in setting this aside refused to attend to many features of Freud's scheme which could hardly have failed to appeal to them if they had been able dispassionately to face the situation.
Among the laity Freud's views met with a greater interest and a wider acceptance. In some cases this acceptance was founded on observations furnished by the study of dreams or of such, occurrence of everyday life, as had been so ably used by Freud to support his scheme, but inability to study the main line of evidence upon which the Freudian system was based prevented the interest of these students from being more than that of the amateur.
The frequency of the psycho-neuroses of war brought the subject within the reach of many who had hitherto taken no special interest in this branch of medicine, while in other cases, those whose interest had hitherto been of an amateur kind were now brought into contact with clinical material by which they were enabled to test in detail the Freudian doctrine of psycho-neurosis. The opportunity thus afforded to independent and unbiassed [sic] workers had certain definite results. Freud's work, in so far as it deals with psycho-neurosis, has two main aspects. As in every scheme of a pathological kind we can distinguish between the conditions or causes of the morbid process and the mechanisms by which these conditions produce the manifestations or symptoms of disease. In the heat engendered by differences of opinion concerning the conditions of psycho-neurosis, the pathological mechanisms had been neglected and had aroused little interest, a neglect which is readily intelligible, for few will find it worth while to study the details of a structure resting on foundations they reject.
The first result of the dispassionate study of the psycho-neuroses of warfare, in relation to Freud's scheme, was to show that in the vast majority of cases there is no reason to suppose [p. 5] that factors derived from the sexual life played any essential part in causation, but that these disorders became explicable as the result of disturbance of another instinct, one even more fundamental than that of sex-the instinct of self-preservation especially those forms of it which are adapted to protect the animal from danger. Warfare makes fierce onslaughts on an instinct or group of instincts which is rarely touched by the ordinary life of the member of a modern civilised community. War calls into activity processes and tendencies which in its absence would have lain wholly dormant.
The danger-instincts, as they may be called, are not only fundamental, but they are far simpler both in their nature and their effect than the instincts which are concerned in continuing the species or maintaining the harmony of society. The awakening of the danger-instincts by warfare produces forms of psycho-neurosis far simpler than those of civil life, which depend in the main on disturbance of the other two great groups of instinct. The simplicity of the conditions upon which the psycho-neuroses of war depend makes it easier to discern the mechanisms by which these conditions produce their effects. Those who were able to approach the subject without prejudice could not fail to see how admirably adapted are many of the mechanisms put forward by Freud to explain how the conditions underlying a morbid state produce the symptoms through which the state becomes manifest. It seemed as if Freud's mechanisms might have been obvious to all, or at least might have met with far earlier acceptance, if war-neurosis had been of habitual occurrence and civil neurosis had occurred only as the result of occasional catastrophes. The aim of this book is to consider these mechanisms in their relation to the more normal processes of the animal organism, and especially to the mechanism by which certain parts of experience become so separated from the rest that they are no longer capable of recall to consciousness by the ordinary processes of memory. Psycho-neurosis depends essentially upon the abnormal activity of processes which do not ordinarily enter into consciousness, and the special aim of this book is to consider the general biological function of the process [p. 6] by which experience passes into the region of the unconscious. I shall attempt to show that the main function of psycho-neurosis is the solution of a conflict between opposed and incompatible principles of mental activity. Instinctive processes and tendencies, and experience associated therewith, pass into the unconscious whenever the incompatibility passes certain limits. As indicated in the title, the special aim of the book is to study the relation between instinct and that body of experience we are accustomed to speak of collectively as "the unconscious." In this study the first task is to make as clear as possible the senses in which these terms will be used and this will be the aim of the following chapters.